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Preventing suicide: assessing and supporting those with no fixed address

by | May 20, 2024

The stress associated with housing instability can intensify feelings of hopelessness and isolation, making individuals more vulnerable to self-harm and to suicidal thoughts and behaviours.  

“Suicide is complex and is rarely caused by one thing.  However, we do know that homelessness, housing insecurity, and poor housing can increase suicide risk.”

In 2021, 13.4% of the estimated deaths of homeless people (in England and Wales) were registered as suicide, emphasising the urgency to address this issue.

A report from the Suicide Prevention ConsortiumTomorrow is too late: Suicide prevention support for people with no fixed address’ suggests some areas of improvement that could help to prevent suicide among people without a fixed address or those experiencing housing challenges.

No fixed address - Image of two people sitting

*Suicide Prevention Consortium

The Suicide Prevention Consortium (SPC) is made up of four organisations: Samaritans, National Suicide Prevention Alliance, Support After Suicide Partnership and WithYou. As part of the VCSE Health and Wellbeing Alliance, it aims to bring the expertise of its member organisations and the voice of those with lived experience directly to policymakers, to improve suicide prevention in England

So, what can you do to help save lives of people with no fixed address?

The importance of a person-centred approach: A person-centred approach allows individuals to share their experiences and relevant information, which is especially important for those at risk of self-harm, suicide, and experiencing homelessness.

The complex nature of homelessness and housing insecurity means a multitude of factors could be influencing an individual’s circumstances. By offering a safe space for individuals to discuss their experiences, you can work collaboratively to effectively tailor support.  

This personalised approach is important during assessment and safety planning, ensuring that provided support comprehensively addresses the distinctive challenges and risks faced by those with housing challenges.

Addressing the housing situation during assessment: When supporting individuals in distress, especially those facing unstable housing or homelessness, it’s important to consider the impact of their housing situation on their vulnerability to self-harm and suicide. If housing is contributing to distress, this should be a fundamental consideration in the assessment and safety planning process. 

Alongside housing, it’s important to explore the person’s other needs, vulnerabilities, and strengths in a holistic way.

Use a psychosocial perspective as a framework to guide your exploration and work with the person to make sense of what’s going on: Housing instability often goes hand-in-hand with a host of other biological, psychological, and social vulnerabilities, such as physical/mental illness, substance use, poverty, and/or trauma. Many of these vulnerabilities are also associated with a higher risk of self-harm or suicide.  

Understanding these interconnected factors through a psychosocial lens allows for a nuanced and holistic assessment of the person’s needs. By moving beyond surface-level indicators, such as housing status, you can gain a clear and comprehensive picture of the person’s circumstances. The clearer the picture, the better placed you are to offer effective help and support. Be guided by the person in front of you: tune into what the person is saying and be compassionately curious to learn more. 

Before moving to action, work with the person to make sense of what you have learnt, taking into consideration what 

Personalised support and ongoing safety planning: Information gathered during assessment can be used to create a personalised safety plan. Safety planning with those experiencing housing insecurity requires a thoughtful approach which accounts for the unique challenges of their circumstances.   

If housing insecurity is contributing to distress, you can address this as part of the safety plan. 

Include strategies specifically aimed at addressing housing instability and any other associated issues.  

This could involve, for example, connecting the individual with:  

  • local housing assistance programs
  • case management services
  • options for temporary shelter  

While the key principles of safety planning remain relevant, it is important to include other associated problems such as debt or financial problems 

Reducing access to means, an important part of planning for safety, may involve identifying safe public spaces or community resources that are accessible in moments of crisis.  

Professional contacts could include not only mental health and crisis services, but also: 

  • local housing assistance programs 
  • options for temporary shelter  
  • free debt advice. 

Explore with the person effective ways of recognising and responding to increasing distress. Include strategies for coping with suicidal thoughts and urges to self-harm. 

Any safety plans or contact details should be provided in a format that is accessible to the person and does not require a fixed address or internet access. For example, the information could be printed or sent via SMS texts.

Offer tailored support specific to suicide and self-harm: Explore with the person effective ways of recognising and responding to distress. Including strategies for coping with suicidal thoughts and self-harm that work for the person.  

Any guidance should be made available in formats that do not require a fixed address or internet access.

Consider providing immediate support information: Ensure that individuals on waiting lists receive clear information on how to access immediate support in case of a crisis. Provide the information in a format that works for the person (e.g., printed cards, SMS texts) and include local and national crisis support contacts.

Explore communication needs: Explore the ongoing communication needs of the person, especially within mental health and other healthcare provisions. Many people experiencing homelessness may have limited access to phones or the internet, making traditional communication channels inaccessible. Explore what will work for the person to ensure they get timely information. You can directly ask individuals for their preferred communication method and note this in their records to ensure all future communications are accessible to them.

Listen to and learn from lived experience: The report gives some direct quotes from those with lived experience of homelessness. Take the time to read them, learn from them, and consider how you might contribute to improving your approach to those without a fixed address. Through actively engaging with their perspectives, you can gain valuable insights into the barriers and challenges that they face in their day-to-day lives.  

We encourage you to have a read of the report. It is valuable work that will help save lives.  

Storm Skills Training CIC would like to thank the organisations and individuals that developed and supported this project; 

A full list of references can be found on page 22 of the report.

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