Time Space Compassion in suicide prevention - practice stories - Volume 2

2. Practice deep dive Sam’s Café Fife by Scottish Action for Mental Health

Creating hope through peer-led support in an Emergency Department

The Scottish Action for Mental Health (SAMH) Sam’s Café team are best known for their peer-led cafés - offering mental health drop-in and one-to-one support, 7 days-a-week across Fife. Working in partnership with NHS Fife and Fife Health and Social Care Partnership, the Sam’s Café team have also now taken their peer-support approach into Victoria Hospital’s Emergency Department, offering peer-led support for people who are over 16 and in crisis.

“To be, is to invite hope gently into one’s life, through offering people and ourselves Time Space Compassion.” (Sam’s Café book – conversations of experience)

2.1 Our challenge

Emergency Departments can be an overwhelming place for someone admitted to hospital in suicidal crisis. The bright lights, noise, staff handovers, protocols and open spaces needed for effective medical care, can make it hard to find the time and space people need - to make sense of what has happened to them, process their feelings, and work through next steps. For NHS staff, the need to balance multiple urgent demands in a fast paced environment, can make offering a consistently personal and compassionate response hard to achieve.

In contrast to the time pressures on NHS staff, time can pass slowly for the person admitted to hospital – as they wait to be triaged, see specialist NHS staff and take part in essential monitoring and periods of treatment.

Our challenge was to look at how peer-led support could bring a measured pace and more individualised approach to person-centred mental health support within this setting. We wanted to do this in ways that would make the most of the time people are in the Emergency Department.

2.2 Our response

The Sam’s team understand that a human response is paramount. We also know that sharing the opportunity for people to talk with peer-led workers can support individuals to let go of enough shame, self-judgement and sense of isolation, to start to process what’s happened. Using these insights, along with support and funding from Fife Health and Social Care Partnership, the Sam’s team worked with Victoria Hospital to place an experienced peer-led support team in their Emergency Department.

2.3 Learning from practice

Starting well – Changes to care pathways – no matter how considered - have big impacts for Emergency Departments. Protocols and clear roles are key to safe and effective crisis care. The Sam’s team aspired to build trusted relationships with the Emergency Department team, working in what can be described as an already crowded day and space. The first thing Sam’s needed to do, was to gather as a team to discuss and put aside presumptions and views of what it would be like. Facilitating a compassionate approach to the Emergency Department team was core to this. Informal chats over a cuppa, sorting out leaflets and showing interest in how the Emergency Department worked, helped develop the trust we all needed to make this work. Once the Emergency Department team saw the practical results of peer-led support, and how it supported people to share and choose to open up within this setting, our working partnership went from strength to strength.

Following through: as a community based team, Sam’s have insight into local trends, needs and community aspirations. Sam’s Café drop-in sessions take place seven days a week across Fife and offer an important source of postvention^[1] support. Experiencing peer-led support in hospital helps people understand the value of what we do in the community and what they can expect when they access one of the Sams café locations. It also starts to build their trust in a peer-led approach to supporting their mental health needs.

Listening and responding - listening with compassion and without judgement are core to our approach. This isn’t about detailed personal disclosure of our own lived experience of mental health issues. Instead, Sam’s team members share that they’ve had a journey through mental health issues and recovery. We find this approach can support people to express their own unique mental health journey and consider moving forward with their own recovery.

2.4 Impact

“it’s incredible the respect that Emergency Consultants give the Sam’s team – it truly is very much a partnership working environment. NHS and Sam’s are very clear about each other’s roles and work so well together, to the benefit of the patient.”

Susan, SAMH, Fife Community Services Manager

Between January and October 2023, the Sam’s team have supported 544 people at Victoria Hospital’s Emergency Department. The Sam’s team are inspired and motivated by the welcome and support they’ve had from the Emergency Department team. They always make their patients aware of our work in the community, and people have told us stories about how this connection and our support has stopped them ending up back at the Emergency Department. The team at Victoria hospital have also made us part of their trainee doctors’ orientation into the department, so that all new doctors passing through their doors understand the potential of peer-led support, when it works alongside an Emergency Department team.