Topic: Blog

Norfolk and Suffolk suicide prevention collaboration

Why are you collaborating?

A priority of the Norfolk and Suffolk NHS Foundation Trust Suicide Prevention Strategy 2017-2022 was to play a key role into taking action to reduce suicide in our community. As part of the Five-Year Forward Plan for Mental Health each county is working to a multi-agency suicide prevention plan supporting a 10% reduction in suicides nationally. We have a shared ambition to prevent suicide in Norfolk and Suffolk, which includes people who have been in contact with mental health services and those in the wider community without a mental ill health diagnosis.

This approach affirms the Norfolk and Suffolk NHS Foundation Trust’s commitment to the Zero Suicide Ambition where we are able to share our knowledge and learn best practice from others around the county, in turn strengthening the way all organisations work together to reduce suicide within our community.

What and who does the collaboration involve?

Both counties of Norfolk and Suffolk have separate multi-agency suicide prevention steering groups and the Norfolk and Suffolk NHS Foundation Trust is an active member of both these. We work alongside other partners at these meetings to share best practice, provide regular updates and an overview of progress to plan joint approaches to training, events and our engagement at a national and regional level.

In addition to these priority meetings all three Suicide Prevention Steering Groups are represented at the “Suicide Prevention Leads for East of England Network Meeting” hosted by Public Health England which meets bi-monthly. This provides the Suicide Prevention Leads a valuable opportunity to meet with and learn from other regions.


  • Joint planning and involvement in events and promotions. Most notable examples are an NSFT lead Men’s Mental Health conference (held in both Norfolk and Suffolk), Suicide Prevention Learning Events (Norfolk Public Health led) and promotion of Suffolk Life Savers work.
  • Integrating the approach between the countywide strategies of Norfolk (I’m OK / I’m not OK) and Suffolk (Suffolk Lives) and Norfolk and Suffolk NHS Foundation Trust suicide prevention strategy.
  • Collaborating on sharing of data and information which we hope will enable us to learn more about areas where suicide risk is higher.
  • Ensuring NSFT and other partners are represented at all decision-making groups.


Norfolk and Suffolk NHS Foundation Trust has invested in a dedicated Suicide Prevention Lead which has enabled flexibility and representation at local and national suicide prevention groups along with ensuring that suicide prevention is at the fore front of planning and delivering services for Norfolk and Suffolk NHS Foundation Trust. An important aspect of the position is to have local knowledge across a wide, geographical area with differing economic, political and social infrastructures. Much of this has been established through actively visiting different areas and attending meetings in person to allow those local relations to be established and respected.


  • Five CCGs in Norfolk and two CCGs in Suffolk means there are different services commissioned and operational depending on geographical location within Norfolk and Suffolk NHS Foundation Trust. For instance clinical pathways to access crisis support, psychiatric liaison services and services for children and young people will vary across the two counties and even between localities.
  • In June 2018 Norfolk received additional funding under the first wave of the Suicide Prevention Transformational Funding. This is in response to Norfolk having a statistically higher rate of suicide than Suffolk. This will allow for more investment in services within Norfolk aimed at Suicide Prevention – some of this Norfolk and Suffolk NHS Foundation Trust will benefit from and it will be a challenge to replicate this funding in Suffolk even though the perceived need is there.
  • Norfolk and Suffolk NHS Foundation Trust has adopted the Zero Suicide Ambition and a further challenge will be aligning priorities for suicide prevention between the trust and the wider community.

What would you do differently if you had to do it all again?

From Norfolk and Suffolk NHS Foundation Trust’s side I would insist on a greater representation of service user, carer and those bereaved by suicide from the start when planning future care delivery. Those with lived experience are already active members of our Suicide Prevention Panel and contributed to the formulation of the Suicide Prevention Strategy but that is not to say we cannot continue to improve how we listen and respond to those effected by suicide. We are currently reviewing the Suicide Prevention Training which is delivered to the professionals providing Clinical care to those who work for the Norfolk and Suffolk NHS Foundation Trust. Those with lived experience are being actively consulted from the start in the planning of the training alongside the educational department and clinical leaders. It is hoped that success from this will not only be a rewarding experience for those involved but will deliver effective, fit for purpose training with the aim that this training will be co-delivered. Those effected by suicide need to be involved at the start of any change or review of our services.

The City of London Corporation’s suicide prevention work

The National Suicide Prevention Alliance recognises the importance of promoting good mental health at work, and the vital role this can play in suicide prevention. The City of London Corporation, a member of the NSPA, is raising awareness of workplace well-being in the city, promoting help seeking and providing practical support.  You can read about some of the important work they are doing below.

The City of London Corporation

Poor mental health – including stress, anxiety, depression and suicide – is recognised as one of the biggest local issues in the Square Mile, as it is across London and at a national level. Stress at work (whether work-related or otherwise) is one of the main reasons for sickness absence in the UK.

The City of London Corporation is the organisation with local authority responsibilities for the City and over the past few years has been targeting its local resident, worker and visitor populations to provide a coherent place-based approach to mental health and wellbeing across the Square Mile – the UK’s financial and business hub. Almost half a million people come into the City of London every day to work, from across London and the South East.

In the context of the workplace, Business Healthy is an award-winning programme delivered by the City Corporation’s Public Health team. It supports local employers to improve the health and wellbeing of their workforce, providing signposting, access to resources and guidance and hosting expert-led events.

The City Corporation has taken a strategic approach to promoting good mental health in the City, which covers the following areas:

  • Awareness-raising and fighting stigma
  • Creating a dialogue within the City around mental health
  • Opening a physical space to help people to de-stress and build mental resilience
  • Taking a partnership approach to suicide prevention
  • Establishing a Street Triage service

Awareness-raising and fighting stigma, through marketing, local campaigns, and strategic partnerships with businesses and the third sector

The City of London Corporation launched the City’s first-ever mental health and suicide prevention campaign in June 2017, called “Release the Pressure”. Based on a successful campaign developed by Kent County Council, the Release the Pressure campaign is ongoing and is aimed at those working, living in and visiting the Square Mile. It encourages people to recognise day-to-day stresses that could trigger poor mental health and to seek help for them. By advertising in high-footfall areas in the City and sharing campaign resources with the local business community, the campaign has seen much engagement and led to a tenfold increase in views of the list of mental health support services on the City Corporation’s website.

The City Corporation and Business Healthy supports, resources and promotes other local campaigns and initiatives to local businesses, residents and workers (including the City Corporation’s own 3,000-strong workforce). These include the local CCG’s “5 to Thrive”, the Lord Mayor’s Appeal’s “This Is Me” and green ribbon campaigns, the City Mental Health Alliance and most recently the Samaritans’ Wellbeing in the City tool. All of these are aimed at eradicating stigma attached to mental health – particularly in the workplace.

Creating a dialogue within the City around mental health, parity of esteem, and the role of employers in safeguarding employees’ mental health

A partnership with local businesses is in place, facilitated through the City of London Corporation’s Business Healthy network. Two-way flows of information and best practice are facilitated, including face-to-face and online, and events on mental health in the workplace are hosted for member organisations and their staff, including regular Samaritans’ led Suicide Prevention Awareness Training workshops.

Opening a physical space to help people to de-stress and build mental resilience

Business Healthy has facilitated a collaboration between Mental Fight Club, Barbican and Communities Libraries and Output Arts to open Dragon Café in the City in February, which is based on the successful Dragon Café that has been running in Southwark for the past five years. Funded by the City Corporation and Carnegie UK and the Wellcome Trust’s “Engaging Libraries” scheme, Dragon Café in the City is a six-month pilot and is hosted in a library in the Square Mile. It hosts free activities to help visitors de-stress and build mental resilience, referencing “Release the Pressure” as a key theme. Based on the concept of positive mental wellbeing, it addresses common mental health conditions, such as stress, depression and anxiety. Dragon Café in the City also provides a local platform for Thrive LDN’s Problem-Solving Booths.

Taking a partnership approach to suicide prevention and disruption of suicide attempts

The City Corporation has been leading on a long-term suicide prevention programme, bringing together the City of London Police, Samaritans, RLNI, the local CCG and primary mental health service and other organisations, to reduce suicides among City residents, workers and visitors. This work – focusing on helping those at crisis point – includes placing Samaritans signs on bridges crossing the Thames, distributing suicide intervention guidance to 10,000 commuters, and engaging with the local business community through Business Healthy, to deliver suicide prevention awareness training at a low/ minimal cost (see above).

Establishing a Street Triage service, to divert people in mental distress from being detained

The City of London Corporation and the City of London Police have developed a “Street Triage” programme (launched May 2017) with the local mental health primary care service. Initially introduced as a pilot, it addresses the large number of those detained under Section 136 of the Mental Health Act. The triage moves those at crisis away from police detention to a more care-focused approach, reducing the large amount of resource used to detain those at-risk under police supervision. Mental health professionals join police patrols overnight four times a week, determining the best support for those in crisis on the spot. The evaluation of the first seven months of the triage found that 41% of all potential Section 136s were avoided. Most police officers agreed that the force had given a far better level of care to people in crisis since the triage began. Ongoing funding to expand the triage to seven nights a week has been secured.

To find out more about the work that the City of London Corporation is doing, please get in touch with Tizzy Keller – Strategy Officer and Suicide Prevention Lead, or Xenia Koumi – Project Lead for Business Healthy.

Annual Members Meeting 2018

Regent's Canal from our meeting room, interior shot of 'cabaret' layout and view of NCVO from other side of Regent's Canal    

Our Annual Members Meeting took place on 2nd May at NCVO, London.  NSPA members and supporters came together to hear about the work of the NSPA over the last year, to discuss issues such as the impact of Brexit on suicide prevention and what our priorities should be for the next few years, to learn more about each other’s’ work, and to network.  A wide range of members attended with representatives from the private, voluntary and public sectors, as well as individual supporters.

We have received overwhelmingly positive feedback from the event, with participants valuing the opportunity to share ideas, challenges and hopes in such a diverse group who all care so much about suicide prevention and bereavement support. Thank you to those members and supporters who came along and made it such a great day.



Below is information on each of the presentations from the day, please click on the title to view the slide sets.

Update from the NSPA

Penny Fosten, NSPA Executive Lead, updated members on some of our work in 2017-18, including new resources for local suicide prevention work, our national conference, World Suicide Prevention Day activities, and government engagement and influencing. She also welcomed the 37% increase in membership in the last year, and how much it strengthens our collective voice. Penny outlined plans for the coming year, including significant improvements to the resources available on our website, enhancing connections and communication with and between members, and continuing to represent and advocate for our members nationally.

Farming Community Network – The potential impact of Brexit on the farming community

Glyn Evans talked about the potential impact of Brexit in the farming community. Farming is an inherently risky and volatile industry to work in and Brexit means more uncertainty.  The FCN are encouraging farmers to build resilience to change and to prepare for the effects of change on business and personal lives, and continuing to provide them with support and advice.

Highways England’s Suicide Prevention Strategy (slides not available publicly)

Nicola Tweedie from Highways England (who are responsible for operating, maintaining and improving England’s motorways and major A roads) shared their suicide prevention strategy, which includes prioritising high-risk locations and training and supporting their staff to have the skills and confidence to identify and talk to a suicidal person.

PAPYRUS Prevention of Young Suicide – The class of 2018 

Ged Flynn presented PAPYRUS’ current campaign ‘The class of 2018’ (you can view the campaign films in the slide sets). Over 200 children are lost to suicide every year in the UK, and suicide is the leading cause of death in young people. Papyrus are committed to building safer schools and colleges, and have developed resources for schools, you can download these here.

Suicide Bereavement UK: National Bereavement Survey

Dr Sharon McDonnell talked about this survey, which is supported by the Support After Suicide Partnership and the University of Manchester.  It aims to help our understanding of the impact a death by suicide may have on the lives of those who are bereaved or affected by the death, to establish the support people bereaved or affected by suicide received, how the support was helpful, and identify where support is lacking.

Over 4000 people have already completed the survey.  If you would like to take part you can do so here.

NW Counselling Hub – Domestic Abuse and Suicide

Naomi Watkins presented their work in domestic abuse. One incident of domestic abuse is reported to the police every 30 seconds and every day almost 30 women attempt suicide as a result of experiencing domestic abuse. NW Counselling hub works with survivors of domestic abuse, they provide counselling, encourage help seeking and assist survivors with vital safety plans.

Recent Research

Dr Alexandra Pitman, Senior Clinical Lecturer, UCL Division of Psychiatry, provided an overview of some recent research in suicide prevention and high-risk groups, including construction workers, LGBT youth, people with access to lethal means and people bereaved by suicide.

Annual Members Meeting 2017

NSPA members and supporters gathered at NCVO in central London last month for the Annual Members Meeting. Attendees heard what the NSPA has been doing over the last year, and some showcased their own recent projects and findings in a series of presentations. The meeting – open to all members and supporters – happens every year and is a great opportunity for people working in all areas of suicide prevention to network and share challenges, experiences and ideas with each other.

There were also morning and afternoon table discussions sessions. The first allowed people to think and share about how the last year has been for them and how NSPA can help them further. In the afternoon the table discussions were on: men and suicide, working in a small organisation, successful campaigns, and how to better enable and empower people with lived experience.

We are very grateful for everyone who attended, contributing valuable insight into suicide prevention.

Here is a summary of the presentations throughout the day. Click the headings to download PDF versions of presentations slides

NSPA Review 2016/17

Over the last year the NSPA has delivered events such as our conference, local suicide prevention planning masterclasses, and mental health champion training; and we have produced resources including the Local Suicide Prevention Planning guidance, a suite of resources on postvention support, and resources for World Suicide Prevention Day a few weeks ago that reached far beyond our alliance members. All of these activities have contributed to a 32% increase in membership to 92 organisations and nearly 100 individual supporters. Over the next year we intend to: continue to grow and support our membership, with more special interest groups and regional events; enhance the website with more resources and information; and continue to be a strong voice that represents our members.

David Mosse, from the Haringey Suicide Prevention Group, then talked about how the loss of his son to suicide lead him to set up this multi-agency group to lead on suicide prevention planning and delivery across the borough.

The Bridge Pilot

Nicole Klynman, from the City of London, and Will Skinner, a Samaritans volunteer, talked about the challenges of suicide prevention in the City and how they have worked together with the police and health services on the ‘Bridge pilot’, which involved putting signs up on London Bridge, giving out leaflets to pedestrians to raise confidence in helping someone they think might be at risk, and delivering suicide awareness training to front-line staff and people who work near the bridge. They are now working on similar work for Southwark, Tower and Blackfriars Bridges.

Lived Expertise of Suicide: Inclusion, Engagement and Strategic Partnerships

Gill Green, from STORM Skills Training, and Jacqui Morrissey, from Samaritans, talked about an Australian initiative – Roses in the Ocean – which works to “engage and empower people with a lived experience of suicide in order to change the way suicide is spoken about, understood and prevented.” Their definition of lived experience includes having had suicidal thoughts, having been bereaved by suicide, and caring for someone who has suicidal thoughts, and they work to include a diverse range of people and ensure they are supported and trained, and their voices valued. It felt that there was support for the idea of this or a similar model existing in the UK, and the NSPA will continue to work on this.

Suicide and Autism

Jon Spiers, from Autistica, shared their research data on autism and suicide. Findings include higher levels of depression, anxiety, suicidal ideation and higher rates of suicide in people living with autism. The research also highlights how challenging it is to find appropriate support when one finds it very difficult to identify or discuss emotions, work in groups, or call helplines.

Building Collaboration, Investing in Communities

Bianca Hegde, from STORM Skills Training, talked about how they invest money back in to communities through free training and education for front-line staff, running their social change campaign #HeyAreYouOK?, and working pro-bono for organisations including State of Mind and the Greater Manchester Fire Brigade.

Emerging Themes – contact us for more info

Victoria Sinclair, from the Nightline Association shared their data on the challenges faced by students, the themes coming up regularly (including sexual violence, loneliness, self-harm, suicide and the transition to and from university) and their focus on how to support specific groups of callers better, particularly post graduates, international students and male students.

Suicide Prevention Masterclasses

Helen Garnham, from Public Health England talked about the 2017 Suicide Prevention Planning Masterclasses, particularly what was learned from them, which included how extra funding might be better invested, the desire for more examples of good practice, the benefits of wider collaboration, and the need for more workforce development.


Learning points from Churchill Fellowship Research for National Suicide Prevention Alliance


Last year I was privileged to be awarded a Winston Churchill Travelling Fellowship to visit Australia, New Zealand and Ireland to meet with organizations and individuals who support families after they have been bereaved by suicide. As a child bereavement practitioner, and until recently a manager of services for bereaved children, especially those bereaved by suicide, I have long been aware that children are often overlooked in the quest to provided better services for those bereaved by suicide.

Children are affected by the death of a family member, especially when the person has died by suicide, with all the added complications that brings. Adults, both parents and professionals, often feel at a loss as to how to talk to children about suicide. Children need to be involved in the processing of what has happened in order to develop into resilient adults. Children bereaved by suicide are more vulnerable as they grow up, so it makes sense to put in place services for children that may prevent mental health issues in adulthood.

There are many developments in relation to support after suicide in the countries I visited that are cited as good practice. My Fellowship looked at how children are supported within these different models and services, and how specialist child bereavement services relate to these. I hope it will increase the understanding of what will most benefit suicide bereaved children in the growing partnership of organizations that are seeking to develop a national response for support after suicide in the UK.


Funding is obviously vital to the development of every service and across the range of my visits I saw how proper funding can enable services to become well grounded and grow. In Australia there is substantial government funding for services related to suicide prevention and bereavement, and I wanted to know why. Jaelea Skehan, Director of the Hunter Institute of Mental Health in Newcastle, Australia, doesn’t think funding is necessarily obtained through the logical way of running a pilot, evaluating it, showing its worth and applying for funding. It’s as much to do with developing relationships with the right people in government or other positions of influence and convincing them of the need for services, so they can apply pressure or influence where policies are made and funding decided.

Those who have been most influential in driving the agenda forward have had a personal interest in, or experience of, suicide. In the most recent Australian elections the Prime Minister Malcolm Turnbull said that ‘addressing suicide and mental illness would be a “vital national priority” for a re-elected coalition government.’ This statement was in response to a challenge by an alliance of leading mental health advocates to all political parties to announce what they would do to address the rising toll of suicide and self harm.

In NZ the Travellers programme for the prevention of suicide was funded by the New Zealand government and the Mental Health Foundation. At the time the minister was Jim Anderton, whose daughter had died by suicide, making him sympathetic to funding.

Headspace’ is a youth mental health initiative which was established by the Australian government in 2006 and is fully funded by the Federal Government. It emphasised evidence based intervention and was founded by Patrick McGorry, who as Australian of the year gave a big push to youth mental health.

Australia, New Zealand and Ireland have all run successful campaigns to highlight that deaths by suicide are often greater than road deaths. In New Zealand road deaths have been greatly reduced by a big campaign of posters along roads, proving that funding can be effective. Organizations related to suicide prevention are now using this as an argument for funding. Estimates of the total cost of road deaths to New Zealand society were put at around $3.6 billion each year. The national road safety campaign is based on a high level of research.

In Ireland the 3Ts( turn the tide of suicide) charity lobbies governments, raises awareness of suicide and provides grants and funding for research and support, highlighting that 3 times more people die by suicide in Ireland than die in road traffic accidents. Recognizing the need for research into suicide to help inform national suicide prevention strategies it funded the ‘Suicide in Ireland Survey’.  It states that ‘If adequate state funding for suicide prevention is unavailable, then we need a Suicide Prevention Authority similar to the Road Safety Authority, an independent authority to oversee a dedicated National Suicide Prevention Programme.’

The following example shows how, with commitment from those in government, a real difference can be made to the support available after suicide. Working in partnership in the UK is therefore vital in order bring maximum pressure to bear on those in government who can influence financial decisions.

In Australia an audit of 28 electorates between 2009 and 2012 found suicide rates exceeded the road toll in every seat. Between 2004 and 2014 suicide rates rose almost 20%.

Electorate 2009-2012                        Suicides                                Road toll

Canning WA                                          90                                             54

Longman, Qld                                      162                                             68

Cunningham, NSW                                91                                             37

Boothby, SA                                         64                                             13

Corangamite, Vic                                 111                                             65

The shadow Mental Health minister, Katy Gallagher, stated labour’s commitment to a 50% suicide reduction target over the next 10 years and the establishment of 12 suicide prevention pilot projects.


In July 2010 the Prime Minister Julia Gillard said a labour government would spend $277 million to help Australians at risk of suicide, with a priority on providing services for men.

  • The Lifeline counselling hotline would be expanded
  • The Beyond Blue organization would be given funds to target men with depression Programmes would be made available to students through schools.

Money was given for research and a proposed service model was drawn up and launched in 2012, initially as a recovery programme, which then led on to a recognition for the need for preparedness. There is now a coordinator in every state and territory.

In Dec 2014 Julia Gillard joined the board of ‘Beyond Blue’. She said “as the daughter of a psychiatric nurse, I have always understood the need to talk openly about mental health and respond to those in need”.

Funding and Services

It is not surprising that large well organized agencies attract more funding. Australia has well developed mental health services and a lot of government funding has gone into organizations like Headspace, Beyond Blue and MindMatters, all of which seek to address the mental wellbeing and resilience of young people, either as a preventative to suicide or as a support after suicide. Headspace in particular has grown rapidly with its full government funding, with 100 Headspace centres nationally, 200+ staff in the head office and 2000 schools it has worked with. But these large services are often about facilitation and information and there is a lack of services to refer on to for direct support. One person I met in New Zealand commented that there are ‘leaflets, leaflets, loads of glossy leaflets, but no one actually works with families’. Large national organizations are better funded and often highly manualized. They have less understanding of direct work and less ability to connect with the local community, although they attempt to overcome these by referring on and by embedding the service in local organizations.

Those organizations that do work directly with children and families, such as the Jesuit Social Services Support after Suicide, and the Centre for Childhood Grief in Australia, Barnardos in Ireland and The Grief Centre in New Zealand, have a wealth of knowledge and experience in supporting children, but are small and find it difficult to attract funding.

It was striking that where Government funding has continued, albeit on a year to year basis, in Australia and Ireland, suicide support services have thrived, whereas in New Zealand promising initiatives and projects have floundered through lack of funding, and experienced staff have become demoralized or lost their jobs. The Ministry of Health is presently discussing the next 10 years for the Suicide Prevention Strategy in New Zealand and many professionals are waiting for the outcome of this. It is problematic that in New Zealand there is a political argument between government departments as to whether suicide is social or a mental health issue. I was told that no government department wants to be responsible for suicide prevention. They have done the research, written a document and an action strategy, but leave District Health Boards to put this into practice, which has led to a fragmentation of suicide support services in New Zealand.

What I have learnt from this is that in the UK we need to try and get a balance between large scale facilitation, which can co ordinate services at the national level but will be less responsive to local needs, less personal and more bureaucratic; and small scale direct work, which can provide very good practice,  expert knowledge and a high level of satisfaction for both those who receive and deliver services, but which find it hard to attract funding or offer services over a wide geographical area.

I was informed by a number of people that the Australian government is keen to fund e-programmes. One example of these is eHeadspace, which enables young people equal access to a service where they can email, phone or skype with qualified mental health professionals. Similarly in New Zealand 185 of 300 secondary schools are signed up for the ‘Travellers’ resilience programme developed by the child bereavement organization ‘Skylight’. Schools are trained to run the training and the whole cohort of year 9 pupils complete an online survey. On the basis of this high scoring pupils are offered counselling, medium scoring pupils are offered the Travellers course and low scoring pupils have anything of concern addressed.

Academic Rigour

Governments need convincing with evidence and good collection of data and successful projects are often evaluated by external bodies, such as universities or research institutes and have research evidence to highlight the need and show that costs of preventative services are less than the costs of doing nothing, e.g. hospital admissions, working days lost, and mental health. A good example of this is an influential study in Australia that did exactly this and helped deliver funding to the national organization StandBy. (‘Cost Effectiveness of a Community Based Crisis Intervention Program for People Bereaved by Suicide’. Tracy Comans, Victoria Visser and Paul Scuffham). In Ireland the National Suicide Research Foundation in Cork is an independent research unit which undertakes research into topics relating to suicide to provide the knowledge base for suicide prevention, intervention and postvention strategies.

In Australia there is a strong connection between research and practice, this makes the sector very vibrant and services well grounded in evidence and theory. The Hunter Institute of Mental Health in Newcastle, Australia focuses on research on the development of services that have a practical application in mental health, developing projects in relation to organizations on the ground that can carry them out. Jaelea Skehan, the director, is passionate about translating evidence into practice and finding better connections between research and practice. She believes there should be a middle ground between practitioners and researchers with a constant flow in both directions. The Institute of Suicide Research and Prevention at Griffin University in Brisbane has a taught Masters degree and Diego De Leo, it’s Director from  1998-2015, has been influential for a number of practitioners in their work in suicide pre or postvention. Griffin University in Brisbane Directs the WHO Collaborating Centre on Research and Training in Suicide Prevention.

This has also been true of the Irish National Suicide Research Foundation, which has worked in conjunction with those who are developing services for support after suicide in Ireland, while In New Zealand Chris Bowden, lecturer and researcher at Victoria University of Wellington  worked with Skylight to develop the Waves psycho-education programme, while also completing his own PhD on young men’s experiences of losing a close male friend to suicide, and Annette Beautrais and Prof David Fergusson at Otago University were joint authors of the New Zealand Suicide Prevention Strategy 2006-16 and were involved with the Christchurch Suicide Project.

On the service side in Australia there is a high academic level among practitioners, with many having Masters in Suicidology or a PhD related to their work in suicide. Some are working towards professional doctorates at the same time as working. Several PhD students are being supervised by Dr Myf Maple, associate Professor in the School of Health at the University of New England (UNE). The UNE works with four other universities and a local health district as part of a Collaborative Research Network (CRN) on mental health and well being, which has attracted $4.8 million funding from the Australian government. This means that research is joined up and has a strong profile. As mentioned in the blog of Sharon McDonnell, Honorary Research Fellow at Manchester University and Churchill Fellow, on April 4th 2014, ‘it is possible to suggest that Myf’s postvention department is a virtual one, in that many of her staff are PhD students and study via distance learning. It is commonplace to hold meetings via a video link’. This is a practical response to the vast distances in Australia.

I believe this interrelationship between research and practice, with movement in both directions has greatly helped practice to be grounded in research and research to be based in practice, and has given credibility to both. Governments are more likely to fund joined up working and more likely to be convinced of the importance of funding research that leads into the development of services that are effective, and the efficacy of funding practice that is evidenced by research.

Working in Partnership

I came across many examples of collaborative working which must inevitably aid the development of good joined up services for those who are seeking support after a suicide. Organizations working at a national level, such as StandBy and Headspace, do so by having a Memorandum of Understanding with local partner organizations and arrangements whereby coordinators of services meet together and train together. In the district around Melbourne Headspace do more general work in schools but refer children to the Jesuit Social Services Support after Suicide for direct work with individual children. This not only encourages cooperation but also develops an understanding of each other’s services. In Australia information about The Centre for Grief and Bereavement is given to families by funeral directors.

In all three countries the fact that coroners report deaths by suicide to those organizations providing services makes an enormous different to their ability to offer services, as people are less likely to fall though the net.

  • The Centre for Childhood Grief in Australia works together with the local coroner to run a ‘Support after Suicide Group’ with social workers from the coroner’s office. This group is funded by the coroner, who also provides the venue.
  • StandBy was initiated by the coronial service and the police, which has meant an ongoing positive working relationship between the different agencies.
  • The Department of Forensic Medicine in Newcastle works closely with coroners.
  • As a Regional Suicide Postvention Coordinator in Wellington New Zealand Jennie Jones is informed of every suicide by the coroner, who gives basic information, and by the police who share more details through an encrypted site.
  • Victim Support, who offer a service to those bereaved by suicide in New Zealand, also commented on the enormous advantage of being informed of deaths by the coroner.

This is an area that clearly needs a lot of attention in the UK, where contact with local coroners is patchy and sensitive.

Many different professionals are involved after a suicide, e.g. fire service, police, ambulance service, clergy, GPs and funeral directors. The most successful organizations had worked to get each profession onboard at a high level, in order that cooperation and good working relationships percolated down throughout the organization, and maintained these by good networking, joint training, clear guidelines and protocols. These are often brought together in manuals. Having a facilitator whose task it is to put all these things into practice seems also to be the mark of a successful service.  Prime examples of this are StandBy, the Mayo project in Ireland and the work of the Suicide Postvention Coordinator in Wellington.



Developing a Model

Those organizations that have been most successful in growing and attracting funding have developed clear models of working based on research and evidence.

Services for the prevention of suicide and support after suicide are gradually being coordinated and strengthened in the UK through the coming together of different working partnerships, some in local areas and some nationally. Decisions need to be made on finding models of working that are most effective in our own circumstances in the UK.

As the provision of support after suicide in the UK is developed it is vital that the partnerships of organizations involved have clarity around the models that evolve from their collaboration, with clear theoretical underpinning, evidence for the efficacy of the model from pilots or other examples, and hold fast to best clinical practice as far as possible.

I saw several different models in the course of my Fellowship.

Direct work with families and children

For example,

  • Jesuit Social Services Support after Suicide in Melbourne.
  • The Centre for Grief and Bereavement, Melbourne
  • The Centre for Childhood Grief, Sydney
  • Skylight in New Zealand
  • Barnados in Ireland
  • The Mayo Project, Ireland

The mark of these organizations is high quality work, long standing experience and a real knowledge around suicide and it’s affect on individuals, families and society. These organizations are small and find it difficult to grow because of precarious funding and are fearful they may lose out to other organizations ‘that are better funded, better marketed and more glossy.’

The use of professionals who have another main job but an interest in suicide

These professionals are paid to offer counselling or run groups. This enables organizations to get input from professionally qualified people, but sometimes means these professionals have less experience in working with those bereaved by suicide.

StandBy refers children who need a level of expertise beyond what they can offer to specialist child counsellors they have an ongoing working relationship with. They provide training around the impact of suicide for these counsellors. They provide similar training to those who provide supervision to staff.

Chris Bowden, lecturer at Victoria University of Wellington, helped Skylight develop their group programmes and supervises students who are doing Masters on the work of groups. He co facilitated the Waves adult grief education programme for many years and now conducts research on the programme and its impact. He is now researching similar programmes for children. He will also work with individual families if needed.

The Grief Centre in Auckland contracts self employed counsellors to work with bereaved adults and young people.

Offering qualified professionals internships

This is a model used by The Centre for Grief and Bereavement in Australia. Professionally qualified interns go through an accredited grief training which is run by the paid counselling team of the organization. It gives interns access to training and 80 hours of supervised individual work, and it gives the organization a stable, qualified workforce, especially as many of those trained stay on with the organization to work as volunteers.

Through the use of volunteers

This seemed to work well where volunteer numbers were small, well trained, well supervised and integrated into the team. e.g. Barnardos in Ireland.

It appeared to provide a poor experience for those receiving a service when there was an unmanageable number of volunteers who were not sufficiently trained, prepared or supported, or given appropriate work, e.g. Victim Support, where volunteers may attend the scene of death and families report poor experiences.

Setting up national Drop In Centres

This is a model used by Headspace designed to offer easy access for young people to local services. It is often run by a local lead agency that is familiar with the local area and resources.

Community Postvention Response Model

These are services specifically set up as a community response to a suicide and is their main aim and function. StandBy in Australia, the Regional Suicide Postvention Coordinators in New Zealand and the Mayo project in Ireland are all examples of this type of model.

Features of this model are:

  • a clear protocol for responding to a suicide
  • the coming together and coordinating of all responders to a suicide
  • the gathering and sharing of information in order to make a coordinated response
  • a coordinator to drive forward and coordinate the response to avoid duplication or confusion.
  • work with the local community to train and support those around the bereaved e.g. families, workplace, neighbours, community, school, local professionals
  • a standardised information pack for the bereaved
  • a clear structure that is replicable


Each organization that tries to address the needs of those bereaved by suicide has grown from different roots and has a different emphasis, and all are influenced by the level of funding they can attract. Some approach it from the angle of mental health, some are influenced by their geographical location, some have evolved into a specialised service from other more general services and some have developed an area of expertise within a specialization of working with children. The Community Postvention Response Models stand apart in being set up with the sole aim of providing postvention support, and drawing in all the different agencies and professions to provide maximum support at the grass root level. Because it has protocols and a coordinator it can respond immediately with an ever increasing knowledge and experience base. It has the capacity to provide training at different levels and support to those who respond, and because it is embedded in the community knowledge is hopefully disseminated and resilience is built up.

My Fellowship was primarily aimed at researching how children are supported within the models that have been developed in Australia, New Zealand and Ireland. Those who had most knowledge and experience of supporting children after a suicide were small specialist organizations undertaking direct work with children. Large national organizations felt they lacked the expertise to support children, although may have specialist counsellors or therapists who work with children to refer on to. Most interventions were aimed at adults, with the hope that it would percolate down to benefit any children in the family. More organized responses are available for schools after a death.

In New Zealand there is a worrying acknowledgement of lack of skills to support children, and lack of confidence to develop these skills. One centre said they wouldn’t know who to refer children to and that it is difficult to maintain standards as there is no solid base of training. In Ireland it appeared that better support is available for children after a suicide in organizations orientated towards children e.g. Family Centres and Barnados, where there are specialist children’s therapists. Family Centre therapists in Mayo who work in the same venue as the Suicide Liaison Officer (SLO) have agreed to prioritize suicide bereavement referrals, and the SLO is confident in their work.

As a result of my visits to a large number of different organizations I am now convinced that in developing services that support people after a suicide in the UK we need to work towards more interaction between adult and children’s services, so that the learning embedded in children’s bereavement services can be utilized by those supporting adults, to the benefit of the many children who may be part of those families but not receiving a service in their own right.

Liz Koole

Churchill Fellow 2015