Today is World Suicide Prevention Day. The theme of this year’s awareness day is 'Creating Hope through Action’. Hope is the central theme that people stated they need when in their darkest moments according to those with lived experience, who fed into this year’s National Confidential Inquiry into Suicide’s (NCISH) Annual Conference.
As we support individuals during such dark times we need to utilise their wider support networks to foster hope - services cannot do this in isolation. The NCISH safer services tool kit, highlights those NHS Trusts that have put into action policies and practices that involve families. These Trusts have seen a reduction in suicide rates of 24%.
When working with families, we must be mindful of when and how we can share confidential information. In August of this year the Department of Health and Social Care (DHSC), in partnership with the Zero Suicide Alliance, updated the Consensus Statement on information sharing and provided some practical guidance to support mental health professionals.
In this document, Steve Mallen, Co-Founder of Zero Suicide Alliance, says:
"As a father bereaved by suicide, I am acutely aware of the importance of seeking consent, respecting confidentiality and sharing information with families, carers and significant others in mental healthcare and suicide prevention. Despite considerable innovation within the healthcare sector, both routine and best practice in this complex yet crucially important aspect of healthcare is all too frequently overlooked or poorly applied. This SHARE Guide is designed to assist all healthcare practitioners and service user facing personnel in adopting best practice within the limitations of the appropriate legislation, rules and regulations. Properly applied, this Guide will produce better patient outcomes and save lives."
Our organisation has some great examples of services putting working alongside families into action. Some examples are given below.
Emily Poole, Involvement lead and George Adams, Social Work lead, say:
"At Langdon, the social work team and I have been working together to engage family members at the earliest opportunity. We have developed a robust database and social workers let me know who I need to contact so I can send a comprehensive information and welcome pack. This pack includes various ways to be involved in the care of their loved one. I also phone them to explain my role and offer support. Family members are also added to our monthly newsletter distribution list.
"We have a family and friends steering group which highlighted consistent communication as an issue. The social work team is addressing this with ward checklists for family member contacts and inclusion in CPA meetings when this is requested by the patient. This is working well, as evidenced by a recent brief audit. The team has also introduced a checklist for patient transfers, to ensure family members are kept in the loop. We are now exploring the possibilities for family therapy and Open Dialogue which has also been requested by the steering group members, via our governance groups.
"We are offering learning sessions for family members each term through our recovery college, based on people’s requests and interests.
"Family members, as well as patients, are involved with on-site interviews, and induction sessions for new staff about engagement and involvement.
"I’m also co-producing, with family members, patients and staff, a carer awareness resource for staff which sits on the Triangle of Care principles."
Testimony from family members
"I felt welcomed and cared for by you and the rest of the team. Jan was brilliant could you please send my thanks to everyone 😊."
"As we live in a village visiting is not easy and of course COVID-19 has made it impossible. I just wanted to write to say how much my husband and I appreciate receiving the regular updates and news from Langdon."
"My son moved wards and for the first time ever, I was contacted not once, but twice – it makes such a difference."
Torbay – Peer Open Dialogue
Bethan Cramer, Open Dialogue Facilitator/Practitioner, for Torquay, said:
"The Open Dialogue approach is characterised by an emphasis on family and community involvement and on a collective, rather than individualist, stance on the 'problem'. Open Dialogue might be an invitation to have a conversation about what makes someone's life worthwhile. Rather than asking the standard questions, "Do you have a plan?" or, "When was the last time you made an attempt on your life?", we are interested in finding out the context of the experience of suffering. This recognises that the person suffering is only a part of the problem. So, we might ask instead: "In taking your life, what are you taking a stand against?"
"Emphasis on context makes room for community involvement and human connection and resistance to injustice.
"People are not objects to be intervened upon and yet suicide prevention can be dehumanising when it categorises people based on a risk paradigm. The collaborative quality of Open Dialogue wants to empower and bring hope to those people whom the 'problem' affects most strongly, by drawing on the collective wisdom of a person's social network.
"Suicide is not a pathology. It might well be a question: "Why must I go on living in the face of all this?" or an expression of dissent. Understanding the context for suicide through a collective, transparent and non-directive conversation can make sense of someone's distress with a broader focus of hope and reasons to live, rather than simply keeping them alive."
"Our enthusiasm as a family for Open Dialogue has grown over many months under very trying circumstances. Both my child and myself, being hospitalised at separate times for months on compulsory orders, and my partner at one stage needing temporary respite care."
"We feel that Open Dialogue has really worked well for our family because it has given us time, patience and sensitivity in order to recognise, alleviate and communicate what are often invisible or hard to get at difficulties surrounding mental illness."
North Devon Psychiatric Liaison
Sara Ward, Liaison Practitioner, said:
"The Triangle of Care Lead has been raising the importance of gaining collateral information from family to aid assessment and provide more robust mitigation plans, whilst finding out the barriers to this faced by the team. Often, a big theme is the time pressures faced and the administrative burden associated with assessment. Therefore, working alongside the team administrator to make it easier to share information for busy practitioners, the team have develop a simple system of printing off labels that can be added to assessments.
"These labels highlight to the administrative staff what information needs to be sent out. Examples of this can include:
Sending care plans and appropriate support information direct to carers including information on Devon Carers, how to access services, information sheets on diagnosis or specific treatments, such as those available via Mind and Rethink.
In absence of consent, where they have details of the carer, they will still send generic carer advice, how to access services and information leaflets.
"Feedback from carers is still in the early stages but initial feedback has been very positive. Carers feel more involved, but also hopeful. In some cases these simple steps have meant massive life changes. One carer reported that due to the information received in the packs, they felt informed and more able to step back, feel hopeful about the future and see other family members who they have not seen for many years."