On Monday 10th December at 20:00 GMT, we will be hosting our second in a series of Twitter chats with Zero Suicide Alliance. The theme of this chat will be Assessment and Safety Planning in Suicide Prevention.  Whilst this title appears clinically focused, we hope that this chat encourages a broader conversation about how to recognise the signs that a person might be feeling suicidal and to share thinking, experiences and resources about what each of us might be able to do to help. We fully support the ethos of the Zero Suicide Alliance, that suicide prevention is everyone's business. The reasons behind a person taking their own life are often complex. It is therefore important that health and care, emergency services, prison services, schools, charities and communities all work together and that we raise awareness across our society generally. One of the ways we can do this is by having open conversations, such as this one,  that everyone can participate in.  Suicide can affect anyone and many of us have been personally affected by suicide at one time or another. Suicide doesn't discriminate and we can all make a difference if we know how to recognise the signs and if we feel confident about reaching out to someone in distress. 

Hashtag for Twitter Chat

To encourage a diverse conversation across all health care communities, we will be using the #WEMDT hashtag throughout this chat. Please remember to include this hashtag in all your tweets so that everyone can easily follow the conversation and so that we can capture a transcript of all the tweets to share with people not able to participate on the night.

Emotional Support and Trigger Warning

Suicide is an emotional issue. We will do our best to facilitate this conversation in a caring and compassionate way and we hope that you will also be kind and respectful to each other. However, if you feel that this conversation might touch on themes which are too painful and/or traumatic, we would encourage you to avoid or mute the conversation during the chat. 

We also urge people to reach out to family, friends and/or professionals if you feel that you need to talk to someone during or after this twitter chat. Zero Suicide Alliance provide a very helpful resource page on their website if you need urgent help for your mental health. It can be accessed here.

Many thanks to our invited guest @jack29847818 who has kindly offered support to anyone who becomes distressed during this chat

 If anyone is in distress,  the Mental Health helpline CALL @CALL_247  have kindly offered to provide support during our chat and also ongoing support post chat.

The Samaritans are also available 24 hours a day on 116 123 or can be contacted by email to Jo@samaritans.org (24 hour email response)

A word about sensitive use of language

We would ask that you consider the sensitive use of language tonight during this chat and also more generally in conversations about suicide. The term 'commit suicide is steeped in history and suggests that suicide is a criminal act which it is not. Please use the alternative term 'died by suicide'

The Samaritans have published a very comprehensive and thoughtful Best Practice Suicide Reporting Guide which you can access here. 

Dr Alys Cole-King* , @AlysColeKing has kindly agreed to be a guest for tonight's chat and will be sharing with us her thoughts, experiences and expertise around safety planning. Alys shares the following thoughts with us ahead of the chat on tuesday. 

Zero Suicide Tweetchat 10^th Dec 2019

Suicide is not the inevitable outcome of suicidal thoughts. Most suicidal people are ambivalent about living and dying but unable to imagine solutions to their distress or their situation. Many do not know where to seek support, do not believe that anyone cares about their suffering or they are reluctant to disclose suicidal thoughts due to stigmatised attitudes in others.

Suicide cannot be accurately predicted at the individual level. A paradigm shift among clinicians is required: from ineffective attempts to predict risk as a means of allocating care to the adoption of a holistic, universal, population-based approach (Cole-King A, Platt S 2017)

McLean (2008) outlined that increasing hope, emotional resilience and reasons for living decreased suicide rates. A systematic review in 2005 suggested that ‘Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates’ (Mann 2005).   Suicide reduction interventions include reducing access to suicide methods, increasing hopefulness, promoting effective help-seeking and reasons for living. A Safety Plan can potentially act as a summary of all of these.

At times of intense distress or crisis, it may be di?cult to think clearly, so the idea behind safety planning is to prepare for the difficult times before they happen. A Safety Plan can be thought of as the emotional health equivalent of putting on a car seatbelt. It’s a planned set of actions, strategies and sources of support that a person keeps with them and can use to help them stay safer when experiencing distress and before they reach a crisis point.

A Safety Plan does not replace ‘treatment as usual’ it is a parallel process which can be undertaken in partnership with NHS colleagues but does not rely on busy NHS or social care colleagues to instigate. Ideally, people will have a Safety Plan in place before they reach crisis point. A Safety Plan is highly personal to each individual and typically includes things they can do for themselves, practical ways they can make their situation safer and who to contact for emotional,  practical and emergency support.          

A Safety Plan is highly personal to each individual and typically includes:

• What the person can do for themselves to get through di?cult times,
• Activities to lift or calm mood
• Activities to distract including
• Practical ways they can make their situation safer Who to contact for emotional or practical support                
• Where to go or who to contact in an emergency

What we know so far

Despite international support and being actively promoted in several countries, the NCISH recently found that Safety Plans were used by 10 (12%) Mental Health Trusts (The assessment of clinical risk in mental health services. National Confidential Inquiry into Suicide and Safety in Mental Health, The University of Manchester, 2018 ) A November 2019 publication from NCISH team included ‘safety plans’ in their examples of good clinical care. (Littlewood et al 2019)

A recent study (Stanley B. et al 2018) showed that, that six months after ED discharge, fewer patients in the safety planning intervention group engaged in suicidal behaviour compared with the usual care group (3.0% vs. 5.3%,respectively), nearly halving the odds of a patient engaging in suicidal behaviour A formal RCT on safety planning is in progress

The 2019 RCPsych Psychiatric Team of the Year for Quality Improvement where chosen partly for their implementation of Safety Plans https://www.rcpsych.ac.uk/about-us/rcpsych-awards-2019

Dr SarahMarkham @DrSMarkham  published a BMJ blog ‘As a survivor of a serious suicide attempt, I am aware what is missing from mental health support is a genuine element of caring. This online tool changes that…full of genuine care, empathy, and compassion as well as sound, evidence-based practice…I’m grateful that finally there is something for people experiencing despair that feels as good as the advice and support it offers.’ https://blogs.bmj.com/bmj/2018/12/21/sarah-markham-online-tool-provides-support-for-people-with-suicidal-thoughts/

Resources:

StayingSafe.net was co-funded by NHS England and is free to access. It features short videos and a blank Safety Plan for download or an on-line option with pre-populated suggestions (which can be stored on-line or printed). StayingSafe.net was developed in collaboration with an Expert Reference Group of over 180 people including international academics, people with lived experience, suicide prevention experts, mental health practitioners, general practitioners, policy makers, public health experts, charity and voluntary sector experts, educationalists and concerned citizens

BMJBest Practice Suicide risk management

FREE for ALL #NHS Staff via Athens and FREE 1 weektrial for anyone in UK and beyond

https://bestpractice.bmj.com/topics/en-gb/1016

References

Cole-King A, Platt S (2017) Suicide prevention for physicians: identification, intervention and mitigation of risk.Medicine. DOI 10.1016/j.mpmed.2016.12.012

Littlewood, D.L., Quinlivan, L., Graney, J. et al. Learning from clinicians’ views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study. BMC Psychiatry 19, 346 (2019) doi:10.1186/s12888-019-2336-8)

Fleischmann A, Bertolote JM, Wasserman D, et al (2008) Effectiveness of brief intervention and contact for suicide attempters: a randomised controlled trial in ?ve countries. Bulletin of the World Health Organisation

86: 703–9.

Mann et al (2005)  Suicide Prevention Strategies, A Systematic Review. JAMA Vol 294, No. 16

Stanley B. et al.  (2018) Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry. 1:75(9);894-900. Doi: 10.1001/jamapsychiatry.2018.1776

At the last Zero Suicide Alliance Conference, we also interviewed @amy_harvey and her colleague, @sarahbpilling who shared their thoughts with us about safety planing in acute mental health settings. You can access the podcast here . 

Questions for Twitter Chat

1. What are the signs to look out for which might indicate that someone is feeling suicidal and what can you do to help?
2. What are the key components of effective suicide risk assessment?
3. What are the key components of safety planning?
4. Can you share any positive examples of good practice in assessment and safety planning for suicide prevention?
5. How can we promote hope and compassion in suicide prevention?

* Dr Alys Cole-King 

Dr Alys Cole- King is the Clinical Director of 4Mental Health and is the first person from the U.K to be awarded the Ringel Service Award from the International Association of Suicide Prevention for her work in suicide prevention http://www.connectingwithpeople.org/about She was named one of the most influential women in medicine by the Women Journal and has been profiled in the Guardian, Lancet and the Psychiatrist. Alys works with the media (film, radio and newspapers) to ensure safe and compassionate public health messages around suicide and self harm. She actively contributes to twitter and has co led several international tweet chats @AlysColeKing