Yet, do we or the Health Service truly value them? Listen to them? Include them? Give them a voice? Understand their concerns? Treat them as an ally? Respect their abilities and contributions? Answer their questions? Educate them? Empower them? Support them? Partner with them as well as we could? Sadly not.
In my experience and that of many other families of individuals with a mental illness, the power imbalance between the health care providers and the service users does not allow for an equitable relationship. Hence, denying the patient the best chances of recovery. There is national and local evidence that proves that carer engagement saves lives.
Triangulation of services is essential for best outcomes for patients and professionals. Risk averse practices may help reduce risk in the short term but may increase risk in the long term. A recovery approach to risk and development of a “life worth living” may have longer lasting benefits through rebuilding relationships, increasing service-users skills and confidence in collaboration with carers.
Norfolk and Suffolk Foundation Trust (NSFT) have developed a program called “Stepping Back Safely” up-skilling staff, carers and service-users. It is based on five main drivers of Recovery: CHIME
NSFT are offering free training in Stepping back Safely in July 2021 on-line. Having heard many stories where a life could have been saved only if there was a meaningful and effective communication between the three parts of the Triangle of Care, I think this training is most relevant and essential. I shall be taking it as I am sure it will deepen my understanding of the subject. If you or anyone you know might like a point of contact, here it is: firstname.lastname@example.org
The above is an example of a highly inadequate safety/crisis plan. The one that Saagar was given. It does not mention the word ‘Suicide’.
A safety plan should include:
Reasons for living and reasons not to harm themselves
A plan to create a safe environment How they can remove or secure things they could use to harm themselves? Can they identify and avoid things that they know make them feel worse? These are called distress triggers
Activities to lift mood, calm or distract
People to talk to if distressed. Include contacts for general support (not necessarily confiding their suicidal thoughts) and specific suicide prevention support.
Professional support such as 24 hour crisis telephone lines
Emergency NHS contact details
Personal agreement that Safety Plan was co-produced and a commitment to follow when required
Include names and all phone numbers for people to be contacted
Bank of Hope
A. Maximise the power of the individual not to act on their suicidal thoughts;
Increase wellbeing and resilience – enhance protective factors
Increaseemotional resourcefulness and share simple problem solving techniques to better equip them to deal with their triggers for suicidal thoughts or adverse life events should they occur/continue;
Increase internal locus of control – ‘do not be a passive victim of suicidal thoughts’
Increase self-efficacy – uncover or learn the skills and techniques not to act on suicidal thoughts
B. Reduce the power of suicidal thoughts;
Help patients see that suicidal thoughts don’t last forever;
Intense suicidal feelings are often short lived (although acknowledge that individuals may have long lasting suicidal thoughts which can still be very distressing)
Share examples of others who made serious and potentially lethal suicide attempts but who changed their mind immediately before or half way through and realised that they did not want to actually die, it was just that they felt so desperate and hopeless that they did not know what else to do to make those feelings go away. Their real wish was to feel better, not to actually die.
Reduce ‘the power’ of their suicidal thoughts, whilst acknowledging and validating the distress they can cause to the individual experiencing them;
Help the individual experiencing suicidal thoughts to view those thoughts as nothing more than ‘a symptom of distress’ (like having a temperature due to a viral illness), rather than some powerful magical impulse that they cannot resist.