This review shows that, while momentum is unquestionably increasing, the pace of progress has perhaps been slower than anticipated or desired at the time Every Life Matters was published in September 2018. In addition, implementation has been uneven across the different Actions. The impact of COVID-19 from March 2020, while giving added urgency to the need for suicide prevention measures, has put further practical obstacles in the way of the delivery of some Actions. As discussed above, this did not mean a complete hiatus. Several Actions were paused, but have subsequently resumed; and others continued, but not in the form that was anticipated.
By the start of 2020, the temporal trend in suicide incidence was clearly upward (see section 2.1), possibly resulting from the impact of external factors on the economic and psychological wellbeing of the Scottish population. While adverse external factors are likely to have continued to exercise some influence on suicide rates (and suicide prevention activity) during 2020, the findings of this review suggest that at least some of the barriers to progress relate to implementation. As one of the delivery leads commented:
"Understanding the landscape, developing the infrastructure and building relationships all take time."
This point is clearly illustrated by evidence, detailed in this review, of the extensiveness and intensiveness of activity required to implement the SPAP. This, in turn, underlines the need for operational, as well as strategic, leadership, with sufficient resources (personnel, funding) to support delivery. Given the complex lead-in processes, a delivery infrastructure, together with clear decision-making and governance arrangements, also need to be in place early on, in order to get to the point "where all the pieces are in place". Any future suicide prevention strategy needs to be underpinned by an action plan and supporting infrastructure to facilitate an implementation process that can contribute efficiently and effectively to agreed outcomes.
What also emerges from the review is the extensiveness of stakeholder engagement that has been undertaken. The involvement and contribution of those with lived experience is key in shaping implementation, but the range of other agencies, partners and professionals, drawn in and contributing to the evolving Actions, suggests that the process of delivering on the SPAP, may, in itself, add momentum to a gathering social movement.
Despite the evident commitment, enthusiasm and energy invested in delivering the Actions, what the review also, indirectly, underlines is the limited available evidence concerning whether and how the different Actions, collectively or individually, may contribute to the ultimate goal of a reduction in suicidal behaviour. As the SPAP moves forward, there may therefore be limited ways of knowing or being able to demonstrate its impact. This may suggest the value of investing in further support for evaluation and monitoring as the SPAP progresses into its final year. It also points to the importance of ensuring that any subsequent suicide prevention strategy is outcome-focused and evidence informed; that the direction of travel from long-term, intermediate and short-term outcomes to activities is clearly mapped, and is of sufficient durability and sustainability to achieve the identified outcomes; and that, as far as possible, measurement of the distance travelled, through evaluation and monitoring, is embedded from the start.