Action to Prevent Suicide in North Wales
Conference Report
Tuesday 6th October 2009
The Interchange, 317 – 319 Abergele Road, Old Colwyn, Conwy, LL29 9YF.
Contents
North Wales Suicide Stakeholders Network
Conclusions and recommendations
Downloads
Delegate list (to follow)
Evaluation Report
The North Wales Suicide Stakeholders Network – Chair’s Foreword
Ø The Wales Assembly Government made some funding available to Mind Cymru in 2005 to enable suitably qualified trainers from the 3 regions of Wales, North, South and Mid and West Wales, to train as Trainers in ASIST – an internationally renowned evidence based skills based suicide intervention course.
Ø The difference between ASIST and other suicide intervention models available in the UK at that time was that it is not simply a risk focussed model. ASIST enables participants to explore historical, societal and their own personal attitudes to suicide before teaching them a coherent and easy to apply intervention model. Feedback from practitioners and workers at all levels has been very positive.
Ø The trainers in each are were asked by Mind Cymru to set up Regional Forums, Carol Evans, one of the North Wales ASIST trainers employed by Vale of Clwyd Mind, duly set up an inaugural meeting which was very well attended. The members of the embryonic Network felt very enthusiastic and positive about continuing to meet as there is no other comparable forum in North Wales (although we later became aware of the Wrexham Suicide Strategy Group).
Ø The NWSS stakeholders Network continued to meet regularly and one of their target aims, along with continuing to share good practice across North Wales, was to hold a conference in 2009 on the subject of what action is being taken to reduce suicide and self harm in North Wales, and what should be done,
Ø The imminent launch of the Wales Assembly Government “Talk to ME” – An action Plan to Reduce Suicide and Self Harm in Wales prompted our Network to take the opportunity to invite the Minister for Health to launch this important policy document at the conference in North Wales, but without success.
Ø Members regularly attending the Network between them hold a vast amount of knowledge and were only to keen to showcase their work at the conference, so there was no need for us to look outside North Wales for the expertise and good practice we needed to produce a world class conference.
Ø The conference was oversubscribed almost as soon as details were cascaded out. We had to set up a reserve list with the promise of holding a less formal seminar in the Spring of 2010 for those who were so bitterly disappointed that they were unable to attend this conference.
Ø Mind Cymru kindly made a grant of £3000 available to the conference. Many thanks. Vale of Clwyd Mind agreed to cover any short fall.
Ø Thanks to Positive Choices for their administrative support, to Anne Parry for graciously chairing the conference, to all the speakers and workshop facilitators and finally to Geoff Lees, Director of Vale of Clwyd Mind, for allowing me to divert so much of my time and attention to making the conference happen.
If you would like to join the Network, or just receive papers, please send me an email at carolmind@ruralnet.org.uk This Report will also be published the Wales Mental Health Promotion website.
Carol Evans
Chair, N Wales Suicide Stakeholders Network
Vale of Clwyd Mind
November 2009
Introduction
Following the Wales Assembly Government publication of “Talk to Me” – its Draft National Action Plan to Reduce Suicide and Self Harm in Wales, this conference was organized by the North Wales Suicide Stakeholders Network to examine current best practice in North Wales. It was jointly funded by Mind Cymru and Vale of Clwyd Mind
Structured around the themes of prevention, intervention and postvention, it drew together research, expertise and experience to determine how North Wales can best meet the challenges of the proposed Wales Action Plan.
Bringing together organisations such as PAPYRUS Prevention of Young Suicide, Vale of Clwyd Mind, CRUSE, the North Wales NHS Trust, Survivors of Bereavement by Suicide, Mind Cymru, NSPCC and many others, this conference was for service providers, service users and carers, commissioners and planners and anyone else having an interest in working together to reduce the despair that causes people to have thoughts of suicide, the agony of being prepared to act on those thoughts and the pain of the people who care about them.
The conference was chaired by Anne Parry, a founder member of PAPYRUS, and Chair since 2000.
The morning key speakers were Phil Chick, National Leadership and Innovation Agency for Healthcare, Sofia Wadman, ASIST trainer and a Specialist Practitioner in Self-Harm for Specialist CAMHS. This was followed by a plenary session chaired by Geoff Lees, Director, Vale of Clwyd Mind
Following lunch there was a presentation by Dr. Alys Cole-King, Liaison Psychiatrist and Gavin Peake-Jones, both partners within Mind Cymru's Positive Choices Programme.
A short synopsis follows below and the presentations are available to download
Presentations
Phil Chick
Presented a background to the National Action Plan to Reduce Suicide and Self Harm in Wales, illustrated with graphs and statistics. He made a point of the link between deprivation and suicide and highlighted the above average completed suicide figures for Conwy and Denbighshire.
Download presentation Phill Chick PresentationSofia Wadman
Reported on a Welsh Youth Consultation on attitudes to Suicide (Oct 08 – May 09) and used the conference to formally launch the Report.
Download presentation Youth Consultation Oct 09
Plenary 1
There were questions from the floor concerning the link between depression and suicide and whether these people were accessing services, also whether GPs were referring these people to mental health services. A discussion followed on why only 26% of completed suicides were known to services and how this fact had influenced the whole community approach adopted by WAG for the Policy
Another issue raised was the lack of mention of exam stress in the report on young people, which was answered as this might be due to age range (14-15 year olds) of the survey respondents
Mr. Phil Chick, Dr. Alys Cole-King and Gavin Peake-Jones
Phil Chick announced additional WAG funding for the new ‘Connecting with People’ suite of suicide awareness training as part of the Positive Choices project which has its content and length tailored according to the needs of specific groups, including doctors and nurses of all grades and specialties, allied health professionals and emergency services.
WORKSHOPS
As well as the presentations an ambitious programme of 10 workshops were well attended. On reflection the number of workshops could have been reduced but the range and quality of proposed workshops was so high that the Network decided to go with them all. For those who missed workshops, there will be another chance to catch them at the Spring 2010 Seminar. Short reports on the workshops follow below.
Workshop 1 – PAPYRUS – Media and suicide Prevention - Anne Parry
Responsible reporting by the media is recommended in every national suicide prevention strategy in the UK.
This workshop considered:
· the evidence for the need to report suicide responsibly in the media
· the guidelines for responsible reporting
· examples of newspaper reports
· action that can be taken if a report is deemed to be irresponsible
Anne pointed to the link between media reporting and copycat suicides and pointed the workshop participants at historical evidence in particular the ‘Werther Effect’ a theory which dates back over 200 years.
The focus was brought right up to date with reference to the Samaritans guide to responsible reporting and the Shift initiative, run by NIMHE in 2007, also reference was made to The MediaWise Trust.
There was a lively debate about what constitutes good reporting and with reference to recent events locally a few points were put forward for consideration in any responsible reporting policy:
· Needs of the family – sensitivity – not to glamourise suicide
· Lack of education of reporters around issue
· Maybe having dedicated reporting around suicide and mental health
· Using liaison officers or equivalent
· The phrase that came out strongly was ‘in the public interest’ who decides?
· Why report factors?
· Keep articles short and factual without ‘second guessing’ causes
· That help-lines and support organisation addresses are put on the bottom of articles
An example was raised as how irresponsible reporting made it seem as there is a danger to being admitted to a psychiatric hospital ward.
The consensus was that unfortunately people will still read about other people’s grief and misery and it will be difficult to control this as it sells newspapers. It is also a fact that newspapers will keep a story going with often very little evidence, relying on supposition and theory to keep the story alive.
The Press Complaints Commission and Editors Code of Practice were then described, and the importance of making complaints stressed.
Finally Anne described how PAPYRUS works with the media to address this important aspect of suicide prevention. The example of recent suicides in Bridgend South Wales was quoted and how PAPYRUS (unsuccessfully this time) campaigned for a media blackout.
Workshop 2 – DBT in Suicide Intervention - Dr. Michaela Swales
This workshop summarised the evidence base for Dialectical Behaviour Therapy (DBT) and why it is a useful treatment as part of comprehensive services for the treatment of suicidal behaviour. Dr. Swales described the structure of the treatment and provided a brief overview of the treatment strategies and how it was:
l A psychotherapy nested within a comprehensive programme of care
l Developed in 1991-1993 by Marsha Linehan specifically for the treatment of chronic suicidal behaviour in the context of borderline personality disorder (BPD)
l Evidence-based treatment recommended by NICE in the guidelines for the treatment and management of both self-harm and BPD
She went on to describe the structure of DBT and using models went on to describe how it is used in practice.
She finished by describing the need to balance treatment strategies and how this worked in practice.
A couple of main points that came out of the Q&A session that followed were:
· The “relentlessness” of the therapeutic model and how it consumed so much energy, resources and time
· How difficult it is to access the therapy due to lack of practitioners and the high resource element
Download presentation Dialectical Behaviour Therapy.
Reference: Swales, M.A. & Heard, H.L. (2009) Dialectical Behaviour Therapy: The CBT Distinctive Features Series
Workshop 3 – Suicide and Chronic Conditions - Geoff Lees
This very well attended workshop explored the interface between chronic physical conditions, emotional wellbeing and the risk factors for suicide.
Drawing on narratives of coming to terms with the often devastating life changes following diagnosis of chronic conditions, Geoff introduced and discussed a holistic model for managing the emotional fallout of, and suicide prevention strategies for, people newly diagnosed with a chronic condition.
Geoff outlined the programme being piloted by Vale of Clwyd Mind in Denbighshire and went on to describe how in conditions with, for example, chronic pain people may well experience psychological issues which need addressing.
The stepped model of care used in the programme was described in some detail and how there is an emphasis on developing ‘coping strategies’. As an example a copy of the MH Recovery Star was handed out for comment and a debate followed on best practice.
The session finished with a description of the ‘Menu’ of interventions and support available through the programme all aimed at supporting mental wellbeing and allowing people with chronic conditions to gain control in their lives.
Download presentation Suicide & chronic conditions
Workshop 4 - Suicide Risk in People with Learning Disabilities - Dr. Lesley Leeds
Dr Leeds explained that people with a learning disability (PWLD) are amongst the most marginalised and neglected individuals in society. PWLD are especially vulnerable to abuse and significant mental health problems. It is not surprising that a considerable minority of PWLD experience suicidal thoughts or self harm. However, there is a poor understanding of the difficulties that these people face in their everyday lives and PWLD often have difficulty accessing the help that they need.
Through a combination of discussion & case studies, this workshop discussed the problems faced by people with learning disabilities. The workshop aimed to raise awareness of the problems that PWLD face and the potential for individuals to present as suicidal or engage in self harming behaviours.
· 10/100 cases seen by Dr Leeds were suicidal
· International research findings cited, very limited research in this area
· Risk factors noted including epilepsy, bereavement and transition
· Case studies discussed
· Emphasised that the intention to kill themselves is as serious as any other person
· IMHA asked what is the best way to communicate with her clients?, and Dr Leeds suggested discussing this with her later and that speech therapist would be a good source of guidance.
Download presentation NWSS presentation on Learning Difficulties and suicide
Workshop 5 – Keeping Young People Safe - Sue Walls
This workshop was interactive looking at the definition of self harm, how this is managed in the relationship between worker and service focusing on risk; sharing skills and some techniques used by the NSPCC team.
The workshop was very structured, looking at definitions, prevalence of self-harm amongst young people and issues around confidentiality.
The discussion then moved to suicide and the importance of being direct. The fact that most young people don’t want to die, just for the emotional pain to stop was also raised.
The focus then moved to the practicalities for the NSPCC team and how they deal with self harming youngsters. It was noted how difficult it is for practitioners to manage the risk-versus-confidentiality issues which often arise.
The workshop was wound up with a look at treatment and prevention as practiced by the team and closed with some case studies.
Download presentation and notes Self Harm Workshop Notes to go with self harm presentation
Workshop 6 - Stigma and suicide - Claire Bailey Anglesey MIND
Claire discussed Stigma in a rural community and how environment can affect accessing or barriers to accessing support.
She described that they were focusing on targeting young audience in Anglesey.
Attendees completed a suicide survey on entering the workshop, and had the opportunity to discuss occasions that they had felt prejudice, how they had dealt with the matter and what they may do differently today.
The power point presentation included extracts from the radio programme they had developed with young service users and Bangor University radio station. Activities such as creative writing and media courses are open to all to minimise stigma and a website which includes music, culture and the arts is attracting attention. Following the success of a 30 minute radio programme on mental health they plan to produce another programme on self harm. Other projects include using the online social networks to offer appropriate support to young people experiencing mental distress.
The ‘Time to change’ commercial was shown and Dr Craig Thorneycroft was cited as an expert in stigma that had worked with her project
· Only 25% of suicide cases are know to MH services
· Prejudice against people with mental health problems is increasing
· Aim to maximise the person and not the illness
· ‘Don’t mind me’ poster campaign to tackle stigma in Anglesey
Workshop 7 - Suicide Mitigation - Dr. Alys Cole-King and Gavin Peake-Jones (to be amended)
Not available at this time – will be circulated at a later date
Workshop 8 - Surviving Bereavement by Suicide - Phil, Hayley and Jean
The workshop opened with a description of the work of the national charity, and using anonymised examples went on to describe how they support people. There are a large number of people who are bereaved by suicide that are determined that they must firstly prevent at least one other person from experiencing the intense pain they have suffered and feel driven to support others beginning the journey of survival.
A discussion then followed about the numbers of people bereaved by suicide in Wales that are in need of this service.
The workshop was informal with an emphasis on the practical and emotional support provided without overemphasising grief in a dramatised fashion. There was an emphasis on the survivor’s perspective with examples of the intrusive and insensitive media hounding of a bereaved family.
The point was made that this is a complicated grief with many facets and issues and that the postvention practices need to reflect this. This was illustrated by introducing a theory of constructive grief.
The issues raised follow the themes discussed by Clarke and Goldney in Keith Hawton’s Handbook.
“As those bereaved through suicide are a group at risk of poor bereavement outcome, psychosocial problems and suicidal behaviour, it is pertinent to ask what postvention programmes exist. Fareberow, in reviewing the 52 countries of the International Association of Suicide Prevention, found only 27% reported any such programmes. Mostly these were support groups provided by non-government and non-professional sources. In reviewing support groups in the USA, it was found that access is mainly by word of mouth and that there is a paucity of services for certain groups, such as children, adolescents and ethnic groups. Support groups have developed in response to community need for assistance. They are valuable in assisting the bereaved person to recognise that his/her feelings of intense emotional pain are normal, and to provide experiential expertise and role models of survival. Other important functions are those of advocacy within the community and destigmatisation.”
Workshop 9 - The CRUSE Crisis Team -
The workshop outlined the work of the CRUSE Crisis Team and their role in suicide postvention, and with children and young people
Those who attended though small in number commented that the workshop would help in their professional capacity working with children and young people and that by using tangible examples of cases it facilitated interesting group discussion.
Workshop 10 – ASIST and MHFA (Wales) - Gwynfryn Evans
As MHFA and ASIST are essential elements of the draft Welsh Assembly Action Plan to Prevent Suicide and Self Harm this workshop allowed participants to sample some of the resources used in these programmes.
The reasons behind having the 2 programmes was discussed and shown to be linked to the ‘whole community’ strategy of the Action Plan
Drawing on resources from the course materials the workshop compared the approach in both models of using best practice in asking about suicidal intent and reviewing risk.
A lively debate followed on the importance of training for suicide prevention, and how something as simple as a resource card with helpline details could be useful.
The workshop finished with a short film in the form of a testimonial from a survivor of suicide attempts from the MHFA course to illustrate the importance of open discussion of suicide.
Download presentation MHFA & ASIST
Close of Conference
The day was closed with a short plenary session chaired by Anne Parry and Geoff Lees where the main subjects were around how this event could be followed up and how it will link into implementation of the Suicide and Self-Harm Reduction Action Plan.
Finally Carol Evans, Chair of the North Wales Suicide Stakeholders Network /Vale of Clwyd Mind and her team were thanked for their hard work in arranging such a successful event
Conclusion and Recommendations