Suicide Bereavement Support Service: final evaluation report

6. Considerations and options beyond the pilot period

Areas of consideration and options for the provision of suicide bereavement support beyond the pilot period are presented below. These were developed through a workshop with the service leads and managers of the SBSS service, discussions with stakeholders and consideration of the findings from previous evaluation phases.

The following is not intended to represent an options appraisal, and further work would be required to fully consider the funding implications, viability, strengths, weaknesses, opportunities, and threats associated with the different options presented in this chapter.

6.1 A local gap if SBSS is not continued

Local stakeholders held a strong view that the SBSS had filled an existing gap in the support available to people bereaved by suicide in the service area.

“It’s definitely filled a gap, and that’s not to say there wasn’t anything before, we just didn’t have anything that offers quite what the bereavement service has and the way that it does it. So I think it would be devastating for us to lose it to be honest.”

While there was acknowledgement that local support services were available for people bereaved by suicide in the pilot areas before the service launched, these were not perceived to offer the same level of rapid response, one-to-one, person-led practical and emotional support as the SBSS. Referral organisations also highly valued the SBSS as a referral option that they can offer when needs relating to a bereavement by suicide are expressed or identified. The SBSS is perceived to provide support that is specific to the needs of people bereaved by suicide which is seen as a particular strength among stakeholders.

6.2 The need for planned and managed exits if the service ends

The evaluation findings have demonstrated that people receiving support from the service can remain engaged and have an ongoing need for support over a sustained period. This reflects the bereavement journey supported people can go through, in which progress and setbacks are experienced. The SBSS continues to take referrals, and it is reasonable to assume that there will be those who still need support when the current funding for the service pilot ends. Service staff and stakeholders highlighted the critical need for a closure of the service to be carefully planned and managed to minimise the potential impact on those receiving support if the service does not continue.

6.3 Gaps in learning and understanding

Delivery of the SBSS pilot has generated extensive learning about the enablers and challenges for people bereaved by suicide in accessing support and learning what has made the support effective for those who have accessed the service. However, service staff and stakeholders identified further issues to consider, for example:

• Has general awareness-raising activity been effective in reaching all parts of local communities in the pilot areas?
• Do current referral pathways facilitate and support access for all the different communities in these areas?
• Would the current model of support provided through the SBSS meet the needs of different communities?
• What are the additional considerations, if any, that need to be made to ensure that the support provided through the SBSS is accessible and appropriate for different communities?

Examples of different communities and additional considerations mentioned by service staff and stakeholders included different faith groups, LGBTQ+ and Gypsy/Traveller communities, and those living in poverty and/or areas of multiple deprivation. A question was also asked about the presence of cross-sectional stigma and discrimination, the extent to which this could create additional barriers to accessing support, how these could be overcome, and the role of organisations already trusted and working with different communities.

6.4 Referral pathways and general awareness

In considering the future of the SBSS, it was suggested that should there be a national rollout of the service, this would create opportunities to supplement local referral pathways by creating one or more national referral routes. The Distress Brief Intervention (DBI) referral pathway through NHS 24 was cited as a successful model which could be considered. Furthermore, service staff and stakeholders suggested that a rollout of the service would also enable an effective national awareness-raising campaign, which could achieve greater reach and encourage self-referral across a wider range of those affected by a bereavement by suicide. This could be supported through a dedicated website for bereavement by suicide support, which included a simple online self-referral function.

6.5 Future role and remit of the service

Another consideration raised by service staff and stakeholders was the potential for future service development beyond the current role and remit of the SBSS. This included:

• The role of the service in helping to equip others to provide support to people bereaved by suicide, for example, workplaces, faith leaders, organisations that work with marginalised communities.
• Exploring whether and how peer volunteers and those with lived experience could support the service and potential service development, for example, with supplementary group-based support, where none is locally available. While it wasn't in the scope of this evaluation to explore service delivery models used by other services, models that use volunteer/peer support do exist, and there may be learning from these approaches that could inform future service development.

6.6 Outline options

There are several permutations for the SBSS beyond the pilot period. In the context of the considerations set out above, and in the absence of a full and rigorous options appraisal process, three skeleton options are presented below that have been drawn from discussions with service staff and stakeholders.

Option 1 – Service rollout to all Health Board areas in Scotland

This option would see the SBSS delivery model replicated in each Health Board area. The service would have a physical presence in each area, developing local referral pathways, raising local awareness and participating and contributing to local suicide prevention planning and activity.

Delivery in each Health Board area would represent new spokes in the existing hub and spoke model, with the hub maintaining its current central functions (e.g. provision of core staff training, quality assurance, and service monitoring).

This option provides the potential for creating a national referral pathway and a centralised self-referral pathway to supplement local referral activity. This could be facilitated through the creation of a suicide prevention website for Scotland, which included functionality for referrals to be made by other services and organisations as well as for people to self-refer. The national referral pathway would be managed as one of the hub’s central functions. A national campaign could be developed to increase and support awareness raising among the general public.

Given what is detailed in section 6.3 about the gaps in learning and understanding, there would be scope for local investment and development to address any local priority areas or needs which are not being met through the current SBSS delivery model. While this has the potential to create variation in the service across the country, it provides the flexibility to accommodate any needs and priorities specific to each Health Board area.

Option 2 – Single national service linked with local delivery to meet local priorities

This option is similar to option 1, but instead of replicating the existing SBSS delivery model in each Health Board area, a national service team covers the whole of Scotland. This would see the option of face-to-face support removed from delivery, with text, telephone, and video calls being the only available support formats.

A combination of local and national referral routes would be developed and implemented. As with option 1, this could be supported through a suicide prevention website, which included functionality for self-referral and for other services and organisations to make referrals on behalf of someone who has been bereaved by suicide.

At a local level, those with responsibility for suicide prevention would be expected to work with existing provision and services to equip and enable them to address any local priorities and needs that the national SBSS service model is not meeting. This will likely result in variation across each Health Board area, but any variation should reflect local needs and priorities.

Option 3 – managed closure of the SBSS

In this option, SBSS enters a period of managed closure that would likely need to run beyond the end of the current pilot period to ensure those currently receiving support from the service experience as little negative impact as possible.

The learning that has been generated through the pilot, particularly the elements of the service delivery model that have generated a positive experience and a range of outcomes for those who have received support, is shared with local suicide prevention leads.

Based on discussions with local stakeholders involved in local suicide prevention activity in the pilot delivery areas, an implication of this option would mean that meeting the needs of those bereaved by suicide would be challenging and reliant on existing provision and services outside of the SBSS.

This option would likely see a continuation of the existing variation across Scotland in the availability, accessibility, and quality of support in terms of experience and outcomes for those bereaved by suicide.