Choose Life: Long term leadership in suicide prevention

14 June 2016

For my final blog in this series, I’d like to focus on the time I spent with colleagues from Scotland who are responsible implementation, review and revision of the Choose Life Scotland suicide prevention strategy. Thank you to Niall Kearney, Darren Rocks and Shirley Windsor for being so generous with their time (and our good friend Professor Rory O’Connor for the introductions).

Here are some thoughts from these meetings. I look forward to presenting more on my findings at the National Suicide Prevention Conference coming up in Canberra this month.

A ten-year plan people! A ten-year plan!

Ok so maybe my father had a point when he called me the dramatic child, but in this case I think the exclamation points are justified.
Since I started working in this sector, all I have seen (besides a lot of extremely dedicated and overworked people) is funding stress after funding stress. In my time here I’ve seen a 12-month extension followed by a 9-month extension to our funding and many of our member organisations. Not to mention, services not being refunded just days before contracts expired. This is not the way to retain a workforce and certainly not the way to ensure our most vulnerable people have appropriate and timely care.

And this is nothing new. As Jaelea Skehan, Hunter Institute of Mental Health Director, says in our Federal Election Manifesto “Australia experienced its last peak in suicide rates in 1997, which led to a coordinated national commitment and effort that saw rates reduced by about 30%, with an almost 50% reduction in youth suicide. What followed that period was almost a decade of little change, There is a clear and immediate need to refresh our approach.”
In Scotland in 2002, however, the Scottish Executive launched a ‘Choose Life’ National Strategy and Action Plan aimed at reducing what was at the time one of the highest suicide rates in Western Europe. They allocated 12 million over three years, the first phase of a comprehensive 10-year plan with the ultimate goal of reducing the suicide rate in Scotland by 20% by 2013.

They focused on implementing a coordinated programme of activity involving national and local agencies, local community-based initiatives, voluntary organisations and self-help groups.

“Reducing the rate of suicide is not something we can change overnight and tackling it requires addressing a number of long-standing societal problems. But, as this National Strategy and Action Plan indicates, commitment, collaboration and collective action are vital first steps.”

So what happened?

In 2015, Scotland announced a reduction in suicides, a 17.8% reduction in rates over ten years. Some of the things they attribute this to include:

  • Establishment of a Scottish Suicide Information Database, to record details of the circumstances of people who die by suicide, helping health professionals to better plan how to prevent it
  • Choose Life Co-ordinators recruited to the majority of Scottish local authorities, helping to co-ordinate, plan and direct suicide prevention work tailored to local needs
  • The establishment of a national leadership and co-ordination team
  • At least half of all NHS frontline workers trained in suicide prevention awareness by 2010
  • Awareness-raising campaigns encouraging people to seek help if they are feeling suicidal, and offering support and advice for people worried about someone in that position.

Visit the Choose Life website.

This all sounded great but I wanted to know more. How did they engage the national and local stakeholders in working together on this? How did they maintain interest and momentum over such a long period? Most importantly, how can we learn from some of this and apply it in Australia? Here are some of my top takeaways from my discussions with Niall and the team:

Plans and targets aren’t sexy but they do work

The bipartisan agreement to a long term, SMART plan for suicide prevention is crucial. It is important to get political will translated into sustainable action. Scotland has had that commitment to a ten-year plan of action. They did things like introduce national targets for waiting times, had local Boards sign up for reduction of referral times and communicated who did and didn’t meet these targets. They set up evaluation measures from the start and looked at how to make national targets applicable locally. They also insisted on joint Boards between health and local authorities – “It is only by knowing each other and talking to each other regularly that real change can happen”.

Now in 2016 Scotland has appointed its first Minister of Mental Health, with a mental health and wellbeing focus. This has come with additional funding enabling the team to review what has worked well in the past several years (and keep doing it!) and what didn’t have the impact they would have liked (and stop doing it!)

Time will tell in terms of how successful the review will be but if past performance is any indicator of future performance, the signs are good.
What does this mean for Australia? Our leaders must not only speak up but stand up for suicide prevention. Download our Federal Election Manifesto to see what essential first steps we recommend the incoming government implement.

“Read between the lines”

As a professional communicator I was interested to hear about their national public awareness campaign, ‘Read between the lines’.
The Read Between the Lines campaign calls on everyone to be alert to the warning signs of suicide in their friends, family and workmates. The message is that if you’re worried about someone, asking directly about their feelings can help to save their life. You can view some of their sample resources here.

This campaign really resonated with the general public within local communities. While the team admitted that it is difficult to attribute the reduction in suicides in Scotland to one thing, there is agreement that complementing system change and patient service targets with an awareness and education campaign did add to the overall outcomes. They now to plan to focus on men in their middle years as well as areas in Scotland that are “locations of concern” according to their data collection systems in place.

Their assessment of the awareness campaign was reassuring to me as we have some great initiatives in Australia working to similar briefs. Suicide Prevention Australia members and friends R U OK? beyondblue SANE Australia Lifeline Australia and headspace have engaged us in some fantastic campaigns over the years and I know that our focus is also on how to better engage men as well as deepen those conversations so that we are building communities that are more capable of giving help and getting help. Visit Communities Matter.

Getting to “Distress free interventions”

A really interesting piece of work I’ll be keeping my eye on is Scotland’s work on a pilot for a new model of care for those who are discharged from Accident and Emergency departments in hospital. Similar to Australia, Scotland sees a disturbing number of deaths taking place within three months of someone leaving hospital. This is not good enough.

They are looking at designing a follow up process and training package that may look at a model using ‘Distress Brief Intervention’ Officers to help an attempt survivor and their carers navigate the system and support they need, particularly in those early days’ post discharge. This could include things like connecting the individual with counselling or community social services, developing a resilience plan together and sense checking whether the hospital follow up they received was helpful. This multi-pronged patient service model really excited me so will be keeping in touch with the team on how it progresses, particularly in light of our interest in what a ‘zero suicide’ in healthcare approach might look like for Australia and potential lessons for implementation of peer worker support structures.

Celebrating and sharing what we do well

While I have sung their praises from the rooftops, my Scottish colleagues would be the first to admit that they experienced challenges along the way. They were also quick to reference programs outside Scotland as inspiration, a number of those I am proud to say have come from Australia. In fact, this was a common theme in all of my meetings in the UK. I learnt so much about things we could do better in Australia as a result of the good work being done internationally but I was also reminded of and humbled by the work we are contributing to the international knowledge pool.

Just a few of the programs and initiatives that were name checked during my trip (and that you should check out if you haven’t already) included, but are not limited to:

My final thought and heartfelt thanks

A heartfelt thanks to all I spent time with on this trip and a hearty thanks to Ian Potter Foundation for making this invaluable learning experience possible. As many of you who work in charities know, funding to do all the things you want to do can be challenging, let alone being able to take the time to share knowledge with your colleagues and have the headspace to absorb and apply these lessons. I would encourage anyone given the opportunity to do something like this to grab it with both hands. Time away from your regular work and family life can be hard to fit in but it is well worth it – both from a professional and personal perspective.

As always, if you have any questions or comments for me after reading this blog, please get in touch.

Kim Borrowdale, Head of Communications

Note. This blog has been published as part of Kim’s commitment to sharing lessons from the UK as recipient of an Ian Potter Foundation International Learning and Development Grant. She will be reporting on findings and observations at the 2016 National Suicide Prevention Conference in Canberra in July.

Read 1 June blog post "National strategy and community action: Top down, bottom up and inbetween" 

Read 21 May blog post "No health without mental health: development sector lessons"

Read 19 May blog post "Give them a gift: Thinking differently about data"

Read 17 May blog post "Somewhere between heartbreak and hope"

Read 12 May blog post "Collaborative working: Moving beyond the willing"

Read 10 May blog post "So what? Translating research into practice"