In launching the National Framework for Suicide Prevention and Deliberate Self-harm Reduction, one of the key challenges will be to secure the interest, engagement and commitment of the wide range of sectors and agencies who have a role to play in this important area of social policy implementation.
This project set out to gather examples of practice and work on the ground that contribute in a variety of ways to the prevention of suicide and deliberate self-harm, as well as to the improvement of mental health and well-being. It was considered important to ensure that further policy development was founded on recognition of the diversity and richness of existing activity in this area, which may not necessarily be explicitly identified as falling within the ambit of the Framework.
The project focused on two areas of Scotland - the Scottish Borders and Edinburgh. Information was gathered on a selected range of projects and initiatives working with groups identified as potential high-risk groups in the draft Framework. The aim of the exercise was to provide an illustration of the range of work being undertaken rather than to provide a comprehensive data set.
This extract presents a summary of the material gathered from the research. The services provided, and approaches taken, by each project are summarised in Tables 1 & 2 below, as are the target groups and issues facing project users. The key features of each project are also highlighted.
Project | Target group | Issues | Services / approach | Key features |
1. Be Well
Craigmillar Health Project | Local people | Stress
Anxiety
Depression | Counselling
Group work, including men's group
Drop-in
Complementary therapies | Community development
Mutual support and volunteering
Developing skills and self-confidence |
2. Time for Talking
SAMH | SAMH employees | Personal and work related issues: e.g. stress, relationships, bereavement | Short term free counselling (5 sessions)
Longer term requires self funding | Confidential
Independent of employer |
3. Men in Mind | Black and ethnic minority men with mental health problems | Isolation
Racism
Cultural identity
Risk of suicide | support
Group work
Drop-in and user Forum | Activities and interests to stimulate discussion and reduce isolation (drama, IT)
'Mental health by stealth' |
4. Ward 1A, Edinburgh Royal Infirmary | Toxicology inpatient care, patients referred (fast track) from A&E or the Royal Edinburgh
Ages 16-65 | DSH, especially overdose
Abuse
Bereavement
Relationships | Full assessment
Treatment
Follow up support in community
Training for staff in Community and A&E | Opportunity to assess
Time out for people, including to sober up in safe place
Database of local resources for onward referral
Good liaison with GPs
Procedures in place to deal with regular attenders |
5. Wester Hailes Youth Agency | Young people aged 8-25, living in W Hailes
Vulnerable young people: 'low achievers' | Lack of confidence
Bullying, violence
Coping with independence | Adventure play
Educational work in and outside school
Prep for school leavers and college students
Detached street work | Mix of formal, structured and informal, ad hoc work
Building communication skills and confidence
Help with choices and transitions |
6. SACRO | Ex offenders, more recently incl. Women | Mental health
Drugs and alcohol
Anger and aggression
Women esp vulnerable - abuse, DSH and depression
Most young offenders have been in care | Supported accommodation
Hostel for young offenders
Linking people in training and work opportunities
Behavioural programmes, group and individual work | Working holistically with an individual
Get people settled, stabilised and work with them to build skills and self esteem |
7. Grass roots community work
Church of Scotland | Clubbers | Hopelessness
Loss of connections and community
Disillusionment with club scene | Building networks or resourceful friends and healthy structures | Working within the club culture
Helping build connections |
8. Stonewall | Lesbian, gay, bisexual and transsexual young people | Isolation and rejection
Family relationships
Identity
Practical problems with housing etc | support by phone and
email
Groups
Drop-in
Pen pals
Practical social and emotional support | Focus on issues of self acceptance in relation to gender and sexual orientation
Hard to reach groups e.g. people with a disability are a priority |
9. Barnardos 16 plus | Young people 15 1/ 2 to 21 | Self harm
Drugs
Abuse | Practical and emotional support
Drop-in | Consistency - establish long term supportive relationships
Develop problem solving skills |
10. Student Counselling Service, University of Edinburgh | Students | Anxiety and depression
Smaller numbers with severe mental health problems
Increasing number of students are self harming | Assessment and brief counselling intervention
Train other University staff and volunteers on Nightline | Proactive campaign to promote awareness of service
Ease of access, encourage early use
Training for Wardens and Directors of Studies to identify problems at an early stage |
11. Nari Kallyan Shangho | South Asian women and children | Isolation
Relationships
Poverty
Adapting to culture in UK | Groups
Support networks
1-1 support | Dedicated youth worker
Training for health agencies
Mutual support |
12. Lothian PCT Suicide Review Committee | Review of suicide incidents among patients | To identify learning points and improve quality of care | Examination of cases - situation reviewed, meet with care team | Reports to Clinical Governance: quality enhancement not blaming. |
13. Streetwork | Young people and rough sleepers at risk on the streets
People with 'too many needs' for most services | Mental health
Suicide and self harm
Drugs and alcohol
Homelessness | Assertive outreach to make contact
Detached work, on the issues that people want to address
Small goal-directed steps, starting with basic needs
Practical and emotional support | Fluidity around structure
Active engagement of people who other services do not reach
Acceptance and tolerance
Providing a sense of belonging |
Project | Target group | Issues | Services / approach | Key features |
14. Big River
Turning Point Scotland | People whose lives are affected by drugs | Drugs
Mental health
Relationships
Housing
Many people have experience of suicide attempts or DSH | counselling
Drop-in
Advocacy support and liaison with other services | Continuity of support
Harm reduction focus |
15. Health promotion
NHS Borders | Age groups and local communities | Improving confidence and well being | Work in schools
Community health development in disadvantaged local area
Health and exercise class for older people
GP exercise referral | Range of initiatives using community development and health promotion approaches |
16. Burnfoot Community School | Pupils, families and community | Peer relationships
Self esteem
Bullying
Bereavement | Drop-in for pupils
Family work and home visits by school nurse
Activity based groups | Use of activity as basis for discussion of health and social issues
Drop-in provides accessible information and advice |
17. Royal Scottish Agricultural Benevolent Institution | People in rural occupations | Isolation
Loss of confidence
Depression
Relationship stresses
Financial anxieties | Helpline operated by volunteers (due to end) in response to Foot and Mouth crisis | Loss of traditional community supports
Impact of initial financial worries and increasing social isolation now being manifested as mental health problems |
18. Penumbra Youth Project | Young people with mental health problems | Social isolation
Abuse
Family relationships
Self harm | Drop-in several towns
1-1 support on
harm reduction
Developing coping strategies
Practical support with housing, training etc | Self harm regarded as a choice people make
Work with the whole person not just the self harming behaviour
Allow time and space for person to talk about deeper issues when ready |