New initiatives for working with suicide and self-harm

Psychologists have been at the heart of creating new frameworks of competencies that aim to guide practitioners in the skills needed to work with suicidal people and those who have self-harmed. The three frameworks cover the individual and organisational competencies required for working with children and young people, adults and older adults, and those working in the community and public health, as well as outlining available interventions.

Emeritus Professor Tony Roth and Professor Steve Pilling (both University College London) had prior experience developing competency frameworks through work with the UCL's Centre for Outcomes Research and Effectiveness (CORE). The creation of the current frameworks was driven by general concerns over the quality and consistency of information available to practitioners who work with people who are suicidal or have self-harmed. Health Education England commissioned the work with the National Collaborating Centre for Mental health – a collaboration between the Royal College of Psychiatrists and CORE. It has been supported and endorsed by the British Psychological Society.

The NCCMH team set out by looking at the information and training that is currently available, although they found many resources these were not always of consistent quality. 'Some of the advice that's out there is good quality, some isn't, and some of the training that's available to people in the health service and public sector is first rate but some, again, falls short of what you'd expect. There was a general sense that the competence frameworks should be a practitioner support tool, giving a sense of guidance about what good practice would look like.'

The NCCMH team also carried out a systematic review to find what the evidence can, and cannot, reveal. 'With suicide and self-harm there are things which are quite challenging. For example, if you say "what's the evidence about that would help us predict whether someone will commit suicide?" we know it's very hard to predict, but it's actually very helpful to know what the limits of our knowledge are because in a sense that becomes part of the framework.'

The development of the frameworks was also guided by three expert reference groups for each of the frameworks, which brought together practitioners, researchers and experts by experience. Professor of Psychiatry Nav Kapur (University of Manchester) chaired the adults' group, Professor Jim McManus (Director of Public Health Hertfordshire County Council) chaired the group exploring skills relevant to those working in the community and public health, and former President of the Royal College of Psychiatrists Professor Dame Sue Bailey chaired the children and young people's group.

One important feature of the competency framework maps is they are fully encompassed by a box labelled 'Attitudes, values and style of interaction'. Roth said, while he didn't wish to point fingers, attitudes towards people who may be suicidal or self-harming can be variable, and those attitudes may impact on a person's care. 'Then if you look at something like risk assessment, which is a really important area but often done in a way that can be something of a tick-box exercise, you can see people following a set of procedures but not really treating individuals as individuals and having a broad framework for understanding where people are coming from.'

Roth said he had found the development of these frameworks to be an interesting journey and thanks to the input of the expert reference groups felt he was part of compiling a resource that would be genuinely useful. 'There was a lot of expert consensus and a lot of excitement among people that this was being done because it's making somewhat explicit what I think sits rather implicitly in services – that very often suicide and self-harm is seen as something that sits alongside what one is doing, rather than being seen as something that one can take on board in a more direct way. So, for example, when you look at people who are suicidal or self-harming there's often a close association with depression, and there are decisions to be made around how one picks up self-harming and suicide – does one treat this as if it's just an accompaniment to a primary disorder or as something that is important to address in its own right? Those sorts of decisions are incorporated into the framework.' 

See tinyurl.com/compframe for the frameworks

Researchers are looking for people to take part in a new study to better understand why autistic people may be more likely to die by suicide. The three-year project is being led by the University of Nottingham in partnership with Coventry University and the University of Cambridge, and is the first study of its kind. It aims to find out whether autistic people have unique needs that could help guide prevention efforts.

The project involves interviewing the friends and family of people who have died by suicide, who were either diagnosed with autism, or were likely autistic but not diagnosed before they died. Friends and family are asked about the person who died, their medical history, early development, social communication skills, and circumstances prior to their death.

According to UK autism research charity Autistica, autistic people are nine times more likely to die by suicide, and autistic children may be 28 times more likely to consider suicide. However, until now there has been a lack of research to determine how to effectively prevent suicide in the autistic community.

Dr Sarah Cassidy at the University of Nottingham's School of Psychology is leading the study, funded by Autistica, NIHR-CLAHRC East of England, and Coventry University, and is working with coroners to better gather evidence of autism during inquests, to make recommendations to services and government and better prevent people with autism dying by suicide. 'Speaking to those close to someone who died by suicide will give us important insights into why autistic people are more likely to die by suicide, and what can be done to prevent the tragic loss of even a single life. We understand this is a hugely sensitive area which is difficult to talk about, and we are truly grateful to the families who come forward so we can help prevent others experience the same tragedy and pain from losing a loved one by suicide.'

For further details and to take part e-mail the research team on [email protected]