Our understanding of suicide, and our approach
Our understanding of suicide and its prevention continues to develop which is shaping our strategic approach. Both published research and our extensive consultation and engagement confirms that suicide is not caused by a single factor and that the pathway to suicide is complex.
Frameworks that help us understand this complexity, specifically how different risk factors interact, are essential to guide our suicide prevention efforts. The integrated motivational-volitional (IMV) model is one such widely used framework that does this.
This model was developed from the recognition that suicide is characterised by an interplay of biology, psychology, environment, and culture and that we need to move beyond psychiatric categories if we are to further understand the causes of suicide risk.
The IMV framework maps out the common pathway to suicidal thoughts and suicidal behaviour, as well as identifying potential areas for prevention and intervention. The IMV model (Figure 1) is so named as it integrates different perspectives to help identify the factors associated with the development of suicidal thoughts (the ‘motivational’ phase) and the other factors that increase the likelihood that someone engages in suicidal behaviour (the ‘volitional’ phase).
The IMV model is a tool – alongside our outcomes framework – that will support the implementation of this strategy. We will use it to continue to build understanding of the intersectionality of factors for suicide, and to guide action. Specifically, the approach we take to delivery – drawing on lived experience, research / data, expertise and practice – will allow us to identify emerging themes, how they connect, and thereafter to design and deliver appropriate actions.
Risk and protective factors for suicide
Our understanding of the factors that make people more or less likely to be affected by suicide has increased in recent years, and this strategy is focussed on taking decisive action.
Over the last year, the Academic Advisory Group has undertaken research to develop a greater understanding of risk and protective factors for suicide. The high level findings are:
Key risk factors:
- Age and sex should be considered when other risk factors of suicide attempt are present, for example, self-harm history, impulsivity, and feeling of entrapment.
- Specific risk factors include: employment status, a sense of defeat, hopelessness, and challenging relationships.
- Perceptions of relationships should be considered, for example, feelings of burdening others.
- Intergenerational interventions can help avoid negative experiences in early life, for example, poor maternal mental health in the antenatal period is associated with negative impact on the emotional, physical and mental development of the child, during infancy and the early years, but also through to teenage years.
- Interpersonal connections should be developed / improved to help maintain relationships (as they provide vital social support).
Once the research is finalised it will be shared with key partners and organisations to further aid understanding and suicide prevention action.
The action plan which accompanies this strategy is influenced by this understanding of risk and protective factors, as well as trends in suicide. For example, we know the largest number of suicide deaths occur in males, and that the suicide rate is around 3 times higher in our most deprived areas. We also know that other factors are significant, such as, relationship status (54% of people who die by suicide are single at the time of death), employment status (68% are in employment), and gender identity (people who are transgender are 3-4 times more likely to die by suicide than the general population). Finally, we know that social isolation is a significant risk factor, and therefore social connection acts as a key protective factor.
It is often a combination of risk factors (including life events) which can lead to suicidal behaviour. Understanding these risk and protective factors helps us put inequalities at the heart of our approach – so we can reach and connect with people who are most at risk, and build up the protective factors across our communities; all in the desire to reduce suicide.
To achieve this, we must increase our focus on the contributing factors to suicide risk, and take every opportunity to identify and support people when they are suicidal (as set out in our whole of Government and society approach). Further, we must also tailor our approaches to reach groups at higher risk of suicide, by working alongside trusted organisations who are working with, and for, minority groups, and by taking a strong community focus.
Time, Space and Compassion
Under Every Life Matters, the focussed work on suicidal crisis did not recommend a particular model of crisis support. Instead, it set out the Time, Space and Compassion approach which was developed through developed by engaging with people with lived experience of suicidal crisis and practitioners. Work is now underway to implement this approach across services and communities to ensure the responses people receive when suicidal are truly compassionate and helpful. This work includes integrating Time, Space and Compassion into strategic planning, commissioning, and service design – so that we grow the capacity, capability and learning to offer Time, Space and Compassion across settings and communities.
However, these principles have come to encapsulate so much more than what people need at the point of suicidal crisis; in fact these are what people need at any point in their suicidal experience. As such we see a much wider opportunity to embed these principles right across our strategy so that our approach to suicide prevention is defined by the principles of Time, Space and Compassion.
Suicidal support – at every age, and every life stage
Our approach also recognises that people’s suicidal experiences and needs change depending on their circumstances and their life stage. We also recognise the need for particular focus at points of transition.
The strategy covers all life stages, for children and young people (under 25), for adults (over 25), and older adults (over 65).
Throughout the strategy and action plan, we talk about ‘everyone’ or ‘people’. When we use this language, we are talking about the whole population at every stage of life. There are some actions which target specific groups of people, where this is the case, we have provided details of who these groups are.
Stages of preventing suicide
We know that suicide prevention needs to be much more than acting at a point of crisis, and we must use our knowledge of risk and protective factors to take early action, and to do that in a way that offers Time, Space and Compassion. Our support and action must respond to the suicidal experiences that people face. We recognise that experiences of suicide are personal; they vary from one person to another and are unlikely to follow a linear route. As such our efforts must span the following areas: promotion of wellbeing (primary prevention), early intervention, intervention, recovery and postvention.
The diagram below sets out the type of responses we need to be able to offer people. None of these responses are stand-alone areas; indeed we need action across these areas to help prevent suicide.
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