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SUICIDE AND SUICIDAL BEHAVIOUR: ESTABLISHING THE TERRITORY FOR A SERIES OF RESEARCH REVIEWS
CHAPTER ONE: INTRODUCTION
CONTEXT
1.1 In common with the rest of the UK, Scotland does not have an exceptionally high suicide rate by international standards (
see glossary for definition of 'suicide' and related terms). Nevertheless, the increase in suicide rates among men in Scotland (more than doubling during the last 30 years) is a cause of major concern. In both sexes there has been a dramatic shift in the age-related pattern of suicide, with younger age groups now showing the highest risk. Among young-middle aged adults suicide now constitutes a far more significant cause of death than was previously the case. Among men suicide rates are in excess of 25 per 100,000 in the 15-44 year age groups. While suicide incidence is considerably lower among women, the massive increase in rates among 15-24 year olds (by over 150%) is also causing concern. Compared to England, male suicide rates in Scotland are now about twice as high among all adults aged 15+ years, with a threefold increased risk in the 15 to 24 age group. Among women, the overall adult rate is 60% higher in Scotland, but 160% higher in the 15 to 24 age group (GRO, 2000).
1.2 In 1999, the Scottish Executive embarked on a process to consult and develop ideas on what actions could be taken to reduce the rate of suicide in Scotland. Two national consultative seminars were held in 2000 and 2001, involving more than 200 people from a wide range of backgrounds. These seminars resulted in strong support for the development of a national strategic approach to suicide prevention that addressed not only suicide and its prevention, but which also took a more universal and combined approach to addressing a range of issues that affect people's mental health and well being. The ideas put forward at the 2 seminars informed the development of a Draft Framework for the Prevention of Suicide and Deliberate Self-harm, which was issued widely for formal consultation between October 2001 and January 2002. The Executive then commissioned further work to explore the experiences of groups and services directly affected by suicide and self-harm.
1.3 The National Programme for Improving Mental Health and Well-being was established in 2001 as part of the Executive's commitment to address the increasing burden of mental ill health in Scotland. The National Programme's work forms a key part of the Scottish Executive's health improvement and social justice policy agendas which aim to reduce mental health inequalities and the related social exclusion experienced by people with mental health problems. One of the Programme's work strands is suicide prevention (Scottish Executive, 2003).
1.4 Choose Life, the National Strategy and Action Plan to Prevent Suicide in Scotland, was published in December 2002 and set a target of reducing the rate of people committing suicide in Scotland by 20% by 2013 (Scottish Executive, 2002). The Executive is allocating 12 million over the period 2003-06 to support and complement the implementation of the Choose Life strategy and action plan at national and local levels. The Head of the Choose Life National Implementation Support Team started work in January 2004 and suicide prevention co-ordinators have been appointed in each of the 32 local authority areas of Scotland. The co-ordinators submitted their local suicide prevention action plans to the Executive in December 2003. These action plans describe how agencies and communities in each local authority area will work in partnership to tackle suicide prevention guided by the seven main objectives in Choose Life. The local action plans outline how local authority areas will use Choose Life monies to encourage coordinated and innovative suicide prevention initiatives by investing in and supporting local voluntary and community based organisations and local training programmes.
One of the 7 main objectives of Choose Life is:
'improving the quality, collection, availability and dissemination of information on issues relating to suicide and suicidal behaviour and on effective intervention to ensure the better design and implementation of responses and services and use of resources.'
1.5 In addition, key players have identified a need across Scotland for information and research evidence to inform and guide action on the ground (7 November 2003 Choose Life national meeting). This is a significant challenge in view of the complexity of the field. However, there is an extensive body of research literature on suicide and deliberate self-harm (DSH) which can be used to inform the development and implementation of policy in Scotland.
1.6 To meet the objective noted above, the Scottish Executive's Mental Health Research Team (on behalf of the Choose Life National Implementation Support Team) has embarked on a three stage process to collate, co-ordinate and build on the available evidence base. A series of reviews will be commissioned to focus on risk and protective factors, as well as co-ordinating information on prevalence and reviewing evidence of the effectiveness of specific preventive interventions. The reviews will be an important step in drawing together key findings from previous research relevant to Choose Life priorities. Once reliable evidence to suggest gaps in information has been established, and precise requirements for work defined, primary research will be commissioned.
1.7 The Scottish Executive's Mental Health Research Team and the Choose Life National Implementation Support Team identified that a scoping exercise was required to map out the territory for the series of reviews on aspects of suicide and deliberate self-harm. This work should draw on the expertise of researchers specialising in suicide-related research (nationally and internationally) and include the perspectives of policy makers, practitioners responsible for the implementation of Choose Life and other relevant stakeholders. The Scottish Development Centre for Mental Health (SDC), in partnership with the Research Unit in Health, Behaviour and Change, University of Edinburgh, was commissioned to undertake the work, following a competitive tendering process.
AIMS AND OBJECTIVES
1.8 The design of the research was based on the Choose Life strategy's adoption of a multi-factorial model to understanding suicide and associated risk and protective factors at the levels of society, community and individual and in terms of the quality of response from services. Although other potential high-risk groups were not excluded from consideration, the research acknowledged the identification of a number of priority groups in the Choose Life strategy, including:
Children (especially looked after children)
Young people (especially young men)
People with mental health problems (particularly service users and people with severe mental illness)
People who attempt suicide
People affected by the aftermath of suicidal behaviour
People who abuse substances
People in prison
People who are recently bereaved
People who have recently lost employment or who have been unemployed for a period of time
People in isolated or rural communities
People who are homeless
1.9 The overall aims of the scoping exercise were to:
Co-ordinate information about the interests and areas of expertise of organisations and individuals specialising in suicide-related research
Establish the territory and focus of the series of reviews. This was to be undertaken with reference to: information on prevalence; risk and protective factors; and the effectiveness of specific preventive interventions.
1.10 The specific objectives were to:
Establish, and build on, links with centres and individuals specialising in suicide-related research (in Scotland, the rest of the UK and internationally)
Explore the specific areas of interest and expertise of individual researchers and research centres
Build up a database of information relating to interests and expertise, to facilitate invitations to tender for the reviews and primary research
Establish the territory and focus of the series of reviews, drawing on the advice of specialists
In consultation with those specialising in suicide-related research and policy implementation, map out ways in which the reviews might be organised in order to minimise overlaps and gaps
Provide the Choose Life National Implementation Support Team with the information database and a paper which summarises the results of the scoping exercise
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