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Interview with Professor Nav Kapur on the development of NICE guidelines and the year ahead

by | Mar 9, 2023

Nav Kapur is Professor of Psychiatry and Population Health at the University of Manchester and an Honorary Consultant Psychiatrist at the Greater Manchester Mental Health Trust. 

He has worked in suicide prevention for 25 years, published books and many academic articles, and leads the suicide programme at the National Confidential Inquiry into Suicide and Safety in Mental Health as well as sitting on a number of advisory groups and NICE guidelines.

Professor Nav Kapur

Thank you for talking to us Nav! Your work is so relevant to our community, and we’re very excited to chat with you about it. Many people will be aware of your experience in the field, but we’d love to know how it all began. Can you tell us how you first became involved in suicide and self-harm research?

I do get asked a lot about how I ended up where I am, and the answer is there was no plan! It almost happened by itself. I trained to be a doctor, then decided that I was going to specialise in psychiatry. I took a research job in Leeds just for 12 months and found I enjoyed the process of academic work and was quite good at it. That always helps. I was offered a job in Manchester, a major centre for psychiatry, and I’ve been here ever since. I’m a clinical academic, with most of my time now spent on research and policy work.

I lead the suicide work of the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). For about 25 years, we’ve been focused on how we improve safety – and particularly how we prevent suicide– in mental health services. We do that through collecting comprehensive data from clinicians and people on the ground from all services in the country. By building up a detailed picture of people who sadly die by suicide we can investigate how we might best improve services and patient safety.

In one of our biggest studies, we found that involving families in care, the availability of crisis support, and tackling drug and alcohol misuse can help improve safety and reduce suicide rates. On these issues and many more, we’ve been able to generate recommendations for services. Every year we hold a conference and publish a report looking at the latest trends and focussing in on specific topics. I also work on the Manchester Self-harm Project which collects information on everyone who self-harms in Manchester and presents to hospital, and the Multicentre study of Self-harm in England which is one of the best sources of information we have about self-harm.

I’ve worked a lot with The National Institute for Health and Care Excellence (NICE) over the years, most recently on the revised self-harm guidelines. I also work with the Department of Health and Social Care to advise on the national suicide prevention strategy. These days I spend a lot of time giving talks on self-harm and suicide. One of the reasons I love research is that it gives you an opportunity to have an impact on clinical care as a whole and not just the patient in front of you (although of course that’s absolutely vital too).

A hot topic over the past few months has been the new NICE guidelines for self-harm. A lot of our community will have been working through what the guidelines mean for them. Can you tell us about the development process for the new guidelines and the key message people should take away from them?

Guideline development is a long and complicated process. NICE develop guidelines with the help of specialist committees which have a wide range of members – some people are experts by experience (both service users and carers), some people are clinicians, and others are researchers or come from other professional disciplines. We get round a table – either physical or these days virtual! We review the research evidence and ask how should we best help people after self-harm?

Sometimes there isn’t much evidence, so we have to come to a consensus-based decision. It is quite an involved process; in this case, I was involved for over two years.

The guideline is full of lots of detail about assessment, aftercare and treatments which we hope will be helpful but there are a couple of big things that are new.

First, the two previous guidelines (short-term and long-term management of self-harm) have been combined so that all the evidence and advice is now in one place.

Second, the guideline takes the view that self-harm isn’t something that only mental health professionals should know about. Self-harm can present anywhere. We have suggestions and recommendations in the new guidelines for Emergency Departments, GPs, paramedics, teachers, and people working in the criminal justice system – a wide variety of settings.

I think that’s the main message from the guideline: everyone has a role to play in how we help people after self-harm. We aren’t asking everyone to be a mental health professional, but everyone should have a bit of basic knowledge around self-harm – that it isn’t a diagnosis but a behaviour, that every person is different, and how to signpost people for help.

In fact, perhaps the single most important skill has nothing to do with being a psychiatrist or mental health nurse. It is just about being able to listen in a kind and sympathetic way. I think we can all do that.

Everyone working in mental health, self-harm and suicide prevention at the moment will likely have encountered some challenges due to the pandemic and the cost of living crisis. What do you think are the most important things to focus on this year? Where are the biggest pressures and what can our community do to best help and support people?

A major focus for us in the last couple of years has been looking at the impact of the pandemic (thankfully we didn’t see the rise in suicide that many people were worried about) and now, of course, we need to keep an eye on any impacts from the cost of living crisis and the economy.

It’s going to be challenging, but in the end – almost regardless of what the statistics on suicide are doing – the important thing for me is action. Some of the response is always in the hands of governments and their policies on welfare and support, but there is a lot we can do on the ground as well. We are working on the revised National Suicide Prevention Strategy for England, which will hopefully be published later this year. Some of the priorities may well be focussed on children and young people, domestic violence, and gambling – important issues which have come to the fore recently. But others have featured in our strategy since 2002, for example, the role of mental health care and high quality services for self-harm.

One of the crucial things that we’re really beginning to realise is the essential role of the voluntary sector in supporting suicide prevention. They are in touch with people and listen to them every day. Others advise on debt or signpost to help. They understand the pressures people are under and how to navigate systems locally. The staff who work in financial advice settings are also on the frontline for people in crisis, so one of the challenges might be how can we equip them with a working knowledge of mental health?

There is also an enormous demand on our health and social care services. We all have work to do to ensure that patients and service users get the care they need and deserve, but also that we look after health and social care staff as well.

Despite all the challenges, though, the basics haven’t changed. The evidence is still the evidence. High quality care is still high quality care. Yes, the context is more difficult, but how we talk to people in distress and hopefully get them the care they need remains the same. I think it’s really helpful to remember that.

Read more about Nav’s research work on the NCISH website.


View Professor Nav Kapur’s research profile

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