Time, Space, Compassion Three simple words, one big difference: Recommendations for improvements in suicidal crisis response

Recommendations

Short-term

• Culture change takes time; in the short term we must still act on the urgency of need to reduce the lives lost to suicide particularly given the potential negative impact on mental health and distress arising from COVID-19 and its aftermath. The Scottish Government and CoSLA should work together with local area governance structures such as Community Planning Partnerships (CPP's), Strategic Planning Groups (SPGs) etc to ensure a choice of immediate 24/7 crisis response services (physical and virtual) is available on a sustainable basis, promoted across geographic communities and sensitive to the needs of communities of interest. It will be important to take stock of the work undertaken in response to the pandemic and address any evident gaps. The reorganisation of unscheduled care should also include work to embed the Time, Space and Compassion approach.
• The application of existing clinical guidance^[8] in frontline health and care settings could support a step change toward the principles of Time, Space and Compassion. Specifically, in line with this guidance, health and care staff should be supported to move away from prioritising assessment of risk and eligibility for service, to assessing psychological and social wellbeing and the formulation of safety plans in partnership with those in suicidal distress.

• Planned work on mental health crisis for children and young people must be progressed as a matter of urgency, including a focus on suicidal crisis and consider the applicability of the principles of Time, Space and Compassion as set out in this report.
• The mental health assessment centres currently in development must be established following the Time, Space and Compassion approach. This will allow the approach to be tested and in turn will influence the development of an assessment framework, as detailed below. This opportunity should not be missed as these centres are likely to be a point of contact for many people in suicidal distress.
• Work to engage those with lived experience and the wider social movement should continue to ensure the Time, Space and Compassion principles are embedded further into the work of action 2 (mental health and suicide training) and action 3 (public awareness) particularly within United to Prevent Suicide campaigns.

Medium-term

• Scottish Government, through the NSPLG^[9], should provide funding for a full-time Action 5 implementation lead for two years, to support embedding the principles of Time, Space and Compassion for suicidal crisis response through:
  • Mapping existing suicidal crisis supports in the post-COVID recovery phase.
  • Leading on developing a collaborative Crisis Care Agreement (action 4) built on the principles of Time, Space and Compassion.
  • Developing a Time, Space and Compassion framework for suicidal crisis response in partnership with people with lived experience, providers and commissioners of services / programmes, and researchers. This framework, applying the definitions set out in this report, should work across different settings and service / programme types and take account of the available evidence including the use of models such as the Integrated Motivational-Volitional (IMV)^[10].
  • Supporting the testing of the assessment framework across a selection of existing and new settings, programmes and activities. We specifically recommend that the new mental health assessment centres are included in this early work in order to support design of service specifications for this significant new crisis investment across Scotland.
  • Apply the learning from Action 7 (preventative actions for at risk groups) and pilots associated with Action 10 (reviews into all deaths by suicide), to the development of the Time, Space and Compassion framework.
  • Ensure the work of Action 6 (digital technology) supports the development of additional digital resources to fill any gaps which may be identified to ensure support for suicidal crisis is available 24/7
  • Sharing early findings and promoting examples of good practice nationally and with SPGs to inform early improvement in wider services and programmes.
  • Supporting roll-out of the assessment framework in different settings, programmes and activities.
  • Supporting development of methods for sharing evidence and good practice, in order to inform service / programme design, commissioning and delivery in the longer-term.
  • To work with the relevant delivery leads to ensure continued work with people with lived experience and the wider social movement which embeds the Time, Space and Compassion principles into ongoing developments of action 2 (mental health and suicide training) and action 3 (public awareness) to support conversations about suicide – seeking resource as appropriate.
  • Work with communities and organisations in remote and rural areas including harnessing the engagement of members of the National Rural Mental Health Forum, to ensure effective responses in these areas.
  • Supporting the development of an evaluation framework for the Time, Space and Compassion approach.

Longer-term

• The next suicide prevention strategy should include outcomes to improve early intervention and prevention, with appropriate actions to achieve these outcomes.
• The next suicide prevention strategy should include outcomes to improve the provision of after-care for those who have experienced suicidal crisis, with appropriate actions to achieve these outcomes.