Cambridgeshire and Peterborough’s suicide prevention

Fiona Breaker-Rolfe has the led the suicide bereavement support service for Cambridgeshire and Peterborough since October 2017. Working for the mental health charity Lifecraft, Fiona was responsible for setting up the service from the start and has shared some of her learnings and experiences with us.

Suicide bereavement support was a key part of Cambridgeshire and Peterborough’s suicide prevention strategy, to ensure information and access to support services are available to those bereaved by suicide.  Initially there were a few other services around like AMPARO in Cheshire and Outlook South West in Cornwall to research information on postvention models of delivery.  This helped enable the local Care Commissioning Group and Local Authority to develop a contract to commission a service in the area.

We have a strong, effective partnership, chaired by the Head of Public Health. This has been vital in providing strategic direction and in keeping the key players engaged in the process of postvention work. These include not least the police, Local Authority, coroner, voluntary sector. NHS and Network Rail. With senior decision-makers around the table, the trust was already established between partners to make a real impact on suicide prevention.

Lifecraft was successful in winning the contract for delivery of the service and advertised for a person to come in to develop and deliver the service. As a qualified bereavement counsellor with mental health experience, I was successful in getting the job and funded to work 15 hours (so two days) per week. This has now increased to 18 hours per week.

As this was a brand new service, I built on the original specification from the outset. I researched good practice and spoke to other people doing the same work. I used resources from NSPA, SASP and Public Health England around developing a service and particularly, how to evaluate. Although I looked at other services for models that worked, I had to shape our service to fit the funding we had available and to meet our local need.

The first priority for Lifecraft was to set up a confidentiality agreement with key partners; the police, NHSE, and the Coroner’s Office.

This allowed me to accept referrals immediately. Once the Police report a suicide to the Coroner, I am copied in (where the next of kin agrees to support). This means I am working with ‘real time’ data where I can be in touch with the family within days of a possible suicide.  We are also able to support people who self-refer, however we would expect this to be within the first year of a loss.

I am a mobile worker based from home, with easy access to the office in Cambridge and plenty of autonomy to manage the caseload. I have a line manager at Lifecraft with a wealth of experience in mental health and an independent clinical supervisor. The service at present is managed effectively in the 18 hours allocated, although there is always demand to do more. This does mean having some boundaries and priorities of course.

In addition to case work, I get involved with local partners to meet and provide an ‘on the ground’ view of loved ones’ experiences, and also offer outreach support to schools, NHS, family support staff and voluntary agencies. I have recently set up a suicide bereavement support group for those who have received a service from us and are ready to move to the next steps.

With case work, I make my first contact with families and loved ones within the first week, Sometimes people need time to process what has happened before they can engage with support – once I have made contact the service is open to them.  Early contact is essential in identifying people in crisis and needing medical support. Sometimes one call and some information is enough. Other times, someone will want to meet face to face for coffee and a chat. I can signpost, listen and offer emotional and practical support, whichever that person needs.

It is sometimes easier for loved ones to talk to someone outside of the family, someone who understands their grief and can listen, and support in complete confidence (subject to safeguarding). Sometimes people may not have a family or people they can talk with. I use my counselling skills to offer emotional support – it is not therapy that is provided. Families can put a face to a name and build trust to share their experience and hopefully relieve some of the burden that comes with loss.

It was a positive decision to have one person as a single point of contact, meaning the story and the detail only needs to be said once, with no need to pass people around or share the information. I can offer a responsive service within the bounds of working hours and immediacy and consistency, being a trusted name and face for someone to talk to when they feel they need it.

If I were to offer start-up services some tips and advice, I’d say:

1. Use information that is already out there via national and other local organisations. There are a growing number of postvention models  and guidelines on everything from funding to evaluation.

2.  The confidentiality agreement is essential and real time data is hugely important to the service, it provides an early choice for families and loved ones to have early support where needed.  Most of my referrals come from this route.

3. The service offers crisis intervention, emotional support and practical support, It is particularly important to be able to recognise signs of crisis in the immediate aftermath of a suicide, so being able to contact the bereaved person quickly is key.

4. I would not recommend this type of post be a full time role for one person, due to the nature of the material, the distress and the graphic information on some of the reports. It is well recorded that this can take a toll.  Part time hours and or job share could work well.

5. Independent clinical supervision is essential for the mental health and wellbeing of the worker.

I find this work incredibly rewarding, helping people on a very difficult part of their life journey and I hope this article helps you in developing an essential service for those in your area.