The alarming increase in suicide and suicidal feelings is an opportunity to look at the issue differently. Rather than, what will get people through the system the quickest? Or what will result in the lowest cost? How about our starting point is what will best meet the needs of someone who is feeling suicidal?
1) It would be sustained and long-term. The approach of most mental health services by necessity is to offer a limited number of sessions. This immediately sets the intervention up to fail. Why? Because it indicates to the suicidal person, that they will be cut off from support. It effectively sets a timer on recovery. Healthcare doesn’t do this with broken legs or heart disease. Yet, in mental health, despite its seriousness, we say you get six sessions and by that time you need to be better. It is one-size fits all approach that dehumanises people when they are most in need of being treated as an individual with specific needs.
2) It would be confidential. Suicidal people often have major concerns about the implications of speaking about their distress. They often worry about its impact upon their career, family and even their freedom. In spite of this, NHS mental health services are not confidential. If you cannot guarantee the confidentiality of people’s stories, they will not be able to speak openly about what’s causing their distress. If we accept that talking about mental health is important and effective, then we should guarantee 100% confidentiality otherwise we cannot reasonably expect them to recover.
3) It would be face-to-face. Medication and digital services are both excellent at treating a wide number of people quickly at a low cost – however they are not human-centred. Medication only works for some people and you cannot treat someone who is suicidal without giving them the opportunity to talk. Research has repeatedly shown that medication on its own, will not resolve people’s suicidal feelings. Equally, there is no evidence as of yet to suggest that increasingly popular text and web services are effective in supporting the suicidal and there is even evidence to suggest that the use of technology can increase isolation. Maybe it’s time to accept that the best approach is the one that most resembles treating someone as a human, speaking with them face-to-face. Not only is face-to-face interaction the best way to facilitate trust, it immediately signals to the individual that you care much more than a text or an email.
4) Volunteer input It is widely accepted that there is a declining mental health workforce with 1/11 Psychiatrist posts unoccupied and 1/7 Mental health Nurse posts. It is also widely accepted that there is a huge amount of pressure on the NHS. The best possible service would harness the power of volunteers to deliver longer-term suicide support. As we saw during the Coronavirus, there are plenty of people willing to help and contribute to our healthcare system – if we can harness that goodwill into a programme of support that does not necessitate professional qualifications, then we might be able massively increase the workforce available to support suicidal individuals while keeping the cost low. Furthermore there is academic evidence that volunteer -led support can be effective in supporting those with mental health issues (Turkington, Spencer, Lebert, & Dudley, 2018).
5) It would be compassionate and would not use CBT Due to pressure on services, many NHS mental health interventions now operate in ways which maximise efficiency (in terms of getting people through the system) and reduce the compassionate element which would actually make it an effective service. For example, most services operate a three strikes and you’re out rule. If you do not attend a session, there will be a warning letter or email. They offer the appointments available regardless of the needs of the visitor. They use long waiting lists to manage demand which communicates both that the individual is further stretching the service and that they are not important enough to be seen urgently.
A more compassionate service would respect the severity of the situation and see people quickly – there would be no waiting list. The best possible service would be more compassionate – it would check in with visitors when they didn’t attend appointments to try and understand why – no angry emails. Lastly from the moment they stepped on site, they would be made to feel valued as a human being. They would be greeted in a comfortable and welcoming space. Instead of CBT, it would allow the person to tell their own story rather than using blanket strategies to ‘fix’ them. It would focus on listening over advising.
6) It would be with the same person The ideal service would be with the same person. Many charities use digital services which mean that suicidal individuals are supported by a different person each time they call/text. This forces them to retell the same painful story each time they engage with the service. This retelling is for the benefit of the service rather than the benefit of the individual. It should be the opposite, the service should know their story. By seeing the same person who knows their story, you can begin to build up trust which will enable the visitor to open up and share their pain.
This might sound ambitious and starting from an idealist viewpoint but if we accept that suicide is a matter of life and death, then surely it makes sense to create the best possible service rather than just muddle one together? This is an uncomfortable issue but it is not a niche concern. Suicide remains the biggest killer of all adults under the age of 35 and the biggest killer of men under the age of 50. If healthcare is about saving lives, then this is a good a place as any to start. It’s time to actively invest in alternative approaches to suicide support that make use of the human skills of ordinary people.