Ensuring that Connecting with People is evidence based and our new academic papers

Alys Cole-King
July 02 2013

I would like to thank Advances in Psychiatric Treatment for allowing us to host the abstracts of the three articles I co-authored in this month’s Journal on our website. There is a real appetite for change and the Connecting with People approach of compassion, collaboration and instilling hope is gaining momentum. The abstract for the following papers can be found on our resources page:

At the heart of our paper ‘Suicide mitigation: a compassionate approach to suicide prevention’ is the desire that health professionals and those people in a therapeutic relationship with someone who has self-harmed realise that ‘every encounter with a suicidal person is an opportunity to intervene to reduce their distress and, potentially, to save a life.’ This paper included many useful strategies for assessing and helping someone with suicidal thoughts. The importance of a thorough assessment is also backed up by the latest research from the National Confidential Inquiry which highlights that the assessment of patients with suicidal thoughts should be sufficiently thorough, robust and detailed to help mitigate the possibility of Human Factors Errors (the science of how people make mistakes – this will be covered in another blog).

Our paper ‘Suicide prevention: are we doing enough?’ provides a summary of the literature on how we currently assess and respond to patients with suicidal thoughts, proposes the paradigm shift of suicide mitigation (which I included in my previous blog) and reviews the evidence for compassionate interventions. We are delighted that the new NICE Guidelines Quality Statements for people presenting to the Emergency Department following self-harm launched last week placed compassion at the core of assessments.

‘Hey kid, are you OK? A story of suicide survived’ is a deeply poignant and inspirational account by Kevin’s Hines (our 1st Guest Blogger) of suicidal crisis, which culminated in an attempt to end his life, and of his recovery and return to mental well-being. As a health professional I believe we have so much to learn from him. I was particularly moved when Kevin once said to me ’People do not end their life because they want to – they do so because their illness or distress is telling them to’.

I really hope you find the time to read the papers – they are thoroughly researched and I have been incredibly lucky to have invaluable academic support and advice from Professor Stephen Platt (Professor of Health Policy Research, University of Edinburgh), Professor Linda Gask (Founder STORM Skills Training CIC ) and Dr Gill Green (Chief Executive STORM Skills Training CIC ).

Introducing our first guest blogger: Kevin Hines

We are delighted to introduce Kevin Hines as our first guest blogger. Kevin has been collaborating with Connecting with People for about 4 years and he has appeared in a BMJ Podcast with Alys Cole-King and co-authored 2 papers which are being published in the July issue of Advances in Psychiatric Treatment.

When Kevin was 19-years old, two years after he was diagnosed with bipolar disorder, he attempted to take his own life by jumping from the Golden Gate Bridge. He is one of thirty-three to survive the fall and he is also the only survivor who is actively spreading the message of living mentally healthy around the country and the globe. Since then, Kevin has become an award-winning international speaker, author, and mental health advocate.In 2012, he was awarded a Lifetime Achievement Award for his outstanding work as a suicide prevention advocate and speaker.

Kevin writes:
I am honored to be Connecting with People's very first guest blogger.  We share the same vision:  the prevention of suicide and promotion of mental health equality. I hope by sharing parts of my story that I can help others to learn the art of living mentally well, just as I have done in my forthcoming memoir: Cracked, Not Broken, Surviving and Thriving After a Suicide Attempt. I look forward to working with 'Connecting People' today and in the future.

Guest Blog: Depression is not the Exception, But is Quickly Becoming the Rule

Kevin Hines
June 26 2013

What a beautiful Wednesday it was! as I bade my wife goodbye and left my San Francisco home in the Sunset District for a speaking engagement at the University of California Riverside. I couldn’t help but be excited by this speaking engagement: I was sharing the stage with Dr. Daniel J. Reidenberg who is the Executive Director of the SAVE organization, which stands for Suicide Awareness Voices of Education. The speech would begin at six pm. Rain dripped from my jacket as I climbed into the Super Shuttle I had ordered. When we pulled away from the curb, I discovered I wasn’t alone: I shared the airport shuttle with a woman from China who told me she had lived most of her life in our city.

When I sat down next to her, she asked me politely "What do you do?"

I told her that I was a professional public speaker, she asked the question: "What do you speak about?"

I replied "Prevention of Suicide and Living Mentally Well while dealing with depression."

I was not surprised (as so many respond like this to me) to hear from her directly after my response, "My son suffers from depression and has for over ten years." She went into much detail, explaining that he was doing well with his depression after he got mental health help.

She told me that it was hard the first few weeks following his diagnosis: the family denied there was anything wrong with him. It’s a reaction I know all too well and nodded in sympathy. There is an unfortunate stigma/discrimination attached to mental illnesses in our country even though one in four adults in our population has been diagnosed with some kind of mental illness.

That ends up being 26.2 million. Yes, 26,000,000+ American adults who were 18 years old or older who live with a diagnosable mental illness in any given year. I am one of those Americans. I let the woman on the shuttle know that if she ever needed a friend to talk to her son, to help or guide him to the help he needed, I would make myself available. Luckily she and the family were currently getting him the mental health care he needed. We exchange cards and by the time the conversation was over we had arrived at SFO (San Francisco International Airport). She felt the meeting was serendipitous, as did I. She thanked me before getting off at her stop, and then with a smile she was gone. I said a prayer for her son and their family and I left the city with a grin on my face.

My role in developing Connecting with People suicide and self-harm mitigation training

Alys Cole-King
June 19 2013

I have been actively promoting compassionate healthcare throughout my career. I have always concentrated on being as compassionate as possible with patients, carers and colleagues within the circumstances and constraints of any situation. I have also been very keen to empower colleagues and students to do the same and I have been supporting them to understand suicide and self–harm for over 19 years. Connecting with People training was developed, into the structured training programme it is today, 5 years ago. This training is delivered, by a not-for-profit organisation called Open Minds Alliance CIC, throughout the UK.

A key motivation for developing and scaling up the training was the knowledge that the majority of people who end their lives by suicide are not in touch with mental health services within a year of their death. However 40% have contact with Emergency Departments (D Cruz et al 2011) and around 60% visit their GP within a month or so of their death by suicide (Luoma 2002). I believe that every contact with a suicidal person represents a potential opportunity to intervene and prevent them from going on to die by suicide. However, it was clear that the skills and training were not widely available or accessible. Working with Gavin Peake-Jones, who had had experience of developing large-scale training programmes, we were able to develop training that could be delivered and quality managed on a much wider scale.

Along with compassion at the heart of the training, another key theme is the concept of suicide mitigation. This is an alternative way of thinking about individuals at risk from suicide. The starting point is that suicidal thoughts need to be taken seriously and need to be met with empathy and understanding on every occasion. Instead of focusing on quantifying and characterising suicide risk so that it can be ‘managed’, the emphasis in suicide mitigation is on identifying the person’s individual needs. It also concentrates on instilling hope, creating jointly with them a ‘safety plan’ and empowering them to seek and accept help (Cole-King & Lepping 2010). Suicide mitigation highlights the ambivalence that people with suicidal thoughts and feelings experience and challenges the common perception that it is not possible for someone without specialised knowledge and training to help a suicidal individual resist acting on their suicidal thoughts. The question we all should be asking is: What can be done to enable this person to not want to end their life today…this week…this month?

I passionately believe that everyone has the potential to help someone with suicidal thoughts. Increasing hopefulness, resilience and reasons for living have been shown to reduce suicide risk. The response to someone experiencing suicidal thoughts needs to be compassionate, proportionate, appropriate, person centred, pragmatic and timely. The key is to be sensitive to the nature of the suicidal thoughts and the individual needs of the person experiencing them.

The whole ethos underpinning the Connecting with People training is that it places the importance of compassion and person centred care at its heart. It has been designed to engage the ‘hearts and minds’ of attendees, take away the fear of talking to a suicidal person, demystify the process of assessing and responding to suicidal thoughts and provide user friendly clinical tool to support a clinical assessment.