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choose life: A National Strategy and Action Plan to Prevent Suicide in Scotland
1. Introduction
1.1 THE FACTS
OVER 600 PEOPLE COMMIT SUICIDE IN SCOTLAND EACH YEAR
1
Suicide affects all age groups and communities in our society. In fact, few people escape being touched by the devastating effects of suicidal behaviour in their lifetime and the emotional, social and practical repercussions of suicide are felt by family members, friends, neighbours, colleagues and people working in a wide range of services and agencies.
The suicide rate among young men is particularly high. Scotland's rate is much higher than the rate for the UK as a whole. The rate of increase in suicide in Scotland over recent decades is among the highest in Europe.
Over 7,000 people are treated in hospital each year following episodes of non-fatal deliberate self-harm. The number of young people, and in particular girls in their early teens who are treated for self-harm, gives real cause for concern.
For more facts and figures on trends, see
Appendix 1.
There are many factors which put a person at risk of suicide. Four key groups of risk factors can be identified:
Risks and pressures within Scottish society
Risks and pressures within communities
Risks and pressures for individuals
Quality of response from services.
For more information on causes and risks of suicidal behaviour, see
Appendix 2.
DEFINITIONS AND TERMS Suicide and Deliberate Self-Harm This strategy covers a range of behaviours brought together under the heading 'suicidal behaviour' it distinguishes between: Suicide: an act of deliberate self-harm which results in death. Deliberate self-harm: an act which is intended to cause self-harm, but which does not result in death. The person committing an act of deliberate self-harm may, or may not, have an intent to take their own life. Effective strategies to reduce suicide within a population need to be mindful of the overlap between suicidal behaviour and deliberate self-harm. A proportion of people who deliberately harm themselves are at increased risk of subsequently completing suicide. However, the relationship between suicide and self-harm is complex: Some deaths which are classified as suicide may result from acts which were not intended to cause death or where the motivation (suicidal intent) was equivocal. Likewise, some acts of deliberate self-harm may have been intended to result in death but may have been foiled through rescue by others, imperfect knowledge, the choice of method or some other reason. Many acts of deliberate self-harm are not intended to end the person's life.
Because of this overlap between the two behaviours, deliberate self-harm needs to be regarded as one of a range of risk factors associated with suicide. It would, however, not be appropriate to regard all deliberate self-harming behaviour as suicidal behaviour. Indeed, the majority of people who self-harm do not go on to take their own life. This strategy includes only those aspects of self-harming behaviour which might be considered as an indication of risk of suicide. It is recognised that there are other dimensions and manifestations of deliberate self-harm that are not covered within the strategy's scope. |
1.2 PREVENTING SUICIDE
This Strategy and Action Plan responds to the challenge of reducing the rate of suicide in Scotland. Work is already taking place in local areas and this needs to be sustained and supported. But more immediate action is now required. As well as supporting current work and implementing new actions we need to recognise the long-term nature of the challenge facing us all.
Taking action to prevent suicide will involve a combination of efforts across many aspects of Scottish life: eradicating poverty, addressing social exclusion, tackling inequalities, improving educational opportunities, improving health. Action must involve people from a range of organisations, professions and groups, with sustained effort required over a long period of time.
Making Investments
In this financial year, the Scottish Executive is providing 6,604 million for health and community care services (579.9 million of this for mental health services). Funding for Education, Children and Young People by central government together with specific grants is over 400 million in 2002-03 and in total funding for local authority services is over 7,000 million. Over 33 million is being made available from both the Health and Education budgets for the Changing Children's Services Fund, and across the Scottish Executive 180 million is being spent on tackling drug misuse.
As well as making better use of existing and future resources in line with evidence, it is important that an additional investment is made to support and complement national and local action. This is why we are investing 12 million over the next three years to ensure the effective implementation of this strategy and action plan.
Three-quarters of this new investment will complement work at a local level and focus on:
supporting the improved co-ordination of efforts by local agencies;
developing and implementing local action plans;
encouraging and supporting more innovative local voluntary, community-based and self- help initiatives that address suicide reduction and prevention in local neighbourhoods and local communities; and
supporting the development of appropriate training programmes.
National investment will focus on:
supporting the leadership and co-ordination required to implement this strategy;
improving cross-departmental and national agency collaborative working;
ensuring the collection, dissemination and sharing of evidence on what works and practice already underway from which we can learn;
developing the collection and use of information on suicidal behaviour and completed suicides;
undertaking additional research work into suicide, suicidal and self-harming behaviours; and
carrying out a detailed evaluation of progress being made towards achieving the objectives of the strategy, so that we can improve our actions based on sound knowledge and information, knowing what works best, for whom, where and why.
Taking Actions
It is important to recognise that prevention may not always be possible and there will be occasions when no amount of preventative action can avert a suicide. However, there are actions that we as individuals, families, neighbourhoods, communities, agencies, organisations, groups or as a society can take which will help either directly, or indirectly, prevent suicide and reduce the rate of suicides in Scotland.
When a person's problems become so severe that the possibility of suicide is heightened, we must aim to provide accessible, sensitive, appropriate and, where required, intensive support by:
offering earlier interventions and supports to prevent problems that might lead to suicidal behaviour (Early Prevention and Intervention);
working to alleviate the immediate crisis(es) and reduce the severity of any immediate problems (Responding to the Immediate Crisis);
supporting people over a period of time to provide hope and recovery (Longer-Term Work to Provide Hope and Support Recovery); and
supporting people affected by suicidal behaviour or a completed suicide (Coping with Suicidal Behaviour and Completed Suicide).
In addition to the immediate actions and longer-term supports for individuals and their families, work will also be undertaken nationally and locally which:
continues to promote a greater awareness of potential problems and risks amongst all age groups and works harder to eliminate stigma and fear when talking about problems which can actually prevent us from seeking help when we need it most (Promoting Public Awareness and Encouraging People to Seek Help Early);
ensures that, in the event of suicidal behaviour or following a completed suicide, any media coverage of these events is undertaken sensitively and appropriately, with due regard to confidentiality (Supporting the Media); and
improves the availability and quality of information, undertakes more research and makes information on evidence and practice more readily available on suicide and suicidal behaviour (Knowing What Works).
And in the longer term we need to:
ensure that there is national leadership and commitment through the development of a cross Executive approach on polices and strategies, and enable more effective national/local links to provide support and encouragement for local and national implementation efforts;
look more widely and more deeply at our attitudes and the value we place on human life and, in doing so, adopt a combined and collective approach to suicide prevention in common with the majority of suicide prevention programmes around the world; and
recognise the need to take a long-term perspective, as many influences on suicidal behaviour are deep-rooted and are not readily amenable to immediate or short-term change.
Providing Support
Nationally, a new National Implementation Support Team will be established to provide focused and co-ordinated national leadership and provide information, assistance and support to encourage and sustain local work.
Locally, the implementation of this strategy requires a high level of co-ordinated and focused action and support by local agencies. This will be led by the immediate development of local action plans which will include current work, future plans, investments to be made and improvements in services and training.
1.3 A COLLECTIVE APPROACH
This National Strategy and Action Plan is an important part of the Scottish Executive's efforts to improve the mental health and well-being of the Scottish population and, ultimately, reverse the serious rise in suicide rates in recent years. It forms part of the Scottish Executive's drive for social justice and improvements to health, and links to a range of recent Scottish Executive policies. For details of these linked policies - see
Appendix 3.
The over-riding theme of this strategy is collaboration: a collective, concerted effort is required from all groups in society - health, social care and other professionals, communities, voluntary and statutory agencies and organisations, parents, friends and neighbours, combined with an integrated and co-ordinated approach across all Scottish Executive departments.
This Strategy will therefore involve actions from:
Scottish Executive | All Scottish Executive departments, including those responsible for developing and implementing policies, namely, Health, Education, Enterprise & Lifelong Learning, Development including Communities Scotland, Justice, Environment and Rural Affairs. |
National agencies | Scottish Prison Service, national regulation and welfare bodies, (such as Mental Welfare Commission for Scotland, NHS Quality Improvement Scotland, Scottish Commission for the Regulation of Care), PHIS/HEBS, JobCentre Plus. |
Local agencies/ | NHS Boards, NHS Primary Care Trusts, NHS Acute Trusts, |
bodies | LHCCs, GP Practices, Health specialities, such as Accident and Emergency services, police, ambulance and other emergency services, Social Inclusion Partnerships (SIPs), JobCentres, universities and colleges and others. |
Local authorities | Education authorities, schools, social work departments, community care, housing departments, criminal justice social work, children and family services, after care services and others. |
Voluntary | Large national voluntary organisations (such as Samaritans), |
organisations | mental health voluntary organisations, children's voluntary organisations (such as Childline) and smaller local voluntary organisations, community groups, self-help groups and others. |
Other organisations | Academic and research organisations, community groups, faith groups, self-help groups, support groups, survivors groups, parents groups and others. |
Organisations that shape public perceptions and opinions | Faith groups, national media, local media and others. |
Individuals | Professionals and those working in the field, such as GPs, psychiatrists, nurses, social workers, teachers, youth and community workers, voluntary workers, police, ambulance and other emergency service officers, the general public. |
This National Strategy and Action Plan has been developed following extensive discussion, deliberation and research and is informed by the Draft Framework for the Prevention of Suicide and Deliberate Self-Harm which was issued for formal consultation from October 2001 to January 2002.
For more information on how this National Strategy and Action Plan has been developed, see
Appendix 4.
1. This figure excludes deaths from undetermined injury which, by convention, are normally included.
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