NATIONAL FRAMEWORK FOR THE PREVENTION OF SUICIDE AND DELIBERATE SELF-HARM IN SCOTLAND: ANALYSIS OF WRITTEN SUBMISSIONS TO CONSULTATION
Chapter 1: Introduction
Background
1.1 Over the last thirty years, the rates of suicide and self-harm in Scotland have been increasing, especially among young men. The pain and distress that such actions represent and in turn cause, are a major cause of concern. The challenge is not just one to individuals and families, but to society as a whole, making it imperative that agencies coordinate and work together to prevent suicidal and self-harming behaviour. The Public Health Division of the Scottish Executive has sponsored a process of policy development since 1999 leading towards the development of a National Framework for the Prevention of Suicide and Deliberate Self-Harm. The draft Framework built on the principles and values of the Scottish Executive's commitment to improving well-being through its social justice programme and its efforts to reduce social exclusion and health inequalities. This included social justice milestone 11 regarding young people, and specifically included a commitment to improving health through reductions in suicide rates among young people.
1.2 Using the results from two consultative seminars held during 2000 and 2001, Scottish Executive and its National Planning Group produced a Draft Framework for Consultation with the assistance from the Scottish Development Centre for Mental Health. The proposed Framework was one element among an array of measures indicated in Our National Health a plan for action, a plan for change (Scottish Executive, 2000) to improve mental health and well-being. The National Framework was drafted in response to four key points raised by delegates at the national seminars. In particular, delegates wanted:
1.3 In October 2001 the Consultative Document was circulated widely to interested parties including NHS Boards and Trusts, Local Authority Departments of Social Work, Education and Housing, Police Forces, the Scottish Prison Service, Voluntary Organisations, all who attended the seminars on suicide prevention in November 2000 and May 2001 and many others who specifically requested a copy. The Consultation Document was also available on the Scottish Executive website. Consultees were invited to comment by the end of January 2002. The Central Research Unit (CRU) of the Scottish Executive commissioned Scottish Health Feedback, an independent research company, to analyse the responses received and this report is an analysis of these responses.
1.4 During the period of formal consultation on the draft Framework, the Scottish Executive commissioned the Scottish Development Centre for Mental Health to undertake two interlinked pieces of work designed to feed into continuing policy development and to act as a resource to inform subsequent implementation. The first project explored perspectives on suicide and DSH with three sets of informants: groups affected by suicide and self-harm either directly or indirectly; service providers; and key influencers of opinion such as the media. The second exercise set out to identify examples of good practice in Scotland.
1.5 The Draft Framework for the Prevention of Suicide and Deliberate Self-Harm consultation document was in six parts. Part I provided the background and context of why a national framework was needed, the policy context and explanation of suicide and DSH and what was meant by prevention. Part II outlined the scope of the Framework including guiding principles. Part III offered an action plan with proposed steps for implementation of the strategy. Part IV presented priorities for action and identified success factors and Part V offered a timetable to 2004. Finally, Part VI presented specific consultation questions to ascertain the extent to which the Framework supported local and national agencies in planning and delivering the range of activities required. The analysis is built around the document structure as well as the consultation questions in Part VI.
Research Aims
1.6 The aim of the research was to provide an analysis of the responses received to the Consultation Document. The results of this analysis will inform the further development of the National Framework, so that it may take account of the information, views and insights offered, and so that remaining gaps in the Framework may be addressed. It was also envisaged that it would help to assess what support various agencies were likely to require implementing the measures recommended or implied by the Framework in planning and delivering activities aimed at preventing suicide and DSH.
1.7 The responses were many and diverse. A detailed analysis of respondents by sector/interest group and type of response is provided in Chapter 2. The central purpose of the work was to provide as much assistance as possible to those undertaking the next phase by presenting the content in a clear, unbiased way and to assist by summarising wherever appropriate. Where there were different schools of thought on a topic, this was made clear.
Research Design and Methods
Overall approach
1.8 Each response document was logged and entered onto a database, along with relevant details of the respondent, dates and so on. If not already in electronic form (e.g. email attachment), it was converted to digital text form using Textbridge with relevant information about the respondent attached.
1.9 Each relevant part of every response was coded, using computer software for qualitative analysis (QSR N5), in one or more of the following three ways (a comment or section of text might be multiply coded):
- in relation to the question(s) in Part VI, Section 12 of the Consultation Document to which it refers
- in relation to the Part and/or Section or paragraph to which it referred in the remainder of the Consultation Document
- in relation to a more general theme or themes that emerged as significant from the content of the responses themselves.
1.10 Towards the end of the project, "coding reports" were generated that extracted all the comments on particular Parts/Sections, questions and themes. In particular, all comments relating to each of the questions set out in Section 12 of the Consultation Document, Parts or Sections of the remainder of the Document, and the main themes were extracted so that they could be read together.
1.11 Each of these coding reports consists of the verbatim text of the relevant portions of the responses - that is, those sections of the responses referring to a particular paragraph or theme. Each extract has been identified with the details of the relevant respondents. To each coding report is attached an analysis of the characteristics of the respondents who have made comments about this paragraph, section or theme. These reports together form the "digest" of responses asked for in the Research Specification.
Preparatory work: planning
1.12 At the start of the contract, Scottish Health Feedback met with the commissioners from the CRU and Health Department to fine-tune the methods proposed and to help anticipate any main themes expected to emerge from the analysis. At that meeting, it was also identified that the commissioners wished to examine the extent to which the contextual background in the Framework was provided in sufficient detail, views on the guiding principles and approach and what respondents' views were of the proposed actions and whether these stood up to measurable scrutiny.
Preparatory work on responses
1.13 Responses were received from the Scottish Executive in paper and electronic form, and an initial batch was available immediately at the start of the project on 14 th January 2002. Subsequent batches were received on a weekly basis until 14 th February, two weeks after the official deadline for responses.
1.14 All paper responses were scanned, converted into digital text format, checked and corrected for conversion errors. Each response was logged on to a database with the name, position and profession of the respondent, the organisation to which he/she belongs (if any), the sector (Social Work, Education, Health, Police, voluntary, private, legal etc.), and whether the respondent was commenting on behalf of the organisation or in a personal capacity. The categories were agreed with CRU following this initial meeting. This information has been used to calculate response rates by sector and/or type of respondent.
1.15 The analysis was carried out in two passes. In the first pass, coding concentrated on identifying text relating to specific questions and paragraphs, while at the same time notes were made about emergent themes. A second analysis pass was then carried out, in which all responses were re-visited and coded according to any emergent themes. These are discussed under 'other issues' at question 15 in Chapter 4 and more generally in the summary and discussion in Chapter 5.
Interpretation of this report
1.16 This Report is essentially a presentation of the views of respondents, sorted by topic, analysed and summarised as accurately and faithfully as the authors have been able. It does not purport to make any judgements about where the balance of arguments lies, or make independent recommendations about changes to the Framework.
1.17 In order that those who have responsibility for reviewing the documents might have direct access to the comments of the respondents, in their original verbatim form, these comments have been made available to Scottish Executive staff in the form of the coding reports described above. In these reports, all the comments have been sorted according to the coding scheme as described.
1.18 While this Report therefore provides a full and detailed picture of the responses overall, it only forms part of the output of the process of analysis. The definitive product is the combination of this document and the totality of the coding reports.
Structure of the report
1.19 Chapter 2 provides a profile of the organisations and individuals who responded to this Consultation Document. Chapter 3 identifies and analyses the responses corresponding to Parts I-V of the Framework document. Chapter 4 analyses the responses to the individual questions contained in Part VI, Section 12, and Chapter 5 summarises and discusses the main issues arising from the responses. The Appendices contain details of the consultees and respondents, how they were categorised, the consultation questions and lists the members of the planning group.