Suicidal Thoughts

Patients at crisis point

Please read in conjunction with Remedy page on Self Harm

For adults at crisis point, refer to PCLS immediately (also known in Bristol as Referral & Triage Team)

For children in crisis then please consider obtaining urgent advice from CAMHS - see the CAMHS Remedy page for further information 

Suicide Risk Red Flag

Suicide Risk Red Flags (non-exhaustive list)

Red flags are significant risk factors that alert us to a person being at increased risk of attempting suicide at time of assessment. 

This risk will require a clinically appropriate intervention and a Safety Plan put in place. This may also include discussion with and/or referral to the Mental Health Services.

 Demographic and social 

• Lack of social support, lives alone, no close friends/family
• Male (this demographic may not disclose extent of difficulties/suicidal thoughts)
• Stressful life events (eg bereavement, relationship difficulties/ending, loss of employment, financial difficulties, housing issues, victim of abuse)
• LGBT 
• Ethnic minority group. 

Personal background 

• Alcohol and/or illicit drug misuse (particularly if use is linked with recent relationship breakdown)
• Gambling
• Bereavement by suicide of person in close relationship or family member or being exposed to suicidal behaviours of close relationships/family
• Use of suicide-promoting websites or social media 
• Access to lethal means. 

Clinical factors in history 

• Previous self-harm or suicide attempt(s) (regardless of intent)
• Mental illness (particularly if recent relapse or discharge from in-patient mental health care)
• Disengagement from mental health services 
• Impulsivity or diagnosis of personality disorder
• Long-term physical health conditions (recent discharge from a general hospital, pain)
• Medically unexplained symptoms 

Mental state examination and suicidal thoughts 

• High levels of emotional pain and negative thoughts (feelings of hopelessness, helplessness and guilt)
• Feeling trapped in their situation or feeling unable to leave (sense of entrapment) and/or feelings of shame
• Worsening of suicidal thoughts
• Suicidal thoughts with researching/planning or a detailed plan
• Psychotic symptoms (particularly if distressing – persecutory delusions, command hallucinations).

Source: Royal College of Psychiatrists (2020) Self-Harm and Suicide in Adults: Final Report of Patient Safety Group.

Safety planning

A safety plan is a tool that can help to set out how a person can support themselves or seek support from others if they are experiencing thoughts of self-harming or suicide. 

Depending on the level of risk, you may use this in conjunction with onward referral to the AWP Crisis Team or Assessment and Recovery Team, VitaHealth NHS Talking therapies or other local support such as Off The Record (OTR) for young people, Self Injury Support, Second Step, Changes Bristol, and CASS for culturally diverse services. For more information call CASS on 0117 304 1400 or email info@cassbristol.org).

A safety plan can include: 

• Early warning signs of deteriorating mental health
• Distracting activities
• Individualised strategies/activities to lift mood
• Ways to make the situation safer ie removal and/or mitigation of means to self-harm
• Contacts for social and crisis support.
• It helps the individual to keep all useful information, resources and contact numbers in one place for ease of access and can be shared with a loved one/carer.
• The level of detail included may differ depending on the complexity of the patient.
• It may be something that you build on over time with a patient – discussion and agreement of immediate safety is key in co-production with the patient.
• As well as being able to print off paper worksheets with safety plans, there are now phone apps that people can also download and are often free.
• Safety planning can be very effective. For supporting evidence for this approach see https://stayingsafe.net/https://pubmed.ncbi.nlm.nih.gov/33913799/

Resources for Safety Planning

How to create a safety plan, and its potential value to patients: Staying Safe 

Paper safety plan: https://stayingsafe.net/sites/default/files/BlankSafetyPlan.pdf 

Electronic safety plan:  Staying Safe | from suicidal thoughts (the electronic version contains prompts).

Stay Alive free app: https://www.prevent-suicide.org.uk/find-help-now/stay-alive-app/  The Stay Alive app contains an online safety plan that the user can customise. The app is a pocket suicide prevention resource for the UK, with useful information to help people stay safe. It can be used by someone having thoughts of suicide or those concerned about someone else who may be considering suicide.

DistrACT free app: distrACT app - Expert Self Care.  The distrACT app gives easy, quick and discreet access to information and advice about self-harm and suicidal thoughts. It contains links to local services and ideas that could also be used in a safety plan.

Counselling: NHS Talking Therapies

NHS Talking therapies and courses are available across BNSSG. Please see the Talking Therapies page. However, this is not suitable for those at high risk to themselves and/or at crisis point.

Student counselling is available from individual colleges and universities.

Please also see Mental Health Resources for Children and Young People

Hope Project

The Hope Project provides short-term emotional and practical support for men aged 30-64, specifically those who are in psychological distress or have recently self-harmed.  Our aim is to prevent suicide among this high-risk group.

Our experienced support workers work with men across Bristol, North Somerset and South Gloucestershire over a twelve-week period, and specifically focus on helping men who aren’t currently using mental health services. We know that 62% of all suicides are by people who aren’t known or connected to any services.

The Hope Project accept professional & self referrals. 

Client Paul says our work is life-saving:

"Through my torment, being able to speak to Hannah and make a plan for my life, has been a game-changer."

Contact the Hope Project on hope.project@nhs.net

https://www.second-step.co.uk/our-services/recovery-mental-health/hope-project/

Other sources of help

• AWP 24 hour helpline

AWP provide a Mental Health 24/7 phone service providing support for people worried about their own, or someone else's mental health.

The telephone line offers out-of-hours care for adults and children in crisis 24 hours a day, 7 days a week, 365 days a year.

Telephone: 0800 953 1919

• Samaritans

https://www.samaritans.org/

Open: 24 hours per day, 7 days per week

Tel: 116 123           Email: jo@samaritans.org

• Prevention of young suicide (Under 35's) PAPYRUS

https://papyrus-uk.org/

HOPELINEUK is a specialist telephone service staffed by trained professionals who give non-judgemental support, practical advice and information to;

• Children, teenagers and young people up to the age of 35 who are worried about how they are feeling
• Anyone who is concerned about a young person

Open: Mon-Fri: 10am-10pm, weekends: 2pm-10pm & bank holidays: 2pm-10pm

Call: 0800 068 41 41               Text: 07786 209697        Email: pat@papyrus-uk.org

• Campaign Against Living Miserably (CALM) Aimed at men of any age in the UK

https://www.thecalmzone.net/

CALM, is a registered charity, which exists to prevent male suicide in the UK. Suicide is the biggest killer in males under 50.

The helpline is for men who are down or have hit a wall for any reason, who need to talk or find information and support. Calls are taken by trained staff who are there to listen, support, inform and signpost. Because calls are confidential and anonymous we don’t and can’t offer a counselling service.

Open: 5pm - midnight, 365 days per year

Call: 0800 58 58 58           Webchat & WhatsApp option available on the website

Calls are anonymous & confidential and won’t show up on phone bills. Calls are free from landlines, payphones and all mobiles

• The Mix - Essential Support for Under 25's

https://www.themix.org.uk/

Offer a crisis messenger text service which provides free, 24/7 crisis support across the UK. This support is free and for any issue. They provide in-the-moment support and problem solving. If aged 25 or under, text THEMIX to 85258.

"We know that finding the right support is important, especially if you need someone to talk to right now. We aim to connect every texter to a trained volunteer in less than five minutes to provide crisis help. They will listen to you and help you think more clearly, enabling you to know that you can take the next step to feeling better."

Can also offer up to 8 counselling sessions for a range of issues via telephone or webchat for 11-25 year olds.

• MIND

MIND - Suicidal feelings

Web support and signposting to other help

Let's talk about suicide

The Zero Suicide Alliance offer free online training that is aimed at everyone and gives a basic understanding of how to support people who are showing signs of depression or crisis and offers guidance on how you can deal with such situations.

You can access the training presentation online, with the training taking approximately 20 minutes. The training is excellent for both clinical and non-clinical staff.  A mass undertaking of this training would have a huge impact in reducing stigma and increasing support.

If you would like further information regarding the work being undertaken by the Zero Suicide Alliance please see their website

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.