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Understanding self-harm in older adults – An interview with Dr Isabela Troya

by | Jul 10, 2020

A Clinical Psychologist by background, Dr Isabela Troya completed her degree in her home country of Ecuador. Soon after completing her degree, she moved to London to study a master’s degree in Global Mental Health at King’s College London.

The knowledge and experience that she gained during the master’s degree led her to develop a strong interest and passion for research within her field. It was then that she made the decision to pursue a PhD…

Dr Troya’s PhD aimed to explore the motivations of self-harm behaviour in older adults and identify the barriers and facilitators to access to care for older adults who self-harm.

As part of her research, she conducted a systematic review of the international evidence of the characteristics of self-harm in older adults. 

Now a Postdoctoral Researcher at the School of Public Health at University College Cork and the Irish National Suicide Research Foundation, Dr Troya is currently working on a Health Research Board programme titled – ‘Individual and Area Level Determinants of Self-Harm and Suicide in Ireland: Enhancing Prediction, Risk Assessment and Management of Self-Harm by Health Services’ which is led by Professor Ella Arensman.

Throughout her career, Dr Troya has gained a wealth of knowledge and experience in research into self-harm behaviour, and we know that her research into self-harm in older adults would be of particular interest to the STORM Community.

We caught up with Dr Troya to find out more about her work…

Where did your career start?

“My career started in psychology. I am a Clinical Psychologist by background, qualifying for this degree in my home country of Ecuador. When completing this degree I developed several interests, one of these understanding self-harm behavior.

My clinical psychology background allowed me to approach the field of mental health, which was always of interest to me, especially the prevention of mental health disorders, as well as the improvement of people’s quality of life and well-being.

The last year of my profession consisted mostly of attending patients using the different branches of psychotherapy (systemic-family, cognitive behaviour, psychoanalysis). Seeing the differences in the evidence provided by each of these branches, I became more interested in research and its contribution to mental health.

Soon after completing my degree, I moved to London to complete a master’s degree in Global Mental Health at King’s College London given it addressed the issue of prevention and development of mental health programs worldwide.

Up until my Master’s degree, my experience in understanding mental health had been limited to a psychological perspective, focusing on treating the individual and their symptom. During my clinical psychology degree we did indeed study broader issues that could affect mental health (e.g. social psychology), but it was in the year of my master’s degree that I could truly start to understand all the social determinants that affect an individual’s well-being and mental health (including social, political, historical, economic issues)

The experience I gained during the year of the master’s degree led me to develop a strong interest and passion for research within my field. Being surrounded by so many academics and colleagues who encouraged maintaining critical and deep dialogues is something that certainly marked my professional career and led me to want to pursue a PhD.

I then relocated to Ireland, where both at a professional and personal level was a great timing and opportunity for me.”

We know your PhD research will be of particular interest to the STORM Community, can you tell us a little more?

“I completed my PhD at the School of Primary, Community and Social Care at Keele University, where I conducted my research in Exploring Self-harm behavior in older adults.

This research was conducted under the supervision of Prof Carolyn Chew-Graham, academic GP, Prof Lisa Dikomitis, social anthropologist, and Dr Opeyemi Babatunde. My PhD aimed to explore the motivations of self-harm behavior in older adults and identify the barriers and facilitators to access to care for older adults who self-harm.

As part of my PhD research, I conducted a systematic review of the international evidence of the characteristics of self-harm in older adults. Then I conducted interviews with older adults with self-harm experience, and support workers to further understand self-harm behavior within this age group.

During the 3 years of my PhD, I had active Patient and public involvement, meaning I relied on a group of people with lived-experience to help inform my research.

Where can people read more about the findings from your PhD research?

If you are interested in reading more about the findings from my PhD research, please take a look at:

 Academic Peer Reviewed Publications

If you have trouble accessing any of the articles please do email me at isabela.troya@ucc.ie and I’ll happily send a copy to you.

Other resources

What are the risk factors that make older people particularly vulnerable to self-harm?

“There are similar risk factors to self-harm in young and older people such as previous history of self-harm, psychiatric history.

However, there are also different risk factors that make older adults particularly vulnerable to self-harm. Physical illness, including complex health conditions and comorbidities (diagnosis of 2 or more illnesses), isolation, loneliness, are risk factors for self-harm in older people. In particular, increased access to medication, which can potentially become access to means for self-harm (e.g. overdose).”

Why is it important to understand lived experience of older people who self-harm?

“Understanding lived experience is important in all health related research.

In research conducted with people who self-harm, including older people, it is important to learn their experiences and understanding of their self-harm. If we are conducting research that aims to prevent suicide and self-harm, and improve people’s mental health and wellbeing, it is fundamental to have people’s perspective.

With older adults, gaining their particular views and experiences is even more important as many researchers will not gain full access to their insight if not.”

Are there are any common misconceptions about self-harm in older adults and how can we challenge them?

“One of the most common misconceptions (that is being slowly challenged) is that self-harm in older adults does not exist.

Although self-harm rates in older adults are lower when compared to other age groups, evidence from different countries have seen an increase in rates in this age group, in particular with more lethal methods. It is important for clinicians and people supporting older adults who self-harm to engage with them, in order to understand their motivations for self-harming and to provide appropriate support and referral for further management.”

What can we do to help improve awareness of self-harm in older adults?

“I think one of the key factors to improve awareness of self-harm in older adults (and in all populations) is to break the stigma that exists around self-harm. Stigma can prevent help-seeking, and can therefore be detrimental to people who self-harm. However, given that stigma and shame is further accentuated in older adults according to findings from my PhD, I would really encourage the public, people working or supporting older adults, to be mindful of the existence of self-harm in older adults so adequate support and provision of care can be given.

The video we co-created with the PPIE group summarises the findings from my PhD research regarding self-harm in older adults. It also encourages for those older adults who are struggling, to reach out and ask for help. This may not be easy and is different for each individual but I think by sharing the message and having the adequate support, help can be sought. We would love for the video to be shared via your network.”

You recently co-led a workshop with Prof Chew-Graham at the 2020 National Suicide Prevention Alliance called ‘Involving those with lived experience’ which received excellent feedback from the delegates. How did it feel to be invited to share your work at such a prestigious conference?

“Being invited to present at the 2020 NSPA conference was a great experience and a highlight in my career. NSPA is a great conference to present at with a diverse audience, including researchers, policy makers, clinicians, people working in the third sector or voluntary sector, and members of the public.

Sharing findings from my research with a diverse audience is important, and throughout my career I have tried to ensure sharing findings with as many people as possible. This can be difficult for researchers, as we spend a lot of our time and effort doing the research but forget that equal time and effort should be put in getting the findings out there. For me this is an ethical responsibility.

I was pleased to see interest in our workshop, from diverse delegates and representatives. Sharing my research at NSPA allowed me to further connect and network with other members I would have not been in contact with. Including doing this interview.”

What is next for you in your research journey?

“I would like to continue conducting research that has implications for policy and practice, specifically in mental health, self-harm and suicide prevention.”

We’ve heard so much about your fantastic research (thank you!) but we know having some time for self-care is extremely important – what do you like to do in your spare time when you’re not working?

“I enjoy travelling, reading, and cooking. But mostly spending time with my family and loved ones is something I enjoy and is essential to my wellbeing.”

We would like to say a huge thank you to the lovely Dr Isabela Troya who shared so much of her valuable time with us to learn more about her work. 

As Dr Troya mentioned in her interview, if you are interested in reading more about the findings from her PhD research, please take a look at:

Academic Peer Reviewed Publications

If you have trouble accessing any of the articles please do email  isabela.troya@ucc.ie and she will happily be able to send a copy to you.

Other resources


Linda's Story:

Meet Linda Gask: Co-founder

I studied medicine in Edinburgh, before moving to Manchester where I trained in psychiatry. I had both professional and personal interest in mental health, having experienced depression and anxiety myself. I was acutely aware of the need for effective communication to better understand and work with my patients.

Storm Skills Training started as a research project Manchester University funded by the Department of Health in the 1990s. Myself and Richard Morriss developed a training package that demonstrated how using viewing recorded roleplays could actually change people’s behaviour. We first tested our approach in Preston, then across a wider area in South Lancashire.

At that point, we named it Storm Skills Training and we were joined by Gill Green to roll out the delivery of training. Gill further developed Storm as a CIC and it’s wonderful to see how it has grown to where it is today under Bianca and her team.

My passion for many years has been on making mental health support more accessible in primary care. Until the Spring of 2023, I was Presidential lead for primary care at the Royal College of Psychiatrists and I continue to offer advice on the issue.

I moved to Orkney full time in 2020 at the start of the pandemic. I am Chair of a local mental health organisation called the Bilde Trust. As a rural community, we face our own challenges with mental health – it’s great to be involved in making a difference where I live.

Orkney is a wonderful place, unlike anywhere else in Scotland or the UK. I particularly enjoy writing here. After my first book, The Other Side of Silence, was published, I wrote my second (Finding True North) about how moving here positively impacted my own mental health.

My third book will be published at the end of 2024, exploring mental health and feminism. Maybe then I will take it easy, but that’s very hard for me to do!

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A not-for-profit social enterprise delivering high-quality skills training in self-harm and suicide prevention.

Keith's Story

Meet Keith Waters: Non-executive Director

Keith has over 25 years of clinical experience in Liaison psychiatry, self-harm and suicide prevention and was awarded an Honorary Research Fellowship by Derbyshire Healthcare Foundation Trust (DHCFT) in 2013.

For many years he was the lead for the Derby site of the Multicentre Study of self-harm in England, a study which he still maintains a very active role in. Until recently he was the Clinical director for self-harm and suicide prevention for the Trust and retains a post within the research team.

Keith is also a Storm Skills Training consultant with many years experience in facilitating, delivering, and supporting Storm Skills Training and has for a number of years held a seat on the National Suicide Prevention Alliance steering group.

He has been the Suicide Prevention manager for the East Midlands and Clinical Advisor for Suicide Prevention with the East Midlands Academic Health Science Network, developed a business and clinical case for Liaison Psychiatry Services in Derbyshire, and was the clinical advisor for its implementation.

Keith is an experienced trainer, facilitator, and presenter in Self Harm and Suicide prevention and management, locally and nationally in addition to the work with DHCFT and Storm Skills Training, has helped develop and delivered an initially lottery-funded suicide awareness training program across the East Midlands and organised chaired and delivered at numerous nation conferences and events. Keith has also been a joint author on numerous published research works, and chapters in clinical textbooks on self-harm and suicide prevention and has contributed to policy and practice guidance developments locally and nationally.

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Alf's Story

Meet Alf Hill: Non-executive Director

I first encountered Storm Skills Training CIC during my time as a volunteer Business Mentor at Unltd – a charity that supports social enterprises. Co-founder Gill Green was one my mentees in 2010 when Storm Skills Training was still within the University of Manchester and at the beginning of its journey to becoming an independent Community Interest Company.

At our first meeting I asked Gill, “How do you think I can help you?” Gill’s response was “Well… you could explain accounting to me.” We worked together for 18 months to develop Storm Skills Training as a social business. When Storm Skills Training CIC was finally incorporated in 2011, I was invited by Gill and Linda to be a non-executive Director and became Chair of the Board ten years later in 2021.

I’ve had a diverse career; initially as a civil servant, then in senior management and executive and non-executive roles in insurance and reinsurance in the UK and USA, in the corporate sector, and in Lloyd’s of London.

I returned to the public sector initially in adult education then at the Equal Opportunities Commission, later the Equality and Human Rights Commission.

A qualified accountant, I’ve been trustee of several charities, local and national, currently the Yapp Charitable Trust and the Centre for Investigative Journalism.

At Storm Skills Training, post-pandemic I feel that we are stronger than ever. I’m excited about the future with our new team with an ambitious plan.

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Gill's Story

Meet Gill Green: Co-founder

My career has taken me from nursing to academic research and finally to the development of Storm Skills Training CIC as a skills training company.

When I was nursing, so many of my patients often expressed that they felt so hopeless that they thought about ending their life. And like so many of my colleagues, I felt ill-equipped to know the right way to respond. It was a dilemma that I wanted to address through skills training – to give fellow healthcare professionals the confidence and practice they needed to have those difficult conversations.

In 1997, it was a chance job advertisement in a national paper for a Trainer and Researcher that introduced me to Storm Skills Training. At the time, I saw the 12-month project, working with Linda Gask at the University of Manchester, as an opportunity to learn new skills to take back to clinical practice. After the project, I stepped away for a few years, remaining in research but working with prisons on a different project. Research was definitely where I wanted to be.

I came back to the University of Manchester in 2003, when Linda and I started to develop the training package we now know as Storm Skills Training. It was important to us to translate the theory into usable, effective practice. I knew that as a healthcare practitioner, it wouldn’t be enough to sit in a room and be ‘taught’ suicide prevention. It is only through practice that we can actually ‘do’ suicide prevention.

I’m looking forward to supporting Bianca in realising her vision for where we go to next – and to exploring even more new directions for my own career. 

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Bianca's Story

Meet Bianca Romanyk: CEO

After 20 years in the mental health field, I am incredibly proud to be CEO of Storm Skills Training.

In my early career as a probationary psychologist working in community mental health, I can remember thinking that I’d like to one day have a role that could influence and impact the lives of many who were in distress. I recall meeting the CEO of the mental health service and being inspired by her and the compassion and empathy she showed those experiencing mental health issues.

Being in a small town in rural Australia I had the privilege of my role spanning across several areas of mental health, including working in an ongoing way with people with severe mental illness and crisis assessment (and being on call). I enjoyed all of it - I loved working with people, building trusting relationships, and working alongside them. I developed a special interest in working with younger adults with complex trauma and was lucky enough to train and be part of the Dialectical Behavioural Team for a short while. All of these experiences in my early career have driven my passion to make a difference for those in distress. I believe it is the quality of the connection that we make with people that makes a difference.

My career took me away from the frontline but rooted deeply in mental health and creating positive change. I found myself sat in a Storm Skills Training session as a trainee facilitator in 2013, Gill was delivering the course. I’d started in a brand-new role, working with schools in Australia to support their communities impacted by suicide. I recall vividly the anxiety of being on film in front of my new colleagues and the relief, value, and benefit the experience gave me. I left the training session feeling so empowered – I knew this course would help teachers and others working in schools to have conversations that made a difference to young people in significant distress. I wanted everyone to have Storm Skills Training!

Life presented itself with an opportunity to move to the UK. In 2014, before I left, Gill returned to Australia, we agreed to meet and talk about the opportunity to work together when I arrived. I arrived in the UK, with my two dogs, on the 7th of August 2015 and started work with Storm Skills Training on World Suicide Prevention Day the next month.

I haven’t looked back, my life here in the UK is lovely! When I’m not working, you’ll find me on my local common with my dogs, Derek and Doris, enjoying the view and nature. Or in my garden having a chat to the plants. I enjoy all things creative. More recently I have become a foster carer and am looking forward to this new life challenge and making a difference to the lives of young people.

I love the Storm Skills Training team, our consultants, and community and am always thinking about how to build and improve on the work we do, to have a positive impact on the world. I know that between us all we can make a real difference to people in distress. That’s what I am most excited about.

I believe passionately that Storm Skills Training helps to save lives. My vision for the future of Storm Skills Training, and our community, is to strive toward a more collaborative, empowering, and person-centred approach to self-harm and suicide prevention. A world where distress is met with compassion, everyone feels empowered to help and the support offered is tailored to the unique needs of people and their stories.





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Find support:

If you need help and support please reach out for it, here are some options:

Samaritans (UK)

Email: jo@samaritans.org

Phone: 116 123 (24 hours a day, 365 days a year)

Visit: samaritans.org

International Association for Suicide Prevention (International)

Visit: findahelpline.com/i/iasp