Suicide prevention strategy development: early engagement - summary report

Theme Three- Crisis

Respondents stressed that individuals in crisis had to be supported quickly and effectively. Concerns were expressed that in the current system there was both a lack of clarity in how to access services and a lack of consistency in the availability of services. It was also suggested that there were issues with the type of services provided.

Examples were offered of individuals requiring crisis support on several occasions, and whilst it was acknowledged that this could happen it was posited that, in some instances, this could be avoided by improving follow-up processes and interventions.

“There is a revolving door and lack of follow up from emergency/acute distress interaction.”

“Intervene successfully the first time.”

“Better safety planning for those who have attempted suicide”

“When someone has been in crisis a follow up should happen – does not need to be a professional service, communities can and should also be involved to make sure people are not isolated and alone.”

Accessing Services

It was suggested that sometimes individuals found it very difficult to make contact to seek the help they needed and so it was vital that they could engage in a way that suited their needs. Once contact was established individuals needed to be connected to the most appropriate type of support quickly.

“An emergency number- not necessarily 999 (but could be) should be provided to access support in a crisis situation.”

“People often need help to actually pick up the phone to call services like Samaritans - need to have a range of options available, telephone, text, email, face to face etc.”

“Need to build on the good elements of digital/technological support which have developed through the pandemic.”

Many respondents suggested that there were issues with the thresholds that had to be met to access services. The criteria that had to be met often acted as barriers. There were many requests for the referral processes to be reviewed and simplified. Several suggestions were offered as to how improvements could be made.

“Need a triage system which someone in crisis can easily access which can then link the person to the local service which can support them.”

“There should be no wrong door – no matter where you turn up you should be supported to find the right part of the system without having to retell your story.”

“3rd sector organizations struggle to be able to refer into statutory organisations which would alleviate need to engage with 999/GP/ Out of hours

“Need to make onward referral part of the process and not ‘an additional’ – it needs to be embedded.”

“When someone turns up to service and doesn’t meet threshold for that they aren’t always sent on to the place they need to go to – there needs to be wider knowledge in these services about the other services available.”

“More clarity on where/what services can be accessed (pathways should include 3rd sector)”

It was suggested that the services offered depended on the initial point of contact and this could mean that individuals were not always able to access, or be referred to, those services that could be of the greatest benefit.

Some respondents felt that people should be able “to re-refer to services if they feel they need the support from a service they found useful in the past”.

The lack of equity across the country was frequently referenced, particularly in relation to accessing services in rural locations.

It was suggested that different communities had different needs and a higher priority should be awarded to equalities issues.

Many respondents expressed concerns about the waiting times for services and the need for them to be reduced.

“People don’t stop thinking about suicide whilst waiting for support”

Service Provision

A need was identified for 24-hour support and it was suggested that this could be delivered through improved partnership working and the use of a generic framework that could be adapted to meet local circumstances.

Many participants expressed the view that there should be a shift away from a medical model of support and consideration given to other types of assistance.

“A menu of support options – beyond home or hospital – needs to be made available.”

“Develop a crisis model of care rather than an illness – so can respond to distress rather than illness.”

“Places of safety – where people can go and be kept safe.”

“People in crisis may want to just talk about how they are feeling when they are suicidal to get things out their head and may not act on their thoughts. Mental health services automatically risk assess and detain when you express suicidal ideation, but this may not be what someone wants, they want to talk about the feelings,”

“There is a need for increased resource for people in crisis, so they get a safe place to go which isn’t a hospital or prison cell – somewhere for people to go when they are deemed medically fit but not safe to be left.”

In those instances where medical support was necessary it was highlighted that, although exacerbated by the pandemic, there had been occasions in which there were no beds available in mental health inpatient units for females anywhere in Scotland

Concerns were expressed by many about the lack of support from individuals working within the criminal justice system.

The work of Samaritans, and indeed other third sector organisations, was viewed positively. Although yet again the disconnect between public and third sector service providers across all areas was highlighted. This has already been reflected in a previous part of this report.

“Samaritans works well as a crisis response; the aftermath is the main issues.”

“The anonymity of things like the Samaritans can be helpful.”