Suicide Safety guidance for Health Visiting staff and Community Midwifes

This guidance provides staff with responses and interventions for those who present with thoughts of self-harm, distress, suicidal ideation, intent or following an attempted suicide.

The guidance will support staff to:

• Prepare for and conduct a conversation about suicide.
• Utilise recommended Edinburgh Post-natal Depression Scale (EPDS) tool to support conversations around emotional wellbeing.
• Identify the signs that someone might be thinking about suicide and ask directly about suicide.
• Create the time, space and compassion required to facilitate discussions around mental health and wellbeing.
• Identify support services /resources which includes safety planning and the co-production of a suicide safety plan.
• Take immediate action where a person has an active plan to take their own life.
• Know what to do following a conversation about suicide, and where to get support for yourself.

This guidance aims to support people who are working at the ‘Skilled’ Level of the Mental Health Improvement and Prevention of Self-Harm and Suicide Knowledge and Skills Framework. Health Visiting staff and Community Midwifes are ‘non-specialist’ frontline staff who are not specifically working in mental health but are likely to have direct and/or substantial contact with people who may be at risk of suicide, we have an important contribution to make in suicide prevention.

This includes people who have taken part in skilled level training such as Supporting People at Risk of Suicide e-learning module, skilled level ‘Be Suicide ALERT’, Scottish Mental Health First Aid (SMHFA) or Applied Suicide Intervention Skills Training (ASIST) or have gained experience through professional development in relation to their role.

This guidance focuses on suicide prevention, in line with the application of existing clinical guidance and the move towards the principles of Time, Space and Compassion which encompass a more person centred approach. This advocates for assessment of psychological and social wellbeing and the formulation of safety plans in partnership with those in suicidal distress. This approach is in recognition that while there are known risk factors across the population for suicide, e.g. first year post-partum risk is increased, it is not usually possible to predict individual risk.

Stigma and discrimination, fear of being a burden and a lack of compassion have been identified as the top barriers to help-seeking. What can help in supporting people at risk of suicide is early intervention and support. Being able to identify the warning signs and in particular recognising feelings of being a burden or feeling hopeless or trapped. Having open and direct conversations about suicide encourages people to share how they are really feeling. Those who experience a compassionate response when in suicidal crisis are more likely to disclose details which inform more effective support.

People also highlight the importance of having sufficient time to talk about their feelings and of support being available at the time they need it, including out of hours. Hence the need for awareness of these resources.

Most people who are thinking about suicide do not want to die; they just want to end the pain they are experiencing.