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

5. Underpinning values

This section describes the values and behaviours that drive Time Space Compassion. These include: listening as a supporting action; valuing people, relationships and different forms of support; working with difference and diversity; and preparing and doing the groundwork.

Value 1: Listening as a supporting action

"The person who is listening needs to be interested, engaged and empathetic."

(lived experience panel member)

Experience, evidence and best practice all point to the critical role of listening as a supporting action – free of assumption and judgment. Evidence from these sourcesxviii also tell us that compassion fatigue, rigid process and assessment protocols, and feelings of anxiety can all contribute to people, consciously or unconsciously, moving quickly through this initial important stage of responding well.

Key resources

NHS Inform’s Surviving Suicidal Thoughts webpages provide a wide range of current resources, advice and links on listening.

This includes the Ask Tell Respond – how to have a mentally healthy conversation animation jointly produced by NES and PHS, as well as practical advice and support including SAMH resources on supporting someone with suicidal thoughts. The What Matters to You website provides ideas and resources to support meaningful conversations.

Learning resources, in a range of accessible formats, are available on the NES website.

Samaritans also offer practical advice for people having a difficult time and anyone worried about someone else.

Childline, Education Scotland’s safeguarding pages, Young Minds, Papyrus, Anna Freud National Centre for Children and Families and the Charlie Waller UK Mental Health Charity all provide information and resources relating to children and young people’s mental health and wellbeing.

In practice^[2]

“I always start with ‘I’m glad you’re here.’ It’s a bit of a ritual – it reminds me to pause and connect with the person. To start a conversation instead of unconsciously slipping into interview mode.”

“We all know to schedule prep time between appointments, right? It’s core in our training. But time pressures sometimes override that training. To overcome some of that, we’ve designed debrief time and spaces for listeningxix into our schedules.”

“There are so many things that can grab or drive our attention away from listening … the fantasy everyone else is doing it perfectly, 24/7 is compelling. Taking a moment to pay attention to what’s behind that drive to rush or fix can unlock an important insight.”

Pause and reflect

What enables and what gets in the way of your ability to listen well to someone experiencing suicidal crisis (personally or as an organisation)?

Based on your own experience and what you know works for you/your organisation, what plans and action could you take now to increase your ability to do this well?

Who could help you with this or has the ability to influence factors outwith your control?

Value 2: Valuing people, relationships and different forms of support

"No one’s life, particularly someone experiencing crisis, fits the neat boxes often used to design and organise services."

(person with lived experience)

Evidence and people describe the positive impact different kinds of support can have. From safety planning^[xx], personal support networks^[xxi], peer and community support[xxii], distress intervention[xxiii] and anonymous listening services, to clinical and medical support.

People with experience of crisis, talk about the importance of support matching and following their needs over time. Recognising the expertise they, and people who know them, bring to the process of shaping and activating a package of support, is key.

Key resources

Guidance and downloadable safety plans are available on-line, including from Samaritans and Papyrus websites. SAMH also offer guidance on developing a Safe Plan. The national trauma training programme provides practical resources, evidence, learning materials and a community of practice. Support for trauma champions and community planning partnerships can be found on the Improvement Service website. The trauma-informed practice toolkit and key policy information is available via Scottish Government webpages. Scottish Recovery Network provide resources to support recovery and peer roles.

NICE Quality Standards on suicide prevention offers insights on how to involve family, carers, or friends as well as supporting people bereaved or affected by a suspected suicide. NHS Inform’s Mind to Mind website and Cruse Bereavement Support’s website also provide resources for those experiencing grief.

The Local Area Suicide Prevention Action Plan Guidance includes guidance and templates

to support joint governance, partnership working and involving people with lived and living experience. The Integrated Motivational Volitional Model (IMV) offers a way of thinking about and understanding the different stages of suicidal behaviour.

In practice

Working with the person to develop their safety plan, including those closest to them where you can, unlocks all kinds of ideas about the places people can access informal support.

“That first point of contact is so important – it’s the critical first step in working towards a trusted relationship and informs everything that comes after it. We need to acknowledge that for people who have experienced discrimination and trauma, just about every cell in their body will be screaming at them not to trust this stranger. Respecting that goes a long way in building a meaningful connection.”

“Investing time, building good relationships with other providers and local groups, can make a huge difference. When you need to move quickly, trust and understanding each other’s roles makes everything simpler. There’s a lot of satisfaction in knowing you’ve supported someone in distress to connect with a service that can make a difference.”

“When you work with people over longer periods of time, you start to see the importance of adapting to their changing needs and hopes, offering help to navigate and connect to different forms of support on their own terms. Being able to mirror their growth and journey helps them move forward.”

Practice story - Distress Brief Intervention Scotland

Distress Brief Intervention (DBI) provides immediate, connected and compassionate support to people experiencing distress. DBI Level 1 is provided by trained frontline staff, working in a range of health and emergency settings. They are trained to listen without judgement, to understand and help ease the person’s distress and to know when to refer someone onto Level 2, provided by DBI practitioners. DBI practitioners follow up within 24 hours and offer support for around 2 weeks.

"We get the key people already working in a community together, working with them to set a shared goal of providing a compassionate and effective response to people in distress and improving experience and outcomes for both those experiencing distress and those providing support."

(DBI Scotland team)

Pause and reflect

This map captures some of the places people regularly seek support in communities and beyond their communities, as well as the spectrum of informal to formal support available. Where would you place yourself on the map?

Value 3: Working with difference and diversity

The Equality Act 2010 describes protected characteristics and protects people who share these characteristics from discrimination.

• age
• race
• pregnancy and maternity
• religion or belief
• disability
• gender reassignment
• sex
• sexual orientation
• marriage and civil partnership

"This is about explicitly acknowledging and responding to the fact different people need different things at different times in their lives."

(stakeholder)

An inclusive approach means recognising that a person’s background, the people around them, their experiences and context (past and present), where they live, their job and other dimensions of their identity, shape their experience of crisis and support. This may include experience of different and overlapping forms of discrimination. For many people, this will have a significant impact on where they seek support. Responding in a way that reflects and places value on all of this, is called taking an intersectional or culturally sensitive approach.

Key resources

The Equality and Island Communities Impact Assessments for Scotland’s suicide prevention strategy summarise what is known at a national level about people and communities most impacted by suicide. They also include links to a broad range of community and identity specific resources. Examples of these include: Men and Suicide report by Samaritans; Autistic people and suicidality by the National Autistic Society; Health needs assessment of lesbian, gay, bisexual, transgender and non-binary people by NHS Greater Glasgow & Clyde, NHS Lothian and Public Health Scotland; the Suicide Ideation – experiences of adversely racialised people report is available from the Scottish Government website; National Rural Mental Health Forum resource pages; and Perinatal Mental Health Network Scotland.

Resources and more information on public health, health data and health inequalities can be found on Public Health Scotland’s webpages and the Scottish Public Health Observatory.

In practice

“Reading the latest evidence on risk and protective factors, including how they combine for different people at different stages in their life, has helped – knowing more, means you can ask better questions that get behind what’s contributing to this moment of crisis. ”

“We need to make mainstream support and services more culturally sensitive – this means knowing when our organisation is and isn’t the right fit, maintaining good links, and knowing how to connect people into community based and peer support.’

“Keeping up to date and reviewing how you meet your obligations under Equalities and Human Rights legislation. Actively seeking to understand and reduce health inequalities^[xxiv] through the support you offer…This is ongoing work for all of us.”

Practice story – LGBT Health and Wellbeing

LGBT Health and Wellbeing provides a range of affirmative support services that reflect the diversity of the lesbian, gay, bisexual, and trans (LGBT+) community across Scotland. This includes offering emotional support through a range of formats, including their helpline, individual support, the LGBT counselling service, groups, informal social meet-ups, and supporting information and resources which are reflective of the intersectional LGBT+ experience.

"Being able to understand and respond to the diversity of people’s experience and lives is core to what we do. We do that through a team of paid staff, volunteer and peer workers, who reflect the diversity of the communities we support. Because of our team’s diversity, we find keeping up to date with learning on anti-racist, autism-aware, trauma-informed principles and practice also enables us to feel confident about doing that well."

(LGBT Health and Wellbeing team)

Pause and reflect

Reflecting on the content of this section, where are you/your organisation already strong? What do others see as your key strengths?

Where do you see opportunity for learning and growth? Whose perspective might be valuable in helping you test and prioritise that?

What would be a good next step and set you up well for further action?

Value 4: Laying the groundwork

"This is about supporting as many people as possible to be engaged and equipped…"

(person with lived experience)

Individual and collective action is essential to support change. Time Space Compassion aims to do both so we can achieve the greatest possible impact. This involves laying the groundwork on two levels:

Working out what you need – planning, gathering people and things around you that will support

you, and then taking action. Building your own Time Space Compassion.

Working out what we need to do this together – actively seeking out other’s experience of us/our organisation and taking action in ways that are informed by that. Building Time Space Compassion into the systems we are part of.

Key resources

The National Standards for Community Engagement and the Community Health Exchange offer on community engagement and community-led health. The Local Area Suicide Prevention Action Plan Guidance provides information on engagement, local suicide prevention action planning.

Public Health Scotland also provide links to training, resources, data, networks and events on suicide prevention. On-line learning and resources have been developed by NES and PHS to offer introductory to skilled level learning content.

Information and learning from the Lived Experience Panel shaping this work is available in the National Suicide Prevention Leadership Group’s fourth annual report. United to Prevent Suicide, Scottish Recovery Network, and COSLA’s Suicide Prevention Guidance – participation practice guide also provide useful insights and approaches. Public Health Scotland also produce guidance to support collective action to prevent suicide, such as the National guidance on action to address suicides at locations of concern.

In practice

“I look out for any opportunity to reflect and learn together – whether it’s joint training or a commissioning process. It helped us build insight and challenged unhelpful assumptions we held about our different sectors.”

“Dedicating time and effort to relationships, asking questions about how we impact on each other, exploring the risks of taking/not taking action. It’s about building relationships and structures that help us do the right thing, at the hardest times.”

“We used to focus on our resources, expecting people and communities to read official documents, respond to our questions and share their stories. Working with community-based organisations has helped us learn the importance of educating ourselves on the community and their organising history, the questions they’re working with and the resources they need to work this way.”

Practice story – the Lighthouse, Perth

The Lighthouse offers crisis support to anyone (age 12+). This includes those who are at risk of suicide or self-injury, or those who find themselves in emotional distress or crisis.

"By centering everything we do around the young people we support, they have built their confidence and trust in us, and that we are doing everything for their safety/benefit.

We’ve gone from 50/60% of young people agreeing for us to share their safety plan with key people at their school, to over 95%. This is really important in allowing us to form a bigger safety network around them."

(Lighthouse Perth team)

Pause and reflect

What are you/your organisation already actively doing to grow your capacity to offer Time Space Compassion?

What would be a good next step and set you up well for further action?