When people reach out for support for suicidal thoughts or feelings, self-harm, suicide attempt(s) and/or bereavement by suicide, they should get the care they need – the first time they ask for it, and wherever that may be. They must also be treated as individuals – listened to and respected, their personal wishes and perspectives prioritised, and offered the lead in decisions about the care they receive.
WithYou, along with our partners at the Suicide Prevention Consortium (DDN, May 2024, page 16) believe these two principles of ‘no wrong door’ and ‘inclusive person-centred care’ are fundamental for ensuring effective, compassionate care for people experiencing suicidality. However, since forming the consortium in 2021, we’ve consistently heard about a critical and concerning gap between policy and practice.
Though the recent Suicide prevention strategy for England clearly calls for a ‘no wrong door’ approach, many people still encounter rigid eligibility criteria, services working in silos, and stigma. This prevents them from accessing the help they need, and disproportionately affects people with co-occurring needs, such as alcohol use and/or stigmatised diagnoses such as personality disorder. Too often mental health services exclude individuals with alcohol-related issues, while alcohol services are unwilling or feel unable to discuss mental health or suicidality. This siloed approach exacerbates risk factors and denies people holistic, person-centred care.
This month, the Suicide Prevention Consortium brought together learning from our previous projects and published our latest report, offering insights and practical actions to improve the implementation of these principles. The report, co-produced with people with lived experience, identifies four actions (all equally important) where sustained and significant effort is required from policy makers, commissioners and practitioners to make these principles a reality for people experiencing suicidality.
1. FOSTERING COLLABORATION
Collaboration – between services, staff and people receiving support – must be at the heart of service design and delivery. Services need to work in a joined-up way, collaborating with each other and the people they support. This includes improving technology and ensuring data can be shared securely, as well as involving people with lived experience in design, implementation and evaluation of services.
2. PRIORITISING INCLUSION
Services should take an inclusive, holistic approach, recognising individuality and the diverse ways people access support. A person’s identity, background or specific needs must not be a barrier to accessing high-quality care. Individuals should be empowered to make decisions and engage openly with healthcare professionals without fear of judgment. Accessible and culturally sensitive approaches are essential for building trust and ensuring meaningful support.
3. BUILDING CONFIDENCE
Staff awareness should be raised, and ongoing training provided, to boost confidence in delivering compassionate, patient-centred care. It’s also vital that good practice is recognised and celebrated – many practitioners are already delivering compassionate, inclusive care. The principles of ‘no wrong door’ and person-centred care should not, therefore, be presented as another new initiative.
4. WORKFORCE SUPPORT
It’s essential to prioritise the mental health and wellbeing of staff, so they can effectively support people affected by suicide. Staff need time and space to reflect on their experiences of supporting people experiencing suicidality, as well as support to manage the impact of providing care. These are crucial for creating supportive environments for staff and minimising the potential impact of compassion fatigue or vicarious trauma, which impact both on the wellbeing of staff and on their ability to provide optimal care.
While national guidance promotes these principles, lived experience and practitioner insights have repeatedly highlighted significant gaps in implementation, especially for people with co-occurring needs or those from marginalised communities. With a collective commitment from policymakers, practitioners and the wider community we can create a system where everyone who takes the brave step to ask for help receives it, and no-one is turned away. By acting together, we will save lives.
Report available here
Robin Pollard is head of policy and influencing at WithYou. The Suicide Prevention Consortium is led by Samaritans and includes WithYou, National Suicide Prevention Alliance (NSPA) and Support After Suicide Partnership (SASP)