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Suicide Prevention Strategy - Commitments

Commitment 1

We will take forward further work on self-harm as part of the publication of a document on responding to people in distress. This work will take into account feedback from the public engagement process which helped inform the development of this strategy, the current work in Tayside in relation to Commitment 19 of the Mental Health Strategy and the Scottish Government's report Responding to Self-Harm in Scotland: Final Report:

We know that many people who die by suicide have a history of self-harm, and also that the relationship between suicide and self-harm is complex. For that reason we limited the scope of the Strategy to suicide and suicidal self-harm.

As part of this process we ran several stakeholder events in 2014 and 2015, to allow colleagues from a range of sectors to work through the challenge of improving responses to the underlying causes of distress in people for whom current practices are ineffective. These events presented an opportunity for stakeholders to discuss key issues and 'connecting ideas' around this agenda. Issues raised at all three events helped inform our thinking on developing next steps in supporting people in distress.

The Scottish Government's Suicide Prevention Strategy Implementation and Monitoring Group considered these issues as part of its remit.

Following an Expression of Interest process, in July 2016 SG announced a small number of pilot areas in which NHS Boards and other agencies will test a proposed Distress Brief Intervention (DBI) model. North and South Lanarkshire Health and Social Care Partnerships are hosting the DBI central team and participating as one of four partnership test sites which will run local pilots, along with Penumbra in Aberdeen; Support in Mind in Inverness; and NHS Borders Joint Mental Health Service.  Development work for the pilot is underway; training is being developed by the University of Glasgow.  The DBI went live in Lanarkshire in June 2017, and is scheduled to go live in the other 3 pilot sites from October 2017.

Work on "evaluability" was developed by NHS Scotland to help inform evaluation of the pilot.  Plans are in hand  for an independent evaluation to begin in Autumn 2017. 

The following document is a detailed Description and Specification which was issued to interested parties at the start of the Expression of Interest process:

This was supported by the following document Distress Brief Interventions: Rationale And Evidence which reviewed the international research literature to understand more about the common characteristics of interventions which might support people in distress and the emerging evidence about their appropriateness and effectiveness. 

Commitment 2

NHS Health Scotland and NHS Education for Scotland will work together to develop and extend the current approach of workforce development activity to address a wider range of experience and in a wider range of contexts. In doing so we will consider how this support can be made available to families and communities. This work will also be linked to the work under Commitment 1 on distress.

Following on from the Scottish Government’s call for interest in the pilots for the Distress Brief Interventions (DBI) programme (see commitment 1, above), work has explored what will help measure the reach and impact of this programme.  The recommendations from the Evaluability Assessment led by NHS Health Scotland are informing the proposed formal evaluation which it is hoped will commence in Autumn 2017.  Running parallel to this is the development of educational resources to support those delivering the core components of the DBI programme developed in the four pilot areas.  This evidence - informed work, commissioned from the University of Glasgow, will be reviewed and revised as the pilot work develops.    The module on 'responding effectively to people in distress' which is part of NHS Education for Scotland (NES) 'Psychological Awareness for Staff in Health and Social Care' e-learning package has been rolled out as a national resource.

Health Scotland’s Workforce Development team have continued to support the suicide prevention training programme with 309 courses provided to 4,992 participants across Scotland between March 2016 and March 2017.  The courses provided include ASIST (133 Events, 2435 Participants) and safeTALK (176 Events, 2557 Participants).  These trainees now have improved knowledge and skills to support individuals in distress, and where appropriate, help them access specialist advice.  In Police Scotland, having started with probationers, further work has rolled out the ASIST programme to all Police Scotland staff. 

NHS Health Scotland is undertaking an assessment of the reach and impact of the national training programmes such as ASIST, safeTALK and STORM (Skills Based Training on Risk Managment for Suicide Prevention) and the nationally led mental health training programmes. This work will help shape the future provision, content and format of such programmes and will help ensure that we continue to have a sustainable programme that addresses health inequalities.   A draft report outlines a number of options and is currently being considered by the Scottish Government. It will be one of a range of resources to help inform the development of the next national suicide prevention action plan.

Commitment 3

We will map existing arrangements for responding to people in distress in different environments and localities and will use this information to develop guidance which supports safety and person-centredness.

Work on this commitment will be taken forward as part of wider action under Commitment 1. This will include work on clarifying the scope of the commitment; as part of this, consideration will be given to practical differences in responding to people in distress in remote and in rural locations.

Organisations selected to take part in the 4 pilot areas for the DBI pilot work will be expected to map existing local resources to help inform local arrangements for DBI workers.

Commitment 4

For those presenting to A&E we will examine how existing local and national data sources, such as the Scottish Patients at Risk of Readmission and Admission (SPARRA), can be used to provide benefit to those at risk of suicide. We will also support improvement programmes that are aimed at linking available data sources to inform service responses for those at risk of suicide or repeat attendance, such as currently exist in NHS Greater Glasgow and Clyde and in Tayside.

Work on this Commitment was led for the Scottish Government by NHS Greater Glasgow and Clyde (NHS GGC).  A full report on the project was provided by NHS Greater Glasgow and Clyde in late 2015:

 

Commitment 5

We will work closely with NHS Health Scotland, see me and other agencies to develop and implement an engagement strategy to influence public perception about suicide and the stigma surrounding it and will use social media, in addition to other communication channels, to communicate key messages about suicide and its prevention.

NHS Health Scotland commissioned research to better understand the general population’s experience and knowledge of suicide and suicide prevention in Scotland. The main objectives of the research were to:

  • Determine awareness levels of suicide prevention messages among key target audiences to provide a national measurement of awareness

  • Develop an understanding of key drivers and motivators to engaging with sources of information, support and advice by target audience

  • Identify actual or perceived barriers to uptake of information, support and advice by target audience group

  • Provide the opportunity to analyse research findings by target audience to identify the best suicide prevention messages and communication route for the target audiences

  • Consider the implications of the research to inform the development of a future marketing and policy plan

    The report was published in August 2015:

Suicide Prevention in Scotland - market research to inform the development of an engagement strategy

These findings have supported the communications focus of annual Suicide Prevention Week activities and will also be used to help inform the development of the Scottish Government's next Suicide Prevention Strategy or Action Plan.

With funding support and direct input from the Scottish Government, together with input from NHS Health Scotland, See Me and Samaritans, the National Union of Journalists published (in November 2014) updated guidance for reporters and editors on responsible reporting of mental health, mental illness and death by suicide. Standards of reporting in this area have improved significantly in recent years; this important practical guide will help continue to raise awareness in the media of the importance and value of appropriate, balanced and sensitive reporting of these issues:

Commitment 6

We will work with Healthcare Improvement Scotland to support improvements for NHS Boards that focus on areas of practice which will make mental health services safer for people at risk of suicide, for example, transitions of care, risk management, observation implementation and medicines management. This will be delivered through the Suicide Reporting and Learning System (SRLS) and Scottish Patient Safety Programme - Mental Health (SPSP-MH).

Work on this Commitment is being led for the Scottish Government by Healthcare Improvement Scotland. There are several strands including:

  • Reducing suicide risk: mental health team discussion framework – this was published in 2015 and is intended for use by mental health multidisciplinary teams to prompt reflective discussion about each team member's understanding of suicide risk and how to reduce suicide risk. A short life working group is being set up to consider how the framework can be used in various care settings to reduce suicide risk.

  • Revision of the national guidance Engaging People, Observation of People with Acute Mental Health Problems: A good practice statement (2002) - this update extends and builds on existing good practice in mental health services to provide a model of person-centred care that can be applied in any healthcare setting. The Scottish Patient Safety Programme Improving Observation Practice team is taking this work forward.

  • Improvement programmes – working with three NHS boards to facilitate improvements to both adverse event reviews and the resulting mental health service improvement. Improvement activities include rolling out suicide risk assessment training; and working to improve the experience of families and carers who are involved in NHS Boards' suicide reviews.

For updates on these three main pieces of work, please visit:

Suicide Review Community of Practice

Commitment 7

We will work with the Royal College of General Practitioners and other relevant stakeholders to develop approaches to ensure more regular review of those on long-term drug treatment for mental illness, to ensure that patients receive the safest and most appropriate treatment.

and

Commitment 8

We will build on work already done in relation to Commitment 22 of the Mental Health Strategy to test ways of improving the detection and treatment of depression and anxiety in people with other long-term conditions

On both of these commitments we have, for various reasons, found it difficult to make progress.  We are therefore considering how best to refresh / reframe the 2 commitments, and we plan to do so in a way which will set out practical actions that can be undertaken as part of the overall planned closer interface between mental health and primary care. For example, Commitments 7 and 8 were written against the background of the Quality Outcomes Framework; and nowadays most people with mental illness will be cared for by community mental health teams, of which the GP is part, rather than by the GP alone.  These issues will be considered in the development of the next Suicide Prevention Action Plan for publication in 2018.

Commitment 9

We will continue to fund the work of the Scottish Suicide Information Database (ScotSID) and the Scottish element of the National Confidential Inquiry into Suicide and Homicide and we will also contribute to developing the national and international evidence base. In doing so we will work with statutory, voluntary sector and academic partners.

The Scottish Government has committed to continue to fund both ScotSID and the Scottish element of the National Confidential Inquiry into Suicide and Homicide - and will continue its interests in other relevant research, study and evidence as appropriate, in order to continue increasing and improving our knowledge of factors which can impact on suicide and which can shed light on potential prevention measures.

Commitment 10

NHS Health Scotland will continue to host the National Programme for Suicide Prevention. This National Programme, in addition to the functions set out above, will continue to provide leadership and direction for local suicide prevention co-ordinators and in respect of other health improvement aspects of suicide prevention.

NHS Health Scotland continue to host the national Suicide Prevention Programme (formerly known as Choose Life), undertaking awareness-raising work and providing leadership, advice and information about suicide prevention to organisations and individuals across various sectors.

NHS Health Scotland undertakes a number of activities to support implementation of Commitment 10 including: 

  • Resurrecting the Choose Life co-ordinators group which will provide a more coherent link between national and local activities and thus support a co-ordinated, consistent approach to suicide prevention

  • Supporting the dissemination of data from the Scottish Suicide Information Database (ScotSID) to help local application as well as service delivery responses

  • Developing and promoting local, national and international evidence through performance stories, Choose Life website and quarterly ebulletins

  • Producing guidance to help effective local responses such as the Locations of Concern guidance and the Erskine Bridge practical case study

More information about NHS Health Scotland’s work can be found on the Choose Life website at:

Commitment 11

We will set up arrangements to monitor progress with implementation of all the commitments in this strategy. This will include an Implementation Board to be chaired by a Senior Manager from the Scottish Government.

The Scottish Government's Suicide Prevention Strategy Implementation and Monitoring Group (IMG) was set up in 2014 to undertake this task. It met two to three times per annum and was chaired by the Scottish Government's Head of Mental Health and Protection of Rights Division.  It held its final meeting on 23 November 2016. More information on the Group's remit and membership is available on the Implementation and Monitoring Group's web page:

 

Next Steps

In late October and early November 2017, a short series of pre-engagement events will take place to help inform the development of a new suicide prevention action plan. These events are to allow people who have lived experience of suicidal thoughts or of bereavement by suicide - and those who directly engage with those affected - the opportunity to contribute their views on what could be done better or differently to reduce suicide and the impact it has on people, families and communities in Scotland. More information about these events is available at the link below:

Suicide Prevention - event invite

If you wish to attend one of the events, or ask about them, please contact the Health and Social Care Alliance at event@alliance-scotland.org.uk or 0141 404 0231.

Following consideration of issues emerging from these events, a draft suicide prevention action plan will be prepared and published for comment in 2018; further engagement events will be arranged to support this too. It is anticipated that the finalised version of the action plan will be published in Spring 2018.