Providing men at risk of suicide with emotional support and advice with employment, housing, and financial difficulties.

The Hope service provides psychosocial and practical support for men aged 30–64 who are at risk of suicide, advising them in relation to any money, employment, benefit, or housing problems they may identify, alongside referring to other specialist services. We work with around 180 men every year. Many of the men referred to the Hope service have attempted suicide or have suicidal/self-harming thoughts and feelings. Working with the range of local statutory services is key, accessing specialist advice from partners in health and local authorities.

“Having support from someone from The Hope project is what has kept me alive. ... I’m housed and sober and those are two things I never thought would or could happen.”

Numerous studies have demonstrated relationships between debt and poor mental health and there is clear evidence that financial recessions are associated with increases in suicide rates, with other factors such as debt, housing and employment issues, relationships, and alcohol or drug misuse possibly contributing .

People with debt and financial problems are twice as likely to think about suicide than those not in financial difficulty . Men are particularly affected, with recession-associated rises in suicide observed in male mental health patients and the male general population, with particular risk for those in mid-life .

While many suicide support services focus on psychological support, it is less common to find services that incorporate advice on finance and debt, housing and employment issues.

The Hope Project takes a person-centred, non-judgemental approach to build trust with clients, and provides both practical and psychosocial support.

The Hope service starts with an initial assessment session to enable an understanding of the problems being experienced by the service user and the type of support that might be needed. This is directed by the service user, where he will prioritise what he feels needs to be addressed first. Key priorities for Hope staff will be carrying out a risk assessment and identifying any urgent priority needs as well as focusing on safety planning to mitigate risks.

If service users are experiencing active suicidal feelings, regular planned phone calls by a project worker can provide an “anchor” in between face-to-face meetings. Focussing on major practical issues (e.g. imminent homelessness, financial difficulties) can enable people to regain a sense of control, helping to reduce risk of harm. For the men using Hope, feeling in control is important in support sessions, enabling men to share thoughts, feelings, and experiences that they may not have spoken about before.

The Hope process is outlined below.

1.Referral from primary care, secondary mental health services, mental health crisis/custody teams, police, voluntary organisations, families, self-referral.

2. Initial assessment (up to 2 hours if needed), where we assess and discuss:

a. Suicide and risk – levels of intent and risk.

b. Housing risk – is the person homeless or at risk of homelessness?

c. Immediate financial needs – is there money for bills and food?

d. Finance/legal/benefits/employment issues.

Actions arising from the assessment will include safety planning and mitigation if a risk, negotiating with housing, helping with immediate costs, and referral to specialist money advice workers.

3. We work with men for a three-month period and sometimes longer (decided on a case-by-case basis). This includes face to face sessions with a Hope project worker and unlimited telephone support.

a. Approaches used: Trauma informed; Motivational interviewing; Action planning; needs-led and person-centred service; coaching; empowering; talking through past traumas to identify support needs.

b. Prioritised according to what is impacting the client the most.

c. Guided by non-judgemental, non-hierarchical and relational safety approaches – making sure people feel safe, heard and validated.

d. Meeting at service user’s place of choice. This could be a café, a walk, a home visit.

4. Tackle service user’s priority issues in support sessions where emotional support needs are worked through with project workers. At this point we negotiate where needed with other agencies and refer onwards to addiction services, IAPT or counselling for those in need. We will advocate for clients or support them to advocate for themselves independently.

5. To conclude our work with a client, we have our final face to face session and clients are advised that they can get in touch in the future if they need support.

We are funded by the Bristol, North Somerset and South Gloucestershire ICB and sit alongside our Public Health partners on suicide prevention groups for the area.

An independent qualitative evaluation of the Hope Project, published in 2022 , identified some of the core aspects of the Hope model that were particularly effective with service users.

1. Hope’s project workers listened to and supported men in non-judgemental and compassionate ways, providing coping and emotional regulation techniques as well as a pragmatic, solutions-focused and motivational approach in an informal, community-based setting.

2. Hope services supported men to have control during sessions as they set the priorities and preferred ways of meeting. Crucially men also gained control over life crises such as homelessness and debt, that from their perspective had become uncontrollable and unnavigable, working with specialists on issues such as finance or housing and referring to others where necessary.

3. There was a perception of less power differentials between Hope project workers and service users in contrast to mainstream health services, where some men had felt threatened or “ostracised”.

4. Hope’s referral pathways enabled communications and integration between mental health and substance misuse services; such an integrated approach has been highlighted as important in other literature where men may use alcohol and/or drugs as a way of self-medicating.

The evaluation concluded that:

The Hope service provided an essential service for men at risk of suicide, with complex needs including addiction, job loss, homelessness, debt, relationship-breakdown and bereavement who often would otherwise have fallen through service provision gaps.

Working in a person-centred, non-judgemental way elicited trust and specialist advice tackled problems such as housing needs, debt, benefit claims and employment, enabling men to regain a sense of control over their lives. Some men shared histories of abuse, for which specialist counselling was hard to access.

Where Hope project workers identify that service users would benefit from specialist advice, they once were able to refer them to funded Hope advice workers, with project workers continuing to provide psychosocial support as needed. Sadly there was no ongoing funding to have specialist money workers in post.

This combination of specialist advice and emotional support is what makes the Hope service distinctive. Clients receive a timely response to referrals and are offered an appointment within two weeks.

Although we are not funded to employ specialist advice workers at present, Hope project workers do still signpost clients to available advice and guidance around their financial issues. Timely access to these, and other specialist services, is important for our clients.

The lack of housing available for single men remains a challenge that we face in helping our clients out of, or to avoid, homelessness.

We believe that this model would work for anybody, in any sector. Essentially, suicide prevention needs to be everyone’s priority.

There are so many creative ways to implement the Hope Project approach in other organisations and across health and statutory settings. For example, if people are attending A&E in crisis, where socioeconomic factors are revealed as an important issue, maybe have drop-in dept advisors to help men regain some of that all-important control.

We have had some specialist money advice workers in our team from across our local authorities. Partnership is key, as is the joint understanding that emotional support + timely access to advice can make a real difference.

We want to be part of shaping a culture of understanding across our ICB where we are all working towards suicide prevention. Encouraging staff in local money and benefits services to take Zero Suicide training for 20 minutes to destigmatise conversations about suicide is part of this approach.

Hope Project is part of Second Step, a South-West based mental health charity

Hope Project evaluation report

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