Hertfordshire County Council and Stevenage Borough Council: A new crisis café to prevent suicide at a high-risk location

We knew that we needed to provide crisis support to people in and around Stevenage train station following a number of incidents across a relatively short period. It was also important that this support was integrated into wider community suicide prevention activity so that people did not end up in that place of crisis. We also took a prevention approach to raise awareness of suicide and support frontline staff through training and a campaign. 

We aimed to:  

• Reduce suicides across the borough, particularly on railways and on the local transport infrastructure in Stevenage  
• Signpost those in need to immediate contact with means of support  
• Make the public aware of the new service  
• Signpost those in need to the Healthy Hub Stevenage (Adult) and Young People’s Healthy Hub 
• Promote wellness, increase protection, reduce risk, and promote effective treatment and recovery  
• Underline that Stevenage is a caring place offering a supportive environment for all  
• Reduce access to means of suicide.  

The Stevenage Suicide Prevention Task and Finish Group was officially formed by the Health and Sport Strategy Manager (Stevenage Borough Council) and the Health Improvement Lead, Mental Health and Suicide Prevention (Public Health, Hertfordshire County Council) to ensure we had system leadership.   

The group also had members from Network Rail, British Transport Police, Samaritans, local commissioning, police, the Partnership Foundation Trust, GP practices and the Herts Mind network. At the first meeting, the Crisis Care Concordat group and Thameslink Railway were able to share data and statistics about the station.  

We looked around the country at what other areas had done. Brighton, for example, has a mental health hub based in the train station. We needed to think differently as Stevenage train station has much smaller platform space. 

The Healthy Stevenage Partnership took the lead in the process, with support from Public Health. The crisis café model was one which we felt would work well and we had the ideal location, just over the footbridge from the station and next to Healthy Hub Stevenage. 

Hertfordshire Mind Network (HMN) provides a countywide out of hours mental health crisis service, called NightLight. There are three elements to the provision including Nightlight Crisis Helpline, Nightlight Crisis Café and Nightlight Overnight Beds.  

The Stevenage NightLight café launched in June 2022, and in the first month we had 108 visits. Rather than contacting police, station staff now know to take a person over the bridge to the café where they can get crisis support. The café is open every day, every week of the year including bank holidays. It provides a safe, welcoming space for people who are feeling distressed and experiencing a crisis.  

Each centre is staffed by a team of skilled and experienced non-clinical mental health workers, many of whom have a lived experience of mental ill health. There are always at least two staff on shift at each base.  

The team works alongside individuals to support them during their stay, providing:  

• A safe space in a welcoming environment  
• Peer support  
• 1:1 staff support (practical and emotional)  
• Support with crisis resolution and building coping strategies  
• Advice and information  
• Signposting  
• Onward referrals to other health and social care providers, housing and community resources 
• Facilitated access to specialist mental health services when needed.  

Collaborative partnership working with Public Health has been invaluable to ensuring the work of Stevenage has both system leadership and links into the county wide suicide prevention strategy. Public health has also funded a Samaritans awareness and behavioural change campaign ‘Real People, Real Stories’ which is being replicated for delivery at a local level in Stevenage town centre. The campaign encourages help seeking amongst high-risk groups of men, who are known to have increased vulnerability to dying by suicide. 

Hertfordshire Mind Network continues to deliver a series of workshops for partners, who also visited the café to understand the services on offer. Local GPs have been invited to come visit too to understand what is on offer.  

At the station itself, trained British Transport Police representatives have a presence on platforms and Samaritans has provided training to frontline staff. Our partnership with Samaritans has also led to: 

• Samaritans signage audit at Stevenage station and throughout GTR/ East Coast Mainline network. We are working to ensure there is crisis signage at ends of platforms where necessary plus awareness raising/ campaign posters to signpost people in local area to Samaritans. 
• Additional signage, for example, in lift at Stevenage station and floor stickers suggested but unable to use due to risk assessments/ health and safety in the station. 
• Promotion of Samaritans Managing Suicidal Contacts training course for rail staff at Stevenage, with 58 per cent already confirmed as trained, and encouraging the rest of staff to attend training.  
• Engagement with Samaritans branches and holding awareness events at Stevenage and stations locally and along East Coast Mainline.  
• Samaritans’ post-incident support offered after each incident, with potential to take this up more often which forms part of prevention work providing support to rail staff/ passengers and increases visible presence at station. 
• Samaritans engaging with Public Health East of England including providing fatality/ incident/ intervention data for the locality. Attendance at suicide prevention group and PHE meetings to promote work on rail network and rail campaigns plus look into ways we can reach people in crisis before they come to the rail. 

In addition, town centre managers and businesses are being trained in suicide prevention, rolling out to bus and taxi drivers. The café has been a driving force in bringing the whole community together to think about and act on suicide prevention.  

Overall, the start up and running cost of the café has been circa £190,000 for seven days a week and across one year. This includes staff and costs, as well as client transport where needed. Public Health has funded the campaign to the tune of £10,000.

From launch on 30 June 2022 until 31 August 2022, we recorded outcomes from 264 visits, all of which followed one to one (face to face) support intervention:  

• 13 showed reduced self-harm 
• 73 reduced social isolation 
• 29 reduced suicidal ideation 
• two averted statutory intervention (police) 
• 12 developed increased crisis management strategies 
• 121 learned improved coping strategies  
• 13 improved daily living skills.  

To date, the Nightlight Crisis Café team have been able to provide every visitor with face to face person-centred support, so the number of interventions provided by the café match the number of visits. 

An important outcome of this work has been the sustainable partnerships built across sectors, as well as the collaborative leadership between county and district councils. 

There are innovative and exciting plans in place to improve and transform Stevenage and bring the town back to the forefront of modern urban development. Stevenage is benefitting from a major 20-year regeneration programme – worth £1 billion – which promises to reinvigorate the town centre and surrounding areas. 

We are making sure that suicide prevention is part of this. We are working with the regeneration team on a new multi storey car park to make sure that safety is part of their planning. We are finding that other council teams are coming to us to talk about prevention, not just crisis, so we are building confidence to talk about suicide and suicide prevention.  

We have also integrated the crisis café with wider prevention activity at the Healthy Hub Stevenage (adult), such as the Men’s Club. The Men’s Club is a free four-week course that includes weekly workshops and activities to help men improve their physical and mental health in a friendly, supportive environment funded by Hertfordshire and West Essex ICS Wave 4 Suicide Prevention Programme’s Suicide Prevention. 

Each week, the course looks at a different topic: mental health, healthy eating and physical activity, men’s health problems and back care. 

Overall, we are aligning our other work to this project, so it becomes a jigsaw – not just one element of work that we are doing.  

The evaluation of the suicide prevention work will be continue to be assessed against the number of incidences recorded at the train station, number of visitors attending the nightlight crisis café together with recorded support intervention outcomes, and number of residents contacting signposted services via the Real People Real Stories campaign.   

The pandemic has left us with significant work pressure, so preventing staff burnout is a workstream we have supported within the council. We have been able to have conversations with colleagues about mental health and have influenced the redirection of funding which has permitted us to support the creation of a staff collaboration area focussed on wellbeing for colleagues to sit and destress.  

It was a slow process to begin with, however, all partners were very engaged and committed There are challenges with busy partners, who can’t always attend meetings. but working online has helped this.  

Having rich data was important. Reading through cases and incidences at the station really helped us to understand people’s stories. Seeing conversations on social media - the age ranges, backgrounds of people – helped us understand it can happen to anyone. Knowing the very local picture is key. 

There are different referral processes for all the different partners. We need to integrate our process with all of these - we are still developing how that works.  

Working with public health is essential. We need to be able to understand how local action is aligned with the work at county level. Leadership from our Director of Public Health and the council’s Deputy CEO ensured this.  

Momentum was needed to get partners involved and for people know their roles. It is important to not leave too much time between meetings, we met every six weeks.  

Ensure stakeholders are part of key milestones. We invited everyone to the launch of the café which was a great event.   

We don’t have the same issues with other stations, but we will certainly roll out the awareness and prevention campaigning elements. The café was the ‘big thing’, but we have a great group together and committed now. We need to continue to get the best use of them.  

We have secured the Local Government Association Suicide Prevention Sector Led-Improvement Programme bespoke support offer.  This will help us to build on the action plan we have developed with expert associates who can ensure we can continue to develop the work of the task and finish group to implement long-term changes. 

A woman came to the crisis café in a distressed state was made comfortable by staff. She was supported with face-to-face support, which deescalated her by providing an understanding, listening ear and a place to talk and be heard. A crisis exit plan was written together and coping strategies were discussed.  She had a plan to meet with the mental health worker at her workplace the following morning. After the face-to-face support, she continued to stay in the café setting, painting and drawing. She left the service feeling better, with a structured crisis exit plan. She knew that she was welcome to come back to the café at any time for support.  

This case study was done jointly with the National Suicide Prevention Alliance and forms part of our suicide prevention resource.