Suicide prevention strategy and action plan: consultation analysis

Formal Public Consultation on the draft Strategy and Action Plan

A consultation on the draft strategy and action plan was open for 6 weeks, from 13 July to 23 August 2022.

The consultation set out a series of questions about the proposed content of these documents. Specifically, we looked for views on the following:

Draft Strategy:

• the proposed vision
• the proposed priorities (which would become the focus of the initial 3 year action plan)
• the proposed outcomes
• the proposed principles
• the proposals for delivering and overseeing the strategy and action plan.

Draft Action Plan:

• the relationship and connection between the strategic long-term outcomes in the strategy and the actions
• the new actions proposed under each outcome
• which outcomes and actions should be prioritised
• continuing to build on the current actions from the previous Suicide Prevention Action Plan - Every Life Matters.

Respondents

We received 213 responses to the consultation: 195 submitted via the online consultation platform Citizen Space and a further 18 submitted by email in an alternative format. As some respondents did not answer every question, the total responses for each question does not always total 213.

135 responses were from individuals and 78 from organisations.

We also offered a small number of online consultation events to hear informal views from the public.

We have published individual responses received on https://consult.gov.scot where the respondents have given permission for us to do so.

Approach to Analysis and Reporting

The Scottish Government undertook a robust analysis of the responses to the consultation. This report presents the range of views expressed and trends made in comments. This analysis is structured around the themes identified in responses to each question. Where response themes span questions, a thematic analysis is provided, with signposting to other parts of the report (to avoid duplication).

We Asked, You Said, We Did

A good consultation should be transparent in showing what people have said and how these views have been considered by decision-makers.

One of the main ways we do this is on the "We Asked, You Said, We Did" section of our consultation website. We have also used this approach to structure this report. This briefly summarises the main points of the consultation (We Asked"), how many responses there were and key messages coming out of the responses ("You Said") and what we have done, or plan to do as a result of the consultation ("We did").

Vision

The vision was developed based on the views collected during the first phase of engagement. We heard very strong messages that communities needed to be at the centre of the work to prevent suicide. We also heard that timely, compassionate support - which created a sense of hope - needed to be available to everyone affected by suicide.

We Asked

Do you agree with the proposed vision, described below, for the new Suicide Prevention Strategy:

"Our ambition is a Scotland where everyone works together to prevent suicide.

To achieve this we will work with communities to become safe, resilient and inclusive - where people who have thoughts of taking their own lives, or people affected by suicide, are offered effective, compassionate and timely support, and a sense of hope."

You Said

There were 202 responses to this question and the table below shows how people responded.

how people responded

Option	Total	Percent
Yes	174	84%
No	28	14%
Not Answered	4	2%

A large majority of respondents agreed with the proposed vision for the new Suicide Prevention Strategy, in particular its focus on everyone working together to prevent suicide, the role of communities, and the focus on ensuring people have a sense of hope. However, 28 people did not agree. In a follow up question we asked those respondents what they would change about the vision and why. The common themes were:

• The wording of the vision was could be more ambitious, this included feedback that more emphasis was needed on tackling the root causes and inequalities of suicide.
• A clearer focus was required on the reduction in suicide, with some respondents explicitly asking for a numerical target to be included.
• A desire to see stigma included within the vision.
• Although it was recognised that communities have a key role to play, some suicide risk factors, such as poverty, were outwith the control of communities and needed to be addressed at a higher level. This linked to feedback about the importance of highlighting the role of businesses and workplaces in preventing suicide.
• A recognition that suicide affects people of all ages, including children and young people, and this should be explicit in the vision.

Relevant quotes:

"Make an explicit reference to Children and Young people not just people".

"While we don't disagree with any of the sentiments within the proposed vision, there is a sense that this feels unambitious in not featuring the vision of seeking a significant reduction in suicide rates in Scotland, building on previous achievements. We appreciate the challenges of selecting a specific numeric target for reduction, but feel this should be seen as a part of the vision for Scotland's long term strategy."

We Did

We listened to what respondents told us when they said they thought the vision should include something different, however we also needed to make sure that people who liked the vision would not be disappointed by any changes – given that a large majority agreed with the proposed wording.

We have therefore refined the vision so that it includes a clear statement on the ambition to reduce suicide in Scotland, and to tackle the inequalities which contribute to suicide. This new vision provides a clear statement of our ambition to reduce the number of suicide deaths in Scotland, and includes a key focus on the inequalities need to be tackled to achieve that goal. We have also added two supplementary statements relating to the vision; the first highlights the need for all sectors and communities to work together and to address stigma, and the second sets out the commitment to support anyone affected by suicide and reinforces the importance of people having a sense of hope. Crucially the revised vision underpins our approach to implementing the strategy, and flows through to our long-term outcomes, priorities and the action plan itself.

A small number of responders suggested there should be a reduction or zero suicide death target specified in the strategy as a vehicle to track progress.

However, the majority of respondents supported the strategy's focus on making improvements across 4 outcome areas – recognising that a target is not always meaningful, or helpful, at a local level, and the need to affect change across society to prevent suicide. We were also aware that including a specified reduction target can lead to increased stigma for bereaved families and communities, and does not sufficiently capture the range of changes the strategy aims to deliver (including supporting people with suicidal ideation, supporting loved ones who are caring for someone who is suicidal, or for people who have been bereaved by suicide). Taking all this feedback on board, a numerical target has not been included in the vision.

We were extremely grateful for the feedback we received on the draft vision and believe we now created an improved vision, which reflects the range of views we received. The new vision for suicide prevention in Scotland is:

Vision

Our vision is to reduce the number of suicide deaths in Scotland, whilst tackling the inequalities which contribute to suicide.

To achieve this, all sectors must come together in partnership, and we must support our communities so they become safe, compassionate, inclusive, and free of stigma.

Our aim is for any child, young person or adult who has thoughts of taking their own life, or are affected by suicide, to get the help they need and feel a sense of hope.

Guiding Principles

We want to ensure there is an effective approach to implementing the strategy which builds on the 'ways of working' used to deliver the previous suicide prevention action plan, Every Life Matters, such as, considering the needs of children and young people. Throughout the engagement, we heard it was important that these ways of working were enhanced in the new strategy and action plan. To achieve these we developed a set of guiding principles, and asked for feedback as part of the consultation.

We Asked

Participants were asked to what extent they agreed with the following guiding principles:

Guiding Principle 1: Suicide prevention is everyone's business. We will provide opportunities for people across different sectors at local and national levels to come together to connect and play their part in preventing suicide.

Guiding Principle 2: We will take action which addresses the suicide prevention needs of the whole population and where there are known risk factors such as poverty, marginalised and minority groups.

Guiding Principle 3: All developments and decisions will be informed by lived experience. We will also ensure safeguarding measures are in place across our work.

Guiding Principle 4: Effective, timely and compassionate support - that promotes recovery - should be available and accessible to everyone who needs it including people at risk of suicide, their families/carers and the wider community.

Guiding Principle 5: We will ensure the needs of children and young people are addressed and their voices will be central to any decisions or developments aimed at them.

Guiding Principle 6: To build the evidence base, quality improvement methodology and testing of new, creative and innovative practice will be embedded in our approach.

You Said

During the engagement people said stigma around mental health and suicide was an important issue which is why it was included as a key guiding principle, to ensure that addressing stigma around suicide will encourage people to talk more openly, seek help, and be aware of where to signpost others to if they need it.

201 participants responded to this question with the table below showing how they responded:

To what extent do you agree with the following Guiding Principles

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Answered
GP1	6%	1%	5%	20%	65%	2%
GP2	6%	2%	2%	18%	69%	2%
GP3	4%	3%	4%	20%	66%	2%
GP4	5%	0%	1%	14%	77%	2%
GP5	5%	0%	3%	19%	70%	2%
GP6	5%	2%	4%	25%	61%	3%

Due to rounding, the total of some of these figures may add to 99%, rather than the expected 100%

Across each of the guiding principles, less than 10% of those who responded, disagreed with what they were setting out to achieve. This is illustrated by:

• Only 5% of respondents, disagreed with Guiding Principle 4 which outlines the availability and access to effective, timely and compassionate support, with no follow-up changes recommended.
• Almost 90% of respondents either agreed or strongly agreed with the commitment of Guiding Principle 5 which highlights the needs of children and young people.

In follow up comments, these themes were identified:

• Lived experience is essential however it must reflect the wider diversity of experience; it must also be considered alongside professional expertise and research.
• Clarity is needed on the importance of engaging with children and young people across the strategy and action plan.
• The risk factors and groups who are at higher risk of suicide (highlighted under Guiding Principle 2) need to be more explicit.
• The cost of living crisis, and its wider impacts on mental health, should be recognised.
• Recognition is needed that cross-sector partnership working is needed at all levels, and should explicitly recognise the valuable role of third sector organisations.
• Data and evidence are crucial, however there are some concerns about the accuracy of existing suicide data, and the fact it tends to be clinically focussed.
• Providing compassionate support for people who are suicidal needs to be a central part of the strategy and action plan.

Relevant quotes:

"In relation to 1.5 (GP3), we fully recognise the value and importance of lived experience but think that the principle would be enhanced by acknowledging the importance of this complementing professional knowledge / expertise and research / evidence. One should not be at the expense of the other".

"Reference to children and young people (CYP) is essential but we would like clarity on how CYP are to be fully engaged and their influence embedded into the strategy and actions".

"(We) don't just want children's views, we want children to be fully involved in the co-production and design of supports & services".

We Did

Based on the feedback, we reworded the original six guiding principles to strengthen their message. This included:

• Naming risk factors and inequalities so it was clear what was meant.
• Being clear that we need diversity across our lived experience insight, which is also representative of the risk factors and groups who are at higher risk of suicide.
• We are also explicitly setting out our commitment to Time, Space, Compassion as an underpinning set of principles, to improve the responses people who are suicidal receive.

We have also focussed specific actions (in the action plan) to reflect the cost of living crisis.

Given the emphasis across the feedback on continuing to focus on the stigma of suicide, we created an additional principle which focused on this.

Guiding Principles

We were extremely grateful for the feedback we received on the draft guiding principles and believe we now created improved guiding principles that reflect the range of views we received. The new guiding principles for suicide prevention in Scotland are:

1. We will consider inequalities and diversity – to ensure we meet the suicide prevention needs of the whole population whilst taking into account key risk factors, such as poverty, and social isolation. We will ensure our work is relevant for urban, rural, remote and island communities.

2. We will co-develop our work alongside people with lived, and living, experience (ensuring that experience reflects the diversity of our communities and suicidal experiences). We will also ensure safeguarding measures are in place across our work.

3. We will ensure the principles of Time, Space, Compassion are central to our work to support people's wellbeing and recovery. This includes people at risk of suicide, their families/carers and the wider community, respectful of their human rights.

4. We will ensure the voices of children and young people are central to work to address their needs, and co-develop solutions with them.

5. We will provide opportunities for people across different sectors at local and national levels to come together, learn and connect – inspiring them to play their part in preventing suicide.

6. We will take every opportunity to reduce the stigma of suicide through our work.

7. We will ensure our work is evidence informed, and continue to build the evidence base through evaluation, data and research. We will also use quality improvement approaches, creativity and innovation to drive change – this includes using digital solutions.