Submission from the Sussex Community Development Organisation (SPR0056)

Summary

This paper is a summary of the Survivors of Suicide service operated in East Sussex. The paper covers the learning from the project so far and also highlights specific areas that have worked successfully and those where learning and improvements can be made. The paper aims to give experiences of how the service has been developed and also to highlight the wide impact of suicide on individuals and the wider community.

Introduction

I am submitting this paper as the project manager of the Survivors of Suicide project in East Sussex. The service was commissioned as a pilot in October 2014 for 2 years and supports both those who are experiencing suicidal feelings and those that are bereaved by suicide. The county of East Sussex incorporates Beachy Head which contributes to a higher than average suicide rate. The project was commissioned by public health together with a series of other initiatives aimed at tackling the suicide rate for the county. We have recently been informed that the project funding will be extended for a further year and that subsequently the service will form part of the core mental health services for the county.

This paper will cover

-          Experience from the service so far including client testimonials

-          Links with other agencies including coroners officers 

-          Anecdotal impact of a suicide on the immediate family and wider community

-          Impact of this type of work for those involved

-          Collecting and usefulness of data collected through the project

-          Final learning and actions for the ongoing project

As stated East Sussex has higher than average suicide rates when compared to the national average. This is due to a number of identified factors including the presence of Beachy Head. There are approximately 77 deaths by suicide across East Sussex each year with approximately 55 of those being East Sussex residents. For those who die by suicide and are out of area many die at Beachy Head or on other nearby cliff sites.

Experience from the service so far

The service has to date received over 200 referrals. This is made up of a reasonably even mix of people that are suicidal and those that are bereaved. The referral process is straightforward with one central telephone number used for referrals and no completion of paperwork necessary. Clients can self-refer or can be referred by other agencies with consent. Once a referral is received the service commits to contacting the client within one working day. For suicidal clients the first counselling appointment can be arranged in a matter of days and where clients are bereaved they are able to access the next group (currently running once a month). In some circumstances where the client is bereaved either due to recency of bereavement or other factors group may not be appropriate and there has been some flexibility to make home visits to these clients.

Clients and referrers report the quick access to the service as being a significant factor in terms of their own experience. Waiting times for other services can be months and clients often report needing the support there and then. The manager of the local CRHT (Crisis and Home Treatment) team made the following comment “[….] there were many clients who were simply not getting a service and were re-presenting via their GPs and A&E. The support for survivors of suicide offers a timely and appropriate short term service which is what clients need in this situation and is quite simply invaluable.”

Links with other agencies including coroners officers

Over the life of the project so far links have been built with many local agencies. These include

-          Grassroots Brighton

-          Secondary mental health care – Health in Mind

-          Crisis Response teams – Conquest (Hastings) and Eastbourne DGH

-          Psych Liaison teams – both hospitals

-          Beachy Head Chaplaincy Team

-          Coroner’s officers

-          Powher

Many clients self-refer although it is likely that many clients have information passed onto them by referrers.

Closer links to the coroner’s officers were established in the second year of the pilot and this has resulted in referrals being received when someone is more recently bereaved. The coroner’s officers have been sending out information about the service when they first make contact with newly bereaved individuals and suicide is suspected. They also send out the ‘Help is at Hand’ booklet. Early intervention is in line with guidance under development by the Support after Suicide Partnership http://www.supportaftersuicide.org.uk/. The partnership was primarily started by Hamish Elvidge whose son Mathew died by suicide. Hamish felt that in the aftermath of Matthew’s death the support for the family was non-existent and he wanted to work towards other families not having the same experience.

Anecdotal impact of a suicide on the immediate family and wider community

As the project has progressed and due to the links described with the coroner’s officers bereaved relatives are finding the service more quickly after their bereavement. Research from Personal Social Services Research Unit & London School of Economics & Political Science (2011) indicates that the cost of a suicide to the local community is c£1,450,000. The breakdown for these costs include the direct costs such as police costs and the inquest, insurance, GP visits, medication, possible counselling, funeral costs etc. The indirect costs include lost working hours and absence from work for the bereaved.

In addition further research including Alexandra Pittman (2015) talks about the increased risk of suicide for those who are bereaved themselves. This is thought to be connected to suicide becoming more in the bereaved person’s awareness and also that they themselves can become more hopeless, amongst other factors. The service attempts to be sensitive to this increased risk and responsive where another person seems particularly vulnerable. In the case of one family who was referred there have been a number of subsequent issues in the family. Since the original suicide of a man in his 40s the deceased’s father has been referred for counselling due to suicidal ideation, the deceased’s wife has made several suicide attempts as has his niece. And recently his brother in law also killed himself in the same manner. More intense work has been carried out with this family in addition to close working with other services.

Observation also shows the impact on those connected with the bereaved through illness and absence from work. A large number of people who attend groups have experienced extended periods of absence from work and have reported symptoms connected to stress and anxiety.

Post-traumatic stress disorder (PTSD) can also be a factor with this client group, particularly where a familiar member may have found their loved one. This has happened with a number of clients who have accessed the service notably to one father who one found his son hanged. The father expressed issues with sleep, flashbacks, sweating and increased heart rate. Whilst the service can identify PTSD it is not a service that deals with PTSD. However the local mental health service does offer this support and the client has been referred to them together with information about what is available to help such as CBT and EMDR.

Another consideration is that suicide appears to impact a wider group more significantly than a death by natural causes. This needs to be factored in when designing services and working out to reach this wider group. This can be very challenging as people can often feel that their grief is somehow not as valid as the more immediate family. In addition these people can be hard to find as are not likely to be referred to services.

Impact of this type of work for those involved

The service has taken this impact very seriously in terms of how workers are supported. All counsellors working in the service receive supervision in addition to that which is received for clients through the generic service. The development worker running the service receives fortnightly supervision to support them in their work dealing with both suicidal clients and those who are bereaved.

The service has researched the impact of vicarious trauma which is very likely to be a factor with this client groups as disturbing matters are discussed and explained. Repeated exposure to the trauma of others is known to have an effect on the counsellor or therapist.

Collecting and usefulness of data collected through the project

The project collects data in a number of ways and for a number of purposes.

-          Initial referral data

-          Fuller data including equalities information required for the commissioners includes

• Ethnicity
• Sexuality
• Disability
• Religion
• Age
• Marital Status
• Carer’s status
• Referral source
• Person who died (for bereaved clients) and time since bereavement
• GP and consent to advise GP about client accessing the service

-          CORE-OM is used for clients who enter 1-1 at the first and final sessions

-          A qualitative questionnaire is also issued to 1-1 clients at the finish of their sessions

-          A brief feedback form is used for clients who attend group (bereaved) at the end of each session

Data collection for the commissioner has been consistent throughout the project although some fields have been added such as referral source and the person who died for bereaved clients. This has allowed additional reports to be produced where necessary. A review of data will be carried out at the end of the pilot to ensure that any additional fields are captured as the project continues.

Data collection can be problematic particularly in completion of the CORE-OM and qualitative feedback questionnaires. Some clients choose not to attend their final sessions (this can be typical in counselling) so sometimes this information has not been collected. Where it has been the results are always positive but there could be an element of bias as perhaps clients who are less positive may be the ones who don’t attend through to the end.

Additionally the bereavement groups have been run as open groups meaning that clients can come and go as they please. Whilst this makes the groups easy to access and very flexible it is more challenging to monitor as a client’s attendance is not guaranteed. After consultation with other services it was decided to use a brief monitoring form at the end of each session. This using scaling questions for the client to identify how they felt at the beginning and end of the session and also whether the client would prefer the group to be held at a different venue or time. There is also a space for other comments. The forms are anonymised in attempt to mitigate bias in terms of wanting to please the facilitator.

Final learning and actions for the ongoing project

What works?

-          Quick and easy referral process

-          Speed of access to service for clients who are suicidal

-          Partnership between SCDA and Counselling Plus

-          Close links to coroner’s officers for those who are bereaved by suicide, allows easy and timely access

-          Robust support for workers within the service through management support and separate independent supervision

-          Flexibility of the service, person-centred approach

What could be improved?

-          More groups so that they are easier to access

-          One to one also available for some clients who are bereaved (either because they are very recently bereaved and group doesn’t feel appropriate or because they don’t want to access a group work programme).

-          Trialling of groups specifically aimed at men

-          The way that feedback is gathered

September 2016