Prevention and postvention guidance relating to self-harm and suicide for UK educational and youth organisations: a systematic review of grey literature

Introduction:
Self-harm and suicide among young people are major public health concerns and delivering prevention and postvention support is crucial. Educational and youth organisations play a vital role in both prevention and postvention. However, evidence shows a lack of understanding of effective interventions, and limited awareness of the available guidance in this area. We reviewed current self-harm and suicide guidance available to education and youth organisations in the UK that support young people and identified gaps in this provision.

Methods:
A systematic grey literature review was conducted between July and August 2023 using the following methods: internet searches (Google and OpenGrey), advice from experts and reference list checks. To be included, guidance had to focus on supporting children and young people aged 11–18 years and be intended for use in education or youth organisation settings in the UK. Guidance also had to include information on self-harm and/or suicide prevention or postvention and be freely and publicly available. A narrative review and content analysis of all included guidance was conducted. Gaps in existing guidance were identified from the content analysis, through consultation with young people and adult advisory group members and comparison with relevant literature. A formal quality appraisal was not undertaken due to a lack of validated frameworks to assess grey literature.

Results:
Two hundred ninety-seven guidance resources were screened; 104 met the inclusion criteria. Regarding prevention guidance, 36 focused on self-harm, 4 on suicide and 21 covered both. By comparison, 29 covered postvention and 14 covered both prevention and postvention (8 were suicide only and six were self-harm and suicide). Notably, there was a marked imbalance in target settings, with over half of the guidance (54/104) focused on educational settings compared with only 5 resources specifically tailored to youth organisations, highlighting a substantial gap in guidance for non-education settings. Three key categories of content were identified: psychoeducation/information, recommended response and resources. Within these, 20 subcategories were identified: definitions and signposting were the most frequently included. The stakeholder-informed gap analysis revealed a lack of support for parents/carers, practical resources for professionals to use and tailored information for specific populations (e.g. neurodiverse, LGBTQIA+). Although 104 relevant guidance resources were available, it was difficult to assess the quality of the guidance as there was a lack of information on how individual guidance resources were developed and whether the content was evidence-based.

Conclusion:
Key recommendations for future guidance include more guidance for youth organisations, more on response and support after a suicide, more tailored guidance for vulnerable groups and more guidance for how organisations can support parents and carers. Additionally, guidance should be co-produced to ensure that key topics identified as important to stakeholders are not missed.