Suicide and self-harm mitigation – a whole-population approach

The University of Wolverhampton shares its experience of a suicide mitigation approach within the university and local community.

A suicide mitigation approach begins from the assumption that self-harm and suicidal thoughts need to be taken seriously and met with understanding on every occasion.

The emphasis in suicide mitigation is on:

• identifying the person’s individual risk factors, needs and strengths
• exploring hope and solution
• encouraging and enabling them to seek and accept support.

This involves compassionately engaging with someone at risk of suicide, making a referral when indicated and jointly creating a safety plan with an agreed and explicit reference to removal of access to means. One such example of a safety planning resource is www.stayingsafe.net.

At a community level, the approach recommends taking every expression of hopelessness, reduction in a person’s felt value of worth or expressed desire or plans to end their life seriously – even if this is not the first time the individual has expressed this feeling (Cole-King, 2013).

This way, we shift the focus on the individual being the sole source of risk, and consider the risk within a system of potential first responders, which may not always be consistent and may differ from day to day.

Between 2014 and 2015, staff members at the University of Wolverhampton who had been first responders to disclosures of suicidal or self-harming distress from students were increasingly reporting that they were 'scared that they would say the wrong thing'.

This presented an opportunity for a teaching and learning approach for staff to discuss and deconstruct a difficult topic in a safe space in order to increase confidence at this community provision level.

A strategy embracing this type of democratised approach, where everyone is seen to have a role to play in suicide prevention, could identify that many more students may be experiencing much less overt levels of distress or may be experiencing thoughts that their life is not worth living.

In these cases, there is the potential for their difficulties to be minimised if they are not considered to be part of a traditional 'at risk' group in the absence of better-known demographic risk factors, or suicidal thoughts might escalate because of a lack of disclosure potentially due to stigma (Cole-King and Platt, 2017).

In order to respond to this, staff groups at the University of Wolverhampton are offered the Connecting with People training from 4 Mental Health. This is delivered through a one-day programme, using a combination of bite-size modules.

These act as building blocks, aiming to shift delegates beyond fear of talking about what can be difficult topics, to a position where they feel more confident to offer a response to those in distress. The building blocks are:

1. Suicide awareness – aimed at reducing stigma by uncovering and demystifying common assumptions, judgements, fears about suicidal thoughts and barriers to disclosure in a safe environment. It introduces a common language and approach to help delegates understand how distress develops and how people can be best supported. This mirrors and explores the concepts that suicidal thoughts are on a continuum (Cole-King et al, 2013; Waters and Cole-King, 2017). This continuum considers that suicidal thoughts can present as more ‘passive’ (such as having no plans or desire to die, but life is considered difficult and possibly not worth living) through to distressing, persistent suicidal thoughts with a well-formed plan for suicide coupled with access to means, where a crisis response is required. It also gives delegates the confidence and the skills practice of talking to someone in distress, shares a compassionate approach for time-pressured environments and offers consistency in response, as well as basic safety planning access for all.
2. Self-harm awareness – aimed at reducing stigma, dispelling myths and common assumptions about self-harm, as well as understanding barriers to disclosure. It explores some of the underpinning theories of self-harm, the need to assess and focus on solutions for underlying distress, exploring self-harm as a coping strategy, as well as the relationship between self-harm and suicide risk.
3. Emotional resilience – this module focuses on staff wellbeing, resilience and resourcefulness, and safety planning. It aims to enhance emotional literacy, challenges stigma around emotional distress and tackles barriers to help-seeking.

What have been the barriers or challenges?

The University of Wolverhampton has offered these modules to staff via the organisational development strategy since 2015, as well as targeted planning for particular student-facing teams. If any staff feel that engaging in this content at this particular time in their life is too difficult and is not ‘the right time’, this decision is supported by the university.

The coronavirus pandemic has impacted this activity. A key aspect of the training is to ensure the emotional safety of the delegates taking part. Sessions are always delivered in pairs, with one person on hand to offer support if anyone becomes distressed or needs to take some time out.

Some sessions were postponed at the beginning of the national lockdown but content has now been adapted and safety principles have been established to allow for this to be delivered online as well as in person.

Each session evaluates staff confidence and seeks to understand satisfaction and any potential areas for improvement. Likert scales seek to explore key questions and text boxes are also offered to gather qualitative insights that add meaning to the scores. This baseline poses an opportunity to engage in more longitudinal evaluation beyond the delivery, which is planned for the coming academic year.

Given the complexity of suicidal thoughts and the span of possible intervention involved, it would be difficult to prove a direct correlation between this training and prevention of student suicide. However, staff and students have reported the impact of this approach.

For example, a staff member received a police award in 2019 for their prompt and decisive action. The police believed her actions saved a life and the staff member attributed her confidence to this approach.

This training strategy is one component of a wider piece of work for both the university and the community in which the university sits and serves, and only covers a partial aspect of a scope of prevention and intervention activity.

Since its inception in 2015, Clare Dickens, Academic Lead for Mental Health and Wellbeing at University of Wolverhampton, has held membership within Wolverhampton’s Suicide Prevention Stakeholders Forum.

Clare represents the university and supported the formulation of a needs assessment that went on to form the basis of the city’s action plan for suicide prevention.

This offers a key opportunity to work with further education and schools, local NHS and third sector providers in the city and wider Black Country population. Clare now chairs this forum.

Sustainability of this commitment to suicide prevention will depend on a number of key factors. For instance, work load allocation has to be ensured for the in house facilitators for training. At present the university has three in house trainers. Initially all facilitators received the training themselves, and then attended and engaged in a three day train the trainer top up in order to be assessed on their ability to deliver the session and the content. Each year each facilitator is re-accredited, which takes a full day.

The approach also has to emerge from a place within a higher education institution’s senior leadership team. The leadership strategy should look out to the community they serve and sit within, but also acknowledge and advocate for the unique challenges for students and staff in their context.