Anne Embury is the Suicide Liaison Service Lead at Outlook South West Service, which is part of Cornwall Partnership NHS Foundation Trust. The service was commissioned in 2010 by NHS Kernow, the CCG for Cornwall & Isles of Scilly, as the first NHS-commissioned specialist postvention service in England.
We asked Anne to share her learnings and experience in promoting and embedding suicide bereavement support across Cornwall and beyond.
Around a third of my time is spent talking, training and embedding what we do and why we do it. It is time-consuming, but I see it as absolutely integral to the delivery of the service. We need relationships with professionals who will refer to us and partnerships with organisations in the community who will help us to support those bereaved and affected by suicide.
I have developed a short, 60-minute training presentation that I will deliver to anyone who wants it, adapting it to their organisation’s needs. Sometimes this can be outside my normal working hours, such as for voluntary organisations whose volunteers meet in the evenings. We are a coastal community and I’ve even been known to climb on a boat when I needed to!
Different organisations will have different structures and resources to deliver outreach, but it will likely be an important part of a suicide liaison worker’s role and one to remember when recruiting and training someone for the post.
When I present training workshops, I make sure that plenty of time is given to outlining the evidence base for why we do what we do.
I talk about the origins of postvention as ‘prevention for the next generation’ and share that the World Health Organisation was reporting back in 1989 that relatives and close friends of someone who dies by suicide can be at high risk of suicide themselves.
I talk about the impact of trauma and stigma as well as outlining what we do as a trauma-informed service. Sharing that the NHS Long Term Plan specifically mentions suicide bereavement – and the need for postvention services in every area – helps to show that what we are doing is nationally recognised and vitally important.
I make sure that I am constantly scanning the horizon for demographic shifts and new or changing local organisations. When a death by suicide occurs, with the consent of the bereaved, I will contact any relevant community organisations who might be able to offer support to the family or individual within their locality. For example, we have a large farming community in Cornwall, supported by a Farming Hub that our service can signpost to. I’ve also worked alongside community-based organisations such as the Fishermen’s Mission and Traveller Space, the service that supports the travelling community in Cornwall. We liaise with faith communities when requested, and we coordinate an annual Service of Reflection for People Affected by Suicide at Truro Cathedral which is open to those of all faiths or none.
Every local service will have its own demographic and geography which will influence who those key partners will be. Map those partners early in your service development and keep your stakeholder map under constant review.
In the beginning, we offered to attend practice meetings at every GP practice in Cornwall, with virtually no take-up. GPs are a hugely important partner to us, and we value their referrals to the service. But it is no secret that they are extremely busy and a patient suicide may not even occur once a year at the average GP practice. However, we have recently delivered training to social prescribers based in GP practices in Cornwall and, as part of Cornwall’s Multi Agency Suicide Prevention Group, the GP Lead for Public Health promotes our service at regular meetings with GPs. Outlook South West also delivers Cornwall’s IAPT service and our single point of access number includes the IAPT service. Any referral that mentions suicide bereavement is passed to me to assess for suitability for our service.
One outcome of the pandemic is a more ready acceptance of online training. With Outlook South West covering such a large geographical area, this has helped me to deliver more training from home.
It was apparent, from the time when we first set up the service, that it was important to invest time in building relationships with our local Coroner’s officers and members of the Coroner’s inquest-setting team. As relationships have developed, and confidence in our service has grown, we have been able to advocate effectively on behalf of our service users regarding issues relating to the inquest which can be a daunting process for many bereaved individuals and families.
We have a service leaflet to promote and explain what we deliver. It is a simple but effective way of getting people interested in what we have to offer. We have also linked our service information to a number of websites in the county that provide sources of information for the public and, specifically, for bereavement. I also sit on the Advisory Panel of Cornwall’s Bereavement Network and the network provides a useful vehicle to promote suicide bereavement support.
The PHE booklet, “Help is at Hand” is given to everyone who accesses our service, and we will circulate other resources, such as “Finding the Words” to work place settings where an employee, or an employee’s relative or partner, may have taken their own life, or to other groups who are unsure what to say to someone who has been bereaved by suicide.
Think about developing a powerpoint presentation that you can use locally to bring people on board. Make sure it outlines the origins and the clinical need for what you do, bringing home the importance of postvention. It is also our role to get people talking, to break down stigma and to feel comfortable with talking about suicide and its impact on those in their communities who may be affected by a traumatic death.
As a sector, we have come a long way in talking about what we do. But there is still more to do and I see it as up to us as, as front line postvention workers, to develop the skills and competencies to build that support every single day.