A new Powys Suicide and Self Harm Prevention Co-ordinator

Jan Roberts recently started work as the first Powys Suicide and Self Harm Prevention Co-ordinator. She previously headed up the Crisis Resolution & Home Treatment Team in South Powys which she originally joined in 2012. Jan recently spoke at a meeting with some of the individual reps who champion improved mental health services in Powys and we found out more about her role.

The new post is funded for 18 months by Welsh Government alongside three regional Suicide and Self-harm Co-ordinators for Wales. Shaun Morris recently stepped into this role to cover Mid & West Wales. The lead within Welsh Government is Claire Cotter - National Co-ordinator for Suicide & Self-harm Prevention – NHS Wales Health Collaborative. The driver behind much of this work is the government strategy on suicide prevention – Talk to me 2: suicide and self-harm prevention action plan for Wales 2015 – 2020.

One of Jan’s first tasks is to understand the Powys picture so that an intelligence led service can be developed in response to identified needs and gaps. This level of intelligence gathering and research into suicide and self-harm has never been done within the health board or the council before.

Jan is working closely with colleagues at Powys Teaching Health Board, including Andrew Mason - the Harm Prevention & Reduction Officer for Substance Misuse, and Freda Lacey - the Mental Health Partnership Officer.

Three key areas of work

1. Analysing Coroner data for Powys residents who have ended their lives by probable 

   suicide between 2015 and 2019

This provides 5 years’ worth of data to understand if there is any particular demographic, or any particular geographical area in Powys, where these suicides may have happened, with the aim of trying to target services to prevent suicides in future, and in particular looking at gaps in service provision.

Powys wavers between the highest and second highest county in Wales for suicides (taking into account population size). The initial findings are interesting as they highlight a difference from the rest of the UK in that there were more deaths in the over 60s in 2019, whereas UK wide there were higher numbers of deaths from the 35 – 49-year-old age group. It will be interesting to see if this trend is also reflected in the analysis of the data from other years.

2. Improving the support available to those bereaved by suicide in Powys

In her previous role Jan had looked for 1:1 or face to face peer support for those bereaved by suicide and discovered that the nearest available group was either Cardiff or Chester. She is now working with colleagues to consider a support pathway which starts within 48 hours of the suspected suicide.

The proposal is that individuals bereaved by possible suicide would be linked in to both the practical advice they might need, as well as the emotional support. This will be in line with the suicide surveillance work being done in both Wales and England currently, which will enable the sharing of information on deaths by suicide at the time, rather than retrospectively, thus enabling appropriate responses to need and prevention being enacted both locally and nationally.

The idea is in its early stages, but the intention is that the family or person would be offered practical and emotional support with regular check ins, where they have consented; it’s about checking in and asking what support they need at that particular time. Peer led support is another option being considered in conjunction with the voluntary sector. Health board staff and partners in the voluntary sector are receiving suicide bereavement training to better equip everyone to work together to progress this in Powys.

3. Self-harm project

Finally, Jan is undertaking a data collation project in order to build an understanding regarding self-harm and self-injury in Powys, looking at prevalence, trends, pockets of particular need, and understanding the various pathways encountered to access support. It is hoped that this data will provide intelligence that will inform service development to maximise early intervention and prevention and reduce any barriers to accessing the right support at the right time.

It is more complex in Powys because of the distance people can travel to receive support, and further complicated due to the fact there are no district general hospitals or psychiatric liaison teams in Powys. Powys residents use approximately 5 or 6 different psychiatric liaison teams if they self-injure or self-poison and seek support, two of which are outside of Wales, so data collection is a challenge.

Many studies on self-injury and self-harm focus on the data from psychiatric liaison services but it’s difficult to get a full picture. A 12-year study from Swansea University into young people under 25 who self-harm in Wales showed only 50% had ever been to a psychiatric liaison service. Jan is looking at how we can source the best data to capture the trends and areas of need.

There is also a need to understand the pathways to service provision across Powys. For example, someone may live an hour and a half away from their nearest psychiatric liaison service and have no way of getting there so they could decide not to attend. Jan will be working with patients and staff to understand the pathways to receiving the right support at the right time – what works well and what could be better.

It is important that Powys residents are offered what is recommended by the NICE (National Institute for Health & Care Excellence) guidelines: a mental health assessment, a psycho-social assessment and referral on to an appropriate service.

Sarah Dale, a mental health rep, has recently delivered some awareness training on self-injury with the Minor Injury Units’ staff which was really well received and further training is indicated for MIU staff, in particular focusing on referral pathways.

Harm reduction programme – substance misuse

Another area of work taking place is the harm reduction programme from a substance misuse perspective. Harm Prevention & Reduction Co-ordinator, Andrew Mason, is focussing on the non-fatal drug overdoses across Powys, looking to learn lessons and identify areas for improving services with the ultimate aim of providing targeted support and intervention for people.

For more information on this ongoing work please contact Jan Roberts, Powys Suicide & Self-harm Prevention Co-ordinator, by emailing jan.roberts3@wales.nhs.uk

Bereaved by suicide – support organisations & resources

Survivors of bereavement by suicide

Papyrus – prevention of young suicide

Support after suicide

Powys Cruse Bereavement Care

Help is at Hand – a resource for people bereaved by suicide

Self-harm research project - SHARE UK - can you help?

by guest author Amanda Marchant

I'm Amanda, a PhD student and research assistant at Swansea University. I run the SHARE UK webpage, Facebook and Twitter accounts. I also work on other research projects looking at childhood and adolescent mental health, self-harm and suicide prevention. As a team we want our research to help improve mental health support. 

Reports out in the summer suggest that 1 in 4 fourteen year old girls and 1 in 10 boys have harmed themselves in the past year. Self-harm is very common but research suggests that up to half of young people who self-harm don’t receive help from anyone. 

We want this to change and for this we need your help! SHARE UK is a ground breaking study looking to learn more about self-harm from people who have experienced it themselves. We want to make a real change but we need you to help us learn about what would make a difference to you. This could be better support in hospitals, schools, anti-bullying policies, help online or maybe even some new ideas! 

The study can be completed all online and you can tell us as much or as little as you like. If you have any ideas or comments or if you would like to write for our blog then we’d love to hear from you too at shareuk@swansea.ac.uk

The UK's first self-harm research register – over 200 people strong so far! 

The most important part of any research with self-harm is real people. We can’t make change without you to tell us about your experience. We have created a register that gives everyone the chance to sign up to hear more about future research and studies that they might like to take part in. People can sign up online and we hope that this will give everyone a voice in research.

We have had over 200 people sign up already and this is amazing! Research is an important part of the push for services, government spending and how support is organised. If as many people as possible take part then we can make this push for change even stronger.

What you guys say

We’ve had some amazing feedback and ideas from you guys especially from our feedback survey where you get to write pretty much whatever you like! Here are some of our highlights:

‘There needs to be more work on the barriers to finding help for self-harm. Things could change to help people engage with services.’

‘There needs to be more community based mental health education classes. This could improve social skills, confidence and give people a chance to support one another.’

‘There needs to be more support for new mums.’

‘The topic of self-harm is very important to me and to so many people. Thank you so much for working in this field!’

The good? Not so good? Dark or not? Role of the internet

World Suicide Prevention Day brought about a lot of debate about the press and the internet and the way we talk about suicide, self-harm and mental health. Creators of content online can reach so many people and have an important role in starting conversations and reducing stigma. This doesn’t always happen though and there have been several high profile cases of online bullying, predators and other dangers conjuring images of a dark and precarious online world.

We want to know more about what you think. What’s good and what’s bad? This can help to make guidance for bloggers, internet service providers and anyone who makes content online for how best to talk about suicide, self-harm and mental health in a sensitive way.

By learning more about how people use the NHS we can help to make it better. Every time we use the health service data happens. This can be from a seeing a GP to visiting A&E or staying in hospital. This data has been anonymised and secured to be used for research.

Here at SHARE UK we want to take this even further. We are giving people the option of linking the information from the SHARE UK site to anonymised healthcare data. All the information is separated from personal details so even our researchers cannot identify anyone. The possibilities for research from this anonymised data are huge and it means that we can give extra meaning to the information collected from the NHS. This could help us make a real impact on healthcare.

To learn more we have created a Pinboard style dashboard where you can add anything you have viewed online to our media databank. Anything you upload will only be seen by you and our research team and you can add comments about sites or groups if you want to. We use this databank to look at things like quality, images and potential for harm or for support.   

Want to know more? 

We need your help to make a real difference. Your story can help make sure that in the future no one has to face self-harm alone. 

If you are aged 16 or over and would like to learn more or sign up visit www.share-uk.co.uk or email shareuk@swansea.ac.uk 

Black Cat project on ITV news

At the end of January this year I posted about Sarah Harmon's Black Cat project. Sarah is based in Presteigne in Powys, and has linked up with the Fixers Project - which supports young people aged 16-25 to tackle any issue that matters to them, however they choose.

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Sarah has written regularly on the TOWIP (The Only Website in Powys) website, written by and for young people in Powys, about her experiences. Yesterday's headline post was about Sarah launching her new project and her television debut:

"From the age of 16 Sarah suffered from an eating disorder and she also self-harmed.

Now on the road to recovery, Sarah has a positive outlook and is ready to raise awareness and support others who might be suffering from mental health issues themselves.

With support from Fixers, she is running workshops aimed at 16 to 25 year-olds in Mid Wales to try to eradicate the stigma surrounding mental health. She wants to encourage young people to talk about mental health issues and to discuss coping strategies."

On the Fixers website Sarah says: 

"When I was 16, I started experiencing mental health problems. It’s hard to describe just how low these conditions can make you feel and how difficult everyday life can become.

It’s improved a lot for me over the years, but I realise it’s a long road ahead.

Drawing on my own experiences, I aim to tackle the misconceptions surrounding mental health issues, so there is greater understanding and fewer barriers for young people to seek help.

By raising awareness, I hope people will become less judgmental about such conditions."

I've really enjoyed reading Sarah's fictional story as Black Star/Cara on the TOWIP website over the past few months, and it's great to see she has achieved her goal of setting up a mental health project for young people in Mid Wales. 

Here at Powys Mental Health we wish Sarah all the best for the Black Cat project in the future! 

Black Cat Project

In July last year I posted about self-harm in Powys, and linked to the blog posts of Black Star on the TOWIP website (The Only Website in Powys) which is where young people in the county get to write about issues important to them. Black Star writes powerfully about child abuse, eating disorders and emotional distress. This week I found out that she is setting up a new project focussing on mental health and young people, and working in conjunction with a nationwide project called Fixers. Appropriately for Black Star it is called the Black Cat project.

Black Star writes: “I have decided to go into the colleges (and hopefully schools too) in Powys to educate young people about mental health, promoting good mental health, help young people recognise the signs of mental health and encourage them to speak up about it.”

It’s great to hear of the new project. We know from calls to our Information Line that there is a real need for more information to be widely available for young people, especially those in severe emotional distress. We signpost people to the Samaritans, Kooth and other support organisations – but how much better would it be if they knew who they could ask for help before things got really bad?

I didn’t know much about The Fixers project, so I checked it out online. It was launched in 2008 by the Public Service Broadcasting Trust. Young people (aged 16 – 25) receive professional support to develop ideas they are passionate about such as issues that have impacted on their own lives. They are helped to set up websites, make videos, or produce promotional material. In return they have to show that they have made a difference to at least one other person.

The social issues which are explored include bullying, child abuse, alcohol and drug use, prejudices and environmental concerns and the videos can be hard-hitting. But they work. They capture the attention, not just of other young people who check out the website, but of wider audiences, as some are featured on the ITV news slot reaching out to over 5 million viewers. In 2012 the award-winning project was expanded across the UK with a grant of £7.2 million from the Big Lottery Fund.

Some “fixers” have gone on to start their own charities and set up websites including Imogen Smith from Bristol, who has produced the Self Harm Organisation website. She says: “while there are support networks out there, a lot of the time young people simply don’t know who to turn to. Self-harming makes you feel very lonely, very isolated, and very different to anybody else. Through a website, I hope to offer support to young people throughout the country who want to seek help to deal with their situation. Also the site will give parents, teachers, and other people advice on how to spot self-harm signs, and how to deal with them.”

So keep your eye out for Fixers on the telly, and Black Star – if you’re reading this, let us know how it goes!

I’ll let Black Star sign off with a question which I found on her Black Cat Project Facebook page (love the emoticon!):

What mental health workshops would you like to participate in? One idea at the moment is a workshop on Psychosis. Any ideas?
>^..^<

Self harm in Powys

A couple of colleagues at Powys Association of Voluntary Organisations work with organisations supporting children and young people (you can be defined as a young person up to the age of 25 these days). Last week they told me that a recent Youth Forum meeting had highlighted an increased incidence of self-harm in the county amongst young people. I don’t know all the details (if anyone reading this knows more then please get in touch), but it makes me wonder what could be done to support young people who self-harm more.

There is an excellent website called TOWIP (“the only website in Powys”), – named by the young people who helped set it up with Powys Youth & Family Information Service “to express their views, reviews and creativity”. I’ve been following the posts of Black Star – also known as Cara – who writes about her own experiences of self harm. She is a 17 year old teenager living in Powys, and comments openly, honestly and eloquently about why she self harms and her efforts to stop - “...to me it’s an automatic reaction to stress, it helps, and it’s addictive. It’s the way I turn emotional pain in to physical pain, physical pain is easier to deal with, and all I have to do is shove a bandage on it.”

Back in April Black Star asked if there should be a self harm support group in Powys, as she had looked around and been unable to find one. I’ve been doing a lot of reading about peer support groups recently and they really seem to help individuals across the whole spectrum of mental distress. It makes so much sense. “A peer has ‘been there, done that’ and can relate to others who are now in a similar situation.” After all, how would it feel to be a self harming young person, isolated in a rural county like Powys, knowing no one else who self harms to talk to? 

There are many online forums and useful websites – I’ve listed some below – but whilst young people are the most ICT savvy folk in the world even they need to meet up and talk face-to-face with peers sometimes.

I’ve also been watching the BBC 3 TV documentary Don’t Call Me Crazy for the last couple of weeks – a distressing but again honest insight into life on a teenage mental health inpatient unit in Manchester – the McGuinness Unit. It’s described by the BBC as “a place of last resort for many adolescents with eating disorders or psychosis, who self-harm or are suicidal”. It’s not an easy watch. But in amongst all the images of cut arms and legs, the screams, the tears, the physical restraints, something shines through. And that’s the sheer positivity of the relationships the young people build, the way this can increase their sense of worth, their strength to overcome their distress and move on, and their inherent deep-rooted desire not just to survive but to flourish – and I’ve found it very moving.

So, what do you think? Is Black Star’s suggestion a good one? And if it is – who can start it off and give it a go?

PS: the support sites I mentioned:

Kooth - online counselling for young people in Powys.
Harmless - a national voluntary organisation for people who self harm, their friends, families and professionals.

Recover Your Life - one of the biggest self harm support communities on the internet.

Feeling on the edge

Last week whilst driving to see my Mum I heard a short but powerful piece on Radio 4 Woman's Hour about the growing incidence of self-harm amongst younger people.

You can listen to the piece at this BBC website here.

"Feeling on the edge, helping you get through it", is a leaflet produced by the Royal College of Psychiatrists which provides information to people who are self-harming and their carers. It describes what happens to people who are provided specialist mental health support, and gives contact details for other agencies such as The Samaritans, Papyrus and The National Self-Harm Network. And many more too.

You can link to the online leaflet here.