Barnsley Metropolitan Borough Council: Developing an attempted suicide follow-up service

Barnsley’s Real Time Surveillance data from South Yorkshire Police provides the team with rich data on individual cases. This intelligence helps to identify patterns and needs and allows targeting of interventions according to what is happening in real time. Data showed that in some cases there could be up to three suicide attempts before someone dies by suicide.

The Psychosocial Engagement Team service was developed as a six-month pilot project, where referrals were made by A&E mental health liaison teams into a six to eight week programme focused on problem-solving and support. In six months, 100 referrals were made, with 85 per cent engagement. The pilot has been evaluated and embedded into the mental health pathway.

The scope of the Psychosocial Engagement Team (PET) service is to provide a timely, problem solving, evidenced-based psychosocial intervention to individuals who have had suicide attempts, or clients with suicidal plans/intent. During the pilot phase (1 February 2021 to 31 July 2021) the service focused on adults with adjustment disorders as this cohort are less likely to be in mental health services, offering an opportunity to intervene early with a holistic approach to their recovery and one which involves their family and peers. An adjustment disorder is defined by difficulty adjusting to life stressors. This could be moving to a new area, changes in a relationship, moving into a new job, illness or bereavement.

The service aimed to:

• educate families and peers on how they can support individuals after self-harming or having an attempt on their life
• support/educate other services as well as strengthen links between them which may aid recovery, such as Recovery College, Andy’s Man Club, Team Talk, Men in Sheds
• identify any common themes that may be emerging leading to a suicide attempt, e.g. isolation, employment, housing, relationships, COVID-19.

Overall, the goal of the service is to reduce suicides in Barnsley. Secondary objectives include the reduction of hospital admissions, presentations to A&E, call outs for emergency services and re-referrals to mental health services.

The PET, based at Lundwood Health Centre, opened to referrals from 1 February 2021. All interventions were held face to face and seven days a week. The service is staffed by three people; a Pilot Lead (Band 7), senior Community Mental Health Nurse (Band 6) and a Community Support Worker (Band 3).

Referrals come via Liaison Psychiatry and the Single Point of Access (SPA) team (both assessment services).

PET is based on a Crisis Recovery Intervention Model. This refers to the methods used by the service to offer short term immediate help to individuals who have experienced/are experiencing an event that produces mental, physical and emotional distress. The purpose of the interventions is to protect, educate and enhance coping mechanisms of the client and their families with the aim that at the end of the intervention, their social functioning will not diminish but be maintained or improved so if faced with a future crisis, they will find a way to cope/manage in a more positive way.

Clients are seen face to face initially two or three times a week (for six weeks) with a clear explanation that ‘recovery’ requires their participation in treatment and family participation/attendance is strongly encouraged. This service is designed to help families recover following an event. It is not a risk assessment or risk management service, so if risk arises for any member of a family, they will be signposted to an appropriate service. If there is the potential for immediate risk to life the service will breach confidentiality by informing the GP. If such risks cannot be contained within the family, then the provision of service may be suspended temporarily or possibly ended. In either of these cases a summary will be written for the Network and a copy sent to the Principal's GP.

I came through the doors at one of my lowest points in my life. I wanted to end my life, I had it planned. I wasn’t getting out of bed or washed and dressed. My anxiety was so high, and I was having mood swings. I couldn’t concentrate and I wasn’t sleeping. I pushed all my family and friends away and I wasn’t leaving the house."

The total for the PET pilot for a six-month period was £89,897 funded from:

• Winter Pressure Monies – NHS England - £49,897
• Barnsley Council – Barnsley Metropolitan Borough Council - £45,000

From June 2021 to March 2022, the service was funded by Barnsley CCG from COVID Recovery Funding and from April 2022 onwards is now funded as part of as a core offer from Mental Health services funded by Barnsley ICB.

Quantitative data collected included:

• referral route
• number of referrals made and accepted
• gender
• age
• ethnicity (where possible)
• number of contacts with the service by the family and type of contact e.g. group, one to one, telephone
• status (education, employment, training, where possible)
• number of external agencies signposted into
• number of external agencies referred into.

Qualitative data included:

• using a standardised monitoring tool (HoNOS – Health of the Nation Outcome Scales) to measure the impact of the service on the individual
• case studies
• personal experiences of the service
• compliments and complaints
• feedback from referring services and GPs on discharge if received
• summary of the service’s learning
• evidence of service user voice and influence and co-production
• after reviewing the data of the 80 clients that PET have worked with, only two clients have returned to services after being discharged.

A number of clients disengaged during treatment or as treatment was ending. It is difficult to understand why this happens for some, however others do well throughout the treatment then do not attend the last appointment. This can be difficult to mitigate as it may well be that they have got everything they need from the intervention, however readmission rates to PET are low suggested intervention has been effective.

From the PET pilot data, of the 20 clients that have been discharged due to non-engagement; five were female and 15 were male. Collectively, disengagement was highest among clients in their 20s.

On occasion, clients with substance misuse issues were referred to PET, which was not apparent on initial referral. Dual diagnosis can be difficult, particularly if patients are under the influence at the time of intervention but we do work closely with the Substance Misuse Service to support both needs of alcohol and substance use and mental health support.

There were several aspects of the service that proved to be effective in the delivery of a successful pilot programme. These included:

• Quick response times: Clients are contacted in a timely manner (within 48 hours from receipt of referral). In person appointments. Seeing people face to face at clinics/community settings or home visits.
• Safety plans and wellness recovery action plans have been useful in clients’ recovery journeys.
• Involving family and friends: Allowing clients to bring family members or friends along to the appointments. This also helps to support families in caring for their loved ones who are experiencing mental health difficulties. Working in partnership. PET built and maintained links to third sector services such as, Recovery College; employment specialists; IDAS etc.
• Collaboration: PET’s practical approach to recovery is responsive to clients’ needs. Goals are identified collaboratively between client and clinician. Client has a clear plan and their expectations are met.
• Focused and frequent: The work is time-specific and client focused. Continuity and frequency of appointments allows for the therapeutic relationship to form quickly.
• Communication: Effective and good communication between team members which is transferred to clients and families.
• Flexibility: Working hours suit clients’ needs (available weekends and later in the evening on weekdays).

I started taking pride in my appearance, I began taking care of myself. My anxiety is still with me but at a lot lower level and with the techniques I learned with PET Team I am better able to deal with situations that I previously avoided. After doing work around sleep hygiene, I now sleep much better, I use soft music and make sure I don’t have my phone with me. I am mixing with family and friends and I’ve been doing my own shopping instead of buying my food online; and after a long period of time off work due to the pandemic, I am now back in work which is something I couldn’t contemplate six weeks ago. It was stressful but I was kind to myself and made sure I went to bed early ready for my day at work.

There has been interest from other Trusts across the country in adopting a similar approach which allows people who have had an attempt on their life or are suicidal to access timely, practical support. It’s been a huge achievement to get this pilot embedded into mainstream mental health services with commitments for funding being recurrent by the Integrated Care Board.

Learning, data and outcomes will continue to be shared to inform best practice.

We also want to look at how people can access support who don’t present at A&E. Across South Yorkshire we are looking to establish an attempted suicide and self-harm data dashboard which includes information from Police, Ambulance and British Transport Police to enable where signposting opportunities might be appropriate for people who are in mental health crisis.

We now have a mental health crisis alternative based in the town centre which will be able to support some of these individuals.

I am no way back to my old self but I am on the right path. Claire has had to be patient with me and understanding as each session my mood was in a different place. I think empathy and support has been fantastic in helping me move forward. I think I will always have slight ‘ups and downs’ as I have suffered with mental health difficulties for a number of years but I am leaving PET team a totally different person to the one that arrived and I hope this support will be in place permanently for anyone else that needs it. It has saved my life and the most important thing I have learned is the be kind to myself. Thank you so much PET team”.