protect life 2 service stakeholder engagement report · stakeholder engagement events in the health...

Protect Life 2 Service Stakeholder Engagement Report

July 2018

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

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

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

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

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

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

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.

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

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.

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”

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

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

• 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.

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.

4.5.2.2Suggestions

• Campaignsneedfollowupandwraparoundservicesoffered

• CouldHSCTsuicidepreventionleadaskforconsentinsteadofithappeningatthescenewiththePSNI?

• De-stigmatise,removeshame-don’tusetheword‘commit’–suicideisnotacrime

• Target20-30yearagegroup–trytotalkopenlyaboutwhathashappened

• PHAshouldseekchildrenandyoungpeoples’viewsonmentalhealth

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.

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

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

• -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

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

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

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

13.3.18DUNGANNON

• 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

13.3.18DUNGANNONCONTINUED

• 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

13.3.18DUNGANNONCONTINUED

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

Postvention

21.3.18OMAGH

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

Postvention

21.3.18OMAGHCONTINUED

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

Postvention

22.3.18DERRY

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–

22.3.18DERRYCONTINUED

saturationisunethical• Needto‘makeitoknottobeok’• Outdatedthinkingincommunitiesneedstobe

addressed• Bereavedmum’sexample–‘3monthsforchildren

tobeseenbyservicespostsister’ssuicide–fearaboutspeakingaboutsuicideopenlyafterwards’

22.3.18DERRYCONTINUED

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

COLERAINE22.3.2018

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

22.3.2018COLERAINECONTINUED

• 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

23.3.18ANTRIM

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

23.3.18ANTRIMCONTINUED

• 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

23.3.18ANTRIMCONTINUED

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

26.3.18BELFAST(FARSET)

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

26.3.18BELFAST(FARSET)CONTINUED

• 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

26.3.18BELFAST(FARSET)CONTINUED

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

26.3.18BELFAST(NICVA)

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”

26.3.18BELFAST(NICVA)CONTINUED

• 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

• 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

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

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

• 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

27.3.18LISBURN

• 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

27.3.18LISBURNCONTINUED

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–

stigmaisstillthere• Difficultygettingpeer-ledsupportgroupsfunded• HowdoBMEgroupsknowwhoandhowtoaccess

services• AccesstointerpretingviaC+Vservicesneededby

Lithuanianpopulation–PHAfunded

27.3.18LISBURNCONTINUED

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

27.3.18CASTLEWELLAN

• NolinkbetweeneducationcounsellingservicesandPHAfundedcounsellingservices

• Improvedresilienceneededinschools• Psych-educationondifferentreferraloptions–level

ofconfidentiality,waitingtimes,whichorganisation,positivesandnegativesofall.Ifyousignpostsomeonetoanotherorganisationanditisnotrightforthem,whathappensnext?Howwillyouknow?

27.3.18CASTLEWELLANCONTINUED

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

29.3.18ENNISKILLEN

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

29.3.18ENNISKILLENCONTINUED

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

22.5.2018BELFAST

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

22.5.2018BELFASTCONTINUED

• 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

• Reviewresearchfindingsforactionsandimplemente.g.SiobhanO’Neill2014.Screeninginareasimpactedbyconflict,socio-economicdeprivation,highsuicides

• Wellbeingandresiliencestrategyneedsownedbyeveryone

• Trustcommunitytomakestrategicdecisionsrefundingprogrammesetc

bereavementsupportservices• Respondingtocommunityintelligence/

communityneedsfollowingasuicideisoftendoneona‘goodwill’basis–particularlyoutofhours

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

ONLINESURVEYFEEDBACK

• 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

• 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,

thearrivaloftheRecoveryCollegehasgivenscoresofvulnerablepeoplewithmentalhealthdifficultiesopportunitiestoboostself-awarenessandconfidence.ThecoursesprovidedbyPIPShavebeendeliveredatlocalcommunitylevelincludingareaswithhighdeprivationlevels.TheActionMentalHealthcourseshaveattractedawidespreadofpeoplefromallwalksoflife.TheworkprovidedbytheseorganisationsalongwithsupportfromAwareNIhavemademajoradvancementsinawarenessandprevention.Theadvancesmadeovertheyearshavebeenslow,butwithouttheNewryMentalHealthForumandActionMentalHealthandinmorerecenttimesPIPSinitiativesliketheRecoveryCollegeincludingpeersupportwouldnothavehappened.AnotherareaofsupportthatrequiresadditionalresourcesistheTraumaServiceforpeopleaffectedbythepoliticalconflictinthenorthofIreland.ThereappearstobealimitedlevelofsupportforpeoplewhoarestilldealingwiththepsychologicalscarsoftheTroubles.ThenorthofIrelandhasveryhighlevelsofPostTraumaticStressDisorder,butthelevelofservicesdonotequatewiththisreality.StaffworkinginmentalhealthservicesthroughouttheSouthernTrustatalllevelshavebeensupportiveofthesocialmodelspearheadedthroughtheRecoverCollegeandthelocalMentalHealthForum.Ibelievetherehasbeenanincreaseinawarenessaroundsuicideandmentalhealthgenerally.However,thereisstillhighlevelsofstigmaaboutmentalhealthinallspheresofsociety.Ibelieveresourcesshouldbemadeavailabletoworkonthis,startingwithinitiativesatprimaryschool

- Ibelievethestrategywillassistwiththeoverallissue,howeverIdonotbelieveitgoesfarenough

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

- Thesteppedapproachwillenableprovisionoftrainingatappropriatelevels,thekeyfocusmustbeonraisingawarenessacrossthegeneralpopulationsothatpeoplefeelconfidenttoseekhelp

- Thesteppedapproachwillenableprovisionoftrainingatappropriatelevels,thekeyfocusmustbeonraisingawarenessacrossthegeneralpopulationsothatpeoplefeelconfidenttoseekhelpandtoencouragehelpseekinginothers.Keytothisapproachisprovisionoftrainingwhichcanbedeliveredinaflexiblewaytomeettheneedsofthegroupandaccessibilityfortheentirepopulation,Thiswillrequireinvestmentinpromotionalworktogetkeymessagestomembersofthepublicandtomarketprovisionoftrainingavailableforthewiderpopulation.Barrierstoattendanceattrainingshouldbeconsideredincludingchildcaresupportandprovisionofonlineandblendedtraininginareaswheretransport/childcaremaybeanissue,bearinginmindinternetconnectivityforspecificareasmaypresentdifficultiesinitself.AlltrainingandtrainersmustbealignedtoandcompliantwithQualityStandardsthataremonitoredanddeliveredbyappropriatelyqualifiedfacilitators.Itisimportantalsothatallcommissionedservicesmustassesstherequests/needsofpeopleandimplementasteppedtrainingplanandhavethecapacitytoprovidesupportforpeopleafterattendingtrainingasthisoftenraisesothersupportneeds.Criticalevaluationofalltrainingisrequired,theNIpopulationhaveuniqueexperiencesandneedsanditisimportantthatwecanbuildtheevidencebaseforwhatworkslocallyratherthanalwayslookingtomodelswhichhaveworkedelsewhere.Thiswillhaveparticular

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

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

personsstory;helpthepersontofindaturningpointandoncefoundthecaregiversupportsit;developasafeplanandconfirmtheactionsfromit.GivethemagnitudeofsuicideandthepaucityofappropriatetrainingitisvitalthatprogrammeslikesafeTALKandASISTandothersareurgentlymadeavailable

• “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”

AnonymousFeedback

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

TrackingAwarenessofMentalHealthIssues(TAMHI)TheHummingbirdProjectThePrimaryCareandTalkingTherapiesWellbeingHub

TheRainbowProjectTyroneandFermanaghHospitalUlsterUniversityUpperSpringfieldDevelopmentTrustWesternHealthandSocialCareTrust

WindsorWomen’s’CentreWolfhillCentreYouthActionNIYouthEducationHealthAdvice(YEHA)ZestHealingtheHurt

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

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