protect life 2 service stakeholder engagement report · stakeholder engagement events in the health...
TRANSCRIPT
Protect Life 2 Service Stakeholder Engagement Report
July 2018
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1.0 Introduction 3
2.0 Methodology 4
3.0 Common Themes Across all Stakeholder Engagement Events in the Health and Social Care Trusts
3.1 Prevention 53.1.1 BuildingResilience 53.1.2 BetterAwarenessof ServicesandImprovedReferral Pathways 53.1.3 SpecificTailoredServicesto MeetNeed 53.1.4 Multi-AgencyApproach 53.1.5 CommunityStrength 63.1.6 ImprovedSupportforCarers 63.1.7 MedicalStaff 63.1.8 SummaryofKey Recommendationsfor Prevention 6
3.2 Postvention 63.2.1 Longer-TermSolutions 63.2.2 ImprovedSD1Process 73.2.3 BetterAwarenessofand AccesstoServices 7
3.2.4 MedicalStaff 73.2.5 DevelopBetterSupportforand WithinCommunities 73.2.6 ImprovedMediaControls 73.2.7 SummaryofKey Recommendationsfor Prevention 7
3.3 TrainingFramework 83.3.1 TheFrameworkApproach andContent 83.3.2 Monitoring 83.3.3 Participation 83.3.4 Delivery 8
4.0 Feedback Regarding Prevention and Postvention via Trust Area 9
4.1 SouthernHealthand SocialCareTrustarea 94.1.1 Prevention 94.1.2 Postvention 10
4.2 WesternHealthandSocial CareTrustarea 104.2.1 Prevention 104.2.2 Postvention 11
4.3 NorthernHealthandSocial CareTrustarea 124.3.1 Prevention 124.3.2 Postvention 12
4.4 BelfastHealthandSocial CareTrustarea 134.4.1 Prevention 134.4.2 Postvention 14
4.5 SouthEasternHealth andSocialCareTrustarea 144.5.1 Prevention 144.5.2 Postvention 15
Appendix 1 ProtectLife2Objectives 17Appendix 2NotesfromPublicMeetingsandOnlineSurveyResponses 18
Appendix 3 StakeholderAttendanceList(byOrganisation) 67
Appendix 4ScheduleofStakeholderEngagementEvents 69
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TheProtectLifeStrategywasfirstpublishedinOctober2006andarefreshedStrategypublishedinJune2012.AformalconsultationtookplacefromSeptembertoNovember2016withareportpublishedinFebruary2017toinformthecontentofthenextversion“ProtectLife2–AStrategyforPreventSuicideandSelfHarminNorthernIreland2017–2022”(ProtectLife2).ThePublicHealthAgency(PHA)commissionedInsight Solutionstodeliverstakeholderengagementevents,nottoreplicatethe2016consultation,buttoseekviewstoinformthefutureprocurementofservicestoimplementthependingProtectLife2.TheseengagementeventswereheldineachoftheTrustareasacrossNorthernIreland(NI)(SeeAppendix4).
Theengagementprocesswastohelpprovideabasisforensuringthatafullrangeofviewsaretakenintoaccountindeterminingwhatandhowservicesshouldbecommissionedandinordertoensurethatitmeetsstrategicprioritiesalongsidelocalneeds.Theeventsaimedtoacknowledgetheextentoftheworkthatishappeningwithincommunitiesinaddressingsuicideandself-harm,andtohelpidentifygapsandhowservicescanbeshapedtoaddresssuchgaps.Usingintelligencefromserviceproviders,serviceusers,commissionersandother
interestedstakeholderswillassistthePHAdesignservicespecificationsforfutureservicestobeprocuredunderProtectLife2andcouldpreventdelaysinprocurementaftertheStrategyispublished.
TheaimsofProtectLife2are:
1.ReducethesuiciderateinNorthernIrelandby10%by2022;
2.Targetappropriatefinancialinvestmenttodeprivedareaswheresuicideandself-harmratesarehighest.
TheStrategycontains14objectives(Appendix1),sevenofwhicharesubjecttotheProtectLifeprocurementprocessandcanbecategorizedunderoneofthethreepillarsof:prevent;intervene;andsupport.Theremaining7requireacrossdepartmental/sectoralpartnershipapproach.ThesuiciderateinNorthernIrelandhasremainedstableoverthelastdecadeataround15.8deathsper100,000population.BothPHAandtheStrategyacknowledgethattomeettheambitiousaimsofProtectLife2,workingtogetheracrossgovernmentdepartmentsandinpartnershipwithotherstakeholdersfromallsectorsofsocietyisessential.
Currently£8.7millioniscommittedtodeliverProtectLife2,£3.5millionofthisisring-fencedforthedeliveryoftheLIFELINEServiceandafurther£1millionwillbeinvestedinconcentratedservicessuchastheSelf-HarmRegistry,mediamonitoring,prisons,etc.Thismeansthatfundingofjustover£4millionwillbegoingouttotenderorwillbeawardedasgrantfundingeachyearoverafive-yearperiod.
1Introduction
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TwelvepublicmeetingswereheldacrossNorthernIreland(seeAppendix4)-twoineachTrustwithathirdinBelfastarea,duetopopulationdensityandnumberofinterestedstakeholders,andthreeinthewesternareaduetothegeographicalspreadofresidentsandservices.
TheeventswerepubliclyadvertisedandtheinformationabouttheeventswasdistributedbythePHAtoallrelevantstakeholdersincludingcurrentserviceproviders,commissioners,clinicians,serviceusers,carersandfamilymembers.ThosewishingtoattendwereaskedtoregisterwiththePHA.
Atotalnumberof367stakeholdersattendedthepublicmeetings.Thisincludedrepresentationfromover125differentorganisationsincludingbutnotlimitedtoserviceproviders;serviceusers;familymembers;thoseworkinginmentalhealthemotionalwellbeing/suicideprevention,drugsandalcohol,victim’sservices,andwiderhealthimprovementandcommunitydevelopmentservices.
Inaddition,from13thMarchto20thApril2018anonlinesurveywaspromotedviathePHAwebsiteandsocialmediatoallowthosewhowereunabletoattendtheeventsandanyotherinterestedpartiestheopportunitytosharetheirviews.
Therewereatotalnumberof36responsestotheonlinesurvey.
FollowingapresentationontheProtectLife2StrategybythePHA,participantswereaskedtoworkinfacilitatedgroupstodiscusssuicideprevention.Anumberofclearlydefinedquestionswereaskedoftheattendees:
• Whatisworkingwellinyourareaintermsofservicedeliverytopreventsuicide?
• Whatarethegaps?• Whatmoreneedstobedonetomeettheobjectives
ofProtectLife2?
Followingfeedback,attendeesweregiventheopportunitytohearabouttheproposedtrainingframeworkandwereinvitedtoshareviews.
Thefocusofeacheventwasthendirectedtosuicidepostvention.Again,clearlydefinedkeyquestionswereasked.Participants,workingingroups,wereaskedtoexploreeachinturnandprovidefeedback:
• Whatisworkingwellinyourareaintermsofservicedeliveryinpostvention?
• Whatarethegaps?• Whatmoreneedstobedonetomeettheobjectives
ofProtectLife2?
InlinewiththeexpectedoutcomesintheTenderSpecificationthefollowingsectionsprovideanoverallsummaryofthestakeholderengagementworkshops
includingsummaryofeachsessionandoverallsummaryforallfiveHSCTareasincludinghighlightsofthemainpoints/issuesraisedateachandwhethertherewereanysimilaritiesordifferencesacrosslocalitiesortheregionasawhole.Allcommentsreceivedhavebeentreatedequally.Thisreportdoesnotrankorprioritisecomments.
Appendix2providesthefullnotesfromeachofthepublicevents(includinganonymouscommentsreceivedondayofeventsthroughcommentbox)andtheonlinesurveyaswasexplicitlyrequiredintheTenderSpecification.
Appendix4containsabreakdownofattendeestotheworkshopusingtheparametersagreedwiththePHApostcontractaward.
2Methodology
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3Common Themes Across all Stakeholder Engagement Events in the 5 Health and Social Care Trust Areas
TheSectionbelowoutlinesthecommonthemesacrossall5Trustareas.TheyhavebeengroupedintoPrevention,PostventionandtheTrainingFramework.IndividualresponsesfromeachTrustareacanbefoundintheAppendix2.
3.1 Prevention
3.1.1BuildingResilience
StakeholdersacrossallTrustareasreportedthatresiliencebuildingfromanearlyageisrequired.Currentlyitisbelievedthatthereisalackofeducationaroundresilience,mentalhealth,self-harmandsuicideanditwassuggestedthatMentalandEmotionalHealthcouldbeintroducedaspartoftheNIcurriculum.This,however,wouldrequireimplementationofsupportforteachers,youthleadersand,notleast,parentstoequipthemwiththenecessarytoolstohelpyoungpeoplebuildresilience.Therewasacommonviewthatbuildingresilienceandsupportingpreventionshouldbepartofcommunitydevelopment.Itwasalsothoughtthatnormalisingmentalhealthsupportservicesandreducingstigmawouldencouragemorepeopletoseekhelpandaccessservices.ThePHAhasrunanumberofsuccessfulpublicawarenessmediacampaigns,anditwassuggestedthattheuseofsuchcampaignsonanongoingbasiswasonewayinwhichstigmacouldbereduced,whilsttheawarenessand
identificationofsignsandsymptomscouldbeimprovedacrossthepopulation.
3.1.2BetterAwarenessofServicesandImprovedReferralPathways
Therewassomegeneralconfusionwithincommunitiesrepresentedattheeventsaboutwheretogotogetinformationaboutservicesandhowtoaccessthem.Thisincludesappropriatereferralpathways,forexample,GPreferralorself-referral.Thereisalsoalackofknowledgeamongserviceusersandthosereferringintoservices,e.g.GPs,aboutthemostappropriateservicetomeetindividualneeds.Stakeholdersbelievedservicescouldbebetterpromotedinpublicareassuchasyouthclubs,GPsurgeriesandcommunitycentres.Itwascommonlyreportedbystakeholdersthatthereisconfusionregardingtheroutesofaccesstoservicesandthereisaneedforstrongerreferralpathwaysinstatutoryandcommunityorganisations.AcommonrecommendationwasthatamenuofservicesforeachTrustareabedevelopedandthatawarenessofappropriatenextstepsforserviceusersbeincreased,includingbettersign-posting.ThisalreadyexistsintheformofMentalHealthZCardswithallmentalhealthandsuicidepreventionservicesineachTrustarea,whichsuggeststhatawarenessofthisresourceislowandmoreneedstobedonetopromoteandencourageitsuse.
3.1.3SpecificTailoredServicestoMeetNeed
Alackofcounsellingservicestomeettheneedsofcertainsocio-economicgroupswithinthecommunitywasidentified.ItwasbelievedthatmainstreamcounsellingandsupportservicesshouldbeestablishedtomeettheneedsoftheBlackandMinorityEthnic(BME),includingmulti-lingualortranslationservices;theLesbian,Gay,BisexualandTransgender(LGBT);andruralcommunities.ItwassuggestedthatsustainableinvestmentoffundingshouldbeidentifiedtoensurethishappensinaconsistentmanneracrossallTrustareas.Theneedforperson-centeredserviceswhichareresponsivetospecificneedsofindividualsorgroupsandthosewhichprovideawrap-aroundservicewereadvocated.Stakeholderswerealsoconcernedaboutdifficultiesthosewithdisabilitiesorlivinginruralcommunitieshaveinaccessingservices.Itwassuggestedthatcounsellingshouldbeofferedandprovidedinarangeofformatssuchasonlineorathometoaddresssuchissues.Othergroupswhichwereidentifiedatriskof‘slippingthroughthenet’weremenaged35-55yearsold;thoseaffectedbytheTroubles;thosewithASDandBorderlinePersonalityDisorder.
3.1.4Multi-AgencyApproach
AcommonthemeattheeventsacrossNIwasstakeholders’requestforservicestobemore‘joined-up’withgreaterconnectivity.Itwasbelievedthatcommunity
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andvoluntarysectororganisationscouldworkincloserpartnershipwithstatutorypartnersandinworkingtogethertheywouldstrengthenstructures,buildcapacity,betterco-ordinateservicesandreduceduplicationtherebyincreasingefficiency.Itwasalsoacknowledgedthatwithinstatutoryorganisationstherecouldbebettercollaborationandcross-departmentalworking,suchasinHealthandEducation.Indevelopingconnectedservicesstakeholdersemphasisedtheneedtoensurenoindividualsslippedthroughanypotentialgaps.Frustrationwasalsoexpressedatthelackofinformationsharingbetweenorganisationsandsectorsandimprovementisessentialasthiswouldalsoleadtomoreeffectivereferralpathways.Inaddition,servicewaitinglistscanbelongduetohighdemand.Itwassuggestedthatagenciesmustrecognisethataquick,ifnotimmediate,responseisessentialinmanycasesandthereforeahighprioritymustbegiventoimplementmeasurestoreducewaitingtimes.
3.1.5CommunityStrength
Acommunitydevelopmentapproachwasconsideredtobeofhighimportance.Stakeholdersbelievedthatcommunitiescouldappointa“firstresponder”,butinordertodosothereisaneedforincreasedresilienceforcommunitiesasawhole.Thereweremanysuggestionstohelpachievethis,withafocusontheprovisionoftrainingtoequipthecommunitytohelpthoseincrisisandincreaseawarenessofsignsandsymptoms,butalsotoreducestigma.
Certaingroupsinparticularwereidentifiedthatwouldbenefitfromthistypeoftraining,i.e.communityworkerswhocouldchampionpositivementalhealth.Theroll-outoftrainingtocommunitygroups,businessesandschoolswasalsobelievedtoberequired.Alackof24-hoursupportprovision(asidefromLifeline24/7service)
wascriticised.Thedevelopmentofdrop-inservices,community‘safespaces’orHUBsforpeopleincrisiswouldbewelcomeinsomeareas.Stakeholdersalsowantedtoencourageself-helpandincreasehelp-seekingbehaviorviacommunitycapacityandresilienceinitiatives.
3.1.6ImprovedSupportforCarers
Basedonfeedbackreceivedthroughtheconsultationprocess,carersfeelunsupportedandoverwhelmedwhenitcomestosupportingalovedonewithsuicidalideation.Specifictailoredtraining,counsellingandsupportservicesweredeemednecessaryforcarerstoprotectandpromotetheirowngoodmentalhealth.
3.1.7MedicalStaff
SomestakeholderswereconcernedabouteitherthelackofknowledgeorlackofempathydisplayedbyGPswhoareoftenthefirstpointofcontactofsomeonewithsuicideideation.ItwasfeltthatGPsandotherfirstresponsehealthcarestaffneedtobebettertrainedinidentifyingandacknowledgingthesymptomsofpoormentalhealth,inparticularsuicideideationandtobemorefamiliarwiththerangeofserviceoptionsavailable.Itwasarticulatedbysomeparticipantsthattherewasadisproportionaterelianceonthemedicalmodelandthatinordertosupportindividualswithmentalhealthdifficulties/incrisis,thereshouldbemoreresourcestargetedattrainingonmentalhealthandsuicidepreventionanditwasfeltthatincreasedinvestmentisrequiredbymedicalstaffonthedeliveryofamoretherapeuticmodel.SomestakeholderssuggestedthattrainingonthesubjectshouldbemandatoryforbothGPandA&Estaff,andotherssuggestedthatthereshouldbeimprovedsupportformedicalstaffwhoareprovidingfrontlineservicesanddealingwithpatientswithsuicideideation.
3.1.8SummaryofKeyRecommendationsforPrevention
• Astrategytohelpreducestigmawhichiswellresourcedandhascommunityandstakeholdersupportandengagement
• Astrategytoincreaseawarenessofsignsandsymptoms
• Mappedreferralpathwaysinanaccessibleformat/s• Provisionoftrainingtailoredfordifferentsections
ofthepopulationdependingontheneedsofthecommunity
• Increasemulti-agencypartnershipandcollaborations• Provisionofmoredrop-inservicestosupport
individualsincrisis• Improvedandtailoredcounsellingprovision• Supportservicesforcarers• Increasedcommunitycapacityandresiliencetobe
consideredaspartoftheProtectLife2Strategy• Earlyinvention,suchasanincreasedfocusonbuilding
resilience,withchildrenandyoungpeople
3.2 Postvention
3.2.1Longer-TermSolutions
Stakeholdersreportedthatlonger-termsupportworkhasmoreimpactandthereshouldbelessfocuson‘short-termfixes’formentalhealth.Therapeuticsupportvariesandcanbeforsixtoeightsessions,however,stakeholdersbelievedthiswastooshortforalastingimpactandcounsellingandothersupportservicesshouldbeofferedforalongerduration.Itwassuggestedthatmoresupportisrequiredforbereavedfamiliesfurtherdowntheline,andthereisaneedtofollowupwithfamiliesinthemonthsandyearsafterwards.OnewayitwasthoughtthiscouldbedonewastolinkthefamilywithaSuicideLiaison
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Officerasapointofcontact,supportandreferral.
3.2.2ImprovedSD1Process
TheSD1formandprocesswasamajortopicofdiscussionatalloftheevents.Concernwasexpressedaboutthetimingoftheofferofsupporttothefamily,thefactthesupportisonlyofferedtoonememberofthefamily,thefactitisaonesizefitsallapproach,andthatitdoesnotextendtothefamiliesofthosewhodieinhospitaloroutsideofNI.Somedeclinedtheprocessascoldandinsensitivewithapoorexplanationoftheprocessatwhatisaverytraumatictimeforfamiliesbereavedbysuicide.
3.2.3BetterAwarenessofandAccesstoServices
Manypeoplebereavedbysuicidearenotaccessingservicesastheyarenotawareofsupportavailableorhowtoaccessit.Stakeholdersrecommendedraisingawarenessofthesesupportservicesbycreatingamenuofoptionsavailableandsecuringacentralpointofinformation.ThismenuofoptionsdoesexistintheformofZcards,butawarenessofthisresourceseemslimitedandneedsfurtherpromotion.Theyalsobelievedserviceprovidershadaresponsibilitytopromotesupportgroupsandotherappropriateservices.Thereisalotofconfusionaboutaccesstoservicesandstakeholderscomplainedthatreferralpathwaysareunclearandthisneedstobeaddressed.Timely,appropriatesupportwithfollow-upand‘wraparound’serviceswasstressedasessentialforbereavedfamilies.Inaddition,stakeholdersremarkedona‘postcodelottery’intermsofsupportoffered.ItwasalsoidentifiedthatthereisanapparentinconsistencyinqualityanduniformityofservicesfromTrusttoTrustandthereneedstobeaconsistentapproachtoservicedeliveryregardlessofwheretheindividualaccessingthemlives.Bestpracticeshouldbesharedtohelpensurethisconsistency.
3.2.4MedicalStaff
Similartothefindingsregardingprevention,stakeholdersencouragedgreatersensitivitybymedicalstafftothosewhopresentafterself-harmingorfollowingasuicideattempt.ThereisaneedforA&Ecareplanstobecarriedoutandthe‘CardBeforeYouLeave’initiativetobeusedconsistentlyacrossalltrusts.StakeholderscommentedthatcurrentlythereisalackofconsistencyofapproachfrommedicalstaffacrossthedifferentTrusts.Again,stakeholdersbelievedtrainingshouldbemandatoryforfrontlinestaffandawarenessneedstoincreasesothatstaffcanbettersignposttoappropriatesourcesofsupport.Trainingnotonlytomedicalstaff,butalsothoseworkingincommunityandvoluntarysectors,shouldbeconsistent.
3.2.5DevelopBetterSupportforandWithinCommunities
Communityattitudestowardssuicideweredescribedasoftennegativeandoutdated.Itwasfeltthatcommunitiesneededtoreceivetrainingonhowtosupportoneanotherfollowingasuicideinthecommunity.Theimportanceofavoidingsuicideclustersincommunitieswasemphasized.SomeindividualssuggestedanappropriateCommunityResponsePlanafteralldeaths,givingthecommunitythesupportitneeds.Communityengagementwiththeestablishmentandprovisionofcommunityclassesand/orsupportgroupswasbelievedtobebeneficial,ensuringpeoplewereencouragedtotalkopenlyaboutwhathadhappened.Thiswasfelttobeimportantspecificallyforyoungpeople.Itwasfeltthatminoritygroupsmustnotbeexcluded.Theimportanceofpracticalhelp,suchasneighbourshelpingwiththeschoolrunordroppingoffgroceriestoaffectedfamiliesshouldnotbeundervaluedbutencouragedandmodelled.
3.2.6 ImprovedMediaControls
WhilstitwasrecognisedthatthecurrentmediamonitoringandinterventionsconductedbyPHAhasbeeneffective,thereremainsaneedtopromotebestpracticewhenreportingonsuicideandself-harm.However,anissuethatcausedmoreconcernwastheimpactofsocialmedia,especiallyonyoungpeopleandtheneedtocontrolsocialmediacontentandreach.Stakeholdersagreedthatstrictermonitoringandcontrolsneedtobeputinplaceforsocialmediaandreactionsonsocialmediafollowingasuicide.
3.2.7 SummaryofKeyRecommendationsforPostvention
• Considerationtobegiventothenumberofsessionsofferedinpostventiontherapeuticsupportservices
• SD1processtohaveanall-encompassingrevision• Improveawarenessofservicesthroughimproved
communicationstrategy• Ensureclarityregardingreferralpathwaysand
communicatethesetokeystakeholdersandthewidercommunity
• Consistenttrainingprovidedtomedicalstaff• Consistenthigh-qualityserviceprovisionacrossthe5
Trusts,basedonsharedandbestpractice• Mediamonitoringandcontrolswithanewfocustobe
placedonsocialmediawherepossible
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3.3 Training Framework
3.3.1 TheFrameworkApproachandContent
DuringthepresentationanddiscussionontheTrainingFrameworktherewasagreatdealofsupportforthemenuofapproachestothetraining.Stakeholdersremarkedthatitwasimportantandbeneficialtohavearangeofdifferentmethodsoftrainingtoassistdifferentlearningstyles.Theflexibleapproachtotrainingwaswelcomedwithacknowledgmentofthedifferenttrainingneedsandtimescales.Stakeholdersreportedthate-learningisimportant,buttheystressedthatitshouldnotbeover-reliedupongiveninternetaccessissuesespeciallyinruralareasinNIandthefactthatnoteveryonehastheskill-settousetheinternet.Thatsaid,tomakethetrainingattractivetoyoungpeopleaspecifictrainingappcouldbedeveloped.Itwasrecognisedthate-learningcouldbeparticularlyeffectiveforthelowerlevelsoftraining.Resilienceisakeythemeandstakeholderswerekeentoseeitembeddedintoeachstepofthetrainingframework.Crisistrainingwasdeemedimportanttogiveindividualstheskillsandconfidencetosupportsomeonewhopresentsassuicidalwithouthavingtocompleteotherlevelsofthetraining.
3.3.2 Monitoring
Stakeholdersfeltthatmonitoringandevaluationofthetrainingframeworkwasessentialtoensureitseffectivenessandmeasureitsimpact.Theywereinterestedtoknowwhatplannedarrangementswereinplaceandhowthiswouldbereported.Commentswerealsomadesuggestingthatthereshouldbeafollowupmechanismputinplacetomonitorifthetraininghasbeenutilisedbyparticipants,whatbarrierstherewereandifsupportisrequiredinputtingthetrainingintopractice.
3.3.3 Participation
Moreinformationwassoughtonhowaccessiblethetrainingwillbeandhowitispromotedandoffered.Stakeholderssoughtassurancesthattheappropriatetargetingofparticipantswasdemonstratedsothatpeopleinruralareasorthosewhoaredescribedashardertoreach,suchasminoritycommunitiesorthosewhosefirstlanguageisnotEnglish,areofferedandcanparticipateinthetraininginanaccessiblemanner.Easeofaccesswasalsodiscussedwithsuggestionsoflocalisedtrainingoptionsensuringavailabilityduringtheeveningsandweekends.Thoseworkingintheserviceindustries,forexamplehairdressersandtaxidrivers,weredescribedaskeyrecipientsfortrainingastheymaycomeintocontactwithindividualswhomaybevulnerableandwouldbeinapositiontocarryoutanintervention.Itwasacknowledgedthattimeandconsiderationshouldbegivenonhowtobestaccommodateparticipationfromthesemembersofthecommunity.Stakeholderssupportedtheplangiventhatnotallthefocuswasonmedicaltraining.ButwhenitcomestotrainingformedicalstafftheybelievedincentivesmayberequiredforGPstoparticipateinthetrainingandforthemtoreferindividualsontootherappropriatecommunity-basedservices.Theywouldalsolikeacleardefinitionof‘frontlinestaff’andoncedefinedtheybelievedtraining,includingsofterskills,forexampleempathy,shouldbemandatoryforthiscohort.Employersarealsoconsideredakeygroupsotheymayensuretheworkplaceisasafeenvironmentforthoseexperiencingmentalhealthissues.
3.3.4 Delivery
Itwasbelievedbysomestakeholdersthatco-productionofthetrainingandco-deliveryofitwouldensureawell-roundedapproach.Thisco-facilitationcouldbewithmembersofthecommunitywhohavelivedexperienceinapeersupportstyle.Stakeholderscommentedthatfirst-handexperienceallowsforimpactandeffectiveness.Somestakeholdersthoughtthatlongertimeperiodsfordeliverymayberequiredtoallowfortruelearning.
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4ThesectionbelowoutlinesthediscussionswithineachoftheTrustareas.TheyhavebeengroupedintoPreventionandPostvention,acknowledgingwhatworks,thegapsincurrentserviceprovisionandsuggestionsforfuturecommissioning.IndividualresponsesfromeachTrust
areacanbefoundintheAppendices.
4.1 Southern Health and Social Care Trust area
NewryandDungannon-13March2018
4.1.1Prevention
Itwasbelievedthatearlyinterventionandsupportservicestobuildresilienceworkwell,forexamplebefriending,mentoringandpromotionofpositivementalhealth.Theimportanceofgoodcommunicationbetweenservicesandmultiagencyworkwasemphasised.Thiscutsacrossstatutory,communityandvoluntarysectors,withcommunitydevelopmentapproacheslinkingintokeyservicesbeingimportant.Anumberofservicesintheareawereconsideredtoprovidegoodpracticeanditwasacknowledgedthattherehasbeenmoretrainingandpeoplearebetterequippedwiththetoolstheyneedtohelpothersandthemselves,butthereismoretodo.Theintroductionofself-referraltoprogrammeshasbeen
massivelypositivesuchasRecoveryCollegesandthemoveto‘self-referral’ontoprogrammeshasbeenanimportantchange.
4.1.1.1 Gaps
Participantsdonotfeelthatholisticservicesarebeingofferedandthereisnotgoodenoughlinksbetweenexistingservices.Servicesaredifficulttoaccessoutofhoursandthereisalackofawarenessofallservicesavailable.GPsareoftenfirstpointofcontactbutlackskillsandknowledgeforappropriateandeffectiveonwardreferral.Referralpathwaysneedtobeextended.Considerationneedstobegiventotheroleofalliedprofessionals,suchasschoolnursestoensurehelpisaccessedbeforeself-harmbegins.Currentlyitisdeemedthatthereisalackofthetherapeuticrelationshipintheclinicalsettingandknowledgeofhowtodevelopa“safespace”.
Servicesneedtobebetteratkeepingwithpeopleontheirjourney,sothatserviceusersarenotforgottenaftercrisissituationbutgivenfollowupsupport.Itwasalsosuggestedthosefromdeprivedcommunitiesmayhavegreaterdifficultyaccessingservices.
Itwasfeltthatmuchpreventionworkwasbeingdonebyservicesoutsideofthestrategyandthereneedstobea
mechanismforcapturingandreportingonthiswork,toinformbetterservicedelivery.
Arecurringthemewastheneedtodestigmatiseservices,tonormalisethelookingafterofmentalhealth.Suggestionswereofferedsuchas“MentalHealthMOT”andPHAsupportedcampaigns.Thisinformationneedstobegiventohelppeopleaccessservicesandreachoutforhelpbeforecrisispoint.Itwasalsobelievedmoreinformationregardingself-carecouldbeprovidedasnoteveryonerequiresserviceintervention.Manyhighlightedtheriskfactorofthoserecentlybereavedasaresultofsuicideanddidn’tfeelenoughisinplaceorbeingofferedtothemtosupportorlookaftertheirmentalhealth.
Moreisrequiredwithyoungpeopleandparents.Theearlyinterventionprogrammeinsomeprimaryschools–6-weekprogrammeatP7onstigmasurroundingsuicide,mentalandemotionalwellbeingandself-harmwaswelcomedandbelievedeffectiveandsimilarinitiativeswerecalledforacrosstheboardinbothschoolsandyouthclubs.Inaddition,itwasbelievedthereneedstobemoreinnovativewaystoengageparents.Itwasbelievedthatschoolsneededmoresupportsothatteachersareequippedwithresourcestoidentifyillmentalhealthandinterveneatalevelappropriatetotheirrole.
Feedback Regarding Prevention and Postvention via Trust Area
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Themodelsofcounsellingservicesprovidedwasquestioned,includingCBTvsDBTandtheneedforspecificservicestomeettheneedsofcertainsectionsofthecommunity,e.g.ethnicminorities,etc.
4.1.1.2 Suggestions
• Bereavementbuddy/champion
• Servicemappingexerciseshowingreferralpathways
• PHACampaign
• MaximisationofsocialmediaandTrustwebsite,e.g.toactasone-stopshopforsignposting
• Walk-incentre&outofhourssupport
• PeerSupportworkers
4.1.2 Postvention
Theshort-termworkbeingprovidedworkswell,butmoreisneededregardinglong-termservicesandsupport.Eightsessionsofcounselling,forinstance,willnotprovidealong-termsolutiontopainandgrief.Thereneedstobecontinuedconnectionswiththoseaffected.
Therewasadiscussionaroundtheshort-comingsoftheSD1formandthetimelinessofthisandthefactonlyonefamilymemberacceptsorrejectssupportonbehalfofothermembersandthedifficultiesthiscreates.Thereisarecognitionthatdifferentfamiliesanddifferentfamilymemberswillhavedifferentneeds.However,referralpathwayswerebelievedtobeoverrestrictiveandthereisalackofknowledgeofservicesavailable.
Thestructuresinvolvedwerediscussedandhowcomplexthiscanbeandthesensitivitiesinvolved,suchastheroleofthepoliceandcoroner,registeringthedeathandthedifficultiesifadeathhappenedoutsidethejurisdiction.Itisimportanttoalsoconsiderhowadeathinhospitaliscategorised,whichcanmeanafamilycannotaccesssupport.
Therewerepracticalexamplesofsupportthatcanbeprovidedsuchasweeklycheck-insbymembersofthecommunityorviapeersupport.Supportshouldbeextendedtoemployersoffamilymemberstoeducatethemandco-workers.Itwasthoughtthatmanyfeelingsuicidalturntotheirchurchforsupportandquestionedtheskillcapacityofreligiousleaders.
Therewassomefeelingthatthereisalackofsupportforthoseindividualsandtheirfamilieslivingwithsomeonewhohasmadeanattempttotaketheirownlife.
4.1.2.2Suggestions
• Thereisaneedtochangethenarrativetoreducethestigma.
• Promotionofalternativetherapies–mindfulness,relaxationetc
• Introductionof“healthywebsites”forself-harmandassociatedfamiliesandcarers
• Thereneedstobeaserviceinplaceforsupportingfamily
• Respitecareforsomeonecaringforsomeonewhoissuicidal
• Greaterawarenessofavailableservices
4.2 Western Health and Social Care Trust area
Omagh,Derry/Londonderry21stMarch2018andEnniskillen,29thMarch2018
4.2.1 Prevention
TheWesternTrustisanextremelydiversearea,havingamixofpocketsofruralityandisolationandareasofhighpopulationdensity.Regionalorganisationsworkingwithandacrossgroupsandprofessionals,andplugginggaps,werethoughttorepresentbestpractice.
Itwasdeemedcrucialtoworkwithboththepersonaffectedandwiththewiderfamily.Althoughtherearemanygroupsworkingproactivelyontheissues,theimportanceofhighlyskilledpeoplecan’tbeoverlooked,andservicesmustbefocused.Trainingisnecessarytoraiseawarenessofpathwaysandguidelines.Programmesbeingdeliveredinschools,suchas“promotingpositiverelationships”,“hope&resilience”andmindfulnesswerecommended,anditwasbelievedthereisgoodcommunicationbetweenschoolsandthecommunity.
Otherpositiveactivityincludescommunitygroupsandsearchandrescuegroups.Currentmentalhealthcampaign‘stickersonheads’wasregardedaspositive,howeverparticipantsbelievemoreofthisworkshouldbedone.Workwhichinvolveshearingfromfamiliesandsurvivors-peoplehavingavoice-wasbelievedtobeverypowerful.Communitytrainingandpeersupportwereallbelievedtobehavingapositiveimpact.
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4.2.1.1Gaps
Theruralityoftheareawasacknowledgedascontributingtodifficultyinaccessingbothservicesandinformation.Thereisaneedforconnectionsbetweenisolation/addictions/self-harmandsuicidalideationsandtophysicallyreachouttothoseisolatedorstrugglingtoengage.
Itwasbelievedthatsomeserviceuserscanfallthroughthegapsduetothelackof“joinedup”co-ordinatedservicesacrosstheboard,includingcommunity,voluntary,healthandeducation.
Itwasbelievedthatremovingdepartmentalboundariesandafocusonthestructureandcapacityofservicedeliverymorecouldbedonethanthecurrent“myriadofad-hocgroups”.Continuingonthetheme,itwasbelievedthereshouldbebettercommunicationbetweenfirstrespondersandonwardreferral.TherewasalsofrustrationthatconnectionsandcommunicationbetweenservicesdiffereddependingonTrustarearesultinginapostcodelottery.
Whilstsomeprogrammescurrentlydeployedinschoolswereviewedasgoodpracticeitwasbelievedmoreearlyinterventioninschoolsisrequiredandthereiscurrentlyadisjointbetweenschoolsandcommunities.
Waitinglistsareregardedastoolong,dropinstyleserviceswithanopendoorforcrisisresponseensuringaccessibilityarenecessary,howeverothersbelievedcrisisinterventionneedstoberesidential.
Therewasanemphasisontrainingto:
• Promotemoreface-tofaceinteraction
• Skillupcommunities,alsomakingthemmoreresilient
• Addressgapsinreferralpathways
• Impactthe70%whodonotaccessservices
4.2.1.2Suggestions
• Lookfurtherafield–internationallyforbestpractice
• MentalHealtheducationintegratedaspartofthecurriculum
• Greaterpromotionofservices
• Considercommunicationstylesofyoungpeopleandroleofsocialmediaandopportunitytocapitalizethis
• QuietroominA&E
4.2.2 Postvention
ItwasstatedthatbestpracticeexistsintheNorthWestandthisissharedacrosstherestofNorthernIreland.Servicesprovidingaone-personpointofcontactwerebelievedtoworkwellasitistimely,flexibleandallowsself-referral.OthergoodpracticeexamplesintheTrustareaincludedtheCommunityResponsePlans,multi-agencyapproachesandinter-agencyprotocols,CriticalIncidentPlanauthoredbyGAAaswellasspecificsupportgroupsinthearea.
4.2.2.1Gaps
Again,theissueswiththeSD1formwereacknowledgedandthecurrentreviewoftheformiswelcome.Intheaftermathofasuicide,communitiesneedtoknowhowtorespond,sotrainingandguidelineswouldbeuseful.Itis
notjusttheimmediatefamilythatisaffectedandsupportviathefamilyliaisonofficershouldbeextendedtothewiderfamily,friends,fellowstudents/colleagues.
Theimpactofmediaandespeciallysocialmediaonyoungpeoplewasdiscussedwiththeneedtoeducateparentsandteachersinhowtomanageandrespondtothis.
Itwasacknowledgedthattheofferingofsupportimmediatelyforsomefamiliesmaynotberight,andthereshouldbemorethanoneopportunityforfamiliestobeofferedandavailofsupport.Thereisnoonesizefitsall,butmoresupportisrequired‘downtheline’aswellasbetterandmorede-briefingforthefamilyandwidercommunityintheaftermath.
Communitycapacityneedstobebuilt,andconsiderationshouldbegiventotheextensionoftheCommunityResponsePlaninsingledeaths.
4.2.2.2Suggestions
• Communitytraining/guidelines
• Mediamonitoring/regulation
• Follow-upatinterimperiodsfollowingthedeath–3-6months,upto1-2years
• Aguidecouldbeleftforpeopleto‘optout’ofthesupportpackageratherthanhavingto‘optin’
• Needforacommunitymentalhealthchampion
• Needforapractical,simplestepguidetohelpfamiliesfollowingasuicide–includinglong-termhelp
• Makeit“OKtonotbeOK”
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4.3 Northern Health and Social Care Trust area
ColeraineandAntrim–22ndMarch2018
4.3.1 Prevention
TherewasaraftofgoodpracticeexamplesworkingwelltohelppreventsuicideintheNorthernTrustArea.Partnershipandmulti-agencyapproacheswithgoodconnectionsandcommunication,underpinnedbyacommunitydevelopmentapproachwerewidelydescribed.
Participantsexplainedthatlocalintelligenceinformsserviceprovisionandtherearetargetedandspecificinterventions.Trainingprovisionhasbeenbeneficialandworktoreducestigmaandprovideanon-judgementalapproachisveryimportant.Inaddition,thelinkwithnon-brandedsuicideprevention/mentalhealthservicesshouldnotbeoverlooked,forexampleMen’sShedsandsportsgroups.
4.3.1.1 Gaps
ManyparticipantswerefrustratedatthelackofawarenessbyGPsandcalledonadditionaltraining,supportandguidancefortheprofession.TheyalsobelievedthatcounsellingservicesshouldbeavailableintheGPsurgery.Withregardstohospital,participantsbelievedthatvulnerablepeoplearebeingdischargedwithoutadequateorappropriateonwardreferral.Crisishubsarerequired,butnotprovidedbyA&E.Itwasthoughtthatmoreco-ordinationofserviceswouldensurepeoplewouldbereferredaccordingtotheirpriorityneeds.Itwasacknowledgedthatpeopleincrisisarenotcomingforward.
Whenpeopledocomeforwardagaintheissuesofwaitinglistsandappropriatenessofthemodelofservice,e.g.session-basedcounsellingwereraised.Moreshouldbedoneonearlyinterventionsuchasmoreresiliencework,aswellaswiderconsiderationofcontributingfactorssuchassocialisolation,deprivation,drugs&alcoholinteraction,andLGBTcommunityissues.Agapwasalsoidentifiedoncrisisinterventionfromtheperspectiveofcommunityandfamilysupport,peopleshouldbeeducatedonsignsandsymptomsofpoormentalhealthfromearlyyears.Theconnectedcommunityapproachneedstobebuiltuponencouragingandusingcommunityintelligence.
Inaddition,questionswereraisedregardingthemonitoringandevaluationofservicestoensureweknowwhatisworking,howandwhy.Therewassomeconcernregardingconsistencyofservicesbeingofferedordeliveredduetofundingissue.Theoversightofprofessionalstandardsbodiesandprovisionofasmallgrantsschemecouldaddresstheseissues.
4.3.1.2Suggestions
• Workplacehelpandsupport
• Knowledgeofwheretheservicesare
• Engagehardtoreach
• Morecampaignsneeded
• Considerationofruralisolation–especiallyolderpeople
• MentalHealthApp(targetingyoungpeople)
• Professionals(GPs,teachers)toreceivetraining
• Mentalhealthdiscussionspartofnormallanguage.
4.3.2 Postvention
Specificserviceswerenamedasworkingwellintheareaofpostvention.Alocalelementtotheseservicesandexistinglinksseemintegraltotheirsuccess.Intergenerationalworkwasalsoacknowledgedforitseffectiveness.IntheNorthernTrustthereisanannualcommemorationservicetorememberallthoselostasaresultofsuicide.
ThereappearstobeconsistencyintheareawithPSNIbestpractice,regionalsharingofapproachesaroundPSNI/SD1deathsandgoodcommunicationprocessesenablingcommunityintelligencesystems.
4.3.2.1Gaps
QuestionsagainaroseregardingtheSD1anditstimelinessontheofferofsupport.Ifthissupportisrejectedbythefamilymemberthereisthenalackofawarenessofsupportavailableandthereforepeoplebeingsignpostedincorrectly.Inaddition,itwasreportedthatevenwhenservicesareknowntheyaretoodifficulttoaccessorruleshavechanged,whichmeanssomearenolongereligible.
Therearegapsinhowfamiliesarecommunicatedwith.Thiscommunicationneedstohappenwiththosewhohavebeenaffectedtoseehowservicescanbeimproved.Morepeersupportwassuggestedasthelivedexperienceofsuicideensuresempathy,withthecaveatandprovisionofappropriatetrainingandsupervision.
Thereisahugeresponsibilityforcarerstokeeptheirlovedonesafe,it’simportantthatthesepeoplearesupported.Thereneedstobeatop-upserviceoradrop-inservice
13
availableas8weekscounsellingsupportisshort.Face-to-facefollowupsareneededtosupportfamiliesmoreaswellastrainingforcommunities.
Thereisanissueofstigmawiththeacknowledgementthatsomeprofessionalsarestillnotrecordingsuicideandinadditiongiveconsiderationaroundattemptanddeathfivedayslater.
4.3.1.2Suggestions
• EducateGPswheretosignpostpeopleto
• PHAtosharecasestudiesandacrossborderexperiencesalso
4.4 Belfast Health and Social Care Trust area
Belfast(x2)–26thMarch2018and22ndMay2018
4.4.1 Prevention
Connectednessandpartnershipsatlocallevelwereseenasimportantinprevention,includingearlyinterventionatcommunitylevel,crossdepartmentalworking,i.e.healthandeducationandsharinginformationandbringingcommunitiestogether.
Trainingwasbelievedtobeeffectiveandimportantinawarenessraising,enforcinggoodmentalhealth,buildingresilienceandstresscontrolwhichcouldcontributetoself-care.Sign-posting,ongoingsupportandclientshavingtheabilitytoprogressthroughservicesallworkwell.In
addition,wraparoundsupportwassaidtoworkwellwhenavailable.
Familysupporthubsandbereavedbysuicidegroupsarevaluedandthereisavalidroleforpeersupportinnormalisingandchampioningtheissues.TheTake5model,walkinservicesandimmediate“safe-plans”weresaidtobeeffective.
4.4.1.1Gaps
Attendeesacknowledgedthatanearlyinterventionholisticapproachiskey,howeveragainasignificantthemewastheneedforgreaterco-ordinationandjoinedupthinkingacrossservices.Betterconnectivitybetweenserviceswascalledfor.Thereneedstobebettermappingofandstrongerreferralpathwaysandinformationmustbesharedfromstatutorybodies.Thereshouldbeinclusionofthewidercommunityandbettertrainingprovision.
Thereisaneedforbettersignpostingandongoingsupportandmoreinvestmentintomoredeprivedareasandprevention.Familysupportwasseenasvital,andtherewasanopportunitytoprovideservicesviaschoolssuchasmindfulnessprogrammes.Therewasabeliefthat‘toxicenvironments’existedinplacessuchasschoolsandhospitalinpatientswhichhastobeaddressed.Therewerealsoconcernsexpressedregardingadditionalriskfactors,suchasyoungpeopleincareandmentalhealthclientsintemporaryaccommodation.
Relationshipswereseenaskeyaswellastheimportanceofbeingheard.Togettothispointpeopleneedtobeencouragedinhelpseekingbehaviour,andtheyneedtoknowwheretogo.Communityplanningisastartbut
thereisaneedforbettercommunityinvolvementandresiliencebuilding.
Thereareaccessissuestospecialistservicesandstatutorysectorprofessionalsknowingabouttheservicesandtheiraccessroutes.Currentlyhubsandothereffectivesupportmechanismsarebeingoverburdenedwithnowhereelseforserviceuserstogo.ThereisalackofconnectionfromGPreferralstoservices.
ServicesarelimitedandinconsistentacrossBelfast.Forexample,the‘CardBeforeYouLeave’schemeforthosebeingdischargedfromhospitalafterself-harmorasuicideattemptwasagoodideabutisnotusedacrosstheregion.Awarenessraisingisnotgettingkeymessagesoutandthereisaneedformorehonestconversationstoreducefearandstigma.
4.4.1.2Suggestions• Stigma–‘Mental’Illnessisabarriertoaccessing
service.NewTerminology-“Emotional/PsychologicalWellbeing”-personfriendlylanguage
• CommunityMentalHealthChampion–pointofcontactforaccesstoinformation,assisttrainerandco-ordinatecommunityresponse
• Campaignssuchasthe‘MindYourHead’campaignneedsustainedandrefreshed
• GPawareness-raisingshouldbemandatory
• CommunityReponsePlans–theremitoftheresponseplancouldbewidenedtosupportthosewhoareaffectedbyanindividual’ssuicideattempt
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• Peopleinthecommunityshouldbeusedandtrained–shop-keepers,taxidrivers,barworkers,barbers,hairdressers
4.4.2 Postvention
ItwasbelievedthattheSD1processwasagoodstartingpoint.Therearefamilysupportgroups,psycho-education,creativegroups,counselling,complementarytherapyalllocalofferingflexibilityandcommunitylevelsupport.Manyofthesearecommunityresponsesdevelopedbypeople,usingcommunityintelligence,itwasacknowledgedthatthereismuchvalueinlocalknowledge.
4.4.2.1Gaps
Similartoprevention,aholisticapproachwascalledforincludingacentralpointforinformationandtheneedforGPstoworkmorewithstatutoryorganisations.
Practicalface-to-faceinformationisneeded,butappointmentsandwaitingtimesareanissueanditwasbelievedthatcrisisteamsareunderresourced.Meanwhilethereisaneedtocontinuetosupporttheclientwaitingonthespecialistservice.Thereisagreaterroleforthecommunitytoprovide24-hoursupportandemergencyresponseinadrop-insetting.Thereisperceivedtobealackofcareforcarers,thatcommunitysupportservices/groupsaremorelikelytobebasedindeprivedareas,meaningagapinserviceprovisionforthosemorelivinginmoreaffluentcommunities.Therewasalsobelievedtobeservicedeprivationinruralareas.
Considerationshouldbegiventotheappropriatetimingtoaccessservicesforspecificneedsi.e.suicidalideationvsbereavement.
WhilegoodchangeshavebeenmadetotheSD1process,attendeeswouldratherhavean‘opt-out’ratherthan‘opt-in’optionasfamiliesareshockedanddistraughtattimeoffirstcontactwithpoliceofficers.Supportthroughthisprocessshouldbeextendedtoothermembersoftheimmediatefamily.TheSD1processwasalsodescribedas“cold”.
4.4.2.2Suggestions
• InformGPsaboutavailableservices
• Generalawarenessraisingofservices
• Menuofservices
• Communityworkers/healthandwellbeingstaffbeingplacedwithinGPstoreferto
• Moreeducationneededinschoolsonself-harmandsuicide
• Awarenesscampaignontheimpactofsuicide
4.5 South Eastern Health and Social Care Trust area
LisburnandCastlewellan,27thMarch2018
4.5.1 Prevention
Amulti-agencyapproachwithimprovedcommunicationbetweenPSNI,community,voluntaryandstatutoryorganisationswithimprovedonwardreferrallinkageandsignpostingtoappropriateservicesisneeded.Thereisaclearroleforcommunityplanninginhelpingallorganisationsdefinetheirrole.Earlyinterventionworksinschoolsdevelopingemotionalresilienceanditneedstobepartofthecurriculum.Havinganearlyresponsesopeoplepresentingwithsuicideideationareidentifiedquickly.Thisidentificationcanbedoneviaresearchtrendslookingathighriskgroupsandclusterareas.
Flexibilityinapproachandtheabilitytoprovidetailoredservicesusingevaluationandfeedbackfromserviceusersandprofessionalsonwhatworksiseffective.Havingsomeonelocalandaccessibletoconnectwithandnotshyingawayfromtoughconversationsandsituationsisausefulresource.Servicesmustbeaccessibleandtimelytosupportpeopleincrisis.Awarenessraisingthroughmediacampaignstoreducestigmaandbuildingresiliencearekeypreventativestrategies.
OtherservicesandapproacheswhichworkwellincludeFamilySupportHubs,InfantMentalHealthStrategywithitsfocusonearlyintervention,theco-ordinatedapproachoftheCommunityresponseplaninresponsetoclusters.
15
Therewasalsoacknowledgmentofruralneedswiththeprovisionofhubswhicharegoodforsignposting/reachingoutandthevalueofpeersupport.
4.5.1.1Gaps
ThereisalackofconsistencyacrossNorthernIrelandandthiscanleadtoanincreaseinanxiety.Therehastobebettercommunicationandinformationsharingacrosscommunity,voluntaryandthestatutorysector.
ImportanceofappropriatetrainingforalliedHealthCareprofessionals,andtheneedtobeworkingcloseracrossthematicarease.g.drugsandalcoholaddiction.
Therearehugegapsininformationprovision,itneedstobelocationspecificandaccessible,peopleneedtohavetherightinformationwhenleavingoneserviceprovider,e.g.A&E,sotheyfeelsupported.Membersofthecommunitywhoprovide“domestic”servicesshouldalsobemadeaware,forexamplehair-dressers/taxidriversoftenneedguidanceandpreparationonwheretosignpostpeoplethatneedurgentsupport.
Moretobedonetoaddressthespecificneedsofdifferentsectionsofthecommunity,forexample,middleagedmen,ethnicminoritiesorwhereEnglishisnotthefirstlanguage.
Waitingtimestoaccessservicesaretoolong.Servicesoffered/providedneedtobefitforpurpose,personcentricandconsistent.Thereistoomuchrelianceonthecommunityandvoluntarysector.
Alotoftheneedremainshidden,e.g.inruralandisolatedcommunitiesanditisimportantthatthisisaddressed.However,thereisstillastigmawithincommunities.Thereisaneedtobuildresiliencewithincommunitiesviaanevidence-basedapproach.Thereisafearoftraining,alackofknowledge,complicatedreferralpathways,evenforGPstonavigate.
4.5.1.2Suggestions
• ShouldbeRecoveryCollegesineachTrust
• Tenderingprocessandaccesstofundinghasanegativeimpactonlocal/smallerprojects–howcanthisbeaddressed?
• 20%ofpeopledeemed‘lowrisk’died–terminologyusedtocategoriseisconfusing(low,medium,highrisk)–thisneedstobeaddressed
• GPtrainingisanecessity
• Fundedinterpretingservices
• Fundedpeer-ledsupportgroups
• Betterevaluationandmonitoringofservices
4.5.2Postvention
CommunityResponsePlanswererecognisedasbeingeffectiveandwerereportedasreducingthesuiciderateafterimplementation.Othergoodpracticemethodswereidentifiedassupportgroups,counselling,alternativetherapiese.g.Men’sShed,practicalsupportandsupportfromfunders.
4.5.2.1Gaps
ThesameissuesaswithotherTrustareaswiththeSD1formcameup.Take-uprateforsupportattimeofdeathisonly50%,sopotentiallypeoplearenotbeingsupportedintheaftermathofasuicide.ProfessorLouisApplebyisleadingpilotprojectsinEnglandinthecoroner’scourt,whichonavoluntarybasisareofferingserviceofsupporttofamily.CouldPSNIseekconsentatlaterstage(10dayspost)togivefamilytimetoacknowledge?
Itwasreportedthatresourcesneedtobeuptodateandthereshouldbebettergeneralawarenessofservicesavailablesoaswheneventhappenspeoplearenot‘lost’.A‘societalapproach’isneededwithbetterconnectedcommunities,withpracticalsupportoffered.Children’srightsneedtobeconsideredifaparentturnsdownsupport,howdoesthatchildhaveavoice?
Again,theissueofalackofajoined-upreportwasacommonthemeinthediscussion,thatPostventionwasnotlinkedorconnected,andhadnofeedbackwithlimitedfollowup.Itwasrecommendedthatvariedsupportservicesarerequiredtoensuretheneedsofthefamilyandwidersocietywerebeingmet.Specialnoteshouldbetakenofthefactthatthereisnocarepathwayforthosewhoselovedonesdiebysuicideinhospital.Suggestionsincludedpeerandfamilysupport;considerationofBMEcommunities;Postventionworkinschools,allofwhichneedtobetimely.
Adiscussionalsocentredaroundtheevaluationofinterventions,measuringtheirpositiveandnegativeimpactandtheneedforongoingmonitoringoftrendstoinformservicedesign/delivery.
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4.5.2.2Suggestions
• Campaignsneedfollowupandwraparoundservicesoffered
• CouldHSCTsuicidepreventionleadaskforconsentinsteadofithappeningatthescenewiththePSNI?
• De-stigmatise,removeshame-don’tusetheword‘commit’–suicideisnotacrime
• Target20-30yearagegroup–trytotalkopenlyaboutwhathashappened
• PHAshouldseekchildrenandyoungpeoples’viewsonmentalhealth
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Appendix 1 ProtectLife2Objectives
1. Ensureco-ordinatedcrossgovernmentapproachtosuicidepreventionandinclusioninProgrammeforGovernment.
2. Provideaccessiblede-escalationservicesforthoseinemotionalcrisis.
3. Reducetheincidenceofrepeatself-harmpresentationtohospitalEmergencyDepartments.
4. Enhancecommunitycapacitytopreventandrespondtosuicidalbehaviourwithinlocalcommunities.
5. Fewerpeoplewhoareincontactwithmentalhealthservicesdiebysuicide.
6. Deliveramulti-sectoraltrainingprogrammeinsuicideawarenessandintervention.
7. Improveawarenessofsuicidepreventionandassociatedservices.
8. Enhanceresponsiblemediareportingonsuicide.
9. Restrictaccesstothemeansofsuicide.
10.Enhancetheinitialresponsetoandcareandrecoveryofpeoplewhoaresuicidal.
11. Improvesupportforthosecaringforsomeonewhoissuicidal.
12.Ensuretheprovisionofeffectiveandtimelyinformationandtailoredsupportforindividualsandfamiliesbereavedbysuicide.
13.Identifyemergingsuicideclustersandactpromptlytoreducetheriskofsuicidesinthecommunity.
14.Strengthenthelocalevidencebaseonsuicidepatterns,trendsandrisk,andoneffectiveinterventionstopreventsuicideandself-harm.
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NotesfromPublicMeetingsandOnlineSurveyResponses
Appendix 2
Whatworkswell:• Earlyintervention• Communitydevelopmentapproach–linking• Multiagencywork–connectedworking• Positivepreventionservices:befriending,
mentoring,multiagencyworking,counselling,buildingresilience,schools,club,takingastepbackandpromotingpositivementalhealthtoeveryone
• SHIPshowstheprocessofreferralworks–responsive,timely–effectiveandcreatessenseofhope(canpreventmedicalisation)
• Supportservicesatearlyinterventiontobuildresilience
Gaps:• Holisticperspectiveneeded• Intheareaofprevention–manyatriskarein
asuicidalstateduetotheirownbereavement–bereavementservicesshouldbeofferedtoeveryoneatthe“getgo”
• ServiceandsupportatTier1isessential–couldcomeintheformofa“bereavementbuddy”orchampioninthecommunity–thiscouldbeanareaofinvestment
• Workinginasolutions-focusedwaytogetherisessential–“sometimesweacceptthatwhathasbeencommissionediswhatworks,andthisisnotalwaysthecase”
• Needstobeaccountability/amonitoringcommitteetoaccountfortheProtectLife2
PreventionEvent
• Steppedapproach–rightapproachtoensuretargetaudienceisreadyfortraining/itispitchedattherightlevel.
• Trainersmustbecompetentinsubjectintermsoffollowupsupport/safeguarding
• Needtoensureco-designoftrainingandtrainingneedstobecredibleandpractical.Thisneedstobeimplementedasap
• Generallybetterunderstandingoftraining/suitabilitytoaudienceneeded
• e-learningwelcomed,powerofsocialmediainreinforcingpositivemessaging
• SuggestionofatierbeforeStep1–campaignsandawarenessraising
• TrainingtoberecognisedwithinCPD• Encouragetheconceptofbuildingupon,refreshing
trainingetc• Betterunderstandingofdifferentlevelsand
suitabilitydependingonknowledge• Needstobeasupportmechanisminplacefor
peoplewhohavebeentrained–checkinginwiththemfromtimetotime
• “Stepsalwayssoundgood,butitcomesdowntounderstandingtheengagementateachstep”
• Lackofclarityonwhatthestepsareandwhatthemodellookslike
• Generallygoodsupportforthemodel• Accessibilitytolearningisimportant• Goodideatocheckinwithpeopleaftertrainingto
seeifithasbeenutilised
TrainingFramework
• Theshort-termworkisok,butthelong-termworkisnotgoodenough
• Toomuchshort“quickfixexercises”–longevityisneeded
• 8sessionsofcounsellingpost-eventisnotenough• Shorttermcounsellingdoesnotworkaswell• Needtokeepconnectionswithpeople,identifying
problemsandknowingthatproblemsortimesofcrisiscouldre-emerge
• PIPs,AMH,BereavementSupportworkingwell(SHIP,CrisisHousealsomentioned)
• Referralpathwayneededforongoingsupport• Moreinvestmentneededinself-helpmaterials• SD1onlycapturesonefamilymember-alsomay
notbetimeappropriateintermsofbeinganofferofhelp
• Questionsonhelpneededneedstobeafamilyapproach–differentfamilieswillhavedifferentneeds,aswilldifferentfamilymembers
• Followupneededwiththosewhohaveaddressedservicesbuthavebeendischarged
• Moreunderstandingneededandsensitivityofhealthcarestaff
• Needtopromotebetterattitudestowardsself-harm/suicide
• Differentapproachneededtowardsself-harmthansuicide
• BetterEmergencyDepartmentservices–onpresentationofsomeonewhohasself-harmedorattemptedsuicidethereneedstobesensitivity,
Postvention
13.3.18NEWRY
19
strategyandtomonitorimpact• EarlyinterventionhappeninginDungannon
Primaryschools–6-weekprogrammeatP7onstigmasurroundingsuicideandself-harm.Similarinitiativesneededacrosstheboard–moreinterventionsinschoolsandyouthclubs
• Muchworkneedsdonewithparents–barriersinbringingparentstogetherneedaddressed,needaninnovativewayofengagingparents
• “Muchofthepreventionishappeningoutsideofthestrategy”–“howdotier1andtier2servicessupportpreventionwhenthatisnotwhattheyarefundedtodo?”
• Thereisahugeamountofworkbeingdoneoutsideofthestrategy,butitisnotbeingreportedon–suicidepreventionisthecoreworkofmanystaff,butthisisnotseenasitisnotreportedon–“itisreportedunderdrugsandalcohol”leadingto“norecognitionoftheworkbeingdone”
• OneparticipantfelttheProtectLife2strategywas“alotofworkandalotofinvestmentforapoorpoorresult”(referringtothereductionof10%by2022)
• Needtonormalisesupportservices–‘ifyou’resickyougotothedoctor…teethyougotodentist’–importanttoremovethestigmasurroundingself-harm/suicide
• Importanceoflanguageused–positivereinforcementof‘mentalfitness’etc
• Betterconnectionsneeded–betterawarenessofservicesavailable
• Difficulttoaccessoutofhoursservicesforonwardreferrals
• Extremelyimportanttolookoutforthementalhealthofthosewhoarebereaved/affectedbysuicidetopreventa‘viscouscircle’
• Shouldbemoreinformationaroundtraining,andmoremotivationtogetpeopletotrain
• Somefeelitisaclearerpathway• Needprogrammestomeetneed• Supportmechanismsneededforstaff• Moreclarityaroundparametersandexpectations
needed• Needageappropriatetrainingforallages–no
needtomention‘suicide’• Trainingneedstobe“credible,notnecessarily
accredited”–althoughcounterargumentsuggested“peopleappreciateanaccreditation–peopleappreciatethecredibilityandthehealthagenciesetcendorsingtraining”
• Somefelte-Learningwouldstrengthenpowerofsocialmedia
• E-learning–sameproductandreach,upliftingkeymessages’
correctlanguageusedetc• Communityresponseplansputinplaceincluding
facetofacemeetingsincommunity,individual/tailoredsupport–bothformalandinformalmethods
• RoleoftheCoroner’sServiceChangewelcomed• Servicesforthosewhodieinhospital• ServicesforpeopleoutsideUK/NI/ROI• Pressureforjusticeimpactsonthoseaffected• Stigmainruralcommunitiesseemstobemore
pronounced• Acknowledgementthatsomelocalitieshavemore
services/betternetworks• Awarenessoftheindividualityofeveryindividualis
veryimportant• Suggestionofmonthlymeetings/weeklycoffee
morningsasawayof‘checkingin’withthoseaffected
• Suggestionofaresidentialtobuildrelationshipswithpeopleaffectedbysuicidewhounderstandeachother
• Needforgreateremployerawarenessonhowtodealwiththosereturningtoworkafterbereavement(languagetouseetc)
• Processofregisteringdeathcanbesensitive–mayrequirechange
• “Arepolicetrainedonstandardswhenprovidinginformationtoaffectedfamilies?”–greatertrainingwithinPSNI
• Findingthebalancebetweenprovidinginformationandoverwhelmingsomeoneisextremelyimportant
• Importanceinthepromotionofalternativetherapies–mindfulness,relaxationetc(NurtureRoomsinBelfastmentioned,suggestionofMindfulnesscoursesinschools)
PreventionEvent TrainingFramework Postvention
13.3.18NEWRYCONTINUED
20
• -Doeseveryoneknowwhateveryoneelseisdoing?Whatisoutthere?Dopeopleknowwhatisavailable?
• Gapsincounselling–needstobegenderspecificcounselling,counsellingforminoritygroups,travellingcommunityetc
• “ThereistoomuchfocusonCBTandnotenoughonDBTtherapy.CBTfocusesonthinkingandDBTonemotions–manysaythey‘werenotthinking’duringasuicidalepisode,becausetheiremotionstookover”
• Needforspecialisedcounsellors• Needtointroducea‘mentalhealthMOT’“welook
afterourhealthandfinancesetc,butnotmentalhealth”
• Peoplearenotawareofthe‘nextstep’theyshouldbetaking–ifpeopledon’tknowtheycanbehelped,theywillbemorereluctanttoask
• Itisimportantthatthosewhodonotwanttobe‘medicalised’canalsobeseenquickly
• Campaignsshouldbecommissionedtohelppeoplerecognisetheirownmentalhealthproblems
• “Communitieshaveadefibrillatortosaveyourlifeifyouhadaheartattackonashopforecourt,butnoservicesinplaceforthosewhoareatcrisispointintheirmentalhealth”–feelingthatthereshouldbeacrisisboxorserviceonhandincommunities–perhapsamemberofthecommunitytrainedtodealwithcrisis
• Fearfactorneedstakenoutoftalkingaboutmentalhealthandsuicideprevention
• Carersneedtohaveavoiceandbeallowedavoiceatpostventionstage
• Feelingthatyoushouldnothavetoreach‘crisispoint’beforeyoucanreceivehelp–needs
• Introductionof“healthywebsites”forself-harmandassociatedfamiliesandcarers
• WrapService/RecoveryCollegesavailable,butneedstobeaserviceinplaceforfamily
• SHIPreferralcriteriaisverystrict–shouldbedeliveredmuchearlierandbemore
• open–referralpathwaysaretoorestrictive.SHIPshouldbeabletotakereferralsfromGPs.Understandingthatthisreferralprocessisduetostrictresource–servicemustbeopenedupifmorefundinggranted
• MACP–acommitteeisbeingestablishedtobeabletoseeyoungpeoplefrom13yearsoldbyGPreferral–requiresvolunteers,training
• Needforrespiteopportunitiesforthosewhocareforsomeonewhoisself-harmingorsuicidal
• 24/7support
PreventionEvent TrainingFramework Postvention
13.3.18NEWRYCONTINUED
21
reframedtoproperlyimplementpreventiontodeliverbeforepeoplereachcrisis
• LifeMOTsneeded–check-upspre-crisisasroutine• Co-production–putcommunityexpertiseat
theplanninganddevelopingtable.Plantoallowspecificareastoberecognisedandaddressed
• Needtolookathowself-harmdoesnotbecomeatragicoutcome
• Needspaceandresourcesforservicestodevelopjointworkingandexperience/expertisesothateverycontacttakeseveryopportunitytobeagoodandpurposefulcontact.Linkedstrategies,workinggroups–ensureallservicesareinclusiveandlistentohighprioritygroups
• “OneimportantpreventativemeasurewouldbetohaveaserviceinplacetoprovidealifecoachtoorganiseaMOTforpeopleinapressuredlife,wheretheymightnotrealisetheirmentalhealthisindangeruntilitistoolate”
Whatisneeded:• Moresocialgroupsatweekends• Recoveryclinics• Educationoffamiliesonsignsandsymptoms• Trainingforteachersinschoolsreearly
intervention• Recognitionofservicesnotprotectedunderor
fundedbyProtectLife• Betterconnectionsbetweenservices/service
providers(multi-agency,makinglinksandworkingtogether)
• Moreawarenessofservicesthatareavailable• Mentalhealthawareness“shouldbeamandatory
subjectinallschools”andschools“needmentalhealthchampions”
• “Schoolsbringinoutsideagenciesandyouth
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workerswhocomein,talkandleavenoresources–thereisnofollowup”
• CoursesavailableinRecoveryCollege–usingpeoplewithmentalhealthproblemstohaveasayinthedesignofservices
• Acardforanindividual’spurseorwallettoletothersknowtheyareincrisis/requiresupport
• GPoftenfirstcontact,butoftenhavelittleknowledgeofcharities/publicservicesonoffer–moretrainingrequired
• Needstobegroupsinthecommunityforthecarersofthosewhoaresuicidal–supportforthemintimesofcrisisorconfusion–“peoplewhosupportneedtobesupported”–thissupportisimportantatthecrisistime,butthesepeopleneedtobefolloweduponandsupportedfurther
• Workforcesshouldbeequippedtodealwithsomeonewhoisfacingmentalhealthproblems
• Publicinformationcampaigns–preventativemessagingandnormalising
• Tolookatwhatelseis‘outthere’–e.g.Lifemaps• ‘ShouldertoShoulder’–betterwaysandformatsof
presentinginformation–notstandardPowerPoint• Needstobe“improvedsupportforsomeone
caringforsomeonewhoisself-harmingorwhohassuicidalideation”
• Peersupportworkerstoequipothersbysharingtheirstory
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Whatworkswell:• SHIP,NiamhLouise,Lifeline,Samaritans,Action
MentalHealth• SamaritansandLifelinearevaluableservices,
althoughusedfordifferentreasons• Familyinterventions/Parentinginitiatives• Therearegoodinitiativesandeducationaround
self-harm• Goodcommunityandvoluntaryinterventionsand
work• Accessibilitytotraininghasimproved–people
traineduptodealwithissues• Therehasbeenmoreequippingpeoplewiththe
toolstheyneedtohelpothersandthemselves• Introductionofself-referraltoprogrammeshas
beenmassivelypositive(Recoverycolleges/themoveto‘self-referral’ontoWRAPprogrammehasbeenanimportantchange)
• Goodawarenessraisingofinitiatives,servicesandconditions
Gaps:• -Notconvincedpostercampaignswork–moveto
digitalandsocialmediawouldbemoreimpactful(printondemandmoreappropriate,mixofmediarequired,Lifelinebusinesscardsdostandout,butotherleafletslostamongstothersinwaitingroomsetc)
• Mentalhealthinfo/resourcesshouldbesignedandseparated/categorisedwithinpublicareassuchasGPwaitingroomstoallowbetterself-selection
• Confusionaroundaccesstoservices–servicesareouttherebuthowaretheyaccessed/whichisappropriate?
• GPsneedmoretrainingandawarenessonwheretosignpostto
• Anotherlevelneededbeyond–couldtrainserviceuserstobefacilitatorsinsomecontext
• Slightgapinsteppedapproach,butotherwiselogicalandplausible
• TrainingcouldbeofferedinASIST• Co-producedandco-deliveredservices/resources
–‘livedexperience’isvaluablesothisneedstobeusedinthebestpossibleway–furtherroleforthosewith‘livedexperience’?
• NeedforaRecoveryCollegeethos• Needstobeagreaterlevelofintegrationacrossall
training–crossboardertraining,connectedness,needstoalsobequalityassured
• Needstobemorescreeningonwhattypeofprogrammeorinitiativesuitsaperson
• Whendealingwithsuicidalclientsa1-1approachworkswell,withthecreationofaconnectionbeingimportant–moreempathyandunderstandingneedsbuiltintothetraining
• Needtoaddressthequestion“HowdoIreactordealwithsomeonewhotellsmetheywanttotaketheirownlife?”
• “Needaframeworkthatisnotsorigiditdoesn’tallowforfluidity”
Whatworkswell:• Bereavementsupportservicesareverygood,very
positive• NiamhLouiseandsimilarservicesareextremely
beneficial• PIPs,CRUSEetcpositive–needstobeaspecific
bereavementsupportserviceforthearea?• Manypeoplefeelingsuicidalturntotheirchurch
–arereligiousleadersequippedtodealwiththis?NotedthatFlourishhasgoodresources–wewillflourish.com
Gaps:• Potentiallackofknowledgeofsupportgroupsnoted• SDIformisfilledoutwhenPSNIattendscene–this
isperhapsinsensitiveandnottheappropriatetime–peoplecantick‘no’forfollowupservicesbuthowdotheychangetheirmindonthisdowntheline?
• Moreaccesstoservicesforbereavedfamiliesisimportant–allfamilymembersareaffecteddifferently“fromthe4-year-oldchildtothe60-year-oldwife”
• ‘Majorgap’forgroupofpeoplewhodonotaccessservicesbecausetheydidn’t‘gothroughwith’theself-harmorsuicideattempt
• Probleminserviceusersnotaccessinghelp–needstobegreaterawarenessofwhatisavailableandhowitisaccessed
• A&Ecareplansarenotbeingcarriedthroughineveryinstance
• Experiencesodifferentforeachfamilyandthisshouldbeaddressedinfollow-up/directiontoservices
• Communityresponseplanningveryimportant–multi-disciplinarygroupingtoprovidesupport.
• Mediareporting–needforgoodpractice
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• Morepromotionaroundself-care–noteveryoneneedsaservicedeliveredbyanorganisation
• Needstobea‘hub’orsectiononwebsitetofindinformation(onememberoftabledidnotknowPHAstakeholdereventswerehappeninguntilhearingwordofmouth).Anonlinehubcouldbeusedasaresourcetoshareinformationonevents,resourcesandinitiativesforprofessionalsandserviceusersalike
• Trustwebsitehaspotentialforinformationonservices,butitisnotmaximised–couldactasa‘onestopshop’resignpostingetc.
• Trouble“connectingthedots”–“findingtherightserviceattherighttime”
• Needstobemuchmoreconsiderationofagegroupsotherthan‘youngpeople
• Earlierinterventionisessential–referralpathwaysneedextendedandthosefeelingsuicidalneedaccesstoservicesbeforetheself-harmstage.Suggestionthatthiscouldbedeliveredthroughschoolnurseorthroughinternalschooleventson‘lookingafteryourmentalhealth’,parentalprogrammesandpeermentoring.ReferralpathwayofSHIPistoostrict–suggestedreferralshouldcomethroughGPforthisprogrammetoopenopportunitiesforaccess
• Thosefrommoreeconomicallydeprivedareas,isolatedareasetcneedhelpaccessingservices
• Crisispointcareneedsextended–developmentof‘safespaces’andforpeopletogotoatcrisispoint
• Schoolsneedmoreawarenesstraining–goodworkhappeningbutneedtoequipteacherswithresourcesandinformation.Suggestionthatthiscouldlooklikea‘menuofservices’soteachersknowwheretogo
• Betterreferralpathwaysneeded
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• Morebespokeforindividuals(foreignnationalsetc)needed
• “Servicesneedtobebetteratkeepingwithpeopleontheirjourney”–feelingthatserviceusersareforgottenaftercrisissituationisdiffusedratherthanbeingfolloweduponor‘checkedinwith’
• Needtoequippeopletobebetterat“buildingtoolsofself-resilience”
• Dungannonneedsasupportservice–developmentofasafespace
• Feelingthatyoushouldnothavetoreachcrisispointbeforebeingreferredtoaservice
• “ThereareTVadvertsonrecognisingSTROKEandwhattolookfor–shouldbesimilarforself-harmandsuicide/mentalhealth”
• DifficultyforC+Vorganisationstoknowhowtoidentifyfundingapplications–knowledgedeficit.
• Lackofknowledgearoundwheretogetfunding• Needforawalk-incrisiscentreforsuicide
prevention• Moreneedfornighttimesupport• Therapeuticrelationshipsdon’texistinclinical
intervention–needasafeholdingplace.Developmentof‘safespace’inhoursandoutofhours.
• Needmoreconsiderationgiventoover60s,thosewhohavelostalifelongpartner,thosewhohavelostabusiness,ruralorisolated
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Whatworkswell:• SHINEProject-developedintoSHIP–regional,
worksacrossgroupsandprofessionalsandplugginggaps.Crucialtoworkwithnotjustpersonaffectedbutwiththewiderfamily
• Peoplenowbeingabletoinputtotheservicestrategically
• Therearelotsofgroups,buttheimportanceofhighlyskilledpeoplecan’tbeoverlooked–focussedisbetter
• Promotingpositiverelationshipsprogrammesinschools(11-18-yearolds)
• Physicallyreachingouttothoseisolatedorstrugglingtoengage–promotionofsenseofbelonging
• Connectionsbetweenisolation/addictions/self-harmandsuicidalideations
• Mindfulness(Paws.B)inPrimaryandSecondaryschoolsisreceivingverygoodfeedback–currentlydeliveredbyAWARE
• Trainingisusefulinthatitraisesawarenessofthereferralpathways/guidelines–trainingdelivereddirectlytocommunitiesisimportant
• Dropinstyleservices–opendoorforcrisisresponse–accessibility
Gaps:• Ruralcommunitiescanstruggletoaccessservices• Appreciationandacknowledgementofthe
extensionsoffundingapplications(3-5-yeartenders)
• Needtolookathowyoungpeoples’mentalhealthismanagedinothercountries
• Needresearchintoyoungpeoples’useofsocialmediatoinformpoliciesgoingforward
• Opportunitiesforcommunityandvoluntary
PreventionEvent TrainingFramework
Whatworkswell:• Familyliaison–timelinessoftheservice,flexibility
oftheservice,self-referral• Exampleofgoodpracticeisthe‘CriticalIncident
Plan’withinGAA• FamilyVoicesgivesavoicetothosebereavedby
suicide• Bereavedbysuicidegroups• CommunityResponsePlans• SD1–althoughsomegapsandcurrentlybeing
reviewed• Reachingouttoyoungpeopleand‘plugging’any
gapsonhowwecommunicatetothem• Interagencyprotocols• Crossdepartmentapproach–e.g.PHAworking
withDE• Localpoliticianscanhaveaverypositiveimpact
–theyshouldbegiventrainingtobeusedasapositiveimpact
Gaps:• ProblemswithSD1form• Needpostventiontrainingonhowtocopeand
interactinthesituationofasuicide–guidelinesforcommunitiestorespond
• Needtostretchthesupportofthefamilyliaisonofficertosupportfriendsandwidercommunity
• Needmoresupport‘downtheline’–who’sresponsibilityisthis?
• Communityresponseplan–problemsarisewhenotherindividualsinputthatresultsinadverseimpact
• Managingmediareporting–acknowledgededucatingeditorsetc.Doweneedtoregulatethismoretoincreaseindividualresponsibilityofnewspapersetc?Sensitivereportingbylocalmedia
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sectorstomeetandconnectwitheachother’sservicestopromotea‘joinedup’thinkingandpreventaserviceuserfallingthroughthe‘gaps’
• Essentialtobuildlinksacrossgaps.Acrossfamilieswecanseefromobjectivesthatcrossdepartmentalboundariesmustberemoved
• Needtobuildstructureandcapacityingroups–thisworksbetterthanamyriadofad-hocgroups
• Needto‘skillup’communities• Peoplebenefitfromfacetofaceinteractions–need
moreofthese• Oftengapsinreferralpathways• Ifpeoplearetraineduptheymaybemoreaware
ofthesignstoimpactthe70%whodonotaccessservices
• NeedaTier1servicetoholdontopeopleinneedbeforereferralstoawaitinglist–canhelpde-escalateasituation(Take5approach)
• Difficultyofknowingtheprocessandservicesthatareavailable–needmoreconnectivityandawareness
• Fearofsomeworkingwith/talkingtopeoplewhoaresuicidal
• Needforaflowcharttomaketheprocessmoretransparent
• Legislationreparacetamolsaleshadhelped–deathsbyparacetamoldownasaresult–however–storesarebreakingthis,andpeoplearenowusingthismethodagain
PreventionEvent TrainingFramework
isrequired• Someissuesregardingconsistencyofthe
SD1couldbeaddressed–thiscanleadtoanuncoordinatedresponsewithanumberofpeople/officersarriving
• Socialmedia–pressuresitaddstoyoungpeople-parentsandadultsneedadditionalknowledgeandskills
• De-briefingafterasuicideisveryimportantforfamilyandwider.Moreofthiscouldbedone
• Thereisno‘onesizefitsall’–needbespokeresponsebasedontheindividual
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Whatworkswell:• Communitygroupssuchas‘OfftheStreets’and
searchandrescuegroups• Workinschools,suchas‘hopeandresilience’
programmes• Currentmentalhealthcampaign‘stickersonheads’• SHIP,Lifeline,Childline• Goodcommunicationbetweenschoolsand
community• Peoplehavingavoice–hearingfromfamiliesand
survivors• Communitytraining,e.g.‘mindset’andmental
healthfirstaid• TakeFivecampaign• Attitudes–lesshierarchy,morecollaboration• Reducedstigmaamongstyoungpeople• Communitydevelopmentpartnerships• Peersupport–SchoolforHope–modelofpractice
whichhasbeenevaluated–TeachingHopetheory
Gaps:• Mentalhealtheducationneedstobeapartofthe
curriculum• Allsectorsneedtoco-ordinatesupport/
programmes–education,health,communityandvoluntary
• Mediacampaignsaroundsuicideverylowcomparedtothoseonroaddeathswhichareveryimpactful
• Betterconnectionsandcommunicationrequired–shouldnotdifferineachTrustarea
• Needtomakecommunitiesmoreresilientorabletorespondwhentheyseeearlywarningsignsandensurecommunitieshaveinformationavailableforearlysignpostingevenbeforecontactwith
PreventionEvent
• Treatment/interventionneedstobelonger• Wholepopulationapproachisneeded–soyou
donothavetogothroughawhole‘procedure’e.g.schoolsknowingwhattodo,taxidrivertrainingforASIST
• Cantrainingframeworkbebuiltaroundtheco-morbidityissuee.g.alcohol,self-harmetc
• TrainingforGPsrementalhealth/ASIST–thisissupposedtohappenalreadyanddoesn’t–shouldtrainingfor‘firstpointofcontactstaff’e.g.receptionbebuiltintotrainingdays
• Schools–workputinshouldbeproactiveandresponsive–earlyintervention
• Needmoreworkonresiliencebuildingandcopingstrategies
• Agreementthatmixedmethodsareneededforlearning
• Needstobeaclearstructure/mapofwhoneedswhattraining
• Amenuofapproachestosupportindividualscouldwork
• Moreunderstandingofsocialmediarequired• Step3–enhancingknowledgeandskills.If
thehelpdoesn’texist,youcan’trefer.Crisisinterventionhappens,butinsomecasesweekslater.Reinforcesmessagethatnoonecares.Someoneinphysicalcrisiswouldneverhavetowaitsolongforhelp–shouldbetreatedlikeanymedicaldisorder.
• Fundingcanbepulled,andinterventionthensuffers
• Ifprofessionalhelpisnotavailable,thenthetrainingframeworkwillnotwork
• Peopleindistressneedhumaninteraction• Postventiontrainingneedstobeaddressed.First
respondersareahugeriskgroupfromsuicide
TrainingFramework
• (Onegroupnoteddisappointmentthattherewasnodiscussiononintervention,inlightoftheaims(10%reduction)
Whatworkswell:• Communication–multi-agencyapproachforall
situations• One-personapproachtothemainpointofcontact• BestpracticeinNWexistsandlearningisshared
towiderregions(CRP)• Communityresponseplansworkwellposta
suicidecluster
Gaps:• Supportonlyforimmediatefamily,notenoughfor
extendedfamily• Therapeuticsupportnotlongenough–only6
sessions.• Followupatinterimperiodsfollowingthedeath–
3-6months,upto1-2years• Offersupportimmediatelyafteradeath–thereare
currentlypossibledifferencesinhowthesupportisoffered
• Medicalmodel–GPs/prescriptions–doesnotwork
• Communitycapacitybuilding–CRPextendedinawaytosingledeaths
• Needautomatichelpforthosewhoareimpactedonbysuicide–somePSNIstaffrespondacoupleofweekslaterandsomedon’t–allmembersoffamilyshouldbesupported
• Aguidecouldbeleftforpeopleto‘optout’ofthesupportpackageratherthanhavingto‘optin’
• CoronerinAustraliatakesovertooffersupportandthishadbeentriedinNIbutcurrentlynotavailable–itisavailablewhensomeonediesbycar
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statutoryservices• Needtoeducateandpromoteservices(e.g.ASIST
training)andpromotehowtoaccesssupporteasily• Earlyinterventionneeded–primaryschooltoolsfor
childrentotalke.g.re:ACEsetc/resiliencebuilding–equipschoolstorespond/communitiestorespondatearliestpointe.g.aHUBwhereapersoncan‘walkinandtalk’
• Crisisinterventionshouldberesidential• Waitinglistsforservicesaretoolong(sometimes
13weeks)• Schoolsandcommunitiesaredisjointed–needto
beawareofearlysigns• Accesstoappropriateservices• Servicestoo‘crisisfocused’• Accesstoinformation• Toomanypeoplefallingthroughthesystem’s
‘cracks’• Lackoffunding• BorderlinePersonalityDisorder–stigma,awareness
raising,familysupport,understanding• Firstrespondersneedtobeabletode-briefkey
workers–thereiscurrentlyadisconnectunlessthishappens–fullstorynotheard.Suicideideation/psychosiscancutlinesofcommunication–somesortofrevisedconsentprocessisneeded
• Wehavefailedtoaddressthefactthatyoungpeoplehaveverypoorverbalcommunicationskills.Theywilltextbeforetheytalk–needtolookatmodalityoftalkingaboutsuicide–appneedstobedevelopedwhereyoungpeoplecanaccesscounsellorsviatext.Counsellingisoftenanobstaclewhenitisfacetoface.Samaritansdidhaveanappbutbecauseofdataissuesithadtobepulled.‘Redbutton’tobebuiltinifsuicideisimminent
butareexpectedtoworkwiththosebereavedbysuicide–propertrainingneedstobeidentifiedandimplemented–mustbeevidence-based
accidentbutnotbysuicide• InWHSCTtherearesuicideliaisonofficerswho
canliaisewithfamilymemberstooffersupport–thisisthenpassedtoGPwithin24hours.Sometimesfamiliesarenotreadywhensupportisofferedbutmayneedthislater.Thisneedstobeafacetofacefollowupbyatrainedperson–e.g.fromowncommunity,asstandard
• Worrythattherearesuicideswhicharenotrecordedassuicides/suiciderelated–somesupport‘missed’
• Worryof‘rippleeffect’inwidercommunity–increasedrisk–CRPactivated–importanceofmakingsureaCRPisinplace–reallyimportanttoensurepositiveoutcomesatlocallevels
• Acommunitysafespace• Needforacommunitymentalhealthchampion• Needmorepublicunderstandingof‘behindthe
scenes’work• Needmorepromotionofself-care/support• Needforequalsupportforbereavedparentsand
siblings• Needforapracticalsimplestepguidetohelp
familiesfollowingasuicide–includinglong-termhelp
• ‘Doesanythingwork’(mumbereavedbysuicide)–resourcesnotthere,lotsofleaflets,lotsofcallsbutnofundingandwaitinglistsfull
• Negativefeedbackofmedical/nursingfrontlinestaff
• MorefundingneededforfamiliesandPTSD–fundamentalneedsarenotbeingmetwithlongwaitingtimesforcounselling
• Notallofthecommunityandvoluntarysectorsisqualityassured–dotheymeetstandards?
• CAMHSoverloadedasaserviceandcan’tcope–
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saturationisunethical• Needto‘makeitoknottobeok’• Outdatedthinkingincommunitiesneedstobe
addressed• Bereavedmum’sexample–‘3monthsforchildren
tobeseenbyservicespostsister’ssuicide–fearaboutspeakingaboutsuicideopenlyafterwards’
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Whatworkswell:• PartnershipApproach(CommunityandVoluntary)• Multi-agencysupportserviceintheNorthernArea• NetworksinNorthernArea• YoungPersonsSupportProject–PHAFunded,
EducationAuthority• NorthernAreaPLIG–connectingand
communication• EmotionalWellbeingHubs• BereavedbySuicideServices–PHAFundede.g.
Barnardo’s,• Strongemphasisoncommunitydevelopment
approach• Trainingavailable–ASIST,MentalHealthFirstAid
andBereavementTraining• Inclusivelocalandruraleventsandspecifically
targetingmen.• Localintelligenceinformedserviceprovision.• SuicidePreventionDevelopmentOfficers(SPDO’s)
inNorthernArea• Youngmen’sproject• Specific/targetedinterventions• SD1FormsfromPSNI–usedtoinformcommunity
network• Nurturingprogrammesinschools• Navigatorprogramme• Youthservice–specificprogrammes• Streetpastors• Earlyinterventions–acrossdepartmental
approach• Supportivefamilyapproach–supportingfamilies/
copingskills• Opportunitiesthatbringyoungpeopletogether
underacommonagendaandgettingkeymessagesoutthere.
• Notallagreedonasteppedapproach• ZeroSuicideAllianceToolkitTraining• Needtouseevidencebasestoinformtraining• GapintrainingforGPsandGPReceptionist• Trainingfor“gatekeepers”–trainthosewhohave
access–makethetrainingworkforthemalthoughrecognitionthateveryoneofusaregatekeepers–makeeverycontactcount
• Thereneedstobe“Increasedunderstandingofsuicidalbehaviour,itscausesandprevalenceandprovidearangeofresponses,includingguidanceandfirstaidtokeepsafetheindividualexperiencingcrisis”atStep1–raisingcommunityawarenessaroundsuicide
• Weneedtoencouragefamiliestotalkaboutmentalhealthmore–yearsagoweavoidedtalkingaboutcancer–thebigC–mentalhealthneedstobepartofeverydaylanguagetoreducethestigma
• 72%ofthosedyingasaresultofsuicidehaveneverusedtheservicesavailable–weneedtoencouragemorepeopletocomeforward
• Weneedtogetinformationintoobviousplaces–solicitors,banks,funeraldirectors–theplaceswherepeoplegoafterthedeathofalovedoneorarelationshipbreakdown
• Weneedtolookatolderpeopleandruralisolationtoo–howdoweinformthem?
• Schools–needtoincludenurturingprogrammesastraininginschools
• Thereisaneedforapubliccampaignaboutsuicide–itneedstobeeverywhere–likewehavedonepreviouslywithHIVandSmokinge.g.“MindYourHead”campaign
• Howdowecollectevidencethatthetrainingiseffective?
Whatworkswell:• SuicidePreventionOfficersx3(PHAFunded)• DanielleGallagherSuicideSupportCo-ordinator• CRUSE–bereavementcounsellingincludes
bereavementbysuicide• Communityresponseplans–supportfor
communitiespostvention• BereavementSupport• SchoolsSupportSystem• Intergenerationalwork• Localness–localneedandlocaltouch• Existinglinks–ChildBereavementServicethrough
Baranardos• Areaveryinformedandworkingwidelywith
familiesandSPDO’sontheground–socialworkersandadviceline
• PSNI–LPT’sresponseteamstrainedinbereavementservicesandprocess–leafletsleft,andpackshandedoutnow
• Consistency–PSNIBestPractice,regionalsharingofapproachesaroundPSNI/SD1deaths
• Goodcommunicationprocesses–SPDO’salongsideSD1’sbringingcommunityintelligencesystemsinplaceandworking
• SuicideSupportandInformationService–knowledgeofsuicideinthearea
• InNorthernTrustthereisanannualcommemorationservicetorememberallthoselostasaresultofsuicide
Gaps:• Lackofawarenessofsupportavailableand
thereforepeoplebeingsignpostedincorrectly.• SD1–doesthattriggersupportbeingmade
available–isitattherighttime?• EducatingGPStopromotewheretosignpost
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Gaps:• GPawarenessofservicesavailableinthe
community• CounsellingservicesneedtobeavailableinGPs
surgeries• SustainabilityofPHAfundedposts/servicesand
longer-termfunding• CrossDept.communicationandrolloutofProtect
Life2• Lackofknowledgeaboutwhatishappening• Whattoolsarebeingusedtomeasureimpact?• Earlyintervention• Lackofhospitalsupport–mostvulnerablearelet
go• Moreco-ordinationofservicesneededtoavoid
whatwasdescribedaspeoplebeingputonacarouseliftheyarepresentingwithmultipleissuesandarenotalwaysreferredaccordingtotheirpriorityneeds.
• LackofconsistencyacrossNI–geographicalpostcodelottery.
• 20-50-year-oldmales• Crisis–peoplearenotcomingforward• Workplacehelpandsupport• Trainingandserviceevaluations• Knowledgeofwheretheservicesare• Howtoengagehardtoreach• Morecampaignsneedede.g.mask• Ruralisolation–especiallyolderpeople• MentalHealthAppshouldbeavailablefor
children/youngerpeople• Teachersneedtobeeducatedinmentalhealthand
encouragechildrentotalkabouttheirfeelings.• Counsellingneedstobeavailableinschools• WeneedtobuildresilienceinouryoungerpeopleWhatworkswell:
• Thetrainingneedstobeprogressive–notrigid–moreflexibleapproach
• Needawidespreadcampaigntoremovethestigmasurroundingmentalhealthandsuicide
• Blendingtrainingavailablewhichisgood• Needtoincludesomebasiclevelresiliencetraining
andpersonaldevelopmenttrainingsothatpeoplehaveabetterunderstandingofthemselvesandtheirownwellbeing
• LookatUniversityofManchesterSuicideBereavementTraining
peopleto.• Needmorepeersupport,livedexperienceof
suicidemakesagoodpeersupportworker,howeveritisveryimportantthattheyaretrainedandregulatedto“donoharm”.
• Problemwithfollowupsforpeopleincrisis–responsibilityoffamily/carer/communitytokeeplovedonesafe
• PHAtosharecasestudiesandacrossborderexperiencesalso
• Raisingawarenessofworkshops• PostventionSupportGroups• Thereneedstobeatopupserviceoradrop-in
serviceavailableas8weekscounsellingsupportisveryshort
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• Whenparentscometogroupmeetingstheyfeelsupported–reducessenseofisolation
• Traininghasbeenverybeneficial.Hashelpedespeciallyingroupsdealingwithtransissues
• SupportinfrastructureforSAILisworkingwellforparentsthroughoutNI
• Providingnon-judgementalapproachisveryimportant
• Therearemoregroupstryingtogetthemessageout
• PIPs• Non-judgementalapproach• Reducingstigma• Walk-inservices• Men/womenspecificprogrammes• Involvementinnon-mentalhealth/suicide
preventionbrandedschemes/interventionsareextremelyvaluable–e.g.Men’sShed,sportsgroupsetc
• ZCardsreallyuseful• Counselling–needearlyintroduction• Employershelpingwithcounselling• Needinitiativestohelpcombatisolationandstress
Gaps:• GPs/teaching/nursingstaffneedtrainingontrans
issuesandhowtheseimpactonmentalhealth• Notenoughfundingforcounselling• NeedforstabilityofPHAworkforceinarea• Professionaltrainingneeded• Lifelinechangeincriteria–wheredopeople
mid-crisisgoforsupport?Inappropriatefocusonprocessnotpersoninrecentmonths
• Thelinkbetweenself-harm/suicideandalcoholneedsconsidered
• WaitinglisttoohighforGPon-sitecounselling
• Trainingneedshavechangedintimebetweenoldstrategylaunch–traininghashadtoadapt.HavegoodevaluationfeedbackfromPHAtoadapttraining
• Frustrationthatmostpopularcourseisoftenmisrepresentedinevaluationfeedback.ChangingstaffinPHAcanimpactonrelationships(maternityleaveetc)
• Trainingisalifelineforruralcommunities–flexibilitytogettrainedattheweekendisimportant.Needtohavetrainedtaxidrivers,hairdressersetc
• Accesstotrainingveryimportant–notjusttierone
• GPsneedmore‘human’basictraining–medicalmodelhascloudedtheirperspective
• Concernthatcertaingroupswouldbeboxedoffagainstcertain‘steps’oftraining
• Sometimespolicyandprocedureforprofessionalsdoesnotalignwithtrainingoutcomes
• Steponeisgivinginformation–thisisnotactuallytraining
• Trainingneedstobeintegratedwithpolicyandpractice.Candoallthetrainingbutpeoplecan’tchangewhattheydo(governance,practiceetc)
• ThetrainingthatisdeliveredundercontractfromPHAetcisonlypartofwhatisneeded.Todotherestisveryexpensivetoprovideresourcesandrecoupcosts.PHAneedtoensurethatrecommendedprogrammesareaffordableoutsideofthecapacitythattheyarefunded–i.e.wherecommunityandvoluntarygroupsneedtosourcefundingthemselves
• Traininglevel1-2/3isgood• Strategyoutcomesultimatelytooheavilyrelianton
volunteers–doesn’tacknowledgethis
Whatworkswell:• PSNIhaveagreattraininginplacenow• NHSCThasbereavementcoordinatorswhichis
areallygoodmodel.ThisisnotalwaysavailableinotherTrusts–itisawell-managedservicewithresources–thisisanimportantresource
• ServiceprovidersinNHSCTareameetregularlyinapeersupportforumtobuildrelationships–thisworksreallywellandbuildstrust
• Lifelineworkedwellbeforethresholdsandruleschanged
• GPon-sitecounsellingworkswellbutnotenoughresourcetoflourish
• EAinsomeareashaveabusoropenedupcommunity/youthcentres
• WHSCTBereavementSupportServiceandBarnardo’sChildren’sServiceprovidequalitypostventionsupportandhavegoodrelationshipswithcommunitygroupsandclergytoofferopportunitytolinktosupportatdifferenttimes
• ‘BereavedbySuicide’basedinHolywellareagreatgroup
Gaps:• Confusionaroundaccesstoservices–first
respondershouldknowthisfromthebeginning.• Familiescanbetootraumatisedatthetimeto
discusssupport• SHIPprocesshasmadeself-harmsupportmore
difficulttoaccess–aregressiveservice• 2-cardstoodifficulttoaccess• Whyisitnotpossibletorollthingsoutacross
differentTrusts?ShouldbealevelofconsistencyacrossTrustareasinservicedelivery
• ServiceprovidersinNHSCTareameetregularlyinapeersupportforumtobuildrelationships–this
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23.3.18ANTRIM
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services• Emotionalwellbeinghadpotentialbut
inconsistentlyfunded• Somelocalisedexamplesofreallyaccessible
communityservicesbutunder-resourcedandnotrecognised/known–e.g.safeplacetobeme
• Sessioncounsellingmodelisnotusefulforsuicideandself-harminterventions
• Post-codelotteryforsomeservices• FamilytherapyinLifelineisbeingstopped• Politicslinkedtosomeorganisations• Moreactiveinvolvementofprofessionalbodies
tosupportcollectiveandconsistentpractice/outcomes
• Needformoreearlyintervention• Addressbenefits/moneyworries• Peoplehavenounderstandingofsignsand
symptomstolookfor• Introduceemployerreferralsystemtocounselling• Needtomakementalhealthdiscussionpartof
normallanguage• GPsneedtoincreasemedicationdoses• Theterm‘mentalhealth’isaproblem• Peoplesimplydonotknowwhatisoutthere• Pressureof‘makingendsmeet’• Needalocalcommunityfocusandaskcommunity
whattheyneed• Socialdeprivation–lackofcommunity–social
isolation–allproblems• Povertyandisolationareproblems–‘likeaspider’s
web’• Whatisthereforyoungermeniftheyarenot
involvedinGAAorsports?• Lifelinenumbershouldbeputintophones• Smallgrantsareimportanttofundsmallergroups
whichcanprovidelocallytailoredservices
• GPscouldbemoreincentivisedtoparticipateintrainingandmakereferrals
• Concernat7hourstimeframe–OCNrequire9hoursminimumforoneunit
• Agreewithonlineapproachtoimproveaccessibility
• Steppedmodeloptionsgivesarichnessandaccommodatesdifferentlearningpreferences
• SubsidisedtrainingforcounsellingincludingCPDtosupporthighercalibreofstaff–moneycanpreventgoodpeoplefromprogressing
• SignificantgainstobehadfromintegratingSPtrainingintoworkplacecurriculume.g.teachertraining,PSNItraining–shouldbearequirementinthehealthandsafety/induction
• Needtoensuretrauma-informedcareisincludedinframework• Needtoconsiderskillsrequiredtoworkwithpersonoverlongerterm–CBTandDBTistheevidencebase
• Supportneededfororganisationswhohavedevelopedtheirowntrainingtoroll-out–pilotandevaluatetobuildtheNIevidencebase
• NeedstobemoresupportforpeopletofindoutwhatIsavailable
• Trainingneedsmanagedsowholecommunitiesknowaboutit
• E-learningnotsuitableforall• Challengingrecapacity/hours• Requiresdualsupportapproachtoavoidisolation
forindividuals• Hastobeneedsbaseddependingonlevelof
supportrequiredandtodeterminehow• Needtobeappropriatelypitchedandmarketedto
avoidpeoplefeelingoutoftheirdepthandtofindthetrainingpathwaymostappropriatetothem
worksreallywellandbuildstrust• CriticalIncidentReviews–practitionersneedtobe
supportedinthatprocessespeciallyifindependentprovidersorincommunityandvoluntarysectors
• Emotionalimpactonstaffneedstobebettersupported
• Linksthroughpolice/carehubcanbeusefulinactivatinglocalisedsupporttofamilyandfriendsafterdeathandCRPs
• Lackofawarenessthatpostventionsupportexistsorthatitcanmakeadifference
• Needamorejoinedupapproache.g.CRUSEtrainingandotherproviderscancontributetopostventionagenda
• Therapeuticsupportisimportantforrescueworkersandvolunteers
• Issueofstigma–acknowledgementthatsomeprofessionalsarestillnotrecordingsuicide
• Needtobeabletoworkinpartnershipwellatcrucialtimes
• Servicesneedtogetbetteratusingsocialmediaatcriticaltimes/incidents
• GPsnottakingmoneyforGPcounsellingservice• Timelinenotlongenough–lackofempathy• Shouldbeanopt-outserviceratherthanopt-infor
supportpost-suicide• Considerationaroundattemptanddeathfivedays
later• Gapsinhowfamiliesarecommunicatedwith• Communicationneedstohappenwiththosewho
havebeenaffectedtoseehowservicescanbebettered
• Facetofacefollowupsneeded–supportingfamiliesmore–trainingforgroupsandvillagesetc
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• Equally,thereisaneedforneutraloptionsoutsidelocalcommunity
• Counsellingyoungpeoplethroughschoolsisveryimportant–bothPrimarySchoolandSecondarySchools–thisshouldbenormalforeveryoneandofferedtoeveryone
• Retainwhatisworking–thereisalotprovingeffectivereCommunityDevelopmentApproachonRMHandSPthroughnetworks,SPDDsandC+Vsector.Communityledworkispivotalinreducingriskfactors.Retainmoreengagementandinclusivityinallservices.Tobeawareofthiswhetheritistheirfocusornottohelpreduce
• Gapidentifiedoncrisisintervention–communitysupportandfamilysupport–needtoeducatepeoplemoreonsignsandsymptomsofMHfromearlyyears
• Needhubs–crisisresponse–notinA&E• Needforcommunityintelligence–connected
communityapproach• Gapinearlyintervention–moreresiliencework
needed,familysupportforpersonatrisk• Workplacehealthiskey–localruralconstruction
businessesneedtofocusonmentalhealthandwellbeing.Staffandcolleaguesneedtobeabletoidentifychangesinmen’shealthandinterestsandbeabletospotwhena‘man’hasnotbeenhisnormalselfsotobeabletosignposttorelevantservicesatanearlystage
• Hastobemandatoryforspecificgroupsofprofessionals–health,educationetc
• Onesizedoesnotfitall–somewillbenefitfromonlineapproach,othersonetoone,dual–anoutcomesapproachcouldpotentiallyfacilitatethis
• Co-facilitationoftrainersandthoseexperiencingmentalhealthissuesshouldbeconsidered–peersupport
• CommunitynavigatorneededinNHSCT–whoknowsabouttrainingandservices
• Agreewithwholepopulationtrainingbutneedtosupportpeopletofindoutwhatisavailable
• Howtodoiteffectively–needtomanageitsothatcommunitiesknowaboutit
• Coursesdrawnfromlivedexperience–workingalongsidefacilitators–greatlearningexperience
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Whatworkswell:• Self-care• Walkinservices• Whenwaitinglistsarenottoolong• Immediate‘safe-plans’andde-escalation• Connectionsandawarenessraising• Keyrings,flyers,‘sport’• Networkingandpartnershipatlocallevel• Sharinginformationandbringingcommunities
together• Postcodefinderofservicesavailable• Training–ASIST,Safetalk,MentalHealthFirstAid• Earlyinterventionatcommunitylevel• FamilysupportHubsthroughreferrals• Sign-postingandongoingsupport• Crossdepartmentalworkingi.e.healthand
education• Peersupport(normalisingandchampioning)• Awarenessraising–resilience/stresscontrol
Gaps:• Traininginlocalcommunities• Targetaudiencesneedtobewider• Communitysupportworkerneedstobepresentin
allsuicidepreventiontraining• Co-ordinationbetweenorganisationsneeded• Informationneedssharedfromstatutorybodies• Needstobestrongerreferralpathways–from
statutorytocommunityforpeopleinsituationalcrisisandemotionaldistress
• Hubsarebeingover-burdened• Lackofconnectionwithcausesofsuicide• LackofconnectionbetweenGovernment
departments• Betterunderstandingrequiredforcurrentservices• Gaps/lackofservicesforpeopleincrisis–problem
• Agreementinprinciplewithsteppedapproach• Widerframeworkontrainingshouldbeavailable
(onPHAwebsiteperhaps)• Agreewithmethodsoflearningbutfeelmore
explanationnecessary• Structuredapproachisimportant• Needtoimproveaccessibilityofonlinetraining–
limitedknowledgeofwhatisthere• Aircautiononover-relianceofonlinetraining• Positivetohaveaframeworkbutimportantitis
tailoredanddesignedtotargetthoseinneed• Takestockofwhatisalreadyavailable• Concernsaroundlackoftraininginsuicide
preventionforGPs–thisiscritical–50%targetshouldbe100%forGPs
• The‘everydayperson’isnotunderstandingsuicideprevention/training
• Lackof‘livedexperience’reflectedinframework• Needtoeducatepeopletohelpthemknowwhen
youneedhelpandwhenalovedoneneedshelp–equipsindividualsandcarerstoknowwhattoexpect
• BelfastRecoveryCollege–goodmodel• For‘everydaypeople’thedurationofprogrammes
requiredneedstobelonger• Needstobeflexibilityaroundtimings• Someprogrammeslongerthan7hours• Withinsteps,targetgroupsandlocationsshould
beidentified• Useroleofpeertrainers• Step1and2needtobeaccessibleandincreased
focusonpopulationawarenesse.g.schools
• EnsuretrainersarecompetentinadherencewithPHAregulations
• Trainerscouldbeacommunityresource
Whatworkswell:• Familysupportgroups–NSEWBelfast• SD1processisagoodstartingpoint• Psycho-educationforfamilies• Flexibilitysessions• Creativegroups–counselling,complementary
therapy• Localcommunitylevelsupportisgood–examples
inEastBelfast–localco-ordinatinggroups• Counsellingservices• Talkingtherapies–onself-harm,bereavement,
crisisresponse
Gaps:• Needstobeacentralpointforinformation• Successstoriespositive• Jointrespectandmotivationneededacrossall
sectors• GPsneedtoknowwhatservicesareavailable• PeopleingroupexpressinghowLifelinehasnot
helped–needpracticalface-to-facesupport• Needdrop-inservicesbuthowtomanagethe
volumeofpeopleattending–veryhighdemand• Peopleslipthroughservices–needsomeoneto
listen• Appointmentsandwaitinglistsareaproblem• Differentservicesindifferentareas• Needstobea‘menuofservices’• Theremustbeanalternativetothepolicebeing
thefirstemergencyresponse–whataboutanambulanceinstead–thenegativeperceptionofpolicelandingatthedoor
• Crisisteamsareunder-resourced• Greaterroleforcommunitytoprovide24-hour
supportandemergencyresponseinadrop-insetting
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spreadingwiderthanBelfast• Betterconnectivityrequiredbetweenservices• LackofadultsafeguardingpoliciesinGovernment
departments–i.e.DepartmentforCommunities(benefitsetc)
• Needforbettersignpostingandongoingsupport• Needmoreinvestmentintomoredeprivedareas
andprevention• Morepublicgeneralawareness/trainingneeded• Youngpeopledon’thaveunderstanding• Familiessupport–understandingemotionsin
familyprogrammesisimportant• Lackoffunding• Therearemoreagenciesthatsupportfamiliesafter
suicidethanpreventionagencies• Needstobemindfulnessinschools• Needtoaddressthe‘toxicenvironments’e.g.
school,inpatientunitwhereothersinfluenceindividuals
• Relationshipbetweenclient/carerandserviceiscritical
• Accessissuestospecialistservicesandstatutorysectorprofessionalsknowingabouttheservicesandtheiraccessroutes
• CommunityReponsesPlans–couldtheremitoftheresponseplanbewidenedtosupportthosewhoareaffectedbyanindividual’ssuicideattempt
• Concernsoveradditionalriskfactorswhichyoungpeoplemaybeexposedtoincaresettingse.g.Beechcroft.Youngpeoplearebeingofferedalcohol,drugs,beingshownpicturesofself-harmbyotherinpatients.Concentrationofverytroubledpeopleinasetting
• Importanceofbeingheardandnotbeingpushedfrompillartopost
• Needtoencourage‘help-seeking’behaviour
• Evaluationneedstoberobust• NeedaccessibilityrightacrossBelfast• Steppedapproachwouldhavebroaderimpactat
correctlevelforindividualneeds• Needstobea‘blendedapproach’–mixofface-to-
faceande-learning• Face-to-faceworkhelpstonormaliseexperience• Howwilltheimpactoftrainingbemeasured?• Ifneedisidentified,howwillsupportbeoffered?• Trainingandprevention–emotionalregulation/
resiliencegroupworkinlocalcommunities/targetedareas
• PHAtrainingisagreatsourceofCPDforindividualse.g.trainedintheoriesofcounsellingtoaddtotheirskillsandknowledgethroughattendingprogrammeoftrainingdeliveredbyPHA
• ConnectingServiceProvidersandTrainingAgencytocometogethertoensureservicesandtrainingarematched
• Familymembers/memberbeofferedtrainingopportunity–(earlycrisisstage)–communitylevel.
• Training–facetofaceworksbest–morecoursesandmoreregular
• Ensurestrategydocumentallowsforinclusionofnew/freshinitiatives–(seentobeworking)–ongoingprocess
• DraftTrainingFramework–Thereisnopointinhelpingpeopletolearnhowtosignpostthosewithmentalhealthproblemsontoprofessionalhelp,ifthathelpdoesnotexist.Theservicesarenotthere.
• TrainingFramework–ResilienceisonlymentionedinStep1–itneedstobeembeddedthroughoutallsteps.Itwillrequirefacetofacesupporttodeliver,ase-learningwillhavelimitationsinbuilding
• Doweknowwhathasworkedwell,orhaveanyfeedbackfromserviceusers?
• Manyservices,butpeopledonotknowhowtoaccessthemorgetreferrals
• Needforholisticapproach• Couldwehavecommunityworkers/healthand
wellbeingstaffbeingstaffedwithinGPstoreferto• GPsneedtoworkmorewithstatutory
organisations• SD1s–verycoldandclinicalthattheperson’s
nameistakenoutandtheyarejustreferredtobyaletter
• Supportingclientswhohavebeende-escalatedwhiletheywaittobepickedupforspecificintervention–giventherearewaitinglists.Toensurethatthisclientunderstandswhensupportwillbeinplace/wherefrometcandismorelikelytocontinuetoengage
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• Peopleneedtoknowwheretogo• ToomuchpressureonGPsandstaff• “Stigma“Mental”Illnessisabarriertoaccessing
service.NewTerminology-“Emotional/PsychologicalWellbeing”-usepersonfriendlyterms.Mentalisnotfriendly–oldstigma–mentalinstitutions–mad.”
• “Jointworking–duetolackofresources,MentalHealthServicescantakeservicesforgrantedandassumetheywillprovideongoingsupportwhentheserviceistemporarye.g.mentalhealthclientintemporaryaccommodationuptomax.of2years.Attemptingtodeliverplannedmoveonbuttoldnowhereforclienttogo.Besttoevictandmakethemhomelessagain.Thisfliesinthefaceofwhatwedoandputsclientatsignificantrisk”
• CommunityMentalHealthChampion–pointofcontactforaccesstoinformation,assisttrainerandco-ordinatecommunityresponse
• Australianmodel–needtobuildemotionalresilienceinchildren.Family/parentalseparationiskey
• Earlyinterventionholisticapproachiskeye.g.pre-birthinhospitals,schools
resilienceskills• Costanalysisforcommunitysector.“Icommend
allthoseinvolvedinthedevelopmentofcommunity/statutorypartnershipinthedeliveryofservicesandtrainingbeingdeliveredacrosstheareatodatesincethedevelopmentoftheWSSIGanddeliveryofthestrategy”.
• Accesstotraining–meetupatschools(mothersdropofftheirchildren),youthclubs,churches,libraries,communitycentres.Askpeoplewhatsuitsthem,offeracrechefacility,offeraprimersessionthenfollowupwithshortcourses/extendedcourses
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Whatworkswell:• Moresuicideawarenessandmanagementtraining
hasbeenavailableforthewholecommunity–bothprofessionalandnon-professional
• Bereavedbysuicidegroupsareveryvalued• Thereismorecross-sectorworkingtoprovide
supportlocally–e.g.workdonetosupportschoolswhohaveexperiencedthesuicideofapupil
• Joined/co-workingtogetherasacommunity• Earlyintervention• Communication• Enforcinggoodmentalhealth• Training• Awareness• Follow-ons• Progressioninservices• Connectingpositivelywithcommunitygroups• Take5model• Lifelineworkedwellpreviously(seebelow)• Wrap-aroundsupportworkswellwhenavailable• FamilysupportHubsandmentalhealthHubs• Outreachservices
Gaps:• Notenoughpreventionservices–limited–not
consistentacrossBelfast• Awarenessraisingisstillnotgettingkeymessages
out–stillaneedformorehonestconversations–stillfear/stillstigma
• Wherehasthe‘MindYourHead’campaigngone?Needssustainedandrefreshed–asmuchasDOEdowithdrinkdriving
• Carezonepilotshowinggaps,especiallyindisadvantagedareas–mapit–lotsofservicesbutit’saboutjoiningthemupandinvolvingcommunities–bringingthemtogetherwithyou
• Uncertaintyaroundtenderingfortraining–isthisalongsideotherservices?
• Notallworkis‘training’–awarenessraisingoftendonethroughrelationshipbuilding
• Concernsarounde-learning–thiscouldbeseenas‘boxed’–anorganisationapplyingtorunoneparticulartypeoftrainingwhereasthisisneverstand-alone
• E-learningnotsuitableforeveryone• Trainingframeworkcan’tbeblackandwhite• Holisticapproachneeded• Communitypharmacistsareanunder-utilised
resource• Steppedapproach‘therightwaytogo’to
safeguard• Needstobesupportbuiltinevenatstep1• Startwithawarenessthenbuildonforthosethat
need/wantit• Targetgroupsneedidentifiedbysettingstoo• Thinkoutsidetheboxretargetingforbars/clubs• Ensurefollow-up–checkifpeoplehaveused
training• Lessfocusneededonmonitoring,morefocuson
impact(step1)• Potentialforbursaryschemeforspecialist,in-
depthtraining• Arewegoingtodefine/decidewhofrontlinestaff
are?–teachers,GPsetc.• Needmoreemphasisontheimportanceof
listening• Involvepeople,parentsandfamiliesinshaping
training–thosewithreal-lifeexperiences–theyseemmissing
• Understandthatconditionsdifferfrompersontoperson
• Learnfromtragediesandmistakes
Whatworkswell:• Communityresponses–developedbypeople,
usingcommunityintelligence• Signposting–SOS,counselling,specialistservices• Muchvalueinlocalknowledge• SD1–somegoodimprovements
Gaps:• WhilegoodchangesmadetoSD1–wouldrather
havean‘opt-out’ratherthan‘opt-in’asfamiliesareshockedanddistraughtattimeoffirstcontactwithpoliceofficers
• SD1processincludingroles,follow-up,linkagesneedlookedat–whoisbest?Whenisbest?Howoftendoyouoffer?
• SD1processtoolongandcold.Whattoexpect/howlongwillittakeneedstobeclearer
• Needstobemoreawarenessraisingofservices• Moreeducationneededinschoolsonself-harm
andsuicide• Mustbeappropriatetimingtogetintoservicesfor
specificneedsi.e.suicidalideationvsbereavement• Lackofcareforcarers• Communitybasedservicesworkmorein
disadvantagedareas–theyseekyououttogiveorlinkyouinwithsupport.Lesscommunitygroupsinmiddleclassareas–lessawareofsupport
• Awarenessofsupportavailableisanongoingissue• Landscapeisconstantlychangingduetofunding
cycles• Drugsandalcohol–biggap–notfundedfor
postventionbereavementsupport• Moretalkingtherapiesneeded–especiallyinrural
areas• Targetedsupporttotackleruralisolation
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andempoweringthem• LackofconnectionfromGPreferralstoservices–
dotheynothavetheinformation,ortheinterest?GPawareness-raisingshouldbemandatory
• Peopleinthecommunityshouldbeused–shop-keepers,taxidrivers,barworkers,barbers,hairdressers
• Youthservices–feeltheymaynotberesourcedenough
• City-wideservicesgetfunding,localservicesdon’tbutknowtheyoungpeopleandknowthecontextandknowthearea
• 6weekscounsellingisnowherenearlongenough–needstobeflexible–respondtoindividual’sneedstofindrootcauses(somewhicharepersonalbutsomewhichwillbesocietal)
• Lookattheimpactofwelfarereform• Specialisedresourcesneededindrugsandalcohol
–dualdiagnosis–combinedmentalhealthanddrugsandalcoholneedsissues
• Familyviews/opinions/experienceisvital–needtobeheardandlistenedtoforinsight
• Negativityaroundmentalhealth• Wronginformationbeinggivenout
• Needpostersinallcommunitycentres• Needformoresignposting• NeedformentalhealthsupportHUBs• MoreprovisionneededforLBGTgroupsand
especiallytransgenderwhoare25xmorelikelytoattemptsuicide
• Importanttobeabletotalkabouttheissue‘it’soknottobeok’
• Needforawalk-inservice• Needformorepositiveactivitiesincommunities• Needmoreresiliencebuilding• Needformoreintergenerationalwork
• Targetedresponserightacrossthehealthservicetohealthprofessionals
• Cascadingapproachspreadsknowledgebutnotenoughbeingdone
• Importantadditionaltrainingisdirectlyavailabletopeople
• Needtoempowerpeopletobemoreconfidentaboutsignposting,havingconversations,talkingtopeople
• E-learninggoodbutonlyonthelowlevel• Importanceofrefreshers–notjusta‘one-stop
shop’• Goodmechanismforequippingnon-professionals/
communitygroups• Themoregroupswhoaremadeaware,thebetter• Howdoesthesteppedapproachwork?Whatdoes
itactuallylooklike?• PSNIneedtoreceivetraining• “Innovation–lookatcreativeprogrammesout
there–theirapproachtoengagetheiraudience.Theyknowtheiraudience.Needaco-designedprogrammetoengage,connect,empower–capacity.Canleavelegacy”
• “Informationavailability–informationispower–professionalsdon’tnecessarilyknowsignpostingorarenottrainedinthoseareas.Theydon’talwayshavethetimeoremotionalwellbeingtodealwithverydifficultissues.Usevolunteerswhohavetheseskillsalready–usethemtoeducate/trainothersincommunities”
• Targetedresponsesneededtobuildresilienceinfamiliesandcommunities–especiallyvulnerablefamiliesandtheyoungchildren/peoplewinthosefamilieswhohavesufferedgreatly
• Finalityandstarkrealityofdeath–focusofhardhittingcampaign
• Familysupportservicesneededofferingpracticalsupport–e.g.bringingchildtoschool,linkingthemtotherightservicesattherighttime
• Needspecialisedservices,nottotalrelianceonmembersofthecommunity
• Don’tdismissimpactandimportanceofcommunityclassesatpostventionstage
• Barriersaroundthestigmaaroundsettingupapostventionsupportgroup
• Difficultiesconnectingminoritygroupswithcommunity
• Cross-referralprocessneedsimproved• Supportneedsofferedtosiblings,partnersand
childrenatSD1processSupportgroupscanproveveryusefulforindividuals;however,thegroupmaybemoreproductivewithsupporte.g.tohowitshouldrun
• Thepeoplewhoaregoingoutsearchingforavictimmaylookdistressedoncamera(CCTV)andthismaytakeresourcesawayfromthepeoplewhoareincrisis
Concerns:• “Howdoyoungpeoplebehaveonsocialmedia
whenafriendorrelativetakeshis/herlife?Doweknowenough?Issomethingbeingdonetoteachthemhowtomanagethat?Isthisagap?Irealiseitwouldbesensitive,challenging,difficulttogetrightbutit’snotgoingaway”
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• Gapsbeingfilledbynecessity–modelmustincludecommunitydevelopment
• Moreworkneededoncapacitybuilding–intergenerationalinparticular–lackofconnectionbetweensectors
• Needmoreteachersandparentsreachingout• Shouldbetargetingpeopleacrossbusinesses• Tenderingprocessmaymeansmallergroupsmiss
out• Waitingliststoolongduetohighdemand• Statutoryservicesarebeingfloodedbyrequest–
peopleincrisisbeingsignpostedbyGPtotheHub• TimeofGPappointmenttoservicetoolong• Lifelineworkedpreviouslybutshouldbeforpeople
indistress/vulnerableaswell• Wrap-aroundservicesnotalwaysavailable• Needmoreoutreachservices–especiallyinrural
areas• De-sensitisinginchurches–talkingopenlyis
important• Communitygroupsneedsupportedtoraise
awareness• Post-traumasupportneededforimmigrants
comingfromareasofwar–vulnerablegroupsneedidentifiedandtargetedforsupport
• The‘CardBeforeYouLeave’schemeforthosebeingdischargedfromhospitalafteraself-harmorsuicideattemptwasagoodideabutisnotusedacrosstheregion
• Lackofqualityspecialistmentalhealthassessmentandsupportoutofhours
• Lackofinformalsupportnetworkssuchas‘dropins’
• Longwaitinglistsforcounsellingandtherapy• MoresupportneededeitherbyGPsoratPrimary
Carelevel
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• Servicesneedtocometopeopleincrisisandnotexpectthemtotravellongdistances(atacost)toreceiveservices
• Lackoffamilyinvolvementandrecognitionoftheirrolesascarers,inidentifyingriskandcontributingtosharedcarepackagesandinvestigations/recommendationsforchange
• Thereneedstobeafocusonchangingourculturetobecomeamoreresilientonewhichembraceshealthierbehavioursandchoices.Weunderstandthatthisneedstobeginatschoolwherementalhealthshouldbecomepartofthecurriculum.CommunityPlanningprocesseshavebeenastartbutmuchmoreisneededintermsofsharingresponsibilityfordeliveringsupportasapackageacrossservicesinthecommunityandthisimpactshousing,poverty,educationaswellashealthandsocialcareservices.Withthegrowingrecognitionthatsuicideisnotaproblemfor‘Health’alone,thenmoneyneedstofollowandbesharedwhereserviceswillprovidethesupport.Servicesprovidinginterventionforsuicidepreventionshouldnotdiscriminateagainstusersofdrugsandalcohol.Suicidalityshouldbeseenasaprimaryproblem,notasecondarysymptomandserviceprovidingmentalhealthsupportinanysectorneedtostartdealingwithitinthisway
• Weshouldhaveresilienceaspartoftheeducationcurriculum
• Largeabsenceofonthegroundservices.Lifelineisaserviceweuseandrecommendonaweeklybasis.Sometimesourserviceusersdon’tcallitbutknowingitisthereisveryhelpful.Alternatively,theymaycallitseveralweeksafterbeingmadeawareofit
• “Difficultieswithyoungpeoplewithadditional
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needs,forexampleASDandpresentassuicidal–ensuringservicescanunderstandthebestwaystoengage/supporttheyoungpersonandthattheycantakeASDintoaccountwithoutbeingdismissive”
Concerns:• Howservicesarefundedisamajorconcern.The
communitywantstoseeservicesprovidedlocallybyproviderswhohaveaknowledgeoflocalcultureandlocalchallengesfaced.However,thetenderprocessdiscriminatesagainsttheCommunityandVoluntarysectorinprovidingtheseservicesinfavouroflargerorganisations.AsseenfromtherecentPublicPerceptionSurveycarriedoutbyNICVAin2017,therearehighlevelsofpublicuseandpublictrustinthissectortoprovidethesupportneeded.Continuingtoprovidesupportservicesonashort-termbasisresultsintheriskofadiminishedcapacitytofocusoncommunityneedsinastableandunderstoodway.
• “Howdoweengagethe70%ofpeoplenotknowntoservices?TheTypeApeoplewhokeepproblemsinternal,don’tshareandwillcarryouttheact.Needtobuildresilienceforpeople”
• “Linkstodrugsandalcoholcrucial–over50%ofpeoplewhohavetakentheirlifealsoconsumeddrugsandalcohol”
• “Widerdepartmentalsupport–anti-povertystrategyneededtoprevent–poorlivingenvironments,crime,poorhealthoutcomes,pooreducation,pooremploymentlevels–apppertaintocorrelatetopoormentalhealthandsuicide”
Whatworkswell:• Earlyresponse–peoplepresentingwithsuicide
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ideationtobeidentifiedquickly• Havingsomeonetoconnectwithwhatislocaland
accessible• Notshyingawayfromtoughconversationsand
situations• Earlyinterventioninschools–developing
emotionalresilience–needstobepartofthecurriculum
• Identifyingthoseatrisk–includingresearchingtrends,lookingathighriskgroupsandclusterareas
• Flexibilityinapproach• Tailoredservices• Evaluationandfeedbackfromserviceusersand
professionals–whatworks,whatdoesn’twork• Multi-agencyapproach–improvedcommunication
betweenPSNI,C+V,statutory
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• Improvedonwardreferrallinkageandsignpostingtoappropriateservices
• Activelisteningisagoodmodel–1:1basis• Lifeline• Easyforpractitionerstoidentifycounselling
services• Accessibleandtimelyservicesavailabletosupport
peopleincrisis• ActionMentalHealth• Raisingawarenessandbuildingresilience• SocialSupermarket–LisburnCityChurchFood
Bank–conversations• CAPcourses–17churches• SHIP–positiveandtimely• Mediacampaignstoreducestigmaandencourage
morepeopletocomeforward• MentalHealthHubs–increasedchanceofcorrect
service,timely,includingBMEgroups• Communityplanning–awarenessacrossall
organisationstodecideprioritiesforaction• FamilySupportHubs–forchildrenandyoung
people• Infantmentalhealthstrategy–focusonearly
intervention• Communityresponseplan–co-ordinated
approach–workedwellinLisburn/Ballynahinchinresponsetoclusters
• Interagencyprogrammesinschools–increaseknowledgeofservicesandaccesstothese(particularlydrop-in)
• Offeringawiderangeofservicesbeforepeoplereachsuicidalstage
• Acknowledgementofruralneeds–hubsgoodforsignposting/reachingout
• Regularsupportmeetingsarerequiredforprevention–peer-ledsupportispositive
• Steppedapproachtotraininggoodbutconcernswithregardstooverlapofexistingprovisione.g.RecoveryCollege,ASIST,MentalHealthFirstAid
• Mappingoftrainingwouldbeuseful–wouldassistsignposting
• Step1–infoavailablebutgettinggeneralpopulationtoaccessitcandifficult–peoplecanlackmotivationtodosoforvariousreasons
• Moreadvertisingrequiredoutside• Staffwellbeingsupportshouldbeinframework• Clinicalstaffneedtraining–isthisstep4orwhere
doesthissit?• Healthprofessionaltrainingisnotrecognisedin
themodel• Howcompatibleissteppedapproachtraining
beingofferedforBMEcommunities?• Peoplearebeingtrainedbutthen‘moveon’–
wherearetheynow?Howtokeeptrack?• Steppedapproachfitswellwithwhatisneededon
theground–allowsameasuredapproach• Freedomofchoice–e-learningforallstaff–
approachacrossthesectors• Developanappfortraining–toolneededtoassess
ifyouareeligibletogetonto‘nextlevel’• Agreedthattrainingmustberesponsiveandnot
simplya‘tickbox’exercise• Goodtoacknowledgedifferencesintrainingneeds• Goodthatyoucanstepupifneeded• Needtogetparityacrossstagesaccordingtoneed
–wouldn’tbe25%acrossall4• Step4–concernsarounde-learning(ASIST)• Fundingrestaffcaredependsonorganisationand
size• Trainingforallorganisationstosupportstaff
needed• PostPrimary/Primary-weneedtobeappropriate
Whatworkswell:• CommunityResponsePlans• Supportgroups• Counselling• Alternativetherapiese.g.Men’sShed• Practicalsupport• Supportfromfunders
Gaps:• Campaignsneedfollowupandwraparound
servicesoffered• Resourcesneedtobeuptodate• Bettergeneralawarenessofservicesavailable
neededsoaswheneventhappenspeoplearenot‘lost’
• Whatpracticalhelpcanbeofferedbycommunities?Simplemeasureslikecollectingchildrenfromschool,a‘societalapproach’needed/betterconnectedcommunities
• Children’srights–whatifaparentturnsdownsupport–whereisthechild’svoice?
• Nocarepathwayforthosewhoselovedonesdiebysuicideinhospital
• Take-uprateforsupportattimeofdeathisonly50%sopotentiallypeoplearenotbeingsupportedintheaftermathofasuicide
• CouldHSCTsuicidepreventionleadaskforconsentinsteadofithappeningatthescenewiththePSNI?
• ProfessorLouisAppleby–pilotprojectsinEngland–coronersonavoluntarybasisofferingserviceofofferingsupporttofamily–FamilyLiaisonOfficer’sroleinmakingthiswider
• PSNIseekingconsentatlaterstage(10dayspost)togivefamilytimetoacknowledge
• Interpretersareveryrestrictedinwhattheycando
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• ActionMentalHealth
Gaps:• Hair-dressers/taxidriversoftenneedguidanceand
preparationonwheretosignpostpeoplethatneedurgentsupport
• NeedconsistencyacrosslocalitiesinNI–inconsistencycanleadtoincreaseinanxiety
• WorkinEmergencyDepartmentshashugepotential–issuesaroundhowwellstaffaretrained
• Canpresentwhenworkinginotherareas–e.g.smokingcessationworkthenpresentedwithsuicideideation
• Socialmediaisabigchallengeforyoungpeople• ShouldbeRecoveryCollegesineachTrust• Needcloserworkingacrossthematicarease.g.
drugsandalcohol,addiction• Tooquicktomovepeopleonaswearefearfulof
situationornotskilled/trainedenoughtodealwithsituation
• Notenoughbeingdoneformiddle-agedmeninSEHSCTarea–statshighlightingthisgroup
• Howdowecommunicateandshareinformationforserviceusersthatmovearoundanumberofservices–betweenCommunityandVoluntarysectorandstatutorysector
• InformationonservicesneedstobeavailablewhenpeopleleaveEmergencyDepartment–peoplecanleavewithverylittlesupport
• Informationneedstobelocationspecific•Tenderingprocessandaccesstofundinghasanegativeimpactonlocal/smallerprojects
• Informationsharingneedstobebetter• CBYLispositive,butisimplementeddifferentlyin
eachTrust
toage/stage• Capacity/numbers/locationoftrainers
beyondtheirjobrolebutwouldliketodomore• Lotofsupportofferedatwrongtime–toosoon
andtoo‘onesizefitsall’–different• familymembersneeddifferentapproaches• Beyondnestofkin–majoritythesedays–
unmarriedcouplesetc• SD1–needaprotocoltogobackandmakethe
offerofsupportagain• Kindsofsupport–peerandfamilysupport,regular
support–againreBMEthisneedsthoughtthrough• RoleofLifelineinsupportingpostventionwork–
e.g.intoschools(youthandcommunitysetting)• Queryreschool’sabilitytorefusehelpor
intervention–shouldthisbethecase?• Evaluatinginterventionsandtheirpositiveand
negativeimpactneeded• Monitoringtrendstoinformservicedesign/
delivery–ongoingprovision• Toohardtofindservicesorknowwhichservicesto
availof• Needstobetimelyfollow-up• Supportgroupsarenotwellpromoted• Carersofpatientsneedsignposted• Issueswithcounselling–consistency,numberof
sessions,timeofaccess,cost• SD1processhaslimitations–needabetter
mechanismforcommunicationredeaths• Needmorefundingforsupportgroups• Coachingandalternativetherapiesneedpromoted
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27.3.18LISBURN
CONTINUED
• Interventionislimitedforspecificpopulationgroups–e.g.languagesupportneeds–Polishcommunity
• TranslationservicesareonlyofferedthroughHSCTservices
• Toolongatimetoaccesscounsellingservices–13weeksistoolong–1st3daysiscrucial
• 20%ofpeopledeemed‘lowrisk’died–terminologyusedtocategoriseisconfusing(low,medium,highrisk)
• Helpneedstobeofferedinamoretimelyfashion• Counselling/psychologytreatmentneedstobe
abletobefitforpurpose.Servicesneedtobe‘personcentred’–responsivetoneed
• Makeinformationsharingbetter–bettercollaboration–partnershipworkingneeded
• Funding• Referralprocess• GPtrainingisanecessity• CampaignCAPingovernmentdepartments• Communityresponseplansnotactivateduntil2
deathsidentified• Feararoundtrainingincommunities• Accessibility• Consistencyinpersonnelandvolunteers• Flexibleadaptiveservicesneeded–improve
postventionsupport• Shouldlearnfromenquiries• ShouldbeconsistencyacrossTrusts• Thereisalotofhiddenneed–e.g.ruralareas
wherepeoplearenotgettinghelp• GPsdon’tknowwhattosayorwhattodo• Linkagesacrossissues/services• Moreawarenesscampaignsareneeded–very
powerful.Broad/widerapproachfor‘lightbulb’momentsespeciallyatkeytimesoftheyear–
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stigmaisstillthere• Difficultygettingpeer-ledsupportgroupsfunded• HowdoBMEgroupsknowwhoandhowtoaccess
services• AccesstointerpretingviaC+Vservicesneededby
Lithuanianpopulation–PHAfunded
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Whatworkswell:• NeedforCBThasbeenrecognised• Trainedcounsellorsprovidingfamilysupport• Men’sShed• Hubs• CommunityGarden(TheArk)• StepstoCopeprogramme• Consciousparenting–understandingaffectsof
behavioursinchildhood
Gaps:• Knowledge–lackofawareness• Lackofinformationlocally• GPismainformofcrisissupportbutnotalways
trained• Howdowecommunicatethepathways?• Howdowebuildresilience?Needevidenced
interventionsthatwillbuildresilience• ToomuchrelianceonC+Vsector• Interventionatcrisisistoolate–needmore
supportforeveryonetobuildresilience• Consciousparenting–skillsandknowledgeneeded
forparentsforsupportatearlystageoflife• Needresiliencefocusedprojectsinschools• Howdowereachthosewhoactuallyneedhelp?• Wheredoyougoforgettinghelpwhenafamily
memberhasattemptedsuicide?• NolinkagebetweenGP,Trustandcounselling• Old-fashionedviewsfromGPsarenothelpful• GPslackofspecialistknowledge• GPjustallocatemedication• ‘Cardbeforeyouleave’needstobegivenoutin
everyinstance–differentTrustsarenotprovidingconsistentservices
• LGBTgroupsnotrecognisedorsupportedwithinSETrust–nolocalisedsupport
• Eachsteprefersto‘hastogethelp/support’–thisisalmostastepinitself
• Howtoensuretherightsupportattherighttime?• Whataboutwaitingtimes?• Hastoensureholistic/personcentredreferral–
everyoneisdifferent• Itisimportantthatfollowingtrainingandwhen
atrainerisworkingwithanindividualandfeelstheneedtorefertheindividualthatappropriateservicesare
• availableonimmediatereferral• Involveinterpretersandbilingualpeopleintraining
–raisingawarenessaboutavailableservices• Targetedtrainingforinterpreterswhoarewillingto
workinahelp-line• Designedguidelinesonhowtogetsupportif
needed
• Needsupportofferedforwholefamily• SuicideslinkedtolosingDLA–needslookedinto• Nojoined-upapproach• Don’tusetheword‘commit’–suicideisnota
crime• De-stigmatise,removeshame• Target20-30yearagegroup–trytotalkopenly
aboutwhathashappened• PHAshouldseekchildrenandyoungpeoples’
viewsonmentalhealth• Friendsandfamilyneedbettersupported• Mentallyillpeoplenotsupportedtogetbetter
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• NolinkbetweeneducationcounsellingservicesandPHAfundedcounsellingservices
• Improvedresilienceneededinschools• Psych-educationondifferentreferraloptions–level
ofconfidentiality,waitingtimes,whichorganisation,positivesandnegativesofall.Ifyousignpostsomeonetoanotherorganisationanditisnotrightforthem,whathappensnext?Howwillyouknow?
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Whatworkswell:• Lotsofgoodworkhappening–ASCERT,Aisling,
Lifeline,Beacon,OakHLC,Clear,ZCards,servicesinWesternTrust
• Frontlinestaff• ASISTtraining• Havingconfidencetoaskaquestion• Usingcommunityinfrastructure–GAAetc• Communitiesbeingalert• Counselling• Samaritans• Publicity–noticeboards,contactdetails,
awarenessraising• Flourish• Goodamountofservicesavailable
Gaps:• Needtolookatthelinkbetweengamblingand
mentalhealth• Needasinglepointofaccess(forfamiliesand
professionals)• Longertermfundingrequired• Needsofruralareasneedlookedat:transport,
communication• Isthereenoughbeingdoneinruralareas?
(domesticisolation,transport)• Schoolisthenaturalenvironmenttodeliver
sessions–thisiswherechildrenandyoungpeoplearetogethermostoften
• Crossagencyworkingneedsembeddedinallstrategies/interventions
• Whoisbestplacedtodeliversessions?(teachers,externalfacilitators,youngpeople)
• Skillingupyoungpeopleaspeereducatorsmaybeasuccess
• Informationavailableisnotbeingfullyutiliseddue
• Shouldbeanadditionalleveldealingwithsomeonewhoissuicidalwithouthavingdonetheprevioussteps
• Lookatallocationoffundingacrossgroups• Needforqualityandmonitoringofcontent•
Peoplewithlivedexperienceshoulddeliver• Internetaccessinruralareasisanissue• Needforacleartrainingpathway–startingwith
SafeTalkandMentalHealthFirstAid–overallhappywithsteppedapproach
• Needforeachsteptoinformrenextstepintrainingforthosewhowishtoprogress
• Needfororganisationstosupportthosesentfortrainingtorelatewhattheyhavelearnedtotheirspecificsituation
• Groupe-LearningforGPsandotherfrontlinestaffwithdiscussionafterwards(becauseitinvolvesashortertimecommitment,soitismorelikelytobetakenup)
• Engagementinover18s–toaccesstraining,gettingpeopletoattend,howtheycanidentifyhowtogetinvolved
• GPsneedtohavemoreinputintothisprocess–theyaremainpointofreferral–oftenthefirstandonlycontactforindividuals
• Needtobeawareoflanguage–howcoursesareadvertisedandpresented–whoisyourtargetgroupetc
• Targetingindividuals/familieswhoaren’tattachedtogroups–howdowetargetthesepeoplefortraining?
• Developingstrategiesneededforthosewhohaveliteracyissues
• Needstobemandatorytraining• Self-caretraining,staffneedtoknowhowtocare
forthemselves
Whatworkswell:• SOBS(SurvivorsofBereavementfromSuicide)• SOSAD(SaveourSonsandDaughters)• Supportgroupsforthosebereavedbysuicide• Drop-insupport/respite–whenthetimeisright,
beingwithlike-mindedpeople,understanding• DarknessintoLightscheme• Communitysupportawareness• Churches/schoolssupport• Supportoflocalgroupse.g.GAA
Gaps:• Grieffromsuicide–needspecialisedcounsellingat
therighttime• TimingofSD1needstobebetter–veryindividual–
askatdifferentpointstoallowsupport• Thereshouldbealettergivingwithsupport
agencies• Peopledonotknowhoworwhotoaccess• Concernaroundwhoisidentifiedasneeding
support–e.g.unmarriedcouples,lackofsupportforlong-termpartners
• PSNIneedappropriatesupport• ActivationofCommunityResponsePlan• Ensuringhighlyvulnerablepeoplearesignposted
toappropriateservices• Socialmediaisabigissue–highercontrolsonall
medianeeded• NeedtolookattheBereavedbySuicideservice–
theirname,whotheysupport,howtoaccess• Somefamiliesarenotreadyforsupportduetolack
ofacknowledgementthatdeathwassuicide,orduetooftennegativestigmaattached
• Possibilityofauto-enrolment?• Needstobemoreaboutfamilyandlessabout
service–supportgroupsaren’tforeverybody
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tosiloworking(leaflets,snappy,multi-lingual,tailoredapproachneeded)
• Havinginfointherightplacesisvital(GPsurgeries,YouthClubsetc)
• Needhelphelpingyoungpeopleidentifyiftheyhaveamentalhealthissue
• Needforworkplaceawarenessraising–howtoseethesigns
• Howpeopleaccessservicesandthereferralprocess
• Transportissuesneedlookedat–peoplearefeelingmoreisolated
• A+Eneedfora‘quietroom’–staffrelyheavilyonPSNI
• Trainingforfrontlinestaff–staffdon’tfeelfullyequippedtohandlepeoplewhoarefeelingsuicidal
• Waitingtimeforreferralserviceistoolong(12-18weeks)
• Needsupportforpregnantmothersandnewparents–especiallyinourruralareas–noteveryonehasaccesstoSureStartorHomeStart
• HealthyLivingcentremodelsextended• Bringservicestopeopleratherthanmakingpeople
gotoservices• Cross-departmentalworkisessential• Peopleneedbetterinformedaboutservices
• Mandatorysuicideprevention/mentalhealthtrainingacrossarangeofundergraduatedegrees
• Youngpeoplenotinvolvedinafter-school/weekendactivitiesarehardertoreachandmorevulnerable
• Moretrainingforbeautytherapists,hairdressersetc• In-Housetraining–OAKgoingouttoorganisationsatatimethatsuitsthem
• OnlinetrainingisnotanoptioninsomeareasofFermanagh–ruralareas
• Stigmastillanissue• CommunityResponsePlanneedstriggeredafter
justonedeath• Needtobetherightpeoplearoundthetable
atCommunityResponsePlanstagewheninvestigatingthe‘why’ofasuicide(tryingtofindpatterns,preventclusters)–verydifficulttoshareinformationduetodataprotectionrules,eventhoughthatinformationcouldsafelives
• Frustrationoffamiliesreawarenessofwhatsupportisavailable
• Difficultywithcross-border–somepeopleinEnniskillen/Fermanaghaccessingservicesacrosstheborderbecausetheyaremorehelpfulortheyaremoreinformedaboutthem
• Localsupportorganisations–healthandwellbeingofficers,e.g.GAAarecriticalinresponseplans
• Breakingthestigma• Fearandignorance• Insufficientuptakeontraining• Gapsinservices
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Whatworkswell:• Structurestillinplacedespitelackofgovernment• Communityservices–peoplecanwalkinandget
helprightaway• Lifeline• Passionforsuicidepreventionisthere• SHIP,ProtectLife• Recoverycollege• Take5isanideawithgreatpotentialtodevelopand
rolloutregionally.Needspromotionatstrategiclevel(withconsistentmessage).Tangible,simpleandpeople‘getit’
• Localgrassrootsinitiativesi.e.basedinsettingindividualiscomfortablein(e.g.sports,MensShed,craft,women’sgroups,youthgroupetc)
• Familysupporthubs–collaboratingatearlystage(tosupportratherthanrelyingoninstincts)
• Self-care• Goodrelationsandinformationsharing(within/
betweencommunityandstatutory)•Talkingtherapyhubs–alternativestoprescriptions–wouldbeenhancediflinked/hadmoreaccesstootherservicesatsametime
• Communityevents(Take5,Pop-upPharmacy)• Increasedknowledgeofbasicse.g.importanceof
connecting,talkingtofamilyandfriendsetc• Structuredprogrammesforschools• SafeTalkandASISTtrainingrollouthasbeenvery
good• Complexservicecross-overimproving• Taxiwatchbreakingoutsidepractitioners• Bereavedfamilieswork• Beginning‘publicplaces’strategies• Take5mentalhealthcampaign–abilitytoidentify
targetedneed• Earlyprevention–childdevelopment,education/
• Everyonedoesnotneedhighestlevel,norisitappropriateforeverybodytohave
• Steppedapproachesrecognisesdifferentlevelsofcapability–bettertohavemorepeopletrainedattherightlevelforthem(i.ethatwillbeusedbythemintheirdaytodaylives)
• Steppedapproachissafer,giveschoice• Willbeneedforrefreshertrainingandreminders
ofkeypointsoflearning• Standardswillneedmeasured• Whatisworkingincommunitywhichcouldshape
andenhanceauniversalco-ordinatedapproach• Take5isuniversal–stayfocusedanddon’t
replicate• Self-masteryiswhatyouwanttoachievewitha
person’swellbeing• Worktoskills,untappedpotentialandtalent• Stepstoovaguetodeliberateon• Howlongdoesittaketooperationalise?MHFA
stillnotupdated–berealistic• Integrativeapproach• Tenderinglotsisnotthewaytogo–e.g.MH
trainingtenderworkedoutat£30perperson• Spendtoomuchtimetalkingaboutreviewingand
notdoing• Accesstotrainingcourses–needsomeonetohelp
navigatetherange• Okaywithsteppedapproachandmethods
oflearningifitistobesetwithinastrategicframework.
• Difficulttocommentonoutofcontext–onitsowntheapproachappearsonedimensional–itwouldneedtobepartofamulti-facetedstrategicframeworkthatwouldenabletrainingtobetargeted(populations/riskfactors/areasofdeprivation)andfocusedonoutcomesand
• Therearegoodexistingmodelse.g.NorthernTrust• Tailoredmodels• Havingtheautonomytosupportpeoplewhenthe
lapse/relapse• Havingscopetoworkwithpeopleaslongasthey
need• Strength-basedapproaches–notwofamiliesare
thesame• Time,compassionandloveneeded• Genderedapproaches/understanding• Knowingtheperson• Beingpresent• Personcentredapproach–activelistening,
humanistic,respectwhatworksforthem,congruence,bodylanguage
• Frontlinesupport–e.g.reflectivepractice,accesstocomplementarytherapiesetc
• Recognitionofimpactofconflict,socio-economicdeprivation,transgenerationaltraumaetc
• ResilienceFollowupaftercompletingsessions,check-inclinic?
• Familycheck-ups,familysupport,familycounselling/intervention
• Supportingeachother• Communityresponseplans• Communityintelligence,goodconnectionsand
sharinginformation• GoodrangeofsupportoptionsheldwithinTrust
centrallywithgoodworkingrelationshipswithcommunity,PSNIetc
• Moreresponsiblereportingbythemedia–monitoredbyPHA
• Localsupportgroups• Personcentredapproach–wellcoordinatedlocally• Communityintelligenceandpartnershipapproach
toprovidingpostventionsupport
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curriculum• Training,normalisingstress• Experientiallearning–communitydevelopment,
upstreaming• 72%notknowntoservicesthatdiebysuicide–
linkingtofamilies,communities,activists• Havingquickaccesstoservices• Activelistening
Gaps:• Waitingtimesforpeoplewhohavechronicpain,
depression,anxietyandstress• ConnectivitybetweenPHAandBHSCT• Communityworkersconnectiontolocalpeople• ‘CARDbeforeyouleave’needstobegiventoevery
personwhopresentstoA+E• Yearonyearfundingmeansservicesstrugglingto
keepservicesandstaffwiththismethod• Expectationsoffundingbodies• Centralpointforinformationonallsupportservices
needed• Fundersneedtolookatfundingcriteria• GDPRtrainingforProtectLife• Tenderingcankillinfrastructurealreadyinplace
PreventionContinued:• Waitingtimesneedreducedfurther• Staffleavingcommunityworkingbecauseof
instability• AppropriatetrainingforPHA• Alcohol/addictiontraining• Needtobuildcommunityresilience–remove
barrierstoservices(childcareetc)• Signpostingtoothersupportrequiresgood
networking• Lackofawarenessoftrauma
priorities• Theframeworkshouldenabletheconnections
toothertrainingprogrammes(includinglocalprogrammes);itshouldsetminimumstandardsandprinciples.
• Itshouldbeaboutmorethatcoordinatingtheexistingtrainingoffer–itshouldenablethestrategicdirectionofresourcestoachievetheaimsofProtectLife2
• Theframeworkshouldincludeanelementofresearchanddevelopment(takingaccountoflocalevidence,issuesandneed)
• Thereshouldbeanelementofmeasurementandevaluationbuiltintotheframework
• Coordinatedapproachtobereavementsupport–recentlyupdatedandimprovedbyBHSCT
Gaps:• Deliverymodelsvaryradically• Followupoffers–whoseroleisthis?• Timescales/appropriatesource• Supportforthoseconnectedwithactivelysuicidal
person–longterm?• Accessissues–informationresources,non-core
connectedgroups• Needforcommunityownership/leadership• CRP–reducedscale,widerangeofdominofactors• Postventionmustincludepreventionforfamilies/
generational• SD1processnotworkingtofullpotential–2/3are
notmarkingboxforsupport–immediatetraumamightpreventagreementatthetime.Needtofindawaytogetknowledgeofavailableservicesatgrassrootslevel
• Traumacanmanifestindifferentcontexts–needtomakeareasoutsideofsuicide
• preventionawareofhowtoaccesssupportetc• Don’tprescribe,ask.• Needsupportforlocalclubs/organisations• Knowingwhatisavailableineacharea–database
orapponwhatservicesareavailablemaybeuseful
• Funeralplans–veryelaborateforsuicidevictims–worryingforyoungpeoplewatchingthis‘attention’
• Needtoinvestigatethemethodsputintoplace–‘hotspots’onservicesavailableetc
• Someonewhoishospitalisedduetoattemptingsuicideandendsupdyinginhospital–whenthispersondiesinhospitalitisnotrecognisedorrecordedasasuicide–noSD1formcompleted
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• NodualdiagnosisforMentalHealthandDrugsandAlcohol
• BenefitsofTake5arenotknownbyeveryone(simple,applicable)–missedopportunity
• Publiccampaign/settingsapproachcouldhelpwiththis
• No24/7crisisservice–A+Eisnotaffective• Befriending/socialsupportneeded• Pathwaysinandoutofservices–co-ordination• Respondingtoalcohol/drugs• Understandingofsubstanceabuseandselfharm• Youth/childrenandyoungpeople–notco-
ordinated/evidencebased.Needforspecificstrategy
• Emergingsocialmediaculture–lackofunderstandingofimpact
• Understandingofevidence-basedpractice/collectingevidence
• SD1basedinformationnotaccurate• Nofollow-upforindividualswhoself-refer• RelianceonPSNI/familiestohelppeopleincrisis• Nojointcommissioning• Targetedtraining/furtherdevelopmentof
workforce• Highsuicideideation/deathsinthecity–leadsto
fire-fightinglocallyasnoresourceforprevention• Disconnectfromcommunitydevelopment/stat
servicesandprocesses• Needworktobeprojectfunded,servinglocally–
tenderingcouldpotentiallyundermineworkbuildupoverlast15-18years
• Needtogenuinelylistentokeyactivistsontheground
• C+VbringmillionsofadditionalitiestoPLfundedservices
• Languagebarriers–accessingservices
• Issueswithfamilies‘admitting’suicidewascauseofdeath
• Traininginhospitals• Structuresrequired–needtobestrong• SD1processneedstobeupdated(the
recommendationsoftheevaluationcarriedoutneedtobeimplemented)
• TrainingneededonCRP/SD1process• Variationsinresources–relieson‘goodwill’–
volunteers,fundingetc.Manyarenotawareofsupportoptions
• DelaysinSD1receiptandcommunityinfo• Needsupportforwidercommunityandother
individuals• CommunicationbacktoHSCfromPSNIfollowing
10dayfollow-up• AccesstoPVservices• Communicationcanbepooranddisconnected
causingconfusionandperceptionthatthereisalackofservicesinsomeareas
• Insufficientfocusonrecoverybeyondinitialsupport–can
• leadtopeoplebecomingre-traumatised• Socialmedia,vigils,etc.• Reachingallindividualsneedingsupportcanbe
difficult• SD1processlimited–paperbasedandconsent
difficulttoobtain.• DelaysinreceiptofSD1sandweekendsand
holidayscancausefurtherdelaysininformationflow
• NeedtosimplifySD1processtoencourageconsent,e.g.PSNIhaveacardintheirnotebooksthathelpstoremindthemhowtoexplainthesupportprocess
• Nooutofhoursserviceforcoordinationof
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• Reviewresearchfindingsforactionsandimplemente.g.SiobhanO’Neill2014.Screeninginareasimpactedbyconflict,socio-economicdeprivation,highsuicides
• Wellbeingandresiliencestrategyneedsownedbyeveryone
• Trustcommunitytomakestrategicdecisionsrefundingprogrammesetc
bereavementsupportservices• Respondingtocommunityintelligence/
communityneedsfollowingasuicideisoftendoneona‘goodwill’basis–particularlyoutofhours
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Whatworkswell:• 24-houraccesstotrainedpractitioner• Peoplebeingabletotalkandaskforhelp(alsoto
belistenedtoinanon-judgementalfashion)• Localprovision,supportandsignposting• Lifeline• ConnectionsProgramme,SafeTalk,MentalHealth
FirstAid,ASIST• Supportforyoungpeople/teenagers• Connectedservices• Primaryschoolsupport,youthcounsellorsin
schools• TheAislingCentre,OakHealthyLivingCentre,
ActionMentalHealth,CommunityFamilySupportProgramme
• Take5Campaign• BereavedbySuicideSupportProjects• Rapidresponse
Gaps:• Protocolsandpathwaysmusttakeaccountof
wherepeoplelive• Appropriatelytrainedpeopleneedtobeavailable
withinreasonabletimeframeswhenthereisaneedincludinginA+E
• Improvedcommunicationbetweenagenciesisstillneeded,particularlyatlocallevel
• Gapremainsconnectingallservicestogether,wheretherearedifferentorganisationspromotingthesamethings–createsabarrierforpeople
• Implementsafeplacesinallcitiesandtownswithconsistentfundingacrossallservices
• ReviewregionalstrategiesforimplementationofchangetoimprovesuicidepreventioninbothstatutoryservicesandC&Vsectorandalsoimproveimplementationtimesforthesechanges
- Whileitisunderstoodthatthereisnoone‘riskassessment’toolormethod,thereneedstobeprofessionalswithsometraininginriskassessmentandpossiblythedevelopmentofnewmaterials.Thesewouldbespecificallyforprofessionalscompetentintheuseofsuchtoolsandwiththeinformationtheymightelicit
- ASISTtrainingneedstohavea‘topup’optionthatcanbeaccessedoverhalfadayratherthanhavingtodothefulltwodaysanothertime
- Thisispartofawholelifeskillsframeworkthatneedsconnectingthinking–thereisnotonething,oneissue,oneareaoflifethatcontributestopoormentalhealthandwellbeing–butoftenawholeseriesofevents,issuesetc–difficulttocategoriseintoseparatetraining.Ifinditdifficultthatthisiscompartmentalised–however,Ialsohaven’tbeenpartofthisparticulartraining
- Goodframeworkbutthereshouldbeascheduleforcompletionwithinwhichyouneedtomoveupalevel
- Wouldbegoodtooffersomerecognitiontothosewhocomplete–gold/silver/bronzeetc
- Getasmanypeopleonthegroundwhocanincreaseawarenessandsignposting–youdon’thavetobeanexperttodothis.Peoplewhocangetsometrainingandgobacktotheirclubs/organisationsandgivea15minuteawarenesssessionandsignpost
- Willprovidegoodstructureinthecommunityhoweverifthereisn’tavailabilityoftheprofessionalhelpthenthesystemislettingpeopledown
- Stepsareanexcellentwayoftacklingtheissueofawarenessandprovidingspecialisedknowledgeandskillstraining.Thereisagrowingneedforthepopulationtobeawareofthepresentingissues
Whatworkswell:• Trainingforemployers,communityleaders,
employees,doorpeople,taxidrivers• Recognisingclusters• Cohesivesupportnetworks• Collaborativeworkingacrosssectors• Bereavementsupportgroups• PIPSandAnna-Caramodel• Wraparoundservices
Gaps:• Havingaccesstosupportfromlocalgroups• Trainedindividualstoexplainprocessesto
bereavedfamilye.g.CommunityResponseprocess,SD1,Coroner’sProcess,accesstobereavementsupportpacks
• Homebereavementsupport• ImprovedSD1process• TimelyaccesstoProtectLifeco-ordinators• Informedidentificationofthecauseofsuicide–
betterpsychologicalautopsytoidentifyothersatriskandpreventcluster
• Co-ordinatedapproach–C+V• Moreresearcharoundself-harm–doesnotalways
infersuicideideation• Mentalhealthdaycentresneeded• Non-clothedpoliceofficersratherthaninuniform• Improvedaccesstocounselling,bereavement
support• Moresupportforcarers• Helpingfamiliesunderstandthatnooneisto
blameforthesuicide• Morepostventionsupportforruralcommunities
–timelyaccesstosupport,workingwithstatandcommunityorganisations
• Betteridentificationofvulnerableandatrisk
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• Moreeducationneededwhereyoungpeopleareinvolvede.g.clubsandschools
• Moresupportforyoungpeople/teenagers• Needcommunitydevelopmentapproachto
communitylearning• Moretrainingtocommunitygroups,businesses,
schools,agenciese.g.ASIST,SafeTALK,MentalHealthFirstAid
• Needfundingforcrisisresponsecounsellingandsupportforlocalgroups–can’tbeprovidedbyjustLifeline
• Needintroductionoffundedwrap-aroundserviceforcounsellingsolocalcounsellingserviceprovidersarefinanciallysupportedinthedeliveryofcrisisservices
• Needtoconnectwithoutofreachgroupssuchastravellingcommunity,ethnicminorities,youthnotengagedinsport
• Encouragepost-primaryschoolstointroducementalhealthandsuicideawarenessprogrammestotheircurriculum
• Moredrop-inservicesinlocalcommunities• Moreconsiderationforcarerswhoknowthe
behavioursandtraitsofthosesufferingmentalhealthproblemsintheircare
• Secureaccommodationforthoseatrisk• Moreunderstandingforlinksbetweensuicide
ideationandcrime• Focusonalcoholanddrugproblems• Betteridentificationofpeopleatrisk• Moreconsiderationgiventomenagedbetween
35-55yearsold• Moreresearchintolinkswithpoormentalhealth
andTroubleslegacyinNorthernIreland• Hospitalfunding–bedsetc• MoreconsiderationforthosewithAutism
andhaveaconfidenceandabilitytointerveneandaccesstheappropriatehelp.Themorepeoplewhoareskilledintheareaofidentifyingmentalhealthissuesofconcernandthoseindistressthebetterequippedweareasacommunitytodealwithandhelptoaddresstheissueofmentalhealthandsuicide.Thereisagrowingneedfortrainingateachofthestepsstatedanditishopedthiswillcontinuetobecomeavailabletoall
- Trainingisanexcellentwaytoraiseawarenessandinformgroupsandindividualsofthehelpandresourcesavailabletothem.ASIST,MentalHealthFirstAid,SafetalkandB+areespeciallypopularandextremelyinformative.Groupsalsooftenneedtoavailofbespoketrainingpackages,bereavementsupportandgeneralinformationonservicesasthisisregularlyrequested
- Excellent!TheConnectionsprogrammedoesalloftheabovesteps
- ThisisanareaIfeelneedstobefacilitatedbythosewhohaveexperienceandworkingwithinthefieldofmentalhealth.Thisisnotacriticismofthosedeliveringtheprogrammeswhoarenotprofessionallytrained,itissoimportantbecausepeople’slivesareatrisk.Weneverknowtheaudienceanditisalwaysnecessarytoprovideaccurateinformationbasedonfactandunbiasedopinions.Thetrainingshouldbeadaptedtotheattendeesanddeliveredinaccordancetotheattendees’suitabilityandunderstanding
- IfeelthattheentirepopulationofNorthernIrelandneedstobepointedinthedirectionofmentalhealthawareness,notjustcertaingroupsandindividuals.Anattemptisneededtochangethepublictothinkdifferentlyregardingmentalhealth.Whatonepersoncansaytoyoucanharm
• Earlyaccesstotalkingtherapies
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• Campaignstobreakstigma• Oneorganisationwhichbringstogetherallmental
healthandwellbeingservicesforonetownorcountry
• Identificationofemergingsuicideclustersandactpromptlytoreducerisk
• ImprovedPersonalityDisorderservices• Mandatorysuicideawareness/preventiontraining• Moreawarenessofsuicidalthoughtsand
behaviours• FurthertrainingforGPsandmedicalstaff• Lessrelianceonmedicationformentalhealth
issues• Bystanderinterventiontraining• WaitingtimesinA+EwhenPSNIbringsomeone
withsuicideideationtohospital• Waitingliststoolong• Moresupportforthosewitheatingdisorders
andtakeawayfromalotofgoodworkdonebyotherindividuals.Otherwise,Ithinkthestepsaredraftedwell
- Trainingcannotbetenderedasastandaloneprovision.Thewholeprocessneedstobevaluedfrommotivatingpeopletoattend,theappropriatenessoftraining,thedeliveryandthefollow-upetc.Whodeliversisimportantaslocalknowledgeisneededandanunderstandingofattendees.Traininglocallyneedstobeco-ordinatedandthereshouldbeagotopersonineacharea
- Thesteppedapproachappearstotargetallthosewhoareorcouldbepotentiallyinvolvedwithsomeonewhoissuicidalorengaginginsuicidalbehaviourswithinthecommunity
- Soundsgood- TheLivingWorksmodelhasprovedeffectiveto
datewithagooduptakeofASISTandSafeTALK.Lessformalisedtraining/awarenesscouldalsocomplementthismodelandagainbelinkedtopublicawarenesscampaignse.g.theFASTcampaignforstrokes.ZeroSuicideAlliance–FREEonlinesuicidepreventiontrainingisanothermodelwhichcouldbeconsidered
- Iagreewithasteppedapproach.Asacommunitygroupweknowpeoplemayonlyneedandcanonlycopewithacertainleveloftraining.Whatneedstostayistheflexibilityoftrainingproviderstoruntrainingwiththeneedsoftheindividualcommunitiesinmind.
- Upuntilabout10yearsagotherewaslittleornopreventativetrainingatanylevelonsuicideprevention.Thankfully,intheSouthernTrustareatherearearangeofskillsbasedcoursesprovidedbyPIPSandActionMentalHealth.Also,
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thearrivaloftheRecoveryCollegehasgivenscoresofvulnerablepeoplewithmentalhealthdifficultiesopportunitiestoboostself-awarenessandconfidence.ThecoursesprovidedbyPIPShavebeendeliveredatlocalcommunitylevelincludingareaswithhighdeprivationlevels.TheActionMentalHealthcourseshaveattractedawidespreadofpeoplefromallwalksoflife.TheworkprovidedbytheseorganisationsalongwithsupportfromAwareNIhavemademajoradvancementsinawarenessandprevention.Theadvancesmadeovertheyearshavebeenslow,butwithouttheNewryMentalHealthForumandActionMentalHealthandinmorerecenttimesPIPSinitiativesliketheRecoveryCollegeincludingpeersupportwouldnothavehappened.AnotherareaofsupportthatrequiresadditionalresourcesistheTraumaServiceforpeopleaffectedbythepoliticalconflictinthenorthofIreland.ThereappearstobealimitedlevelofsupportforpeoplewhoarestilldealingwiththepsychologicalscarsoftheTroubles.ThenorthofIrelandhasveryhighlevelsofPostTraumaticStressDisorder,butthelevelofservicesdonotequatewiththisreality.StaffworkinginmentalhealthservicesthroughouttheSouthernTrustatalllevelshavebeensupportiveofthesocialmodelspearheadedthroughtheRecoverCollegeandthelocalMentalHealthForum.Ibelievetherehasbeenanincreaseinawarenessaroundsuicideandmentalhealthgenerally.However,thereisstillhighlevelsofstigmaaboutmentalhealthinallspheresofsociety.Ibelieveresourcesshouldbemadeavailabletoworkonthis,startingwithinitiativesatprimaryschool
- Ibelievethestrategywillassistwiththeoverallissue,howeverIdonotbelieveitgoesfarenough
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totryandforceanengagement.Thereisstillstigmaattachedandmanypeoplewillnotselfrefer
- Suicideawarenesstrainingand/orMentalHealthFirstAidtrainingwouldgoalongwaytogivingpeopletheawareness,knowledgeandskillstheyneedtocreatetheabove.Workplacesneedtobetargetedalso,astherearealargeofpeopleemployedandalotthatcanbedoneintheworkplaceviaearlyintervention
- Agreeinprinciplewithsteppedapproach.Ithinkweneedtoimproveourmethodsofraisingawarenessforthepublic–shoulddosomefocusgroupsforideas?
- ItismybeliefthatinNIthereexistsamassivedearthoftrainingforstaffandprofessionalsinrelationtoBPD.Commentsmadebyuntrainedstaffwhichcanbelittle,undermine,offendthosewithBPDcantipanindividualovertheedgeandleadeasilytoasuicide.IwouldliketoseethePHAandDepartmentofHealthdeveloppropertrainingbyconsultingwithexpertsandserviceusersforthoseworking/dealingwithBPDindividuals.TherearefartoomanypeopleworkingwiththosewithBPDwhodonotknowthefirstthingaboutit,andthereforecannotbetrustedtobeabletosafeguardthatperson.Theycouldinfact,throughtheirignorance,dodamage.IwouldalsoliketohighlightthefactthatthisonlinesurveyIamfillinginmakesnomentionofspecificsuicidepreventiontraining!Whyonearthhasthatbeenallowedtohappen.Inthetrainingsection,onewouldexpectattheveryleast–thatforsuicidepreventiontraining-thatactualsuicidepreventiontrainingfeaturesasanumberonepriority?Howcouldthisoversighthaveoccurred?Pleaseaddressandincludethisimmediately
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- Thesteppedapproachwillenableprovisionoftrainingatappropriatelevels,thekeyfocusmustbeonraisingawarenessacrossthegeneralpopulationsothatpeoplefeelconfidenttoseekhelp
- Thesteppedapproachwillenableprovisionoftrainingatappropriatelevels,thekeyfocusmustbeonraisingawarenessacrossthegeneralpopulationsothatpeoplefeelconfidenttoseekhelpandtoencouragehelpseekinginothers.Keytothisapproachisprovisionoftrainingwhichcanbedeliveredinaflexiblewaytomeettheneedsofthegroupandaccessibilityfortheentirepopulation,Thiswillrequireinvestmentinpromotionalworktogetkeymessagestomembersofthepublicandtomarketprovisionoftrainingavailableforthewiderpopulation.Barrierstoattendanceattrainingshouldbeconsideredincludingchildcaresupportandprovisionofonlineandblendedtraininginareaswheretransport/childcaremaybeanissue,bearinginmindinternetconnectivityforspecificareasmaypresentdifficultiesinitself.AlltrainingandtrainersmustbealignedtoandcompliantwithQualityStandardsthataremonitoredanddeliveredbyappropriatelyqualifiedfacilitators.Itisimportantalsothatallcommissionedservicesmustassesstherequests/needsofpeopleandimplementasteppedtrainingplanandhavethecapacitytoprovidesupportforpeopleafterattendingtrainingasthisoftenraisesothersupportneeds.Criticalevaluationofalltrainingisrequired,theNIpopulationhaveuniqueexperiencesandneedsanditisimportantthatwecanbuildtheevidencebaseforwhatworkslocallyratherthanalwayslookingtomodelswhichhaveworkedelsewhere.Thiswillhaveparticular
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importanceforanyservicescommissionedthroughinnovationfunds
- Whereistheaccountabilityforprofessionalcompetencetotreatmentalconditionswithinprofessionalbodies?Howdoweknowthatsomeonewithadoctorateinmedicinecaneffectivelytreatmentalillness?Whichrequiresinmyexperiencetheabilitytoeffectivelylistenandinform.Howevertherearedisparatitiesindiagnosis,treatmentandsubsequenthelp.Youwanttobeluckyifyoufallmentallyunwell.Asyoumaygetpillsandbeleftonyourown,youmaynotevenreceivethat.Thereisnocontinuityorsafeguardingforpeopleaccessingprofessionalmentalhealthservices.Lockupandelectroshocktherapiesarepracticedtoday.Youcanbesanctionedanddetainedandallwithintheservicesofapsychiatry&medicalmodelwhichattimescannotagreeadiagnosis.Myownmothertreatedbypsychiatristswhoinformedhershewastoreceivea‘lifetime’ofmedication,mymotherwasunabletogetupfromthesofaasshewasovermedicated.Itwasonlyonmyappointmentwiththem,eventhoughshehadinformedherownpsychiatrist,thattheyreducedhermedication,andinformedmethatshecouldcomeofmedication,sothatwas3psychiatriststreatingonepersongivingout3differentmessages.HerGPknewnothingaboutanyofthis.Mymotherhadbeenmedicatedintoastupor,therewasnosupportofferedtocomeoffmedication.Thisisactuallyfrighteningthatthispracticeisongoingtoday.Athoroughinvestigationofpsychiatry&medicalcareisrequiredasamatterofurgency.Soperhapstheprofessionalstrainingneedsworktoo.Trainingcanhelpusself-care&lookoutforeachother
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buttheDepartmentofHealthmustinvestigate&transformthecurrentprofessionalpracticeswhichareinadequate.It’samoderndayinstitutionaldisgrace..Mymother’streatmentmentionedabovetookplaceandstilldoeswithintheBelfastTrust
- Inquestionthreepopulationawarenessshouldconcentrateonsuicidepreventionawarenessratherthangeneralmentalhealth.Webelievethatacrossthecountrywecanequipgatekeeperstobetteridentifyandmanageorreferthosewiththoughtsofsuicideandsystematictrainingforgatekeeperswouldcontributesignificantlytoreducingdeathsfromsuicide.Itisstrikingthatthesevenobjectivesreferredtointhisstakeholderengagementseemstogetsuchscantattentioninthetrainingframework.Asaresult,weareconcernedthatthiscouldresultindevelopmentandpromotionoftrainingthatdoesnotdirectlyaimtoreducesuicide.ItisSDZ’sunderstandingthatinthePHA’sdraftMentalandEmotionalHealthandWell-being&SuicidePreventionTrainingFrameworkthatsuicidepreventiontrainingisonlyreferencedinstep4oftheframeworkwiththeemphasisplacedonmentalhealthawarenessandwell-bring.ThissuggeststousthatPHAisnottreatingsuicidepreventionasapriority.Caregiversinawiderangeofcontextsarelikelytoencounterpeoplewiththoughtsofsuicide.Theyneedspecificsuicidepreventionskills.Somecouldbetrainedtoidentifyandreferthosewiththoughtstosomeonewhocandoafullsuicidefirst-aidinterventionthatkeepsthepersonsafee.g.(safeTALKprogramme).Weneedawiderangeandlargenumberofpeopletohavethesesuicidefirstaidskills.Oncetrainedtheycan:-identifythesignsofsuicide;askclearlyanddirectly;hearthe
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personsstory;helpthepersontofindaturningpointandoncefoundthecaregiversupportsit;developasafeplanandconfirmtheactionsfromit.GivethemagnitudeofsuicideandthepaucityofappropriatetrainingitisvitalthatprogrammeslikesafeTALKandASISTandothersareurgentlymadeavailable
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• “OrganisationslikeMindYourMateandYourselfshouldnothavetogetalltheirfundingfromthepublic–theydeservegovernmentrecognition”
• “Thankyoufortheopportunitytorespond.Forfutureawareness/consultationitmaybeusefultolookatincidencesofsuicideinTrustsandNorthernIrelandcomparedtoUKregionandEurope”
• “Policedoctorsplayavitalroleinanindividual’smentalhealthassessmentduringthecustodyprocess–itisunclearwheretheirtrainingorunderstandingofmentalhealthoremotionalcrisislies–andtheyoftendonot/dorecommendassessments”
• “Ifthemostimportantpeople(thoseaffected)areincludedinthisprocessIfelttheeventwassteriletotheiremotionsandfeelings–andclinical”
• “Howdoyouputapriceoncommunitydevelopment–localapproachtopreventsuicides?Tendering–doesithavetohappen?Thiscouldputstressandundoalotoflocalwork”
• “Tender/grantprocessshouldrecognisetheneedforallsectorsandthekeyrolestheyplayinthissensitiveareaofwork”
• “Suchahugeissue,suchasmallbudget’”• “Formatofthemeetingcanbeverydauntingforfamilies
bereaved”• “Gettinghelpfortendersforsmallorganisations.Some
smallcharitieshavenoexperiencewithtendersbuthavealotofexperienceandfeedbackforprogrammesandsuicidepreventionsandearlyintervention”
• “Whilsttheprocesswasveryinformativeandhelpful,itshouldhavebeenopeneduptomembersofthepublicwhoareorwhohavehadmembersoftheirfamiliesaffectedbysuicideorsuicidalideation”
• “HowWindsorWomen’sCentrecandevelopforthefuture.Itispartoftheholisticservicesofferedi.e.advice,education,physicalhealthetc.Earlyinterventioniscritical.Weareconcernedabouttenderingaswehavelimitedcapacity”
• “Manycommunityorganisationsinsuicidepreventiondoabitofeverything–e.g.facilitate,motivate,deliver,buildrelationshipsandsoon.Ifthetendersaredividedinto‘lots’ofwork,itwillbreakuptheimportanceoffluidityofacommunitydevelopmentapproach–manyorganisationsunabletotender”
• “Wherewerethedrugandalcoholservicesintheconversation?Isthepennystillnotdroppingthatweneedtohavedirectlinkstosuicidepreventionanddrugsandalcohol–seemsthisdiscussionverymuchledfromamentalhealthperspective”
• “‘FirsttimeIhavebeeninvolvedinsuicideawareness–somethoughts:
-Documentandsharegoodpractice-Continuallyassesslearning–isitfitforpurpose?-Noonesizefitsall-Rootcause,correctiveaction–lessonslearned–understanding
whatwentwrong–documentandcorrect-Shareexperience–celebrate/communicatesuccess-Steps–initiate–develop–enhance–specialist(continuous
development)”• “Anyfutureprocurementforservicesshouldconsiderthe
developmentswithinprimarycare.‘Multidisciplinaryteams’–toincludelinkswiththeCommunityandVoluntarysectors.”
• “Wherewastherepresentationfromthe18-30groupsinthecommunity?Whataretheyidentifyingaswhatworkswellandwhatisnotworkingwell?”
• “HaveyougotfeedbackfrompeoplewhohaveexperienceofProtectLifeintervention?E.g.CommunitySupportPlans”
• “InterventionalsoshouldbepartofthesediscussionsalongwithPostvention”
• “Supportforsuicidepreventioniswhollyinadequateoneverylevel.Mydaughterdideverythingshecouldtorecoverfromdepression.Shedied9monthsago.Thissystemfailedher”
• “Changinglegislationaroundmediareportingincasesofsuicidewillnotaffectsocialmedia.Reportsofmydaughter’s
deathwereonFacebookbeforemyhusbandknewshehaddied”
• “Verypositivemeeting,lotsofgoodpracticeinthisarea”• “Whataboutsomesortofinternet(socialmedia?)‘honey
trap’–similartothatusedtotrapchildmolesterstoidentifypeoplelookingforsuicideinformation”
• “Thebestwaytocarryoutinitiativesisthroughco-production.Findoutwhatthecommunitiesneedandtailortrainingandapproachtothat.Thiswilloptimisetheeffectiveness”
• “HighlightahugeneedforlongertermfundingcommitmentforthePHAcommunitydevelopmentposts–toensureimpact,controlandmeasurement.Iamtenyearsinpost–1styear3-yearcontract–12-monthextensionssince.Sustainabilityofservices–notappropriateorrobustenoughtoworkwithfuturepreventionprogrammeandCDapproaches”
• “IamoneofthreeSPDOs–Ihaveenoughrequestsforsupportfromstat/C+Vsectorsforthreepeopleinmyarea!”
• “Thankyoufortoday”• “Asaformercivilservantthiswasthemostjargonfilledevent
IhaveexperiencedfromIretired.Ihavelittleknowledgeofadirectlinetowherehelplies!”
• “Ihavegreatcommendationforourservicesbutbehumble,weknowlittleaboutthemindandpsychology.Listentowhatpeoplewhoexperiencesuicideknowalready–tellthemaboutthelimitationsinservices–peopleknowthis.Involvethecommunity–usetheyouthclubs,churches,communitygroupsandmeetpeoplewheretheyare’”
• “Atanextremelyhighlyemotiveandtraumatictimepeopleareexpectedtoconnectwithastatutory,clinicalservice.Onedoesnotknowhowtocommunicatewiththeother–lostintranslation’”
• “Timeconstraintsarounddiscussion,particularlyaroundtrainingwhichwasoneofcontextwiththeimportanceofthesubject”
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Appendix 3 StakeholderAttendanceList
RepresentativesofFamiliesaffectedbySuicideActionCancerActionMentalHealthActiveandHealthyCommunitiesDirectorateAddictionNIADHDNIAislingCentreAntrimandNewtownabbeyBoroughCouncilASCERTAutismNIAWAREBarnardosBelfastCentralMissionBelfastCityCouncilBelfastHealthandSocialCareTrustBelfastHealthDevelopmentUnitBelfastHealthyCitiesBigLotteryFundBridgeofHopeCAMHSDrugandAlcoholMentalHealthServiceCancerLifelineCAUSECentreforHealthandWellbeingChurchofGodShankillCitizen’sAdvice(MidUlster)CityandNeighbourhoodServicesDepartmentBCCClanryeGroupCLEARProject
CollaboratingforChangeDerryCityandStrabaneDistrictCouncilCompassCounsellingContactConwayEducationCentreCounsellingAllNationsServices(CANS)CountyDownRuralCommunityNetworkCRUNBEEProject(BuildingEmploymentthroughEducation)CruseBereavementCareDAISYDergValleyHealthyLivingCentreDerryCityandStrabaneDistrictCouncilDerryHealthyCitiesDioceseofClougherDrumalaneMillEastBelfastCommunityCounsellingCentreEastBelfastCommunityDevelopmentAgencyEastBelfastNetworkCentreEHOExternFallsWomen’sCentreFamilyVoicesForumFamilyMediationNIFirstHousingGivingLifeOpportunitiestoWomen(GLOW)GreaterShankillPartnershipGreaterVillageRegenerationTrustHealthandSocialServicesInterpretingService
HealthImprovementTeamHealthImprovement,EqualityandInvolvementDepartment(DCSDC)HolyTrinityCentreHomeTreatmentCrisisResponseServiceHopeforLifeHSCClinicalEducationCentreInspireWellbeingLenadoonCounsellingLighthouseLisanellyRegenerationGroupLithuanianCommunityAMBERLivingWorksMid-UlsterAssociationforCounsellingandPsychotherapy(MACP)MACSSupportingChildrenandYoungPeopleMentalHealthForumMindWiseMindYourMateandYourself(MYMY)N&EBelfastCommunityWellbeingServiceNewLifeCounsellingNewryHomeStatementTeamNIACRONICVANorthAntrimCommunityNetworkNorthAntrimCommunityNetworkNorthWestMethodistMissionNorthWestMethodistMissionNorthernHealthandSocialCareTrustNorthernIrelandEnvironmentalLinkNorthernIrelandFireandRescueService
OakHealthyLivingCentreOasisEastBelfastParentingNIParticipationandthePracticeofRights(PPR)ProbationBoardforNorthernIreland(PBNI)PersonalityDisordersNIPublicInitiativeforPreventionofSuicide(PIPS)PSNIRainbowREACH-outRelateNIRelativesforJusticeRiverviewHouseRuralSupportSailNISamaritansSASGSDLPSimonCommunitySinnFeinSouthAntrimCommunityNetworkSouthBelfastPartnershipBoardSouthEasternHealthandSocialCareTrustSouthernHealthandSocialCareTrustSpaceStart360STEPSStrabaneHealthImprovementProjectStrongerTogetherNetworkStudentGuidanceCentre
68
TrackingAwarenessofMentalHealthIssues(TAMHI)TheHummingbirdProjectThePrimaryCareandTalkingTherapiesWellbeingHub
TheRainbowProjectTyroneandFermanaghHospitalUlsterUniversityUpperSpringfieldDevelopmentTrustWesternHealthandSocialCareTrust
WindsorWomen’s’CentreWolfhillCentreYouthActionNIYouthEducationHealthAdvice(YEHA)ZestHealingtheHurt
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Appendix 4 ScheduleofStakeholderEngagementEvents
Trust Date Location NumberofAttendees
SHSCT 13March CanalCourtHotel,Newry 35
SHSCT 13March TheJunction,Dungannon 14
WHSCT 21March StColumb’sParkHouse,Derry 31
WHSCT 21March SilverbirchHotel,Omagh 25
NHSCT 22March DunsillyHotel,Antrim 21
NHSCT 22March CRUN,Coleraine 20
BHSCT 26March FARSET,Belfast 68
BHSCT 26March NICVA,Belfast 40
SEHSCT 27March CastlewellanLodge,Castlewellan 16
SEHSCT 27March TrinityCommunityCentre,Lisburn 46
WHSCT 29March FermanaghHouse,Enniskillen 30
BHSCT 22May ParkAvenueHotel,Belfast 21