th november 2015) concerns and considerations...views (electronically or by post) by november 19th....

Lifeline Public Consultation

(27th August – 19th November 2015)

Concerns and Considerations

Lifeline Public Consultation 2015: Concerns & Considerations

The following Contact NI paper provides an analysis of concerns and considerations

for the future service design of the NI Lifeline crisis helpline and follow-on support

services arising from the Public Health Agency (PHA) outline business model

currently out for consultation.

We encourage you to assess this brief analysis from the current Lifeline provider,

alongside the papers from PHA, which are available (attached) & here

(www.publichealth.hscni.net/consultation-future-lifeline-crisis-intervention-

service).

We also encourage your engagement in the public consultation returning your

views (electronically or by post) by November 19th.

PHA Strategic Outline Business Case - Proposed Model

The key features of the proposed model include:

1. The Lifeline service ethos will embed a recovery model approach with a focus on

‘enablement and empowerment’, providing an ‘active listening and signposting’

service, whereas the current model offers crisis counselling, advocacy and

referral to follow-on support.

2. Only callers at ‘immediate risk of suicide, self-harm or homicide/suicide’ will be

eligible for, and signposted to Lifeline follow-on psychological therapy with a

‘unique reference number’.

3. Separation of the Helpline provider from Lifeline follow-on crisis support

services.

4. The Helpline will be commissioned from the NI Ambulance Service.

5. The Helpline will be staffed by call operators without professional counselling

qualifications.

6. Follow-on support services will be procured through five Trust-wide

commissioning bodies, as opposed to a single regional provider.

http://www.publichealth.hscni.net/consultation-future-lifeline-crisis-intervention-service



P a g e | 3 Business Case (BC); Public Consultation Questionnaire (PCQ); Equality Impact Assessment (EIA)

Concerns & Considerations

1. Separating the Lifeline Helpline from Lifeline follow-on support services will

result in a fragmented care pathway, leading to gaps in critical information-

sharing at crisis point, and undermining safe ‘warm handover’ for the caller to

follow-on psychological therapy.

2. The proposal to separate the Lifeline Helpline from Lifeline follow-on support

services is at variance with learning from nine years of Lifeline Serious Adverse

Incident (SAI) Reviews, following more than 150 client deaths by suicide. Lifeline

SAI review reports highlight the need for crisis point continuity of care,

communication and collaboration between service users, their family/loved

ones and service providers. The proposed fragmentation of the service risks

undermining Lifeline’s core purpose to help reduce the number of NI suicide

deaths.

3. While ‘enablement and empowerment’ are valued recovery principles, the

proposed focus on ‘advice and signposting’ as a means to foster independence

for people suffering suicidal crisis is misplaced, and will decrease the likelihood

of caller engagement with support services. The current Lifeline model of

outreach, bridging and linking between callers, their identified loved ones and

service providers (statutory/non-statutory), has a proven track record of safely

navigating the transition from the first crisis call, triage and clinical risk

assessment to warm handover to appropriate support services.

4. Restricting Lifeline psychological therapies to people at ‘immediate risk of

suicide, self-harm or homicide/suicide’ raises concern that people assessed as

suffering low to moderate risk will not receive timely service provision. The UK

and international suicide prevention evidence base demonstrates that

immediate risk alone is insufficient as an indicator of suicide potential and

should not be used as a tool to exclude people from follow-on support.

5. The proposal to commission the crisis helpline from within statutory healthcare

(NI Ambulance Service) will dilute the current independent, non-statutory

Lifeline public profile, reducing choice and undermining the independent,

confidential and non-stigmatising ethos of the Lifeline service for people in

crisis.


6. The proposed model and staffing arrangements risks downgrading the crisis

helpline from a professional counselling, advocacy and referral service for

people in distress and despair, to a crisis listening and signposting service for

people at immediate risk of self-harm and suicide.

7. The proposed care pathways for children and young people risk setting up a

signposting ‘revolving door’ at the GP and Child and Adolescent Mental Health

Services (CAMHS) interface, for those who do not meet CAMHS or Social

Services threshold criteria, leading to problem entrenchment.

8. The proposed dispersal of Lifeline follow-on psychological therapies from a

single regional provider to [a minimum of] five locality-based providers

undermines service quality consistency and limits the potential for research and

service evaluation validity.

Lifeline is a unique service which has evolved since its pilot inception for N&W

Belfast (2006), benchmarked against leading international crisis lines. The current

service model, available to the entire NI population, has developed working

practices and protocols from nine years of crisis service innovation and learning

from NI Serious Adverse Incident Reviews and national and international research.

The proposal to commission the Lifeline Helpline from the NI Ambulance Service

and alter the current Lifeline service ethos, design and practice principles risks

losing that valuable learning in favour of a new and untested model. While

innovation is always required in suicide prevention service development, the

current Lifeline model should not be altered without a clear evidence base,

detailed service design and full consultation with all key stakeholder groups. These

features are, we respectfully submit, not sufficiently present in the Lifeline public

consultation process.

We encourage your careful reflection on this paper and request your completion

and return of the public consultation questionnaire by 19th November.

Fergus Cumiskey Telephone 028 90 744499 Mobile - 07977 463094

Managing Director Contact www.contactni.com

HQ and Therapy Centre, First Floor, Lanyon Building, North Derby Street, Belfast, BT15 3 HL

http://www.contactni.com/


Lifeline Public Consultation 2015: Telephone Crisis Helpline

Telephone Crisis

Helpline

Proposed Model Current Model/Contract Concerns/considerations

Core purpose /rationale

• ‘Focus on providing immediate crisis intervention’ (p11 PCQ)

• ‘For those at immediate risk of suicide, self-harm or homicide/suicide’ (p48 BC)

• When Lifeline became a regional service in 2008, it was branded as a crisis helpline for all people experiencing distress & despair with a focus on early intervention at crisis onset, providing services to tiers 1-3, low, moderate and high risk

• Over the last 18 months of the current contract, due to the high number of calls & referrals, demand management strategies resulted in re-profiling towards moderate to high risk presentations, gradually narrowing early crisis provision.

• The proposed model further narrows the Lifeline profile.

• The pronounced focus and increased emphasis on crisis acuity (‘ for those at immediate risk of suicide and self-harm’) will exclude the importance of support service provision for low to moderate risk of suicide and self-harm, the population where most suicides occur (Kapur 2005; Beautrais 2013).

Service Delivery Model

• 24/7 ‘person centred active listening’ service (p11 PCQ)

• Staffed by ‘call operators/handlers’ (unspecified relevant qualifications, experience & training - no professional qualifications required p98 BC)

• 24/7 professional crisis counselling helpline

• Staffed by professionally qualified and accredited crisis counsellors

• Best practice suggests direct crisis line provision by qualified professionals including counsellors, social workers, mental health professionals with visiting time-bound clinical placement facility for all health & social care professionals.

• The interpersonal skills of mental health professionals are noted as very important in engaging young men (Jordan et al, 2012)

Service Provider

• Lifeline branded NHS identity (governed by NI Ambulance Service)

• Statutory (NHS commissioned) • Regional telephony capacity & expertise;

national backup (Scotland)

• Lifeline branded identity Independent 3rd sector (PHA Governed)

• NGO (procured by competitive tender) • Regional telephony capacity & expertise;

L/Derry & Belfast backup

• A non-statutory independent service option is more accessible for hard-to-reach populations & for those reluctant to engage or who feel alienated from conventional statutory mental health care


Telephone Crisis

Helpline


– high risk populations (WHO Report 2014).

The proposal to commission from within statutory healthcare is at variance with the ‘widening access’ recommendation from NI research with suicidal young men (Jordan et al, 2012), reducing choice & undermining the independent, confidential and non-stigmatising ethos of the Lifeline service.

• Lifeline national UK based backup service does not exist – disaster recovery for NI centralised NIAS model much more prone to service failure than the Derry / Belfast alternate site current model provision.

• Procurement is more likely to promote innovation & multi-sector partnership.

Service Ethos

• ‘enablement & empowerment’ to ‘avoid fostering dependency’

• Emphasis on signposting - not referral • ‘Helpline will enable and empower

service users to access services they require through signposting rather than acting as intermediary’ (p48 BC)

• ‘provision of signposting information for those not at immediate risk to empower and enable them to take control of their own actions’ (p45 BC)

• Less than 5% of callers to receive ‘enhanced signposting’ (p48 BC)

• ‘No wrong door’ philosophy • Outreach and navigation to correct

service & warm handover – bridging & linking between people, carers & services

• Follow up imperative with callers assessed at risk of suicide &/or self-harm (inclusive of low, moderate, high risk)

• Continuity of care at crisis point via critical information sharing Memoranda of Understanding, GPs, HSC Trusts & Emergency services

• Promoting safety in partnership (caller, loved ones & professionals)

• Crisis lines play an important role linking at-risk callers to mental health care – evidence that 50% would not utilise referral information without follow up to ensure warm handover to service uptake (Gould et al 2012).

• Over-emphasis on empowerment at crisis point – a high risk of caller not reaching signposted service, heightening isolation & revolving door polarities, noted risk factors for suicide (Joiner, 2005).

• Proposed model privileges autonomy & independence over safety in partnership.


Telephone Crisis

Helpline


Clinical Practice

• Immediate clinical assessment, de-escalation, clinical judgement to determine appropriate follow on care

• Direct referral to emergency services (where necessary)

• ‘All clients not at immediate risk of suicide, self-harm or homicide/suicide to be provided with advice and signposted to other appropriate services’ (p45 BC) including health & wellbeing services / GP and other relevant voluntary, community and statutory services

• ‘Enhanced signposting’ and ‘robust handover to follow on service’ for callers requiring additional support (less than 5% of callers) (p48 BC)

• No post-initial call follow up for signposted callers (˂5% enhanced signposting)

• ‘No check-ins or outreach service’ (p99 BC)

• Only those at ‘immediate risk of suicide & self-harm’ given ‘unique reference number’ to present to Lifeline locality-based psychological therapy provider

• Immediate clinical assessment, de-escalation, stabilisation & helpline follow up

• Direct referral to emergency services (where necessary)

• Navigation to correct service & warm handover for callers assessed at risk of suicide and/or self-harm (inclusive of low, moderate, high risk)

• Check-in calls for high risk presentations until caller safely engaged with appropriate service – also accessible to manage relapse

• Engagement with key Safety Contact (self- identified loved one/safe adult) breaking isolation & supporting natural resources – safety in partnership, close to home

• GP liaison/update on risk presentation • Engagement with relevant current service

providers to ensure critical information sharing at crisis point

• Seamless referral to Lifeline wraparound crisis support within days (where assessed as appropriate)

• Critical gaps in communication & collaboration apparent with proposed model, focus on signposting with very limited option for helpline follow-up: no reference to Safety Contact engagement; no reference to engagement with other relevant professionals (bar GP) for those not receiving enhanced signposting (˂5%).

• The absence of follow up is at variance with the NI research recommendation to ‘bolster proactive outreach’ to suicidal young men (Jordan et al, 2012).

• UK National Inquiry into Suicide & Homicide (2013) reported that 14% of NI deaths by suicide could have been prevented by closer contact between staff and the patient’s family.

• The proposed model refers ambiguously to the call categories which will be eligible for ‘enhanced signposting’ (clearly stipulated to be less than 5% of all callers). For example: ‘Enhanced signposting predominantly directed toward people with sensory impairment, English not first language & learning disability’ (p48 BC); ‘Facility whereby in exceptional circumstances vulnerable clients may be connected with appropriate service’ (p45 BC); All


Telephone Crisis

Helpline


low/high/immediate risk children and young people calling will receive enhanced signposting (p38 PCQ).

• No reference to key suicide risk factors of isolation, perceived burdensomeness, thwarted belongingness, acquired capacity, entrapment & impulsivity (Joiner 2005; O’Connor, 2011; Klonsky,2013).

• No inclusion of check-in calls despite overwhelming support (95%) in PHA Lifeline public consultation 2014.

Bench-marking

• Benchmarked against part-time NHS commissioned listening ear service (Breathing Space, Scotland) staffed by health and social care professionals

• Breathing Space is a ‘free confidential phone service for anyone in Scotland experiencing low mood, depression or anxiety’

• Benchmarked against international 24/7 crisis line best practice (NSPL Lifeline USA & IASP Quality Standards)

• Continuous improvement informed by applied learning from Lifeline serious adverse incident reviews (n=150), international research & evidence based/evidence informed best practice

• Proposed model is benchmarked against a single part-time service targeting low mood, anxiety & depression – not benchmarked against crisis intervention helpline service specifically targeting reduced incidence of suicide & self-harm.

• Proposed model at variance with international best practice consensus on outreach, care continuity & critical information sharing at crisis point as key requirements for effective suicide prevention strategies (NICE Guidelines / Knesper 2011 / Gould et al 2012 / Jordan et al 2012/ Beautrais 2014)


Lifeline Public Consultation 2015: Follow on Support Services

Follow-on support services


Psychological Therapy: Service design

Separation of care at crisis point • Telephone crisis active listening

service separated from locality based psychological therapy

• Separate client information systems – for helpline and locality-based counselling

Continuity of care at crisis point • Telephone crisis counselling integrated with

wraparound support (continuity of care at crisis point – warm handover guaranteed)

• Critical information sharing at crisis point • Integrated information management system

across both helpline and community wraparound

• Real-time client risk management information accessible to client and clinician

• Gaps in care continuity - proposed model separates follow on support services from telephone crisis helpline. Risk of service disintegration / confusion & clinical risk management inconsistency.

• Lost opportunities for critical information sharing at crisis-point, resulting in diminished risk management – model design fault set up for inadvertently heightened risk of client suicide.

Psychological Therapy: Service provider(s)

Multiple locality based providers • At least 5 Local Commissioning

Group/Trust areas • Locality based provider must be able

to offer psychological therapy, complementary therapy and face-to-face de-escalation service

Single regional provider • regional wraparound service provided in

local communities by single provider • Integrated regional care model – consistent

governance, evaluation & professional clinical training

• Proposed model of multiple providers risks follow-on support service fragmentation & quality standard inconsistency

• limits the potential for research and service evaluation validity

Psychological Therapy: Service ethos

Signposting, promoting enablement & empowerment - independence • Services will enable and empower

service users and avoid fostering dependency (p13 PCQ)

• Caller to make their own way to locality-based provider with ‘unique

Referral, providing systematic outreach & engagement – safety in partnership, interdependence • Assertive outreach from allocated

community based (or telephone) crisis counsellor to engage caller for 1st appointment

• Crisis lines play an important role in linking at-risk callers to mental health care – evidence that 50% do not utilise signposting / referral information without follow up calls to ensure warm handover (Gould et al., 2012).




reference number’ • Providers made aware of unique

client reference number (˂5% callers receive enhanced signposting)

• No clear indication of caller engagement target requirements

• Caller provided with community-based crisis counselling within 5,7 or 10 days, depending on suicide risk (low, moderate, high)

• 90% attendance rate required by Key Performance Indicator – 85% regularly achieved by current contract

• Proposed model privileges autonomy & independence over client safety in partnership

• Emphasis on enablement & empowerment too early at crisis point – increased risk of client disengagement, elevated isolation / risk of perceived rejection

• Risk of caller not reaching signposted service, elevating suicide risk, isolation & burdensomeness (Joiner, 2005).

• NICE Guidance CG33 ‘outreach should include following up the service user actively when appointment has been missed to ensure the service user is not lost from the service’

Psychological Therapy: Referral criteria

• ‘reserved for those at immediate risk of suicide & self-harm and who following assessment are deemed likely to benefit from psychological therapy’ (p13 PCQ)

• ‘Normally for adults aged 18 and over’ (p13 PCQ)

• Some ‘low risk’ ‘suitably mature’ children/young people

• Service not offered to clients currently in receipt of therapy (statutory/voluntary/community) or

• For callers assessed at risk of suicide and self-harm (inclusive of low, medium & high risk) and assessed as deemed likely to benefit from brief solution focussed psychological therapy intervention

• For the entire NI population • Not currently in receipt of other services

(statutory/voluntary/community) or on waiting list

• Current model has evolved over the course of the current contract (2012-15) effectively re-profiling to correct demand-management

• The focus on immediate risk of suicide and self-harm acuity in the proposed model risks the exclusion of psychological therapy provision for low to moderate risk presentations, the population where most suicides occur (Kapur 2015; Beautrais 2013)

• NICE Guidance G16 ‘standardised risk assessment scales should not be used as a means of identifying service users at supposedly low risk




on waiting list for such services challenges, within budget who are not then offered services’

Psychological Therapy: Service provision

Locality-based psychological therapy • Assessment & average of 5 sessions

of evidence based & evidence informed counselling/therapy (CORE clinical outcome measures unspecified)

• Indicative rise in annual provision rates from 25,000 to 35,000 counselling sessions, despite narrowing of psychological therapy eligibility criteria from low/moderate risk to immediate risk of suicide or self-harm

Community-based wraparound support • individual brief solution focussed counselling

(telephone & face to face); creative arts therapy; family assessment & support interventions for children and young people

• Telephone assessment & up to 6 sessions of evidence based & evidence informed counselling/psychotherapy (every session COREnet evaluated)

• Liaison with GP in circumstances of risk escalation

• GP update on follow up support outcomes for every client

• Proposed model is unclear about type of psychological therapy to be offered and how clinical outcome measures will be analysed

Complementary therapy

• Up to 2 sessions to support individual to deal with current state of distress & anxiety and enable to commence psychological therapy

• Complementary therapy was excluded from the current Lifeline contract by PHA, pre- procurement (2012-15) on grounds of absent evidence base

• While welcome, this inclusion is at variance with the proposed model core focus on those at immediate risk of suicide and self-harm, as there is no current evidence base for complementary therapy effectiveness in relation to suicide and self-harm.

Face-to-face de-escalation service

• For those at immediate risk who are not able to call helpline (estimated at ˂5%)

• Provider can refer to NI Ambulance Service or Trust based crisis response team

• Provider can call helpline on behalf of individual

• Not included in current contract • Although a welcome experiment, the PHA public consultation outline business case for Lifeline is unclear about how this service will operate effectively and safely.


Lifeline Public Consultation 2015: Children & Young People

Children & Young People


Telephone helpline protocols

• Care pathway included for children & young person caller (no pathway when call made by parent or concerned other p38 PCQ)

• No telephone helpline engagement protocols with parents/safe adults noted in Lifeline public consultation literature

• ‘The helpline is available to all ages and the call handlers should be competent and capable of handling calls from children and young people and providing appropriate responses that enable active engagement and access to additional help and support’ (p32 EIA)

• Lifeline emerged from the piloted suicide prevention helpline in N&W Belfast in 2006 which targeted young people aged 11-25 years. Over the intervening years, the current provider has developed robust mechanisms and expertise in screening all child/young person calls to ensure effective services to benefit children and young people who are at current risk of suicide and self-harm.

• Crisis line engagement with child, young person & key safe adult (usually parent/primary care giver) to risk assess, de-escalate and undertake comprehensive assessment of need

• Engagement with current service providers (statutory, voluntary & community) with regard to risk presentation i.e. information sharing at crisis point

• Follow up by specific Lifeline Child & Young Person Referral Coordination Team

• 24/7 senior consultation facility re. child/young person cases available for all staff (telephone and community counselling)

• GP liaison/update re. any risk presentation

• Majority of initial calls to current service relating to children and young people come from parents/significant others, often GP directed. Proposed model suggests concerned parents/caregivers will be signposted back to GP creating revolving door, and problem entrenchment, unless requiring emergency services or referral to Social Services (Gateway Team)

• Careful engagement with caregivers at crisis point is known to lead to improved risk assessment, increasing immediate safety for the identified child/young person, enhancing opportunities for long term wellbeing for the child & family (Carr, 2014)

• NICE Guidance CG16 notes that 'all children and young people who have self-harmed should be assessed by healthcare practitioners experienced in the assessment of children and adolescents who self-harm’. No specialist child & young person expertise noted in the PHA outline business plan or Lifeline public consultation papers.




Care pathways

• ‘minimal’ risk child or young person caller offered self-directed signposting to health and wellbeing services

• ‘low’ risk child/young person offered ‘enhanced signposting’ to other services, including Lifeline support services

• ‘high’ risk child/young person referred to existing specialist services – Gateway (Family & Child Care) and/or GP for determination re. statutory referral to Child & Adolescent Mental Health Service (CAMHS)

• ‘immediate’ risk child/young person callers referred to emergency services

• All assessments will entail follow up with GP services (p38 PCQ & p49 BC)

• Recommendations and actions are determined in accordance with the child & family’s unique circumstances and presenting issues

• Non-urgent/longer term needs: Child/young person & safe adult assessed as not in need of urgent crisis support or not suitable for short-term intervention, are supported by Lifeline signposting and/or referral to the appropriate community based or HSC support service. Support for child/young person and safe adult to engage with GP & other service – follow up to ensure safe handover for at-risk presentation.

• Helpline only: Child/young person presenting to Lifeline in crisis but ineligible for Lifeline wraparound counselling support, due for instance, to already existing service provision, will still be able to access Lifeline crisis-line support, including Lifeline risk assessment, de-escalation and containment check-in calls where appropriate. All Lifeline telephone support discussed and agreed with existing service providers.

• No service duplication: Child/young person and families already receiving support are encouraged / supported to engage with existing service options.

• Emergency care: Child/ young person

• Strongly agree that all Lifeline services for children and young people must ‘develop a partnership approach with existing statutory, voluntary and community services who provide the specialised services required’ (p64 EIA)

• Concern that a significant percentage of children, young people & their families who currently receive support via Lifeline (telephone & face to face) will be signposted back to GP / will not meet CAMHS or Social Services intervention thresholds, leading to problem entrenchment / isolation and burdensomeness / revolving door.

• There is no categorisation of ‘moderate’ risk within the PHA Lifeline outline business case for children/young people, only minimal, low, high and immediate.




presenting to Lifeline at imminent risk of life-threatening emergency will be referred to emergency services

• Safeguarding: Lifeline identification of child protection concerns trigger Contact Safeguarding disclosure in compliance with statutory obligations.

• GP updated/liaison on all risk presentations

Referral criteria for Lifeline psychological therapy

• Although primarily for adults aged 18 years and over (p13 PCQ), some ‘low risk, suitably mature’ child/young person callers will receive unique reference number and enhanced signposting to locality-based provider (p49 BC)

• ‘Helpline will be accessible to ALL people in NI irrespective of geography & age’ (p49 BC)

• Children & young people assessed by the Lifeline Child & Young Person Referral Team at urgent need of crisis support and would benefit from short term intervention are offered priority face to face assessment (family or individual) which may lead to short-term crisis counselling (individual or family support intervention as appropriate)

• Urgent refers to children & young people with significant situational/potential mental health concerns and risk behaviours including self-harm and/or suicidal ideation and/or suicidal planning/suicide attempt survival, not currently receiving services

• Child/young person (& safe adult) offered community-based crisis counselling/family assessment within 5,7 or 10 days, depending on suicide risk (low, moderate, high)

• 90% attendance rate required by Key Performance Indicator

• Proposed model stipulation of ‘low risk’ child/young person as eligible for Lifeline psychological therapy at variance with the adult caller who must be at ‘immediate’ risk of suicide and self-harm. Although reported to be for all people in NI, irrespective of age, the proposed pathways lead to a concern that a significant percentage of children, young people & their families eligible for Lifeline support through the current model (telephone & face to face) will be signposted back to GP, and will not meet CAMHS or Social Services intervention thresholds, leading to problem entrenchment / isolation and burdensomeness / revolving door.

• There is no categorisation within the outline business plan of ‘moderate risk’ for children/young people, only ‘minimal,




low, high and immediate risk’ cited.

Psychological therapy provided

• Assessment & average of 5 sessions of evidence based & evidence informed counselling/therapy (CORE clinical outcome measures unspecified)

• All locality based providers should be able to provide evidence based/evidence informed psychological therapy to signposted children and young people (p52 BC)

• Specialist child, young person and family interventions available

• Intervention tailored to needs identified at telephone comprehensive assessment by Lifeline Child & Young Person Referral team

• Initial one-off family meeting/assessment offered when child/young person not currently engaged with any service & risk presentation (self-harm/suicidal ideation) to determine appropriate service/resource required

• Support provided for child/young person and safe adult to engage with GP & statutory services should longer term needs be identified at initial assessment / warm handover

• Choice of different forms of intervention to best meet assessed need: individual counselling; creative arts counselling; family support intervention (up to 6 sessions)

• All interventions rigorously evaluated following every session

• GP updated on elevated risk presentation & informed of intervention outcomes

• Option of family-based interventions not mentioned in proposed model despite growing evidence base for family-based systemic interventions in context of child/young person self-harm, suicidal ideation/attempt and adolescent depression (Carr, 2014).

• NICE Guidance CG16 stipulates that assessment for all children and young people who have self-harmed should include a full assessment of the family, their social situation, and child protection issues.

• Without engagement with child / young person’s primary caregivers, and the option to meet as a family subsystem when needed, Lifeline wraparound crisis counselling for some children and young people could not be safely undertaken.


References

Appleby, L., Kapur, N., Shaw, J., et al (2013) The national confidential inquiry into suicide and

homicide by people with mental illness. A UK wide study. London: Department of Health. http://www.bbmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/ [Accessed 1 September 2015] Beautrais, A., Gibb, S., et al (2010). Postcard intervention for repeat self-harm: randomised

control trial. A UK wide study. British Journal of Psychiatry, 197: 55-60

Beautrais, A. (2013) Caring Letter (AAS2013). David Covington: UTube. https://www.youtube.com/watch?v=kbAUFT8fs2o [Accessed 1 September 2015]

Carr, A. (2014) The evidence base for family therapy and systemic interventions for child-focussed problems. Journal of Family Therapy, 36: 107-157

Gould, M.S., Kalafat, J., Munfakh, J.L.H. & Kleinman, M. (2007) An evaluation of crisis hotline

outcomes. Part 2: Suicidal callers. Suicide & Life-Threatening Behaviour, 37: 338-52 Gould, M., Munfakh, J.L.H., Kleinman, M. & Lake, A.M. (2012) National Suicide Prevention

Lifeline: Enhancing Mental Health Care for Suicidal Individual and Other People in Crisis. Suicide & Life-Threatening Behaviour, 42: 22-35

Joiner, T.E. (2005) Why People Die by Suicide. Cambridge, Massachusetts: Harvard University

Press. Joiner, T.E. (2010) Myths about Suicide. Cambridge, Massachusetts: Harvard University Press. Kalafat, J., Gould, M.S., Munfakh, J.L.H. & Kleinman, M. (2007) An evaluation of crisis hotline

outcomes. Part 1: Nonsuicidal crisis callers. Suicide & Life-Threatening Behaviour, 37: 322-37 Jordan, J., McKenna, H., Keeney, S, Cutcliffe, J., Stevenson, C., Slater, P. & McGowan, I. (2012)

Providing Meaningful Care: Learning from the experiences of suicidal young men. Qualitative Health Research, 22: 1207-1219

Kapur, N., (2005) Predicting the risk of repetition after self harm: cohort study. British Medical Journal, 330: 394-395

Klonsky, E.D., May, A.M. & Glenn, C.R. (2013) The relationship between non-suicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122 (1): 231-237 Knesper, D, J., (2010) Continuity of care for suicide prevention and research: Suicide attempts and

suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Boston: American Association of Suicidology and Suicide Prevention Resource Centre.

http://www.bbmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/

https://www.youtube.com/watch?v=kbAUFT8fs2o


Milner, A., & De Leo, D. (2010) Who seeks treatment where? Suicidal behaviors and health care: Evidence from a community survey. The Journal of nervous and mental disease, 198, 412-419.

NICE guidelines [CG16] (2004) Self-harm: The short-term physical and psychological management

and secondary prevention of self-harm in primary and secondary care. Manchester: National Institute for Health and Clinical Excellence. Available at

https://www.nice.org.uk/guidance/cg16 [Accessed 1 December 2013] NICE guidelines [CG133] (2011) Self-harm: The longer-term management. Manchester: National

Institute for Health and Clinical Excellence. Available at http://whqlibdoc.who.int/publications/2010/9789241500128_eng.pdf [Accessed 1 December 2013]

O’Connor, R. (2011) The Integrated Motivational-Volitional Model of Suicide behaviour. Journal of Crisis Intervention & Suicidal Behaviour, 32, 6, 295-298

Stanley, B., Brown, G., et al (2012) Safety planning intervention: a brief intervention to mitigate

suicide risk. London: Cognitive and Behavioural Practice, 19: 256-264

WHO (2014) Preventing suicide: A global imperative. World Health Organization. Available at http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1 [Accessed 1 September 2015]

https://www.nice.org.uk/guidance/cg16

http://whqlibdoc.who.int/publications/2010/9789241500128_eng.pdf

http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1

th november 2015) concerns and considerations...views (electronically or by post) by november 19th....

Documents