Public involvement in suicide prevention: understanding and strengthening lay responses to distress

Lead Research Organisation: University of Exeter
Department Name: Unlisted

Abstract

Suicide prevention is everybody?s business. Previous research has concentrated heavily on the contribution that doctors and health professionals can make, due to the fact that those who take their own lives are usually suffering from a treatable mental disorder. Attention has also focused on government initiatives to make methods of suicide less accessible, for example by reducing the pack sizes of paracetamol and other commonly used drugs. These measures are helpful, but we also need to be looking at the contribution that ordinary people can make.

Relatives, friends and colleagues are usually the first to know when someone is deeply troubled or distressed. They may think it is ?perfectly normal in the circumstances? (after a relationship breakdown, for instance) and assume that the person will get over it in time. Most of us do eventually recover from setbacks, but some do not. Relatives and friends need to make judgements about the seriousness of the distress, about how to respond to it and about whether to seek professional help. These are difficult and complex decisions, and we know very little about how people make them and how they can be better equipped to do so.

By studying in detail the circumstances surrounding particular suicides and asking relatives and friends about the way in which they understood what was going on, we hope to illuminate this neglected area. We will study 30 cases of suicide, in each case interviewing 3-4 people in order to build up a balanced picture. We will interview the deceased?s doctor, as well as family and friends, to try to identify ways in which lay people and professionals can work together to support a suicidal individual.

We aim to discover: who was in contact with the deceased; how aware they were of his/her distress and how they interpreted it; what actions they took, and what additional knowledge, skills and support might have enabled them to manage the situation differently and possibly prevent a fatal outcome.

The findings will give us a better understanding of the role that families, friends and others can play in identifying and supporting suicidal individuals, and will enable us to develop initiatives to promote public mental health awareness.

The team consists of researchers at the Peninsula Medical School in Exeter and at the Universities of Bristol and Swansea, together with a representative of PAPYRUS (Prevention of Young Suicide).

Technical Summary

BACKGROUND: Suicide is a major public health issue. Around 5,000 people take their own lives in England every year, the majority being young, physically healthy adult males. To date, attention has focused heavily on the role of healthcare professionals in suicide prevention and on measures to restrict access to means. Little consideration has been given to the role that lay people can play by supporting distressed relatives and friends, or to the resources they need in order to do so.

AIMS: To understand the contribution that relatives, friends and other members of the public can make to suicide prevention; to identify the knowledge, skills and support they need in order to contribute effectively, and to inform the development of interventions to promote community-wide involvement in suicide prevention.

DESIGN: Qualitative study using multiple case study design and triangulation of evidence from several informants.

SETTING: SW England and S Wales.

METHOD: Thirty cases of suicide aged 18-34 will be investigated. Data will be gathered by means of semi-structured interviews with relatives, friends and others who knew the deceased well, including the general practitioner. For each case, 3-4 informants will be sought. Interviews will explore the family and social networks of the deceased, the ways in which relatives and friends interpreted and responded to his/her distress, the potential for intervention that may have existed within the lay network, and the knowledge and resources that would have helped members to support the distressed individual more effectively.

BENEFITS: The study will inform the development of a comprehensive approach to the prevention of suicide that recognises and capitalises on the efforts of lay people. Findings will form the basis for interventions to promote public involvement in suicide prevention.
 
Description Advisor on Connecting with People training
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Resulted in development of training for healthcare practitioners
 
Description Citation in new National Suicide Prevention Strategy for England (2012)
Geographic Reach National 
Policy Influence Type Citation in other policy documents
URL https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/430720/Preventing-Suicide-...
 
Description Consultation on preventing suicide in England: Development of new national suicide prevention strategy
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Development of Welsh National Suicide Prevention Strategy
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Development of mental health and wellbeing strand of public health strategic framework for Wales
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Improving care for people who are at risk of suicide: The Guildford Consensus
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact Led to consensus statement on limits of confidentiality in mental health care
 
Description Invited to help shape future strategy and priorities for Samaritans
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Local suicide prevention strategy
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
 
Description Overseeing implementation of Welsh National Suicide Prevention Strategy
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Requests to use findings in clinical training
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact Following presentation of findings at the IASP World Congress on Suicide Prevention in October 2009, I had a number requests for copies of slides and permission to use them in the training of mental health practitioners.
 
Description Scientific Advisor to Alliance of Suicide Prevention Charities
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Strategic Clinical Network
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
 
Description PhD studentship competition
Amount £60,156 (GBP)
Organisation National Institute for Health Research (NIHR) 
Department South West Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC)
Sector Academic/University
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 10/2011 
End 09/2014
 
Description Programme Grants for Applied Research
Amount £1,765,660 (GBP)
Funding ID PGfAR RP-PG-0610-10026 
Organisation University College London Hospitals Charity (UCLH) 
Department National Institute for Health Research (NIHR)
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 11/2013 
End 08/2021
 
Description Public Health Intervention Development Scheme
Amount £121,923 (GBP)
Funding ID MR/P01707X/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 05/2017 
End 04/2022
 
Description WAG/MRC Health Partnership Award
Amount £77,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 08/2011 
End 07/2012
 
Description n/a
Amount £5,000 (GBP)
Organisation National Health Service (England) 
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 06/2012 
End 05/2013
 
Description n/a
Amount £7,500 (GBP)
Organisation The Horne Family Foundation 
Sector Charity/Non Profit
Country United States of America
Start 09/2014 
End 05/2015
 
Description n/a
Amount £7,500 (GBP)
Organisation James Wentworth-Stanley Memorial Fund 
Sector Charity/Non Profit
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 09/2014 
End 05/2015
 
Description n/a
Amount £10,000 (GBP)
Organisation Devon County Council 
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start  
 
Title Model of public involvement in suicide prevention 
Description We have developed a robust model of the conditions necessary for public involvement in suicide prevention, and of the barriers to awareness and intervention within the lay context. This understanding will be used to inform the development of new public health messages. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2009 
Provided To Others? Yes  
Impact Papers delivered to World Congress on Suicide Prevention, October 2009, and to European Symposium on Suicide and Suicidal Behaviour, September 2010. Papers in preparation. Public health education materials to be developed for future testing. 
 
Title Narrative data on the suicidal process from lay point of view 
Description A large body of rich narrative data, providing new insight into the suicidal process from the lay point of view, and from multiple perspectives. 
Type Of Material Database/Collection of Data/Biological Samples 
Provided To Others? No  
Impact A number of papers are currently in preparation. Findings will inform development of new public health messages. 
 
Title Qualitative psychological autopsy method 
Description We have pioneered a new way of conducting psychological autopsy interviews, using qualitative in-depth interviewing techniques. 
Type Of Material Data analysis technique 
Year Produced 2008 
Provided To Others? Yes  
Impact A number of other research groups are either using our methods or are interested in doing so. We organised an international symposium in Rome in 2010 to bring these groups together to discuss the challenges and opportunities presented by this method of data collection. 
 
Title Social network mapping and analysis 
Description We have developed new techniques for mapping and analysing the social networks of deceased persons. In the case of suicide, these provide insight into the opportunities for intervention that exist outside of clinical settings. 
Type Of Material Data analysis technique 
Provided To Others? No  
Impact Papers in preparation. 
 
Description Grassroots 
Organisation Grassroots Suicide Prevention
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution Our partners came up with an idea for a project and invited us to work with them on a bid. We are contributing methodological expertise and subject-specific knowledge. We are helping to plan an evaluation of the project, and helping with writing the bid.
Collaborator Contribution Suggested an idea for a project and invited us to work with them on a bid.
Impact none yet; bid in preparation
Start Year 2013
 
Description Norwegian PhD study 
Organisation Norwegian University of Science and Technology
Country Norway, Kingdom of 
Sector Academic/University 
PI Contribution Input into research proposal; agreement to host PhD student in the UK for part of the study
Impact Funding from Research Council of Norway for PhD studentship. The collaboration is multi-disciplinary, involving public health, health services research and sociology.
Start Year 2008
 
Description Norwegian PhD study 
Organisation University of Oslo
Department Norwegian Institute of Public Health
Country Norway, Kingdom of 
Sector Academic/University 
PI Contribution Input into research proposal; agreement to host PhD student in the UK for part of the study
Impact Funding from Research Council of Norway for PhD studentship. The collaboration is multi-disciplinary, involving public health, health services research and sociology.
Start Year 2008
 
Description Qualitative approaches in suicide research: international methodology group 
Organisation Medical Sciences Division
Department Department of Psychiatry
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Multiple 
PI Contribution Initiation and co-ordination of group; provision of support for and methodological advice to early career researchers.
Collaborator Contribution Sharing of methodological knowledge Sharing of methodological knowledge
Impact International symposium held in September 2010: 'Qualitative approaches in suicide research: ethical and methodological challenges' The collaboration is multi-disciplinary, involving (primarily) public health, sociology and health services research.
Start Year 2009
 
Description Qualitative approaches in suicide research: international methodology group 
Organisation Norwegian University of Science and Technology
Country Norway, Kingdom of 
Sector Academic/University 
PI Contribution Initiation and co-ordination of group; provision of support for and methodological advice to early career researchers.
Collaborator Contribution Sharing of methodological knowledge Sharing of methodological knowledge
Impact International symposium held in September 2010: 'Qualitative approaches in suicide research: ethical and methodological challenges' The collaboration is multi-disciplinary, involving (primarily) public health, sociology and health services research.
Start Year 2009
 
Description Qualitative approaches in suicide research: international methodology group 
Organisation SANE (Mental Health Charity)
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution Initiation and co-ordination of group; provision of support for and methodological advice to early career researchers.
Collaborator Contribution Sharing of methodological knowledge Sharing of methodological knowledge
Impact International symposium held in September 2010: 'Qualitative approaches in suicide research: ethical and methodological challenges' The collaboration is multi-disciplinary, involving (primarily) public health, sociology and health services research.
Start Year 2009
 
Description Qualitative approaches in suicide research: international methodology group 
Organisation St Vincent's Hospital
Department St Vincent's Hospital and University College
Country Ireland, Republic of 
Sector Academic/University 
PI Contribution Initiation and co-ordination of group; provision of support for and methodological advice to early career researchers.
Collaborator Contribution Sharing of methodological knowledge Sharing of methodological knowledge
Impact International symposium held in September 2010: 'Qualitative approaches in suicide research: ethical and methodological challenges' The collaboration is multi-disciplinary, involving (primarily) public health, sociology and health services research.
Start Year 2009
 
Description Qualitative approaches in suicide research: international methodology group 
Organisation University of Bristol
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Academic/University 
PI Contribution Initiation and co-ordination of group; provision of support for and methodological advice to early career researchers.
Collaborator Contribution Sharing of methodological knowledge Sharing of methodological knowledge
Impact International symposium held in September 2010: 'Qualitative approaches in suicide research: ethical and methodological challenges' The collaboration is multi-disciplinary, involving (primarily) public health, sociology and health services research.
Start Year 2009
 
Description Qualitative approaches in suicide research: international methodology group 
Organisation University of Oslo
Department Norwegian Institute of Public Health
Country Norway, Kingdom of 
Sector Academic/University 
PI Contribution Initiation and co-ordination of group; provision of support for and methodological advice to early career researchers.
Collaborator Contribution Sharing of methodological knowledge Sharing of methodological knowledge
Impact International symposium held in September 2010: 'Qualitative approaches in suicide research: ethical and methodological challenges' The collaboration is multi-disciplinary, involving (primarily) public health, sociology and health services research.
Start Year 2009
 
Description SANE: Big Lottery funded project 
Organisation SANE (Mental Health Charity)
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution Methodological advice and input into grant-writing. Advice on application to NHS Ethics Committee. Attending advisory group meetings, commenting on findings and advising on analytic methods. Have subsequently sub-contracted a University of Exeter Research Fellow to work with SANE on this project.
Collaborator Contribution Led the research.
Impact Funding from Big Lottery for project led by SANE: 'A new focus for suicide prevention:Harnessing personal experience,' using the methodology developed in our MRC-funded project. Subcontract to University of Exeter One publication so far, PMID:22965934 At least three more in preparation. Presentations at major national and international conferences.
Start Year 2009
 
Description St Vincent's, Dublin 
Organisation St Vincent's Healthcare Group Limited
Department Department of Psychiatry And Mental Health Research
Country Ireland, Republic of 
Sector Academic/University 
PI Contribution Provided advice on major national psychological autopsy study. Provided specific guidance on qualitative methods to PhD student.
Collaborator Contribution Initiated and led the study.
Impact PhD awarded. 3 co-authored publications nearing submission from the PhD study.
Start Year 2009
 
Description St Vincent's, Dublin 
Organisation University College Dublin (UCD)
Department Department of Adult Psychiatry
Country Ireland, Republic of 
Sector Academic/University 
PI Contribution Provided advice on major national psychological autopsy study. Provided specific guidance on qualitative methods to PhD student.
Collaborator Contribution Initiated and led the study.
Impact PhD awarded. 3 co-authored publications nearing submission from the PhD study.
Start Year 2009
 
Description TASC 
Organisation The Alliance of Suicide Prevention Charities
Country Global 
Sector Charity/Non Profit 
PI Contribution Acting as scientific advisor to TASC.
Collaborator Contribution Issued invitation
Impact A number of pilot projects being planned and bids in preparation.
Start Year 2012
 
Description Tavistock and Portman 
Organisation Tavistock and Portman NHS Foundation Trust
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Public 
PI Contribution Invited to co-supervise a PhD student.
Collaborator Contribution Initiated the project and issued the invitation.
Impact The study is still in progress.
Start Year 2011
 
Description Tavistock and Portman 
Organisation University of East London
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Academic/University 
PI Contribution Invited to co-supervise a PhD student.
Collaborator Contribution Initiated the project and issued the invitation.
Impact The study is still in progress.
Start Year 2011
 
Description Widening Participation project 
Organisation Campaign Against Living Miserably (CALM)
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution We were selected through a competitive process to work with this group of charities to develop an innovative idea. We have supplied subject-specific research knowledge, methodological expertise and scientific rigour. We have radically developed and refined the original idea. We are also leading the bid writing process.
Collaborator Contribution Came up with an idea for an innovative project. Invited academic research groups to compete to work with them to develop the idea. We were selected. We are currently working on a collaborative bid that will involve matched funding from the charities and a UK research council.
Impact None yet. We are working on a bid for a Knowledge Exchange grant.
Start Year 2012
 
Description Widening Participation project 
Organisation James Wentworth-Stanley Memorial Fund
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution We were selected through a competitive process to work with this group of charities to develop an innovative idea. We have supplied subject-specific research knowledge, methodological expertise and scientific rigour. We have radically developed and refined the original idea. We are also leading the bid writing process.
Collaborator Contribution Came up with an idea for an innovative project. Invited academic research groups to compete to work with them to develop the idea. We were selected. We are currently working on a collaborative bid that will involve matched funding from the charities and a UK research council.
Impact None yet. We are working on a bid for a Knowledge Exchange grant.
Start Year 2012
 
Description Widening Participation project 
Organisation Matthew Elvidge Trust (TMET)
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution We were selected through a competitive process to work with this group of charities to develop an innovative idea. We have supplied subject-specific research knowledge, methodological expertise and scientific rigour. We have radically developed and refined the original idea. We are also leading the bid writing process.
Collaborator Contribution Came up with an idea for an innovative project. Invited academic research groups to compete to work with them to develop the idea. We were selected. We are currently working on a collaborative bid that will involve matched funding from the charities and a UK research council.
Impact None yet. We are working on a bid for a Knowledge Exchange grant.
Start Year 2012
 
Description ASIST (Applied Suicide Intervention Skills Training) trainers' meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Gave talk to ASIST trainers from across South West England

not yet known
Year(s) Of Engagement Activity 2011
 
Description BBC Radio Devon 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact Interview on breakfast-time radio, alongside PAPYRUS (Prevention of Young Suicide)

none as yet
Year(s) Of Engagement Activity 2011
 
Description Keynote speaker, SOBS national conference 2012 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Gave a talk at Survivors of Bereavement by Suicide, Annual Support Day, Birmingham 2012, to a large national audience of bereaved families/friends etc. The talk was entitled Warning Signs for Suicide: Myth or Reality? It sparked a long and animated question/discussion session and further discussion throughout the day.

Repeat invitation.
Year(s) Of Engagement Activity 2012
 
Description Marie Claire article 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Collaborated with national suicide prevention charity, CALM, in the writing of an article for Marie Claire magazine, to raise public awareness and break the taboo surrounding suicide.

not known
Year(s) Of Engagement Activity 2013
 
Description PAPYRUS (Prevention of Young Suicide) - conf reports and articles 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Primary Audience Participants in your research and patient groups
Results and Impact Wrote article for newsletter. Team member attended annual conference and gave oral report.

Several people contacted us to say that they would like to take part in the study.
Year(s) Of Engagement Activity 2007,2008,2009,2010,2011
 
Description PCMD Research Review 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact Interviewed for feature article in brochure to celebrate first five years of Peninsula Medical School. Widely disseminated to lay audiences.

None known
Year(s) Of Engagement Activity 2007
 
Description SANE WSP day 2013 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Delivered keynote presentation at conference organised by SANE (Mental Health Charity) to mark World Suicide Prevention Day 2013.

not yet known
Year(s) Of Engagement Activity 2013
 
Description SOBS Keynote 2013 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact Gave keynote presentation to national audience of people who have been bereaved by suicide, followed by questions and discussion.

Resulted in recruitment of lay members to online stakeholder panel, to advise on implementation of findings.
Resulted in request to write a short book for those who have been bereaved by suicide, for use within the organisation.
Year(s) Of Engagement Activity 2013
 
Description Somerset Suicide Prevention Workshop 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Primary Audience Health professionals
Results and Impact Gave talk to audience of health professionals and commissioners

Invited to contribute to training of Mental Health First Aid (MHFA) trainers
Year(s) Of Engagement Activity 2010
 
Description Survivors of Bereavement by Suicide 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact Invited presentation at regional conference, followed by questions and discussion


Invited to give keynote presentation at 2012 national conference.
Year(s) Of Engagement Activity 2011
 
Description Survivors of Bereavement by Suicide 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact Gave keynote presentation to national audience of people who have been bereaved by suicide, followed by questions and discussion.

Invitation to speak again the following year.
Year(s) Of Engagement Activity 2012
 
Description Survivors of Bereavement by Suicide (SoBS) - confs and newsletters 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Primary Audience Participants in your research and patient groups
Results and Impact Attended meetings of SoBS (Survivors of Bereavement by Suicide) groups in both Devon and South Wales.
Attended national conference. Wrote articles for newsletters.


Ongoing close links with SoBS. Members of SoBS regularly ask for help with searching scientific literature and with identifying and obtaining copies of relevant studies, and for advice on specific aspects of suicide prevention.
Year(s) Of Engagement Activity 2007,2008,2009
 
Description TASC meeting - PEPS evaluation report 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact Talk given to The Alliance of Suicide Prevention Charities re evaluation of public education materials. sparked questions and lively debate. made plans for further collaborative activity.
Year(s) Of Engagement Activity 2015
 
Description Training to Peninsula Public Health Network 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Gave talk/training session to public health practitioners; lively discussion afterwards; lots of contacts and interest expressed in future work.
Year(s) Of Engagement Activity 2016