Time Space Compassion - supporting people experiencing suicidal crisis: introductory guide

3. The Principles and Practice

When asked what an introduction to Time Space Compassion should cover, people said:

• shared principles
• underpinning values
• ideas for realistic practice and action

This section of the guide describes the Time Space Compassion principles – the core statements that lay the foundation for the approach. Under each principle, it also introduces a set of supporting practices.

Supporting practices are common ways of doing things xvi that people, groups and organisations have developed to help them offer Time Space Compassion. Some practices will be more relevant and achievable in particular settings, but the overall aim is to offer inspiration and demonstrate examples of the principles in action. While getting people talking about Time Space Compassion is an objective for this guide, ultimately, it’s about action that has a positive impact for people experiencing suicidal crisis.

"…people i can trust and that stay with me when it gets difficult…"

The Principle of TIME means

• time to be heard, listened to – that taking time helps people feel validated and understood rather than judged
• receiving a timely response – as well as the response itself, it is important for people to have clarity on when support will be given, and what they can access and expect
• sticking with people over time, being able to offer continuity of support over time and offering ways back in – recognising people may experience recurring poor mental health or crisis over time
• that time and attention is paid to connecting and supporting people when they do need to move between different forms of support or to receiving support from different people within a support setting
• valuing each other’s time, acknowledging and valuing both your time and the time people spend with you

Examples of supporting practices for TIME include

Starting well: knowing about and planning how to start a conversation well when someone may be experiencing suicidal crisis; actively developing and practicing listening skills; regularly tapping into learning and practicing having good and trusting conversations; being able to identify and respond with compassion; understanding the factors that might lead to suicidal thoughts and behaviours.

Following through: being clear on how you support and connect people when they are moving to and from different support; being clear on how and when you will follow up, including how people can keep in contact with you or your service; having clear processes for securely holding information, so people trust they only need to share key information once.

Listening and responding: having ways of working that support listening well; sharing simple methods to help keep a track of and reduce distress and anxiety; offering people different ways to express themselves; and helping them develop safety plans and take practical action to address the root causes of their distress.

Practice story – NHS Borders RENEW

Renew offers a simple route for people working in primary care, to connect people directly into the NHS Borders psychological therapy service.

"Our aim is to build a strong connection with the person by calling as soon as possible – listening to them, working together to reduce their levels of distress and develop a blended plan they feel in control of and a commitment to."

(RENEW team)

This is an example of taking time to listen and offer practical support to someone moving between

services. It is also an example of services working together to develop better connections.

You can read more on this, and all of the Time Space Compassion practice stories, in the publication Time Space Compassion: supporting people experiencing suicidal crisis: Stories of Time Space Compassion in practice. If you have a Time Space Compassion practice story to share, email us at TSC@gov.scot

"Everyone has a responsibility to be trauma-informed … services

should be designed with the needs of those accessing them in mind and consider how the whole environment impacts on them."

(Youth Advisory Group)

The principle of SPACE means

• the places people commonly seek help can offer safe spaces, and when needed help people to reach other safe spaces which can meet their needs
• the offer of emotional and psychological space, to be alongside them, listening to them on their own terms and – when the time is right – start to work through next steps
• the places people seek help being accessible, welcoming and designed to meet the needs of people experiencing crisis and who may have experienced trauma^[xvii]
• supporting people in crisis to feel safe and to help them keep safe – whether that is at home, in communities, online or within a service or particular setting
• to apply these principles to all the spaces we share in person, on the phone and online

Examples of supporting practices for SPACE include

Being accessible: offering clear, safe and accessible ways to get in touch and follow up; being clear on opening times and alternative routes to support when you are closed; communicating clearly; creating welcoming and safe spaces; reaching into communities as well as supporting them to come to you.

Being alongside: working with the person to develop their safety plan; making templates easy to use and personalise; offering to check in with people and where appropriate involving family and friends; drawing on people’s experience to shape what you do and how you do it.

Supporting safety: asking about and taking action that helps people feel physically and emotionally safe; using and staying up to date with national guidance and practice on safety planning; if needed, being able to get people to a safe place; being clear on confidentiality and when you would share information with others.

Practice Story – The Changing Room (SAMH)

The Changing Room is a 12-week programme for men, based in football stadium spaces. The programme focuses on wellbeing, recognising that for some this includes navigating and making sense of crisis.

"Not only are participants supported by trained Changing Room coaches, they are supported by their peers ...

Learning from and supporting others are key components of what makes The Changing Room successful."

(Changing Room team)

This is an example of Time Space Compassion and the ability to respond to crisis being embedded in spaces where people feel safe and are more likely to seek help, creating opportunities to reduce stigma and support recovery.

…where everyone knows what's available to them, where to find it and what to expect…

(person with lived experience)

The principle of COMPASSION means

• demonstrating kindness, respect, and sensitivity as well as ability to offer or connect the person to the right support
• understanding how trauma and crisis can affect people’s behaviour, that it takes time to build trust and a relationship; and that discrimination can shape people’s experience of trauma and crisis
• maintaining contact whilst maintaining the boundaries you both need to stay safe
• being clear on what people can expect from you and explaining when that changes
• talking and working with people in ways that recognise and value their lives, hopes and relationships
• making sure that the people who support others have opportunities to take care of themselves, protecting their own time and space to reflect, learn and rest, so they can sustain and improve the support they offer

Examples of supporting practices for COMPASSION include

Building relationship: putting time into building connection and trust; building your capacity to offer trauma-informed support; offering different ways for people to share their experiences and what works for them; taking stock of how you are and how that might affect your ability to connect with someone.

Being clear and consistent: communicating the support you can offer – the who, what, how and when; breaking down what you do, step by step in ways that are easy to

understand; being clear on what people can expect from you and what you ask from them.

Making connections: maintaining relationships and offering effective ways to connect people to other services or support; agreeing what personal information you will share with other support providers; introducing people to new ideas and possibilities.

Practice story – Glasgow Complex Needs Service

Glasgow Complex Needs Service provides specialist, highly personalised support for people with multiple and complex health and social care needs, which mainstream services are at times unable to meet.

"…we work with people and their experience of suicidal crisis on a longer term basis. Through a focus on building relationships, people have the opportunity to feel supported enough to begin to trust that perhaps there is a different future available to them than the one they once accepted for themselves."

(Glasgow Complex Needs Service team)

This is an example of working compassionately and building relationship with people over time, prioritising relationship development and recognising how their experiences of crisis and trauma shape what they need from the people and services who support them.

Pause and reflect

Where do you see and experience Time Space Compassion?

What are people doing? How are they doing it? How does it make people, including you, feel?

What challenges and barriers do you see them navigate? How have they done that?

What insights and inspiration does that offer for your own practice?