Appendix 1 - Suicide Prevention Update August 2024
Perth and Kinross Council · 23 October 2024
Back to Learning and Families Committee — 23 October 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
Education & Children’ Improving Lives Together Ambition Compassion Integrity 1. Introduction This report provides an update to the Suicide Prevention and Mental Health Work report of May 2023. The work of suicide prevention and mental health is guided by the Perth & Kinross Health and Wellbeing strategy, the ‘Connected Tayside’ Emotional Wellbeing strategy, and the Scottish Government national strategy for suicide prevention ‘Creating Hope Together’ (September 2022 – 2032). The report presented to Learning and families Committee on 26th May 2023 is here: L&F Committee 3 May 2023 • Suicide Prevention and Mental Health Work(255Kb) • Appendix 1 – ECS Suicide Prevention and Mental Health Work (266Kb) It started with a full background concerning the work of suicide prevention and mental health in schools. It covered universal aspects such as the whole school Nurturing Relationships programme and Bounce Back, the whole school resiliency work and liaison with CAMHS colleagues over the Decider Skills training programme for both parents and staff. It described the work of the ‘Counselling in Schools’ programme and related aspects of the Community Mental Health fund. It went on to review targeted actions in respect of self-harm prevention work, critical incident guidance and staff wellbeing supports, and current action supported by Youth Services. Suicide Prevention Update, August 2024 Appendix 1 Education and Learning
Page 2
The report focussed on specific areas of suicide prevention activity, following a survey with school staff on perceived suicide ideation in April 2022. The following areas were a focus: • Systems work – o Child Protection guidelines - the refreshed national guidance continues to include self-harm and suicide as a child protection concern, and this was to be highlighted in the refreshed local guidelines o Multi-agency processes for medical interventions and safety plans – there was no agreed multi-agency protocol of how and by whom schools will be informed when pupils have required a medical intervention after suicide related behaviour o Whole system approach to identifying and meeting need – it was noted that there was not yet an effective, strategic forum that is working to bring data from across partners together to identify gaps jointly and then collaboratively plan to meet need o The approach and continuum of mental health support in schools - The Mental Health Delivery Group was focussed on refining an analysis of need and possible interventions at this level and a whole community approach to mental health. • Guidance – work focused on giving clarity of understanding around processes and roles and specific supports. This included being clear over who is available to support education staff in their decision making, and at what point. • Training/professional development – the aim for a training framework was defined as to support guidance and pupil support teams to feel confident about what to do when in the area of suicide prevention. 2. Summary This section of the report covers the suicide prevention work over the last year in respect of the above areas, starting with the area of greatest activity, the systems work, then the guidance followed by the professional learning. 2.1 Systems Work for Suicide Prevention 2.1.1 Mental Health Delivery Group (MHDG) The MHDG focussed on supporting the Whole School Community Approach to Mental Health work in all Perth and Kinross schools, with tests of change commencing in Perth High School and Breadalbane Academy. One central and one rural school were approached, following analysis of the suicide ideation survey of April 2022. The MHDG is a sub-group of the Health & Wellbeing Overview Group which reports to the Children, Young People and Families Planning Partnership and is a multi- agency collaboration of staff tasked with providing advice and strategic guidance for schools in Perth & Kinross. Over this last year it has been promoting the development and implementation of a whole school community approach to achieve greater community understanding and
Page 3
confidence to promote and manage mental health needs. Improvement work in this area encompasses a wide range of coordinated activities across multiple systems including health, local authority, voluntary sector and are themed under Getting It Right for Every Child (GIRFEC), child protection, trauma informed practice and suicide prevention. Both Perth High and Breadalbane Academy Senior Leadership Teams (SLT) have supported this work by releasing key staff with dedicated time to collaborate with the Suicide Prevention & Mental Health Coordinator as required to advance this work. Principal Teachers for Guidance staff in Perth High and Breadalbane Academy reported increased confidence in knowing what to do to support CYP in their mental health needs as a direct result of the dedicated time to analyse processes and devise solutions. Staff have, for example, increased their use of the GIRFEC Resilience Matrix more systemically and routinely as part of their practice roles and responsibilities. The Resilience Matrix is one tool of a suite of GIRFEC tools aimed at organising information such as the adversities CYP may have experienced and how these can increase vulnerability and reduce resilience. Being supported through consultation and knowing how better to organise information into action in this context has helped to reduce staff anxiety working with the theme of suicide prevention. Wider benefits to this work are that other schools are receiving feedback from the Mental Health and Suicide Prevention Co-ordinator on how the work in the two schools progresses and are supported thereafter to adopt practices they feel would be beneficial to their community. Next steps: During session 24/25 support will be provided directly through consultation and monitoring meetings with Depute Head Teachers, in conjunction with ongoing developmental sessions with school Guidance/support staff. This involves the development of a short, medium and long-term strategic action plan with the school leadership teams to achieve practice, systemic and cultural change. The work will link with Integrated Team Meetings to involve partner agencies as appropriate. 2.2 Information Sharing for Safety Plans Perth & Kinross Education & Learning developed a proposal to initiate a multi-agency agreement to share information through formal means when children or young people (CYP) required a medical intervention because of self-harming and/or suicide related behaviour. The intention is to improve the wellbeing support and safety planning relating to self-harming and/or suicide related behaviour. Previously schools were hearing of suicide related behaviour incidents from a variety of informal sources including parents and peers of the individual requiring a medical intervention. This meant that the school, hearing information second-hand, was less able to reassure and provide the emotional containment to best give all children and young people involved a sense of safety. The governance for this pilot work has been taken up by Public Health Scotland National Health Service (NHS) Tayside and this has facilitated the development of a protocol between NHS Tayside Child and Adolescent Mental Health Service (CAMHS)
Page 4
and the Named Person in schools across the Tayside local authority area including Perth and Kinross. The draft protocol, currently being piloted, requires that the CAMHS Response Team (CRT) responsible for assessment and discharge of children and young people post medical intervention will inform the Named Person service that an admission to hospital has occurred. This will then prompt the Named Person to contact the CRT for further information and advice around the assessment and discharge outcome. The benefit to schools of the protocol will be in their capacity to contribute and be included at the earliest opportunity in community-based safety planning. Being better informed of suicide related behaviour incidents in this way will support schools to respond at the time it is needed and manage the risks being presented by individual or groups of vulnerable children and young people. Young people and their families will then be offered a more informed, coordinated, and timeous standard of support than without this protocol in place. The protocol is being delivered as an initial pilot to be reviewed and will be evaluated after the first six months. Initial signs are that the pilot is working well. Next steps: The pilot protocol began on April 15th, 2024, with the evaluation data to be reviewed/analysed around October/November 2024. 2.3 Review of Continuum of Need This was focussed on the identification of any gaps in service provision at the enhanced/tier level 3. The model of Staged Intervention within Education is for schools to identify, assess and plan to address additional support needs. The model has 4 levels beginning with Universal, progressing to Additional, Enhanced and then Intensive. These levels can be equated to the National Health Service (NHS) Tier levels of need 1, 2, 3 and 4. The Enhanced level equates with tier level 3 and means that children and young people with this level of need may require an enhanced/tier level 3 intervention from an agency/service with the capacity to deliver such an intervention. It is recognised that agency/services such as Counselling in Schools providers, School Nursing, Services for Young People for example are all Additional or tier level 2 need providers. Enhanced/tier level 3 provider agency/services in Perth and Kinross include CAMHS, The Lighthouse, Rape and Sexual Abuse Centre (RASAC) and the Family Change Service. The Mental Health delivery Group was tasked by the Health & Wellbeing Overview Group to investigate which needs were met at which level and how effectively this system is working, specifically if needs are adequately being addressed at tier level 3. Initial findings suggest there will be numbers of children and young people (yet to be determined) with tier level 3 needs being referred to tier level 2 services. Young people who are in crisis are being referred appropriately to the Lighthouse Service. Unfortunately for some children and young people when the crisis works ends, they
Page 5
are still faced with the underlying adversities driving vulnerability and are returned to the tier level 2 system. Recommendations are likely to include how the outcomes of service involvement are tracked and monitored. Adopting a trauma informed approach to this work could support an improved system of early intervention such as a multi-agency triage system to ensure the right service is offered at the right time. Next Steps: Complete this work and report back the initial findings to Health & Wellbeing Overview Group for strategic discussion about the potential development of this work. 2.4 Counselling in Schools Counselling in Schools has continued to operate through a Tayside wide agreement and framework, with providers in every LMG for access to one-to-one counselling for children aged 10 years and older. From April to December 2023 there were 317 children and young people supported through one-to-one counselling and 268 referrals received with most evaluations from children and young people show improvement in the goals set. The top three issues worked through in counselling are anxiety, self-esteem and family issues. The contract was refreshed in July 2024, and in Perth and Kinross this resulted to no change in the existing providers of Counselling in Schools. From April to June and then October to December a pilot was undertaken in two schools, in group work, to ascertain if this form of intervention would support a wider range of young people to access the service. Groups have focussed on managing emotions and confidence and self-esteem. Of the evaluations returned, most young people have felt better able to manage the reasons they joined the group for, with a lesser rating for ‘better understanding of how to manage my mental health and wellbeing’. All enjoyed the experience. Next steps The group work evaluations are being collated and all pilot work for Counselling in Schools is being reviewed, following the contract refresh across the Counselling in Schools framework that took place in July. 2.5 Crisis Supports During 2023, in response to the pandemic and due to a Counselling in Schools underspend and through due procurement procedures, Lighthouse Perth were awarded one off monies to augment their work and establish relationships as part of the continuum of support in each LMG. During December 2023 a further procurement procedure led to Lighthouse being awarded funding over a two-year period. The funding has enabled contact and presence within each secondary school, the current contract has a focus on supporting early intervention and prevention through pupil Mental Health Ambassadors and supporting education staff in managing difficult conversations. In this way young people’s anxieties can be contained through existing relationships which supports coping skills, and the Lighthouse service is kept for situations of crisis.
Page 6
Next steps The contract will continue to be regularly reviewed with evaluation of the Mental Health Ambassador programme a focus this year. 2.6 Resilience – Bounce Back and problem solving Bounce Back is a whole school resiliency programme, focussed on teaching coping skills and awareness of negative thinking. Materials and resources for schools are now all electronic and there were some months when there was difficulties in supply. A new supplier has been identified and shared with primary schools in order to support continued implementation of Bounce Back. Four Secondary Schools worked on the pilot of Bounce Back in Secondary and a progressive curricular framework is now in place from S1 to senior phase to support Bounce Back in Secondary, with lesson plans and resources available. Information and feedback regarding use of the materials is being gathered, with positive evaluations from curriculum work being received by two Secondary Schools to date who will continue to use this programme. Next steps Ongoing support for secondary schools using Bounce Back and those new to the programme did not progress as hoped last session due to staff absence and will be a focus for the 24/25 session. Universal problem-solving skills. Following discussions with school’s post-pandemic and over the Health and Wellbeing census data it was agreed that the Educational Psychology Service would develop a set of curricular based materials that as concisely and straightforwardly as possible aimed to teach problem solving skills and embed the understanding that solutions can always be found. This is something that has been found to be critical in respect of suicide prevention. Lesson plans and materials were developed for S3 learners, linked to Bounce Back, and shared with all secondary schools. Professional learning materials were developed but have not yet been delivered. Next steps: Information and feedback regarding use of the materials will be gathered and taken forward as part of a Mentally Flourishing Schools agenda for progression over the next two academic sessions. Guidance 2.7 Suicide Prevention Risk Management Guidance Framework for Schools This resource has been developed in consultation with stakeholders and is intended to provide staff in schools with the practice guidance required to know what to do when considering the needs of children and young people expressing suicide ideation and/or related behaviour.
Page 7
Staff following the guidance contained within the framework are being encouraged to develop an increased level of engagement with the theme of suicide prevention and learn how to best manage the risks which children and young people can present with. Having this resource available across all Perth & Kinross schools provides an efficient and accessible resource for staff, supporting them with clear actions to follow in managing risk. The Suicide Prevention & Mental Health Coordinator provided a mix of in-person and remote training to all eleven individual Guidance Teams across the authority. The total number of Guidance staff who received this training was 39. There were two further in-person training outputs provided for all secondary school Guidance staff through Subject Network sessions. To embed practice and increase sustainability, follow- through training consultations are offered should any individual or team require them. Several individuals and teams are making use of this to date. The training sessions overall provided a framework and rationale for staff to assign an evidenced level of risk to each young person presenting with suicide ideation or related behaviour. The training supported staff to utilise the GIRFEC Resilience Matrix and the Staged Model of Intervention as tools to aid more critical analysis and solution focussed outcomes. An important message in the training was to make explicit that managing risk is a shared multi-agency responsibility. This resulted in staff reporting reduced stress in respect of this area and an increase in confidence to manage situations sooner and more effectively. The resource was launched on March 21st, 2024, at the Principal Teachers for Guidance Subject Network Session. Further reference to the resource for all staff is made accessible through an EDMS page on suicide prevention. Next steps: • An evaluation process will be undertaken with staff to find out how much the resource has been utilised and perceptions of it, and its impact on improving mental health and suicide prevention. • The resource will form part of on-going training in relation to suicide prevention. • A more visually accessible and public facing version of the document is being developed. 2.8 Child Protection Guidelines The Child Protection Committee inter-agency guidelines were revised and updated in September 2023 and included a greater prominence in relation to child protection and suicide ideation and self-harming behaviours. Professional Learning 2.9 Trauma Informed Approaches Throughout 2022/2023 school staff were supported to access the ‘Sowing the Seeds’ NHS animated resources for developing trauma informed practice. Work was undertaken in 23/24 to review the impact of this resource and the participation of staff in the programme.
Page 8
From this, staff will be supported in 24/25 to access the Perth & Kinross corporate offer of a more intensive package of e-Learning to support the development of trauma informed practice. This work will be undertaken with the PKC Trauma Informed Practice officer to support with the programme and reflective discussions Next Steps: • Development of the professional eLearning offer for schools for 24/25 in liaison with the PKC officer. • ‘Reflective Practice’ sessions for staff on the general theme of mental health in school are being offered over 24/25 as a model for embedding professional learning through peer supported learning groups. 2.10 Applied Suicide Intervention Skills Training (ASIST) With corporate collaboration, ASIST training has been rolled out on a monthly basis since March 2023 with the intention to continue such provision in 2024. ASIST is an intensive 2-day training programme which aims to support staff across working with children and young people across local authority and voluntary sectors with the necessary knowledge and skills to intervene and prevent suicide. To date 9 school support staff have attended the training with a further 9 to follow in 2024. The eventual aim is to have all support staff trained in ASIST with a current focus on ensuring guidance staff in each secondary as a priority. 2.11 Self-Harm Over 2022-23 the self-harm working group progressed work with two pilot secondary schools through whole-staff surveys (October 2023), followed up by pupil and staff focus groups (November 2023). The themes derived from analysis of the data were fed back to schools through detailed joint discussions with the Depute HTs for Support in each school and self-harm working group colleagues from Lighthouse, CAMHS and School Nursing. Each school agreed to a plan of engagement with professional development opportunities, including generally available offers through CAMHS as well as bespoke offers of whole staff training and parent workshops. Both pilot schools experienced some barriers to engagement in the plan including changes of key staff, both schools had a new DHT Support start in post. An in-person session (delivered by EPS and Lighthouse) was delivered in Breadalbane Academy in August 2023. It was not possible to progress work further with Perth Academy due to staff absence and staff changes. In parallel with the work with the pilot schools, initially two Microsoft Sways were created hosting information on decision-making around referrals and support for young people who are at risk of or displaying self-harm behaviours, linking to advice and professional learning resources. A third Sway has been created including four short video interviews with staff from Lighthouse for Perth, CAMHS and School Nursing. These short videos provide practitioners with insights into the way in which different services can support young people at risk of self-harm. Live webinars were offered through the Learning Hub calendar over the course of session 23-24. Links to
Page 9
the three Sways and information about the next webinar have been sent out to all schools. Next steps Planning between Educational Psychology and Lighthouse is currently underway for delivering further in-person sessions focusing upon supporting young people who self- harm. 3. Conclusion Suicide Prevention work in Perth and Kinross has developed over the last year from understanding the data and listening to issues raised by staff to embedding areas of practice to best manage risk, along with preventative systems work. The work has centred on the production and training in, through staff teams, of a risk management framework with linked resources. At the same time collaboration has continued with NHS Tayside as the key partner to agree information sharing practices to better support situations that have required medical intervention. While working on a longer-term basis with Lighthouse to ensure crisis interventions are an on-going part of the continuum of support in schools, work has also continued and will be a focus going forward on system wide programmes and practices to build coping skills and supportive relationships with our children and young people. This area remains an important, significant and on-going aspect of work that will continue to be an area of focus for some time.