All About People

In this blog All About People’s Sarah Marsay shares some reflections and learning on a recent piece of work.

In a recent LinkedIn post, I reflected on my first year as a freelancer, so now seems a good time to talk a bit more about some of the work we’ve been doing, including an important project looking at suicide prevention

One of the areas we specialise in, if that’s the right term, is supporting people to have conversations that matter. Conversations that make a difference, that improve their bit of the world, that look real problems square in the face (or sometimes sneak up on them to see how they react to a surprise attack, hence our many different hosting tools). But I don’t think we could’ve been expected to predict that one of our earliest projects as freelancers would focus on the sensitive, emotionally challenging, and seemingly intractable issue of suicide.

Every death by suicide is a tragedy. For the individual, for their loved ones, and for those around them. Everyone is at risk of dying by suicide, but some people are much more likely to die by suicide than others – suicide is an inequalities issue. Middle aged men have persistently been the highest risk group. But you’re also more at risk if you live in a ‘deprived area’, if you’re out of work or in insecure, low paid work, if you’ve had experience of the criminal justice system or of homelessness. If you tick several of these boxes, your risk goes up. Traditionally, the NHS steps in when people are in crisis, and crisis care is of course critical, or in trying to help someone after a suicide attempt. But as with so many things, the real focus must be prevention – how can the NHS prevent people from reaching crisis point?

We were approached by a Primary Care Network (PCN) with high rates of death by suicide in their local area – even when compared to their wider area, which had higher rates than the national ‘average’. They asked us to explore what their role could be, as a PCN, and as GP practices, in reducing deaths by suicide in their community. We started with the data, trying to understand more about who was dying by suicide, so we could look at target populations and approaches. But unfortunately, the data was largely not available – work was underway, but analysis not complete, findings not yet known. Added to which a lot of the detail we were looking for isn’t routinely collected or recorded consistently. So, we worked from some of the ‘headlines’ in the national data, and used this as a starting point to explore work already underway in the area – who’s already working to prevent suicide, what are they doing, could the PCN link in, or help, and where are the gaps? The focus was on looking at the specific role the PCN, and its member practices, could play, using their unique position as a healthcare provider and community anchor.

We brought many of the people we had connected with together for a day and hosted a workshop with professionals and people with experience of suicidal thoughts and / or of losing a loved one to suicide. Taking an asset-based approach, we discovered lots of fantastic community-based, peer-led activities and support available, which was undoubtedly saving lives. And we discovered that public sector services were really varied, and not all accessible locally. One of the outputs from this workshop was a graphic record – produced by Eddy Phillips – to which we added hyperlinks to all the different services and sources of support identified, as an initial tool for the PCN and their new partners to continue to build connections, and help with signposting and building of relationships. 

We spent time understanding the PCN’s social prescribing model – hugely valued and respected – but inadvertently disconnecting GPs and their clinical teams from the communities their patients are part of. 

We spent inspiring and amazing time with the local branch of Andy’s Man Club and a peer-led bereaved by suicide support group, and we connected with education / school staff to explore concerns and work underway to look at emotional distress, self harm and suicidal ideation in young people.

In all of these conversations, we approached with care, giving everyone – including professionals – clear information about what we’d be talking about, how everyone could keep everyone else safe by being mindful of what they shared, of how to access support, and encouragement to take time out if needed. 

Our recommendations for the PCN included practical steps to standardise and improve actions taken by all Practices in responding to suicidality and suicide risk, reviewing the social prescribing model to support GP connection with their communities, improving connection with peer-led groups and community-based support, and exploring in full opportunities for partnership approaches. 

This was not an easy project, but the easy stuff is not where we need to focus our attention. And exploring questions such as this, which move beyond seeing people as ‘patients’ and as medical conditions, felt like primary care at its very best – rooted in the community, connected into local activities, sharing expertise and working in partnership. 

Can we help you to have an important conversation, to explore something that really matters or is really challenging your team, organisation or community? Find out more about our work at www.allaboutpeople.org.uk or email hello@allaboutpeople.org.uk Or contact me directly at sarah@allaboutpeople.org.uk

If you’re struggling, remember you are not alone, you are valued, and things can get better. You can contact Samaritans 24/7 on freephone 116 123 or email jo@samaritans.co.uk