National Suicide Prevention Advisory Group: annual report 2024-2025

7. NSPAG Report: Recommendations for the next Suicide Prevention Action Plan 2026-29

We have developed a set of recommendations based both on our discussions and learning throughout the year, and on our own professional experiences. For each of these we have set out the rationale and suggestions for possible actions. As noted above, two of our three recommendations from last year are carried over into this report, Recommendation 2 from last year on CAMHS is included here in the recommendation on people who are waiting or missing and Recommendation 3 from last year is reiterated in the section on budgets and funding. Our broad areas of recommendation and actions are where we feel Suicide Prevention Scotland should focus for the next three-year action plan. The actions beneath each recommendation are our suggestions for areas of activity and some of these reinforce our support for existing activity.

Recommendation 1: Developing thinking around marginalised groups

We note Professor Rory O’Connor’s statement to the Equalities, Human Rights and Civil Justice Committee’s Inquiry into suicide prevention (also reported in their letter of 28^th June 2025) during which he said:

“The Creating Hope Together strategy is incredibly ambitious, because, for the first time ever - in any strategy ever published in the world, to my knowledge - we are saying that we want to reduce not only suicide but the inequalities that drive suicide. That is a fundamental shift. When I started working in the area, about 30 years ago, suicide was still considered to be a mental health concern. Mental health is, of course, important and we need to tackle it. It is an important driver, but it is only one driver. It is vitally important that we see suicide as a public health challenge, which is what we do now.”

The Inquiry acknowledged the shift in thinking about suicide and recognition of it as a public health issue. This is incredibly helpful for any wide-ranging problem because it takes it out of one siloed area and allows everyone to have a role in tackling it. We have formulated our ideas based on this concept and so our suggestions are wide ranging.

We have been fortunate to be guided by the Integrated Motivational-Volitional Model of Suicidal Behaviour (IMV) model^[1] developed by Professor Rory O’Connor, Chair of the Academic Advisory Group, that helps to explain how triggering events or circumstances can lead to feelings of defeat, humiliation and entrapment and in turn to suicidal ideation which can then, in some cases, lead to suicidal behaviour. This has helped us to formulate our ideas around where we think areas of focus for the next three-year action plan should lie. Many of the circumstances we discuss below as recommendations for future work, will inevitably fit within this model where people feel trapped by systems that could be improved for them or, by past or current psychological trauma that may affect them as individuals.

We also acknowledge that the current socio-cultural and political climate, that perpetuates often harmful narratives around some marginalised and minoritised groups, has a significant detrimental effect on poor mental health and, as such, suicidal ideation. This is particularly exacerbated by the online nature of our society. Negative tropes and rhetoric targeting minorities are highly visible online, in the media, and on social media which can cause significant harm to the wider mental health of our society.

Communities for which we see toxic tropes most often include the Transgender and wider LGBT+ community, the disabled community, refugees and asylum seekers, as well as women and girls – exacerbated by worsening ‘toxic masculinity’ and public figures pushing misogyny online. We acknowledge that the way that the media, and from this, the wider public often speak about marginalised communities, has a bearing on mental health and suicidal ideation and we would ask for thinking about how to address this to be considered and further developed. This must be more than acknowledging intersectionality and should move towards a more nuanced and involved understanding of how distinct and intersecting communities are affected by such narratives.

We acknowledge that the majority of people who complete suicide are men^[2] and some of that may be related to their reluctance to speak about their struggles or to reach out for help. We note a lot of work has been done to try and support men through various men’s organisations, football clubs and campaigns. The latest Suicide Prevention Scotland campaign was impactful in telling personal stories and encouraging conversations about suicide, with some of the associated podcasts having a particular focus on men.

Whilst we note that men are at higher risk of being susceptible to suicidal ideation and completion we must also acknowledge - and encourage further depth of thought and consideration on - the nuances that may be found here. This is particularly in relation to gender roles and expectations and the high incidence of suicidal ideation and attempts (without completion) in women. Though men complete suicide in higher numbers, care givers, and those with caring responsibilities are likely to ideate without completion.

Additionally, for marginalised communities' statistics such as referred to above may not be very helpful in painting an accurate picture of risk within marginalised and minoritised communities due to their significantly smaller size. Marginalised groups are often at significantly higher risk though are also seldom heard from and are not reflected within data due to lack of demographic understanding. For example – we know that Trans women and New Scots are at a much higher risk of suicide, as are disabled people and those in economic hardship. This is in part due to the current climate as described above. If we are to consider this properly, we will look to figures on completion, as well as to understand ideation and attempts amongst multiple marginalised communities and women.

We also recognise sometimes specific personal circumstances which are often chronic and ongoing added to issues such as SMD or poverty can make individuals feel trapped and hopeless. Sometimes that is exacerbated by the social discrimination or stigma some people face for aspects of their identity that can lead to suicidal ideation. For example, people in the asylum system and refugees may feel suicidal due to housing precarity, funds, displacement as well as prejudice and ill treatment or prejudiced narratives as described above. Trans people may feel suicidal ideation due to lack of access to health care or employment but also due to the aforementioned rise in anti-trans sentiment being visible across the media.

Both feelings of defeat, humiliation and entrapment and societal discrimination can lead to coping behaviours such as gambling and substance use which can contribute to poor mental wellbeing and may increase the risk of suicide.

We have attempted to look at the issues of focus mentioned in this report through the lens of intersectionality and to include people at the margins. We know that often these people are not well represented in suicide statistics, and we feel that they need to be represented in campaigns and in considerations for suicide prevention at every level.

We believe that approaching through this intersectional lens may also present opportunities. Marginalised communities, communities of experience and local geographical communities in financially deprived areas have long since created their own tools and structures of support. There are many existing grassroots, local and marginalised community groups that are already providing both preventative support and crisis support within and for their communities. These are the groups with established context, relationships and cultural and equalities competence to be able to support this work. Many are long standing organisations, and many are new and emerging in response to crisis. It is important that resource is invested into these initiatives and organisations to bolster and provide much needed capacity for this work. This is particularly important given the circumstances that many who work for and within marginalised communities are operating in, and the rate at which third sector, and charity organisations are losing funds and closing due to cuts. These services are a lifeline to their communities and to the work of suicide prevention. We must also acknowledge the power of work that these organisations do and the burden of weight they are under in this context. Investing within may also alleviate pressures across the sector and further the aims of Scottish Government and COSLA.

Actions:

1. Continue the good work being done through the national campaigns and conference to reduce the stigma of speaking about mental wellbeing and to change the culture that prevents people from talking about their concerns and start to normalise these conversations. Future campaigns should include individuals from marginalised groups or organisations who support them and take account of the different ways people in crisis might present and seek support.

2. Work to improve the way we collect, share and use data and add contextual qualitative data to provide a more accurate picture of suicide and suicide risk in marginalised communities.

3. Continue and initiate investment in community and grassroots organisations working with marginalised groups and communities to ensure they can continue to provide preventive and crisis support.

Recommendation 2: A Focus on Poverty

As a group we feel a strong focus for the next plan should be poverty, to include child poverty, but not ignoring that adult and child poverty are inexorably linked. Some of the following observations are drawn from our group’s response to the development of the Child Poverty Delivery Plan.

The social determinants of suicide are well known: areas of higher deprivation have higher rates of suicide; people who are unemployed are two to three times more likely to die by suicide than those in employment; and, those who experience deeper levels of poverty have higher risk of suicidal behaviour as outlined in the Samaritans’ Dying from Inequality report. Poverty exacerbates all the individual challenges and makes them more challenging to address.

Poverty has a strong link to other issues, such as trauma, unemployment, marginalisation and homelessness. Individually these challenges all carry risk of suicide, and together they can lead to greatly elevated risk levels. Whilst some children are born into poverty, others are pushed into poverty, because of other characteristics or life circumstances, such as being LGBT+, disabled or care experienced. Added to this, families living in poverty may face reduced access to support, including for their mental health. This can result in missed opportunities for services to identify and support people who are suicidal. The benefits systems can be extremely challenging to navigate and the entry criteria for some benefits are not consistently applied. People may need more independent support to gain access to the benefits they are entitled to, for example through a Community Link worker, Navigator or Citizens Advice.

There needs to be a recognition that child poverty can increase the risk of disengagement from education, progression towards alternative to school programmes and for some, involvement with the criminal justice system. Similarly, children and young people in the care system who do not have a positive and supportive experience to address past trauma may also face poorer outcomes. Young people may be effectively written off by the system and pushed into poverty by life experiences. Intergenerational trauma plays into this and will add to the likelihood of developing mental health issues.

Both education systems and care systems should be trauma informed and trauma responsive to ensure they can proactively support young people living in poverty. Young people, particularly those living with poverty or whose lives are challenging, need the support of One Trusted Adult. This may be a parent or carer but could equally be a youth worker or teacher. Ensuring that young people remain within an education system which meets their individual needs can be an important protective factor for them.

Actions:

1. Work collectively to ensure young people have an experience of education that is inclusive, meaningful and engaging and recognises their individual circumstances (e.g. neurodiversity, sexual orientation and gender identity, cultural and language barriers) and supports their mental health and wellbeing so that it acts as a protective factor against suicide risk.

2. Strengthen policies to maintain benefits and increase low incomes, framing this as a way not only to reduce poverty but to improve mental wellbeing and prevent suicide.

3. Develop clear and consistent understanding, language and approach to the relationship between poverty, inequality and suicide.

4. Support and develop measures to reduce the stigma and shame of poverty. Stigma and shame are associated with many of the key drivers of suicide and addressing these will likely reduce the risk.

Recommendation 3: A Focus on Severe and Multiple Disadvantage (SMD)

The definition of SMD as outlined in the original English Hard Edges study includes people experiencing three forms of disadvantage: homelessness, offending and substance use. A subsequent Hard Edges Scotland study widened the definition of SMD to include domestic violence and abuse and mental health while continuing to recognise the association with poverty. Adding these two further dimensions brought into focus some of the issues which tend to affect women more than men as they were a group for whom SMD had not been fully recognised using the original three forms of disadvantage. SMD often originates in childhood with a large proportion of people experiencing SMD experiencing childhood trauma. Recognising the risks for SMD in childhood and specifically within the education sector can present opportunities for early intervention.

Overall, services are not well set up to support people with SMD partly because they have not been designed with SMD in mind and so are not well coordinated or collaborative in that respect. This can lead to difficulties in accessing both support and benefits. The Hard Edges report notes that people experiencing SMD often face high levels of stigma and exclusion, and this is clear from the stories of lived experience and quotes included in the report. It is easy to see how this might lead to feelings of hopelessness, defeat, humiliation and entrapment as described in the IMV model.

Recognising these issues for this group of people who do not fall neatly into one area of support is vital.

Actions:

1. Recognise that effective joint working to meet the needs of people experiencing SMD takes person and time resource to achieve to a good standard.

2. Support the adoption of the NICE 2022 Guideline ‘'Meeting the Health and Social Care needs of people experiencing homelessness', which has a focus on SMD, in Scotland, and actively encourage Health Boards need to implement its recommendations.

3. Actively guard against siloed working across both policy areas and organisations as recommended in the Gone Too Soon report. There should be a ‘no wrong door’ approach to mental health and alcohol and drug recovery services especially which would not only help people get the right support but would also guard against stigma which, despite all the good work being done, is still an issue for people experiencing SMD.

4. Include a focus on SMD as part of the Whole of Government approach to suicide prevention, so that it is properly considered in a policy context across all relevant areas of government.

5. Recognise and address NHS, social work, domestic abuse, housing and criminal justice statutory and voluntary services funding gaps in a sustained reliable way so that services can respond to meet people’s needs.

6. In future suicide prevention public campaigning, include the voices of people with lived experience of SMD to reduce stigma.

Recommendation 4: A Focus on Young People and Care Experience

Although this area of work fell outside our reporting period we feel it is important to include this as an area of focus for the next action plan, and we know it is an area of focus for the current financial year. We are aware that work is already underway to support suicide prevention amongst children and young people, including care experienced young people through the dedicated delivery lead for Children and Young People as part of Suicide Prevention Scotland.

In their most recent report from February 2025 the Promise Oversight board stated:

‘Everyone should have access to high quality mental health support to support them through adversity. Care experience is life long and the mental health support which is offered should reflect this.’

We also understand that children and young people who have been consulted on this work have highlighted several areas where they feel thing should be improved in relation to distress and suicide prevention and we feel their voices should be front and centre of any future actions.

Actions (based on the voices of young people)

1. Focus on prevention, recognising the stress associated with transitions.

2. Ensure we improve the way we collect, share and use data on children and young people and suicide.

3. Address gaps in services for young people in distress and support them to embed the principles of Time Space Compassion.

4. Understand the diverse characteristics, circumstances and experiences of children and young people and recognise that their needs are different from those of adults when it comes to suicide prevention and that they need specific resources and support.

5. Develop campaigns, resources, and supports appropriate for and targeted at young people and their families or carers which might help to reduce stigma including bereavement support.

6. Equip parents/carers and any staff working with young people in schools, higher education, care settings, third sector and workplaces, with the skills to speak to and support young people at risk of suicide. Understand the role of peer support in supporting transitions.

Recommendation 5: A focus on occupational risks

Certain occupational groups are also more at risk of suicide and some of that is linked to stress of work, workplace culture issues, isolation, unstable employment and poverty, in some cases alongside access to means. These would include some health professionals, vets, farmers and construction workers. Often individuals in these occupations can be reluctant to reach out for help within their workplaces. Some professions have recognised these issues and attempt to provide access to independent support, for example NHS Practitioner Health which provides confidential mental health and addiction support to health professionals. This approach may be helpful for other occupational groups.

Actions

1. Promote training on suicide prevention to professional and occupational groups who may be most at risk, and their leaders, to raise institutional and personal awareness of suicide. This could be through professional bodies or employers. Sometimes this only happens when a colleague takes their own life, we feel this training should happen pre-emptively.

2. Increase understanding in higher-risk industries of stress of work, workplace culture issues, isolation, unstable employment and poverty as drivers of suicide risk rather than more traditional understanding of suicide as a purely mental health problem.

Recommendation 6: A focus on people who are waiting or missing

We are aware that at present many people are ‘waiting’ for healthcare assessment and/or treatment and many of those are in chronic pain. It is known that the risk of suicidal ideation and completed suicide is doubled in patients with chronic pain. While globally chronic pain is more likely to go untreated in women, in the UK there is a complex relationship between chronic pain and gender and there is a clear link between chronic pain and social deprivation and this in turn is related to employment, or lack of it.

Alongside this there are many patients, including young people, awaiting mental health assessments or for neurodiversity assessments. A recent report from Rethink Mental Illness, Right Time Right Treatment outlined that among people whose mental health deteriorated while waiting for mental health assessment or treatment 1 in 4 needed urgent and emergency care necessitating hospital admission, 65% experienced suicidal thoughts and 25% attempted suicide.

Similarly, there are many ‘missing’ patients who for various serious reasons do not attend multiple healthcare appointments and those who go missing or are pushed away from mental health services, in particular, are at a much higher risk of early death including suicide. Missingness is associated with a range of social adversity experiences including poverty.

While Missingness has a specific definition as ‘the repeated tendency not to take up offers of care such that it has a negative impact on the person and their life chances’ we are also aware that some marginalised groups don’t access mainstream healthcare or mental health support perhaps because they feel these services are not designed for them, are not well versed in equalities, may be quick to pathologise or are stigmatising. This points towards a need for training within healthcare and involvement of marginalised groups in the development of services.

Actions

1. The link between poverty, SMD, mental health and missingness should be highlighted across Scottish Government policy areas to ensure recognition of the higher risk of mortality among this group. This feeds into the ‘Whole of Government’ approach to suicide prevention, which we support.

2. The link between chronic pain and suicide should be highlighted to those managing this patient group at all levels so that conversations about suicide can be instigated and safety plans put in place.

3. Where needed consideration should be given to resourcing equalities competent support and ensuring that existing services that serve marginalised groups are equipped and resourced to do so.

Recommendation 7: Children and Young People Mental Health Services (CAMHS)

The waiting times for CAMHS have improved since we wrote our last report and we note that 90% of children and young people are now seen for a first appointment within 18 weeks of referral to CAMHS. That said, as noted earlier in this report, we also recognise that around half of children and young people are seen urgently, and this is included in the headline data and that the (median) average wait for treatment is closer to four weeks.

However, for those who are not seen urgently, we still consider 18 weeks to be an unacceptably long waiting time for a young person in distress and their family with the burden of support and ensuring safety falling to both the family unit, their GP and wider services. We also note that following this first appointment some young people will have a further wait. We also note that young people waiting for a neurodevelopmental assessment have been moved onto a separate waiting list and as a consequence may have a longer wait, though we do recognise work underway to fully implement the National Neurodevelopmental Specification. While most schools pragmatically provide whatever support they can while young people are waiting for assessment, the delay may lead to the development of other mental health conditions.

Actions:

1. While we recognise that Suicide Prevention Scotland alone cannot influence waiting lists for CAMHS we would urge Scottish Government to ensure that reporting of the start of treatment is accurate and reflects what is being provided at the first visit. We feel urgent attention should be paid towards resourcing of CAMHS and to third sector services that may be appropriate alternative sources of referral for some young people.

2. Urgent attention should be given to the separate waiting list for neurodevelopmental disorders to ensure these young people are not subject to a longer wait and that this list complies with the referral to treatment target time of 18 weeks to ensure that the risks of suicide are mitigated for those removed from CAMHS and placed in separate waiting lists as a matter of urgency.

Recommendation 8: Budgets and financing

This section restates one of our actions from 2024/25. We recommend that work is undertaken by Suicide Prevention Scotland to develop and introduce a process for costing implementation plans. This should begin with the next action plan which will run from 2026-2029, and the results should inform both the resources allocated by the Scottish Government and COSLA to support the plans, and the process of prioritising action.

Actions

1. The Scottish Budget for 2025-26 puts an emphasis on addressing factors, such as poverty and housing, which act as key determinants of mental health and suicide prevention, however, it is challenging to directly attribute the impact of budgets to suicide prevention outcomes. We still feel it would be helpful to know the total amount invested in the current budget to tackle inequalities across different policy areas, and how this contributes to suicide prevention work, including the work of Suicide Prevention Scotland.

2. The Scottish Government is piloting a Fairer Funding approach for the third sector to provide 2 year funding to some third sector organisations to provide more certainty and allow for longer-term planning and project management. Over the coming year we would like to understand whether this is making a positive impact on their ability to deliver suicide prevention activity in a more sustainable way.

Recommendation 9: A focus on prevention

We are encouraged by all of the work that has gone into prevention and intervention around suicide and would hope that will continue. However, we feel there should also be more of a shift towards the primary and secondary prevention of suicide as well as postvention and that should be data driven with a focus on real time data and the data derived from suicide reviews. Prevention activity is fundamental to saving lives. However, many services are heavily focussed on meeting the needs of people in crisis, which diverts resources from prevention activities.

Actions

1. The nature of the data collected on suicides should be more comprehensive, work should be done to improve its quality and to identify and support overcoming barriers in data collection, as well as to make better use of the data this is available.

2. Bring together quantitative data from various sources to inform prevention as below from different sources such as Police Scotland, Public Health Scotland and making use of organisations such as the Edinburgh Futures Institute.

3. Continue use of the OutNav system to provide qualitative data on progress of actions in the delivery and action plans. We feel this provides rich contextual information in a digestible format that is helpful in tracking progress.

4. Capture qualitative data from minoritised and marginalised groups where numbers are small enough not to flag up concerns in national data reporting trends but where the impact of suicide can be much greater than it appears.

5. Identify best practice for local suicide prevention / review groups and support implementation.

6. Create a format for local leads to feed into NSPAG to ensure both local and national needs are met.

7. There should be a measurable and sustained shift in national, regional and local investment into prevention work across all sectors.