Anyone can have thoughts of suicide. Everyone can learn to help Results of the Impact Evaluation of the Choose Life National Training Programme Erica Stewart-Jones Choose Life NHS Health Scotland

Background  Choose Life strategy launched in 2002  Target to reduce suicide in Scotland by 20% by 2013  Training was a key part of the implementation  Key relevant objectives:  early prevention and intervention  responding to immediate crisis  coping with suicidal behaviour and completed suicide  promoting greater public awareness and encouraging people to seek help early choose life: A National Strategy and Action Plan to Prevent Suicide in Scotland (2002), Scottish Government.

Gatekeeper training  Teachers and school staff  School health personnel  Clergy  Police officers  Correctional personnel  Supervisors in occupational settings  Natural community helpers  Hospice and nursing home volunteers  Primary health care providers  Mental health care and substance abuse treatment providers  Emergency health care personnel

Launch of the Choose Life strategy Launch of the HEAT H5 training target

Impact Evaluation Purpose To improve the understanding of the effectiveness and impact of rolling out a cascaded programme of training, involving a suite of training options, as an intervention to help reduce the incidence of suicide in Scotland through increasing incidences of helping behaviour and to reduce the stigma associated with suicide and suicide-prevention training

Impact Evaluation  How has the Choose Life training programme impacted on practice and behaviour change when dealing with people with thoughts of suicide at the individual, community, organisational or systems level across different localities in Scotland?  More specifically, is the Choose Life Training Programme effective in:  Creating behaviour and/or practice change at the individual, community, organisational or system levels  Impacting on attitudes in the immediate environment of participants and impacting on their organisation’s policies and attitudes towards suicide and people with thoughts of suicide  Contributing to the creation of an environment of reduced stress and increased confidence in self and others when helping people with thoughts of suicide

Method  Review evidence of previous evaluations within Scotland  Survey of local areas focusing on reach of the programmes  Survey with past participants of the courses  Interviews with trainers  Four in-depth case studies including interviews with participants, trainers, local co-ordinators, managers and senior managers.  Follow-up analysis reviewing findings in light of international evidence around suicide prevention and the delivery of large scale training programmes and the learning gathered by the Choose Life national team

Reach

Results: Reach  40,000 people trained in Scotland  All key gatekeepers were reached – unclear as to what saturation  Training delivered to gatekeepers in all sectors  50% frontline primary care, mental health, accident and emergency and substance misuse staff trained  Training delivered in all local authority areas and all NHS board areas

Results: Impact Reported and observed  Increased confidence to talk about suicide at individual and team/organisational levels  changes in behaviour and practice of individuals  changes in organisational policies, systems and processes  changes in attitudes to talking about suicide at individual and team/organisational levels  Increased confidence and reduced stress in dealing with thoughts of suicide and completed suicide

Conclusions The training programme has:  increased the knowledge, skills and improved attitudes of participants  Influenced changes in behaviour and practice  Influenced changes to organisational procedures and culture  Led to a reduction of stigma around discussing and dealing with suicide

Discussion: Reach  Targeting professional service provision roles  GPs and Accident & Emergency  Gender

Discussion: Administration  Supporting trained gatekeepers  Integration  National Programme Administration  National centralised team  Local co-ordination  Trainers

Transferability of skills  The range of courses has developed key skills which are transferable  For example lecturers at the University of the West of Scotland saw their students using the listening and questioning skills learned in ASIST in other parts of their training.

Discussion: Delivery Methods  Range of courses  Cascaded delivery  Undergraduate courses vs CPD  Multi-agency/disciplinary training  Blended learning

Implications: part 1  Gatekeepers in a non-professional role  GPs and A&E: development of additional training options  Gender: Targeting the training more towards men  Gatekeeper support:  refresh skills and information on sources of support.  sources of support for themselves following an intervention  organisational and cultural changes needed to support practice  Transferability of skills from the training  Continuing the local and national support was considered vital to the continuing success of the programme.

Implications: part 2  Trainer skills maintenance  Training should be delivered in multi-agency or multi-disciplinary groups as a preference.  Blended learning  more TuneUp and suicideTALK courses  delivering ASIST, safeTALK and STORM is the most effective approach whenever possible.

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