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

I found recovery in putting pen to paper

by guest author Charlotte Underwood

My name is Charlotte Underwood. I am a 22 year old mental health advocate and writer. I have fallen into a passion of writing and raising awareness of mental health and suicide by a beautiful accident; now I wouldn’t change a thing for the world. It’s ironic that for a long time I belittled writing and those who perused it, I had no idea that one day writing would save my life.

I used to laugh at my father for writing poems but now I know why he did it.

I remember the feeling of dread when I knew I had an English lesson. Writing and reading had become a chore, a forced constraint of my time – I hated it almost as much as I hated P.E. which was an immeasurable amount. The very thought of Shakespeare would make me groan in frustration.

It wasn’t always this way. As a child of maybe seven, I spent my spare time writing these stories about tornados (I was obsessed with the film Twister at the time) and writing a very varied volume of song lyrics. I was, at one point, an avid book worm. I could read before I could spell or even ride a bike, it was second nature to me. I was always running out of books to read and found myself wiser beyond my years. I couldn’t understand why no one else liked reading, when a whole new world was at your fingertips. I loved that I could be anyone I wanted to be, see anything I desired and it didn’t cost me a thing – except my pocket money. It was a blissful escape for a life which was hard on my younger self.

I feel like a mixture of those pesky teenage hormones, and the dullness of the school that I was attending, was why I lost my love of the novel and I why no longer enjoyed writing. All my creative juices were compressed into a shape dictated to me by the teacher, where is the fun in that?

Besides, I wanted to fit in and those who enjoying reading and writing were at the bottom of the social ladder, an easy way to get bullied. I never understood the reason for this but I never wanted to argue. I had a hard time fitting in and I was often picked on, so I didn’t want to give any ammunition to my peers. So, for the remainder of my school life, I stuck to social networking and gaming as that was cool, apparently.

When I left school, I could have picked up a book again or started to write but I had no time. If I wasn’t drinking with potential partners, or trying to get noticed online, I was working, like everyone else I knew – another social pressure. My brain was much like an empty fuel tank on a rusted vintage car.

Then a blessing hit me when I turned 20. It was disguised as a very traumatic job loss but turned to be the most wonderful gift. Once I had licked my wounds and made the most of not having an alarm clock or a routine, I found myself bored. I am a very independent person and I like to keep busy. I am very compulsive and can’t sit around and do nothing, so I had to find something before I started to relapse. I did not believe that I needed to write but I was wrong, so wrong. I only wish that I never gave up my love of literature because it seems now that my love had never gone, it was just buried under the weights of life.

I don’t know why I started but I began to write. I wrote a little each day - I must have started and stopped many novels. It was hard because I was trying to drink from an empty cup, though with time found the water I needed to nourish the blank paper. Eventually I found a passion for mental health and preventing suicide, as I lost my father in 2014 this way. I wanted to create something that would support people like me as I noticed how lonely it was to be a suicide survivor and that wasn’t right. Thus, born was my first book and the romance of my two passions, writing and mental health.

Since then, I have found myself entering short story competitions and have written a second short novel, as well as a full-length novel yet to be published. However, my love was found in poetry. Poetry allows me to bend the rules of writing, to ignore perfection and focus on emotion, it is a perfect match for my mental health advocacy – even flaws can turn into roses.

For what began as something to keep me busy, writing has become my therapy and daily self-care. I may not wash myself or brush my hair on some days but I will write, like I have every day for the last 6 months – without fail.

To write is an art but it is also a way to remove negative thoughts and feelings from your mind. From there you can start to unjumble it all and start to make sense of it. It’s enlightening and has been my biggest tool in recovery.

It’s worth a mention that writing has kept me feeling productive, and moving my hands is soothing to a person like me who cannot sit still, which means I have less time to allow that black dog back in.

I think I may write every day until my last.

If you would like to find out more about Charlotte's story, you can download her free e-book, After Suicide.

World Suicide Prevention Day 2015

Today is World Suicide Prevention Day across the globe. The theme in this 13th year of the Day is “Preventing Suicide: Reaching Out and Saving Lives.”

The issue of suicide is as relevant in Powys as it is anywhere else in the world. In speaking to police officers in the local Dyfed Powys force recently I was made aware that the incidence of attempted suicide and self-harm in the county has been rising over recent months. Police officers are often the first emergency services on the scene in crisis situations, along with those from Health. Here in our team we provide an Information Service, not a Crisis Helpline such as Samaritans or C.A.L.L.Helpline, but nevertheless we are still occasionally called or met by people who are extremely distressed and tell us that they want to kill themselves.

According to the Samaritans Suicide Statistics Report 2015: Male suicides in Wales rose by 23% between 2012 and 2013, and rates are significantly higher than those in England since 2010. The BBC wrote more about these statistics here.

The question has to be asked, why are more people feeling so desperate about the quality of their lives that they consider suicide? The Samaritans Report states: 'The causes of suicide are complex, and we need to encourage people to seek help before they reach a crisis point'.

It seems appropriate then, on World Suicide Prevention Day, to flag up some of the resources and services that are available to people at risk of suicide and those close to them. First, though, a bit about the organisation which established the Day originally.

The International Association for Suicide Prevention (IASP) was founded in 1960 and is: ‘dedicated to preventing suicidal behaviour, to alleviate its effects, and to provide a forum for academicians, mental health professionals, crisis workers, volunteers and suicide survivors’.

The President of IASP, Professor Ella Arensman, introduces us to World Suicide Prevention Day with the words: “Every year over 800,000 people die by suicide (around the world)…. We now know that for many people who survive a suicide their main intent was not to die but to have a different life. This important insight should encourage all of us to become more proactive, to reach out and to support people improving their quality of life.”

Resources

Samaritans provide a helpline 24 hours a day, 365 days a year. And you can find more about the local Brecon & Radnor branch here.

C.A.L.L. Helpline offers a confidential listening and support service . Anyone concerned about their own mental health or that of a relative or friend can access the service.

NHS Choices has a very useful webpage on Offering support to someone who’s feeling suicidal. It starts off: “One of the best things you can do if you think someone may be feeling suicidal is to encourage them to talk about their feelings and to listen to what they say”.

The charity Mind has a range of information on its website relating to suicide, including sections about Suicidal feelings and Creating a support plan to use if someone is feeling suicidal.

Author Matt Haig wrote a blog post last year about the time when he nearly killed himself aged 24. It’s called REASONS TO STAY ALIVE.

Survivors of Bereavement by Suicide is a self-help organisation which exists to meet the needs and break the isolation experienced by those bereaved by suicide.

The BBC has on online guide called How do we talk about teen suicide?

Further information

In July 2015 the Welsh Government published its Suicide and Self Harm Prevention Strategy for Wales 2015-2020 - Talk to me 2. There are 6 priority actions, including:

• The development and delivery of a Wales framework for the training of professionals, individuals who frequently come in to contact with people at risk of suicide and self harm, and the general public.
• To promote staff awareness and improve staff knowledge of where to go for help and support through workplaces.

Applied Suicide Intervention Skills Training (ASIST) is run occasionally in different parts of Wales. It is a 2 day skills building workshop which prepares caregivers of all kinds to provide suicide first aid interventions. There are courses in Blaenau Gwent and Torfaen in November 2015, February, May & August 2016.

If you are urgently looking for help and advice in Powys there is a summary of the main contacts on our Powys Mental Health website.

If you have further suggestions for help and support for people feeling suicidal, then please add in the comments box below.

Finally, there is further research being carried out which aims to understand more about suicide and what can be done to prevent it. If you are interested, find out more about The Quest Study, which has been commissioned by Samaritans and undertaken by psychology researchers at Middlesex University and the University of Westminster.

Suicide survivors

A couple of weeks ago my sister, who manages a hall of residence at a large British university, was faced with one of the hardest times of her working life. Tragically one of the young students living at the hall appears to have taken her own life (I have to write "appears" as the inquest has yet to take place). Another member of staff and one of the student's friends found her, in her room, after she had been reported as missing all day. It is hard to imagine a more harrowing experience for that staff member and the friend. And then there is the impact upon the family, other close friends, and the wider social circle both at university and outside.

It has been described as like "a grenade going off within a family or community".

The university has arranged ongoing counselling sessions for those students closely affected which is obviously good to know. However, it got me thinking... what about other people who lose a loved one to suicide... what if there is no official support system in place... what do they do?

Well, there are a lot of resources and organisations out there which can offer support and advice.

Survivors of bereavement by suicide (SOBS) has a national helpline - 0844 561 6855, and there are local groups all across the UK. You can find out more here. The website also has links to useful books, videos, survivor testimonials, and other relevant sites.

You can link to an NHS website called Coping after a suicide.


Healthtalkonline has a section here, where you can watch interviews with suicide survivors - brothers, sisters, parents, partners and friends.

Many sites are from outside the UK, but nonetheless helpful for being so.

The Alliance of Hope for Suicide Survivors has a website page here about the common feelings which surface at a time like this. Other people's survival stories can be helpful - showing that not only is survival possible, but there is a journey beyond: "Survivors must mourn, question and rebuild their shattered lives.  For many though, there is an unexpected gift:  a bond among survivors, which pierces through the isolation and the fear."  

"RedRubySlippers" writes of her poignant journey here.

You can find many more resources online - these are just a few key links. Get in touch or leave a comment if you have some ideas that helped you.

Postscript, July 2013: The Samaritans have produced a guide called Help is at hand for family and friends bereaved through suicide and unexplained death.