Evaluatin f the Scttish SafeTALK Pilt August 2007 Janne McLean Marguerite Schinkel Amy Wdhuse Ann-Mari Pynnnen Laura McBryde
The Scttish Develpment Centre fr Mental Health The Scttish Develpment Centre (SDC) is an independent, nt-fr-prfit rganisatin that aims t achieve better mental health and well-being fr peple in Sctland. We wrk all ver Sctland fr and with all kinds f rganisatins. Our clients and partners include vluntary rganisatins, businesses, health bards, lcal authrities, natinal bdies and netwrks. This breadth and scpe means that SDC is ideally placed t bring a visin f the bigger picture f mental health t everything we d. We have an excellent recrd in canvassing the views f peple with experience f mental health prblems. This means that we can help their vices be heard clearly and prmte their participatin in decisin-making. Firm believers in recvery, ur wrking practices ensure peple are supprted t take part and that ding s is a psitive experience. Researchers Janne McLean, Research and Evaluatin Prgramme Lead, SDC Amy Wdhuse, Researcher, SDC Marguerite Schinkel, Assciate Cnsultant t SDC Ann-Mari Pynnnen, Research Wrker, SDC Laura McBryde, Research and Finance Supprt Assistant, SDC Scttish Develpment Centre fr Mental Health 17a Graham Street Edinburgh EH6 5QN t. 0131 555 5959 f. 0131 555 0285 e. sdc@sdcmh.c.uk www.sdcmh.rg.uk 2
Cntents Executive Summary p.4 1 Intrductin p.8 2 Methds p.12 3 Findings p.15 4 Key issues and implicatins fr rll ut p.39 Appendix A Cmparisn between ASIST, safetalk and p.44 suicidetalk Appendix B1-B4 Data Cllectin tls p.46 3
Executive Summary Intrductin SafeTALK is a new prgramme frm LivingWrks Educatin. Develpers in Australia and Canada designed and field trialled safetalk in 2004-05 based n stakehlder reprts f a training gap between LivingWrks suicide awareness sessins (suicidetalk) and its suicide interventin skills training (ASIST). These three prgrammes are part f a set f five LivingWrks prgrammes fr enhancing suicide interventin capabilities. As part f the develpment f a cmprehensive suicide preventin training prtfli in supprt f the Chse Life bjectives in Sctland, a 6 mnth pilt f safetalk was initiated by the Chse Life Natinal Implementatin Supprt Team (NIST) in June 2006. An assessment f the perceived relevance and quality f the curse was required prir t implementing a Sctland wide prgramme f training. In respnse t this the Scttish Develpment Centre fr Mental Health (SDC) was cmmissined by NIST t evaluate the pilt intrductin f safetalk t Sctland and assess the implicatins fr further rll-ut f safetalk. SafeTALK Gals SafeTALK is a half-day training prgramme, which can be used either as a stand alne r as a precursr fr ASIST training. It has an awareness and training fcus and teaches participants t recgnise and engage persns wh might be having thughts f suicide and t cnnect them with cmmunity resurces trained in suicide interventin. After training, participants in the safetalk prgramme shuld be able t: 1. Challenge attitudes that inhibit pen talk abut suicide. 2. Recgnize a persn wh might be having thughts f suicide. 3. Engage them in direct and pen talk abut suicide. 4. Listen t the persn s feelings abut suicide t shw that they are taken seriusly. 5. Mve quickly t cnnect them with smene trained in suicide interventin Evaluatin Aims The verarching aims f the evaluatin f safetalk were t ascertain: The views and expectatins f key stakehlders f safetalk Perceptins n relevance and use f safetalk The specific bjectives were t btain the perspectives f participants, spnsrs and trainers n: Planning and set up f safetalk Training cntent, materials and delivery Whether safetalk training sessins meet the expectatins f participants 4
The extent t which safetalk facilitates suicide alertness, that is, recgnitin f suicide risk and nward referral t ASIST trained helpers and ther supprt agencies in the cmmunity Hw safetalk fits in with ther training Perspectives n targeting - fr wh shuld the training be prvided? The evaluatin als aimed t identify whether and hw participants used skills gained frm safetalk after the sessin. Methds A range f methds were used t evaluate the safetalk pilt including: Analysis f safetalk curse feedback data cmpleted immediately after training Telephne interviews with safetalk participants ASIST Trainers Fcus Grup safetalk pilt spnsrs fcus grup ASIST trained helpers email survey Key Findings The evidence frm the pilt evaluatin suggests that SafeTALK can achieve its gals and feedback frm evaluatin participants indicated that these bjectives were largely achieved. A cnsistent finding that emerged frm the evaluatin was participants high level f satisfactin with the curse despite the fact that in many cases this was a first training delivery by all trainers. The safetalk prgramme cntent was very well received and the majrity f cncerns were abut marketing and disseminatin. Ninety-three percent (n=222) f thse wh cmpleted feedback sheets said that they wuld recmmend the curse t thers. Eighty percent (n=191) f safetalk participants felt they were mre likely t recgnise the signs f smene being at risk f suicide, t apprach the persn, t ask them directly whether they were having suicidal thughts and t be able t cnnect them t help. N curse attendees felt unprepared t talk abut suicide fllwing the training. The participants interviewed by telephne were almst withut exceptin full f praise fr the cntent and the delivery f the training, ften mentining their psitive experience when they were asked if they had anything further t add The interviewed participants wh were invlved in suicide preventin in their lcal area were all keen t bring safetalk training t their area after attending the curse. 5
Rll-ut f safetalk: implementatin issues The evaluatin findings bradly supprt the rll-ut f safetalk acrss Sctland. Hwever the evaluatin als raises a range f develpment issues that shuld be addressed as part f the implementatin f a rll-ut prgramme. Tw verarching develpment issues arise frm this evaluatin: the need fr clear infrmatin n the differences between, and apprpriate usage f, suicidetalk, safetalk and ASIST the need fr agreement between services and agencies abut rles and respnsibilities regarding the supprt f individuals at risk f suicide. The apprpriate usage f suicidetalk, safetalk and ASIST Incnsistencies in evaluatin participants understanding f hw safetalk fits with ther training suggest that awareness f the cmplementary relatinship between different LivingWrks suicide preventin training curses amngst thse invlved in their implementatin culd be imprved. SafeTALK cannt be viewed in islatin and was designed t be part f a wider training framewrk as described in detail in the intrductin t this reprt. Increasing awareness amngst thse invlved in the rll ut f safetalk f hw it fits with suicidetalk and ASIST shuld underpin the apprach t the rll-ut prgramme. Thse invlved in rll-ut shuld cnsider the balance required between ASIST and safetalk in each different setting in which the training is being delivered, based n identifying the need fr interventin and/r alertness skills within that envirnment. Increasing capacity fr delivering safetalk training T ensure effective rll-ut f safetalk thrughut Sctland, it was felt that mre training fr trainer places are needed and the issue f whether training fr trainers shuld remain pen nly t ASIST trainers was raised alngside cncerns that this culd limit the ptential fr rll-ut. Lifting this restrictin shuld be cnsidered fr the rllut. LivingWrks are in the prcess f pilting a number f T4T frmats and pprtunities fr nn ASIST trainers t becme safetalk trainers. Increasing uptake f safetalk T increase awareness, uptake and the prfile f safetalk amngst thse nt already invlved in Chse Life netwrks, mre publicity is needed. This culd be in the frm f a natinal campaign, lcal publicity and/r the running f demnstratin sessins. Linking in with lcal cmmunity netwrks and large rganisatins such as the NHS, cuncils and scial services departments was als suggested as a way t increase interest in safetalk. 6
Rles and respnsibilities regarding the supprt f individuals at risk The feedback frm all grups f evaluatin participants suggests that the main issue that needs t be reslved befre further rll-ut is systems used by peple trained in safetalk t link peple at risk with apprpriate interventin supprt such as ASISTtrained helpers. The evaluatin suggests that the current netwrks and crdinatin amngst ASIST trainers, ASIST-trained helpers and ther ptential suicide interventin resurces within lcal cmmunities necessary t make this pssible may nt be sufficient. Additinally, awareness f the referral aspect f safetalk amngst ASIST-trained helpers is debateable and thse participating in the evaluatin were split n their willingness t be identified as a cntact pint. It shuld be nted here that safetalk was nt advertised utside the pilt areas s awareness wuld be lw, hwever given this lw awareness it is encuraging that many ASIST-trained helpers said that they were willing t accept referrals. Althugh it is imprtant t state that ASIST-trained helpers will nt be expected t accept referrals frm suicide alert helpers (it is a vluntary rle) and therefre presents a key develpment challenge. It is crucial that this issue is carefully cnsidered in settings r cmmunities where safetalk may be rlled ut, s that neither safetalk participants nr thse they are linking peple at risk with feel they are left withut back-up. Ptential ptins fr develpment include: the develpment f a netwrk f lcal agencies that are willing t accept referrals frm safetalk-trained helpers including vluntary agencies, helplines and statutry primary and secndary health and scial services which have a key rle t play emplyer rganisatins may wish t fllw the example f SAMH, the MOD and the Frestry Cmmissin, where safetalk participants are given infrmatin abut wh the ASIST-trained individuals are, and clear referral pathways are develped when peple wh are trained in ASIST are t be a cntact pint, they shuld be cnsulted n and given the supprt they need t deal with this respnsibility. (This has been added t the netwrking sectin f ASIST and is t be disseminated t trainers sn.) In cmmunities where there is n ne identifiable that a safetalk-trained helper might refer t, safetalk may raise awareness f this issue and ask participants if they want t r believe smething culd be dne abut it. 7
1 INTRODUCTION 1.1 Plicy backgrund Chse Life The Natinal Prgramme fr Imprving Mental Health and Well-being was established in 2002 as a key driver f the then Scttish Executive's cmmitment t imprve health and achieve scial justice. A key plicy aim f the Natinal Prgramme is the preventin f suicide and suicidal behaviur. Chse Life: the Natinal Strategy and Actin Plan t Prevent Suicide in Sctland was launched in 2002 as a majr strand f the Natinal Prgramme s cntributin twards achieving this aim. The verall strategic aim f Chse Life is t reduce suicides in Sctland by 20% by 2013. T achieve this it has a number f supprting bjectives which are: Early preventin and interventin Respnding t immediate crisis Lnger term wrk t prvide hpe and supprt recvery Cping with suicidal behaviur and cmpleted suicide Prmting greater public awareness and encuraging peple t seek help early Supprting the media Knwing what wrks Chse Life actin t prevent suicide is supprted at bth natinal and lcal levels: at a natinal level by a Natinal Implementatin Supprt Team (NIST) and at a lcal level, thrugh suicide preventin actin plans, agreed and supprted by cmmunity planning partnerships (CPPs). In mst areas, a Chse Life partnership was established as a subgrup f a CPP and a nminated Chse Life C-rdinatr identified, r appinted. A key delivery rute fr bth natinal and lcal suicide preventin actin has been the develpment and prvisin f suicide preventin and awareness raising training and Chse Life has allcated 165k per annum twards a training strategy. NIST has appinted a natinal training manager and a training c-rdinatr t lead the develpment f a natinal training strategy. This has included the intrductin and rllut acrss Sctland f training packages such as suicidetalk, and mainly ASIST. At a lcal level, a range f training has been develped and implemented t meet lcal needs. 1.2 Suicide preventin training in Sctland ASIST ASIST was develped in Canada in 1983 t facilitate early preventin and interventin fr thse wh may be at immediate risk f suicide. ASIST als aims t supprt the develpment f a suicide safer cmmunity by infrming and giving skills t members 8
f the cmmunity s that they feel cnfident t intervene if they encunter peple they cnsider t be at risk f attempting r dying by suicide. ASIST is a 2-day curse aimed at enabling peple t spt the risk f suicide and intervene t prevent the immediate risk. ASIST implementatin in Sctland is currently under independent evaluatin. SuicideTALK SuicideTALK was designed t fill an awareness gap between what peple generally knw abut suicide and what they need t understand abut suicide including: Suicide is a majr cmmunity health prblem Anyne can be at risk Suicide can be prevented and there are things that can be dne t prtect neself and thers Open and direct talk abut suicide is a key t preventin There are many different ways that ne can cntribute t the preventin f suicide SuicideTALK des nt aim t teach skills. SafeTALK SafeTALK is a new prgramme frm LivingWrks Educatin. Develpers in Australia and Canada designed and field trialled safetalk in 2004-05 based n stakehlder reprts f a training gap between suicide awareness sessins (suicidetalk) and suicide interventin skills training (ASIST). SafeTALK Gals SafeTALK is a half-day training prgramme, which can be used either as a stand alne r as a precursr fr ASIST training. It has an awareness and training fcus and teaches participants t recgnise and engage persns wh might be having thughts f suicide and t cnnect them with cmmunity resurces trained in suicide interventin. After training, participants in the safetalk prgramme shuld be able t: 1. Challenge attitudes that inhibit pen talk abut suicide 2. Recgnize a persn wh might be having thughts f suicide 3. Engage them in direct and pen talk abut suicide 4. Listen t the persn s feelings abut suicide t shw that they are taken seriusly 5. Mve quickly t cnnect them with smene trained in suicide interventin Target audience SafeTALK is apprpriate fr mst members f a cmmunity, t give participants the skills t recgnise that smene may be suicidal and t cnnect the persn t smene with suicide interventin skills. 9
Structure and cntent SafeTALK stresses safety while challenging tabs that inhibit pen talk abut suicide. The prgram recmmends that an ASIST-trained individual r ther cmmunity supprt persn be at all trainings. The safe f safetalk stands fr suicide alertness fr everyne. The TALK letters stand fr the practice actins that ne des t help thse with thughts f suicide: Tell, Ask, Listen, and KeepSafe. The safetalk learning prcess is highly structured, prviding graduated expsure t practice actins. The prgramme is designed t help participants mnitr the effect f prevalent scietal beliefs that can cause therwise caring and helpful peple t miss, dismiss, r avid suicide alerts. Participants practice the TALK step actins t mve past these cultural barriers. Six 60-90 secnd vide scenaris are selected frm a library f scenaris and strategically used thrugh the training t prvide experiential referents fr the participants. A table summarising the differences and similarities between safetalk, ASIST and suicidetalk is prvided in Appendix A. These three prgrammes are part f a set f five LivingWrks prgrammes fr enhancing suicide interventin capabilities. Scttish safetalk Pilt As part f the develpment f a cmprehensive suicide preventin training prtfli in supprt f the Chse Life bjectives in Sctland, a 6 mnth pilt f safetalk was initiated by the Chse Life Natinal Implementatin Supprt Team (NIST) in June 2006. There was initial interest in safetalk within the abve netwrk but an assessment f the relevance and quality f the curse was required prir t implementing a Sctland wide prgramme f training. In respnse t this the Scttish Develpment Centre fr Mental Health (SDC) was cmmissined by NIST t evaluate the pilt and assess the implicatins fr further rll-ut f safetalk. The pilt was jintly funded by NIST, and the pilt agencies which included the fllwing self-selected rganisatins: Three Lcal Authrity Areas: Argyll and Bute Dumfries and Gallway Western Isles Scttish Assciatin fr Mental Health (a natinal vluntary mental health agency) COPE (a lcal vluntary mental health agency based in Drumchapel) Ministry f Defence A ttal f 239 participants were trained in safetalk ver the curse f the pilt. In each pilt area/rganisatin an ASIST trainer was respnsible fr the implementatin f the pilt. There was n standard apprach t the selectin f participants r marketing f the safetalk acrss pilt sites. Selectin f participants fr the training varied depending n which emplyers were signed up t participate in the pilt and hw the pilt was advertised in each pilt site. Reviewing this activity was nt a fcus f the evaluatin. 10
In all pilt areas there was a higher prprtin f ASIST-trained helpers attending the training than wuld nrmally be expected due t their interest in hw the curse fitted with the ASIST training they have received and in sme cases deliver. During the pilt SAMH rganised tw demnstratin safetalks fr key stakehlders in the Chse Life suicide preventin and training netwrks, a number f evaluatin participants attended these events. 1.3 Evaluatin Aims The verarching aims f the evaluatin f safetalk were t ascertain: The views and expectatins f key stakehlders f safetalk Perceptins n relevance and use f safetalk The specific bjectives were t btain the perspectives f participants, spnsrs and trainers n: Planning and set up f safetalk Training cntent, materials and delivery Whether safetalk training sessins meet the expectatins f participants The extent t which safetalk facilitates suicide alertness, that is, recgnitin f suicide risk and nward referral t ASIST-trained helpers and ther supprt agencies in the cmmunity Hw safetalk fits in with ther training Perspectives n targeting - fr wh shuld the training be prvided? The evaluatin als aimed t identify whether and hw participants felt that they used skills gained frm safetalk after the sessin. 11
2 METHODS T address the key questins identified as f central interest in the implementatin f the pilt, as set ut abve, the evaluatin cmprised a number f strands f data cllectin. 2.1 Analysis f safetalk curse feedback data Standardised feedback sheets develped and prvided by LivingWrks Inc. were distributed t all safetalk training participants immediately fllwing cmpletin f their training (see Appendix B). T gain insight int the backgrund f safetalk participants and their views n the training, these participant feedback sheets were analysed by the evaluatin team. The feedback sheets included: prfile infrmatin f safetalk participants, including their ccupatin and emplyer, previus experience f suicide preventin (training) and rute int safetalk, their views n the impact f the curse, its facilitatin and their suggestins fr imprvement SafeTALK trainers in each pilt area cllected feedback sheets after each training sessin and secured written cnsent frm training participants fr SDC t use the data fr the purpses f the pilt evaluatin and t be cntacted fr fllw-up interviews. The infrmatin n the 239 feedback sheets returned was entered int a database by NIST staff and passed n t SDC fr analysis. 2.2 Telephne interviews with safetalk participants T gather mre in-depth infrmatin abut hw safetalk participants utilised any skills, infrmatin and cnfidence gained frm the training, it was intended t interview a subsample f 35 safetalk participants. Evaluatin cnsent frms were distributed by safetalk trainers t participants at the end f each training sessin. It was intended t sample participants t include a representative crss sectin frm different curses, delivered by different trainers and frm different parts f the cuntry, as well as different prfessinal backgrunds. Hwever, delays in btaining sme cnsent frms, and difficulties recruiting interview participants, meant that the sampling plans needed t be revised. In the end, the evaluatin team cntacted all thse participants wh had submitted cnsent frms and invited them t be interviewed. Of the 106 wh returned cnsent frms, 61 were successfully cntacted and asked if they wuld like t be interviewed. Frty-fur training participants agreed t be interviewed, althugh 10 f these were nt available at the time f interview. A ttal f 34 individuals were successfully interviewed. 12
A structured questinnaire (Appendix B) was used t review participants expectatins f the cntent and impact f safetalk, their perceptins f the value f alertness training and hw the training had been and culd be used in their cmmunities. The interviewer used ntes t recrd the interviews. 2.3 Trainers Fcus Grup The seven individuals frm Sctland wh were trained t deliver safetalk as part f the pilt were invited t participate in a trainers fcus grup. A fcus grup was held with fur f these trainers t cnsider their experiences f: setting up and delivering the training the range f peple reached (and nt reached) cultural relevance f the material whether and hw the curse cmplemented ther training perceived impact n ther lcal resurces and what else is required t imprve/develp safetalk as a resurce A cpy f the trainers fcus grup schedule is available in Appendix B. A further tw safetalk trainers, wh culd nt attend the fcus grup, were interviewed at a later date by telephne using the fcus grup questins. The final trainer was nt available t participate in the research due t ther cmmitments. 2.4 Spnsrs fcus grup Five f the seven trainers were able t identify individuals r agencies wh had financially spnsred them t becme safetalk trainers; the remaining tw trainers were either self-funded, r had identified the funds t participate in the training themselves. A fcus grup discussin was held with representatives f fur f the five spnsrs f the training pilts. This included tw Chse Life C-rdinatrs, ne lcal agency, Drumchapel Life, and ne natinal agency, the Scttish Assciatin fr Mental Health (SAMH). The fcus grup explred: Hw safetalk has wrked in practice and any issues arising Hw the hst agencies perceived safetalk t fit in with ther training and suicide preventin activities Practical cnsideratins relating t csts, targeting and effectiveness Hw safetalk culd best be develped if it were t be rlled ut mre widely A cpy f the spnsrs fcus grup schedule is available in Appendix B. 2.5 ASIST-trained helpers email survey Peple wh were ASIST-trained but had nt been invlved in the safetalk rll-ut were asked t participate in a brief, annymus email survey t ascertain their views abut 13
use f safetalk and referral t peple wh have cmpleted ASIST (see Appendix A fr a cpy f the questinnaire). NIST prvided a sampling frame t SDC which included the names and email addresses f thse wh had been ASIST trained in each Lcal Authrity, apart frm the pilt areas, wh fitted the fllwing criteria: Trained within the last year Having given cnsent t be cntacted fr the ASIST evaluatin It was expected that these individuals were likely t still have the same cntact details and be agreeable t be cntacted t participate in the evaluatin. Frm this, a randm selectin f up t 30 individuals (in sme areas less than 30 peple had been trained within this timeframe) frm each f the 23 lcal authrity areas fitting the abve criteria was made by SDC and this sample (n=514) was emailed t be invited t participate in the survey. Frm this sample, 383 prved t be wrking email addresses, with 131 returned as undeliverable. A survey questinnaire was attached t the email invite and sample members were asked t cmplete this within three weeks and return by email t the SDC. A reminder email was als sent. Only thirty-five individuals respnded t the survey (9% f sample). The number f incrrect email addresses cntributed in part t this return rate, and lw awareness f safetalk training (as evident frm thse wh did respnd) may als have been a factr. The respnses t the ASIST-trained helpers survey shuld therefre nt been viewed as necessarily representative f all thse trained in ASIST. 2.6 Analysis Quantitative data frm the safetalk feedback frms was analysed by taking frequencies and crss-tabulatins using SPSS. Qualitative data were analysed using a staged cntent analysis t identify themes. 14
3 FINDINGS 3.1 Curse feedback frms Respnse A ttal f 239 safetalk participant feedback sheets were cmpleted during the pilt, i.e. all thse participated filled ut a frm. The analysis belw includes all participants acrss the pilt areas, it was nt cnsidered useful t cmpare between pilt sites as a similar range f issues were raised by participants in each curse. Occasinally up t 2 participants did nt answer a particular questin s the ttal f respndents varies very slightly between questins. Participant Characteristics Just ver half (53%) f participants had fund ut abut the curse thrugh their emplyer, 14% thrugh a friend r c-wrker and anther 14% thrugh ASIST. The Chse Life website and ther publicity were nly mentined by 6% f participants, while the remaining 13% had fund ut abut safetalk in ther ways. Mst participants (227) had taken the curse t assist them in their wrk (20 f these participants said they tk part because f their vlunteer wrk) and anther 20 participants citing persnal reasns. Sme participants cited bth wrk and persnal reasns. Table 1 presents an verview f participants prfessinal backgrunds. As the categry ptins were fairly brad, many respndents ticked tw r mre ccupatins t best describe their rle. Table 1: Participants prfessins Occupatin N. f participants Mental health 109 Physical health 33 Crrectins / Plice 26 Sprt and recreatin 20 Educatin and training 12 Service industry 11 Pastral care / Clergy 10 Defence 3 Other 43 The mst cmmn prfessinal backgrund was mental health as a brad categry which may include a variety f rles frm Supprt Wrker t Psychiatric Nurses. Hwever, these results demnstrate that safetalk training was undertaken by a brad cnstituency f individuals. Figure 1 belw prvides an illustratin f the level f suicide preventin training participants had attended prir t the safetalk curse. 15
Figure 1: participants previus training 125 100 N. f participants 75 134 50 25 21 40 42 0 nne 1-3 hurs 1-2 days previus training lnger than 2 days Just ver half f all participants (53%) had nt received suicide-related training befre. The majrity (75%) f all participants had experience f talking t smene with thughts f suicide, as illustrated in figure 2. Figure 2: number f times talked abut suicide 60 N. f participants 40 64 53 53 20 31 36 0 never nce 2-5 times 6-20 times number f times talked abut suicide mre than 20 times 16
There was a psitive crrelatin between the amunt f training participants had received and hw many times they had talked t smene abut their thughts f suicide. An analysis f the feedback shws that 71% f thse with ver tw days training in suicide preventin had talked t smene abut their thughts f suicide mre than 20 times, cmpared t nly 14% f thse with n training. This suggests that previus training may have reached the right participants and/r had an impact n peple s willingness t brach the subject. Perceived impact f safetalk n participants Figure 3 belw shws the difference between the preparedness f participants t talk abut suicide prir t and fllwing safetalk training. Figure 3: Participants preparedness t talk abut suicide 120 befre after 100 N. f participants 80 60 40 20 0 well prepared mstly prepared partly prepared prepared t talk nt prepared As can be seen in Figure 3, at the start f the curse 58% f participants felt either well r mstly prepared t talk penly abut suicide t peple abut their thughts f suicide, which increased t 85% after the curse. The percentage f participants wh felt either partly r nt prepared t talk abut suicide decreased frm 40% befre the curse t nly 10% f participants feeling partly prepared and n ne feeling unprepared after the curse. The reprted impact f safetalk n participants perceived ability t respnd t a persn at risk f suicide is summarised in Table 2 belw. When participants failed t answer each f the questins they were excluded frm the analysis. 17
Table 2: Impact f curse n perceived ability t respnd t persn at risk Recgnise signs Apprach persn Ask directly Cnnect t help Much mre likely 44% (106) 37% (89) 41% (98) 55% (132) Mre likely 39% (94) 44% (106) 40% (95) 29% (70) Abut the same 16% (38) 18% (43) 19% (45) 15% (36) Less likely 0% (0) 0% (0) 0% (0) 0% (0) In respnse t questins abut hw well participants felt able t recgnise and respnd apprpriately t smene at risk f suicide, the curse was felt t have had a significant psitive impact (see Table 2). N ne felt that safetalk had made them feel less able t handle the situatin. Over 80% f all respndents reprted that after the curse they were either mre likely r much mre likely t recgnise the signs f smene being at risk f suicide, t apprach the persn, t ask them directly whether they were having suicidal thughts and t be able t cnnect them t help. A minrity felt that the curse had made n difference (less than 20%); it is pssible that this culd be partly accunted fr by thse attending the curse wh were als ASIST trained, wh may have been less likely t experience a change in their abilities. T explre this further, analysis f this impact data was carried ut t ascertain the impact f safetalk n nly thse wh had three hurs r less suicide preventin training (n=157). The results f this analysis are in table 3 belw. Table 3: Impact f curse n perceived ability t respnd t persn at risk fr thse with less than 1-2 days training Recgnise signs Apprach persn Ask directly Cnnect t help Much mre likely 46% (72) 33% (52) 38% (60) 54% (86) Mre likely 41% (65) 50% (78) 46% (73) 35% (55) Abut the same 13% (20) 17% (27) 16% (23) 11% (16) Less likely 0% (0) 0% (0) 0% (0) 0% (0) ttal 100% (157) 100% (157) 100% (157) 100% (157) The data in table 3 demnstrate that there was n significant difference between thse wh had three hurs r less previus suicide preventin training and thse wh had ne day r mre previus training in terms f perceived ability t respnd t persns at risk. Feedback n the Quality f safetalk Overall, the questins abut the quality f the curse were answered psitively. Sixtytw percent f participants strngly agreed that the trainer was well prepared, ne persn disagreed with this statement, while the rest either partly agreed r agreed. Almst all participants (99.2%) either strngly agreed r agreed that the trainer had been respectful f and encuraged respnses frm participants, with n ne disagreeing. Ninety-three percent f participants said they wuld recmmend safetalk 18
training t thers. Als, mst f the verall cmments made n the frm were psitive, with such respnses as: Excellent curse, has prepared me well fr being Suicide Alert The trainer was very clear and I feel the training has helped me t understand and feel mre able t talk t smene suicidal. Suggested imprvements t curse cntent and frmat When asked hw the curse culd be imprved, eleven participants felt that there was a need fr mre rle play, t give participants mre f a chance t reinfrce the skills that they were learning. One persn felt that rle play wuld be mre realistic if actrs culd play the part f the persn at risk f suicide. Hwever ne participant felt that the current frm f rle play was perhaps nt safe: I didn't like participants turning t each ther t ask abut suicide in case smene actively was. Five (2%) participants felt that the vides shuld be imprved, because they were unrealistic, hard t fllw r difficult t take seriusly. Six participants (2%) said the curse shuld have been mre heavily publicised s that mre participants wuld have attended. Referral n t a suicide interventin trained helper The effectiveness f SafeTALK relies n the safetalk-trained helper being able t refer the persn at risk n t smene wh can review the risk and develp a keep-safe plan. Ten (4%) participants cmmented they needed mre and clearer guidance n referral resurces in their lcal cmmunity. Apart frm participants in wrkplaces hw will I recgnise participants wh can help? There des nt seem t be any way t link up with a persn wh is ASIST trained - needs t be srted in rder t make this an effective strategy. Training culd be mre effective if there was a mre c-rdinated lp f help i.e. bringing tgether helpers with a pssible list f ASIST wrkers t give a mre cntinuus line f care. Targeting There were als sme suggestins fr the targeting f safetalk; several participants felt that training shuld be ffered t new staff r early n in a new jb, whereas tw participants felt that mre health care prfessinals, such as GPs, shuld attend suicide alertness training, such as safetalk r suicide interventin training such as ASIST. 19
3.2 Telephne interviews with safetalk participants Respnse The evaluatin team cntacted all thse participants (n=106) wh had submitted cnsent fr the safetalk evaluatin. Thse participants wh were successfully cntacted (n=61) were then asked if they wuld like t be interviewed. Frty fur training participants cnsented t be interviewed. Ten were nt available at the time f interview leaving a ttal f 34 individuals interviewed. The interviews tk place up t six mnths after participants had attended safetalk. Participants were asked abut their perceptins n the curse and its impact, as well as hw safetalk fits in with ther suicide preventin training and hw it shuld be targeted. Interviewees backgrunds Ten f the peple interviewed wrked in jbs in which they regularly came int cntact with peple with mental health issues, fr example, in mental health supprt wrk r the ambulance service. Three peple had gne n t d the ASIST training since attending the safetalk curse. Ten interviewees wrked in jbs which did nt explicitly have a mental health remit, such as teaching r psitins in the department f wrk and pensins, ne f these had gne n t cmplete ASIST. Table 4 shws the pilt areas interviewees were trained in. Table 4: Interviewees by area and prfessin Area Mental healthrelated prfessin Nn-mental healthrelated prfessin Ttal SAMH 5 5 10 Western Isles 0 5 5 Dumfries & Gallway 1 0 1 Argyll and Bute 4 0 4 Ttal 10 10 20 In additin t these twenty interviews, furteen ASIST trainers, Chse Life crdinatrs, members f NIST and thse invlved with lcal planning arund suicide preventin training, wh had taken the safetalk curse in rder t see what it had t ffer, were als interviewed. They had mstly attended safetalk training prvided by SAMH, but came frm areas thrughut Sctland. Expectatins f and reasns fr attending safetalk I hped it wuld make me less afraid. The wrd suicide is ften quite frightening. I hped I d be mre able t use the wrd suicide if I thught peple were thinking abut it. I hped it wuld make me mre apprachable fr peple wh were having thughts abut suicide and make peple mre cnfident that they can talk t me. (interviewee) 20
In terms f their expectatins f safetalk, sme interviewees had nly heard a shrt time in advance that they were taking the curse and therefre did nt knw what t expect, while the ther interviewees expectatins mstly centred arund learning hw t recgnise that smene may be at risk f suicide and hw t help them. One interviewee wh wrked in a mental health rganisatin but had n direct cntact with service users said she had actually been quite apprehensive abut taking the training, feeling that it was utside f her cmfrt zne and that she wuld nt have much t cntribute, but afterwards she was glad she had attended. Reasns fr attending safetalk als varied: Three peple were required by their emplyers t attend the training while all thers tk the curse because they felt it was an imprtant tpic Thse wrking in the caring prfessins had ften cme acrss a situatin in which smene was at risk f suicide and wanted t be able t deal with such situatins better Interviewees in Strnway mentined the high incidence f suicide in their area as a reasn fr attending the training Six interviewees mentined having been persnally affected by suicide, ranging frm having thught abut it themselves in the past r having a family member wh attempted suicide t mre distant cnnectins t peple wh cmpleted suicide The ASIST trainers and thse affiliated with Chse Life r lcal suicide planning understandably had different reasns fr taking safetalk. Mst said that they wanted t see hw safetalk wuld fit in with ASIST and whether it wuld be useful t ffer in their area. One interviewee als felt that attending wuld prvide her with a gd pprtunity t meet thers invlved in suicide preventin training. The feedback frm interviewees was verwhelmingly psitive with regards t which expectatins had been met. Tw interviewees had expected the curse t give mre pprtunity fr the sharing f persnal experiences arund suicide, but understd that there was little time fr that in three hurs. Other than that, all expectatins were satisfied, and several peple said that they had been exceeded. Lnger term impact f safetalk Awareness Thse wh wrked in prfessins utside the care sectr all said that the curse had an impact n their awareness f suicide. Fur peple said it had made them aware that suicide is much mre cmmn than they thught, and five peple were shcked t hear f the high incidence f suicide in their area. The main thing I tk ut f the training was that 1 in 20 peple think abut suicide in any given week; I thught that was eye-pening. 21
Of thse wh wrked in caring prfessins, nly ne persn said that the curse had increased her awareness; she was surprised t learn that her area, t which she had recently mved, had a high incidence f suicide. One interviewee als said that attending the curse had made her realise that having thughts f suicide culd be a nrmal reactin t life events and that it is nt nly thse with mental health prblems wh are at risk f suicide. Other interviewees had gne n t discuss suicide rates with clleagues, which had resulted, in ne instance, in clleagues describing their wn experiences f depressin. Recgnising the signs Furteen interviewees felt that the curse had helped them recgnise the signs f smene being at risk f suicide. Several peple talked f having becme aware f the need t read between the lines f what peple are saying, r lking behind their wrds and thught that they wuld nw pick up n signs that they may have missed in the past, such as a change in md frm smene s usual dispsitin. Peple als felt mre cnfident that they culd detect the difference between smene wh is just dwn and smene wh may be at risk f suicide. Almst everyne felt that after safetalk they were mre aware f and pen t the signs f peple being at risk f suicide; tw peple thught they wuld have been just as aware befre the training. Respnding t smene at risk Ten f the interviewees wh were new t suicide preventin training felt that the curse had changed the way they wuld respnd if they thught smene was at risk, with nly ne persn feeling that it had nt made much difference. Peple said that they were nw less likely t stick their head in the sand r think that peple at risk were kay, dismissing them with a never mind. Instead, they felt they were nw mre likely t act, t ask questins and t get peple help. Several peple said that the curse had reduced their anxiety abut appraching smene and their fear f saying the wrng thing, giving them the cnfidence t step in. One interviewee said that it had emphasised fr her that she has a respnsibility t intervene when she thinks smene is at risk f suicide. Thse wrking in mental health-related prfessins were just as likely t feel that the curse had changed the way they wuld respnd t smene at risk f suicide as thse wrking in different types f jbs. Hwever, as mre f them had cme acrss a situatin where smene was at risk f suicide in the past, they were mre likely t say that the curse had als enabled them t check whether the ways in which they had handled these situatins was apprpriate. One interviewee said: I had a certain amunt f cnfidence, but it was refreshing t knw that sme f the ways I wuld have dealt with things were exactly the way t d it and sme things we were tld were different. The interviewees wh were als ASIST trainers understandably did nt learn a new apprach n the safetalk curse. Equally, it was difficult fr thse wh had attended ASIST training after the safetalk curse t distinguish what the impact f safetalk, n its wn, had been. 22
Issues regarding directly asking smene whether they are cnsidering suicide The main way in which the curse was thught t have impacted n the interviewees respnses t smene at risk f suicide was thrugh learning the imprtance f asking directly whether an individual is cnsidering suicide. While sme f thse in mental health-related prfessins indicated they might have asked befre the curse as well, mst said this was a new apprach fr them. One interviewee said that in the past she tried t distract peple frm negative and suicidal thughts, rather than address the issue. Almst all f thse in prfessins withut a mental health remit suggested that prir t the safetalk training, they wuld nt have asked peple at risk if they were thinking f suicide, at least nt right away. In the past they were either afraid t bring up the subject, r had wrried that they culd push peple ver the edge. Several peple recunted hw these fears were directly addressed and allayed in the safetalk curse and mst interviewees said they wuld nw ask if peple were thinking f suicide, which cnstituted a significant change in thinking fr many. I wuld never have asked the questin directly befre; I wuld have shied away frm it. Nw I wuld nt feel cmfrtable asking, but I wuld d it, because that s what we were taught and that s what yu have t d. I wuldn t have befre, s the curse has been very gd frm that pint f view. Fur peple felt they wuld nly be able t ask peple directly when they wrked with them in a supprting capacity r knew them well. They felt it wuld be difficult t ask strangers smething s direct and persnal, althugh ne persn said she hped she wuld be able t vercme this. Amngst the interviewees there were fur teachers, tw f whm felt that they culd nt directly ask children at risk in their schl whether they were thinking f suicide. One said that she thught this wuld be inapprpriate. I culdn t d it with children, prfessinally I culdn t be seen t be suggesting it. Nt in my line f wrk, anyway, I wrk with very yung children. The ther teacher felt that they shuld check with their line manager r anther member f staff regarding the best curse f actin if she thught a child in her class was at risk f suicide. Hwever, anther interviewee, wh had taken bth safetalk and ASIST, explicitly said that it was the safetalk curse, with its emphasis n the imprtance f asking, rather than ASIST, that had made her feel she culd directly apprach a child wh she thught might be at risk. Amngst thse in prfessins withut a mental health remit there were sme interviewees fr whm asking the questin directly had nt been a main message f the curse, and ne interviewee wh felt that in her line f wrk it wuld be inapprpriate. I wuld never ask my custmers whether they were thinking f suicide. I just culdn t. We deal with a lt f bereaved peple and it s the last questin yu shuld ask them. 23
Three interviewees, ne f whm wrked in mental health, questined whether asking the questin wuld be as straightfrward and as successful as the curse suggested. One f these interviewees had been suicidal herself and felt that she wuld nt have pened up just because smene asked her and the mental health wrker said that in her experience it can take an extended perid f time and a lt f skill t get peple t respnd hnestly t this kind f questin. Stigma Five interviewees felt that a main impact f safetalk training was the way in which it cunteracted stigma and gave peple the chance t talk abut the difficult tpic f suicide and hpefully enabled them t be mre pen and cmfrtable with it in the future. The media has a biased view n this subject, and prmtes stigma and guilt, but this curse blasts that away. It is abut being pen and hnest. Use f safetalk skills Eight interviewees had, since their safetalk training, been in a situatin in which they felt that smene culd be at risk f suicide. These instances and the interviewees descriptins f their respnse are summarised belw. 1. One persn, wh had als been trained in ASIST, was tld n tw ccasins by clients that they were feeling suicidal and was grateful that she knew what t ask them and that she had gained interventin skills by taking ASIST. 2. Anther interviewee, trained in ASIST, was wrried abut a client f her mental health service and felt that, while she drew n ASIST skills, the safetalk training had als been relevant. I picked up quickly that what they were telling me was different frm what they had said befre. I asked them directly if they were thinking f suicide, I wuldn t have used the wrd suicide befre. It had a psitive utcme because the persn was like She gt it, she has understd what I am saying 3. One persn, withut a prfessinal mental health remit, was tld by a client ver the phne that he was suicidal. She had been in a similar situatin befre safetalk and felt that the training had nt made much difference t her respnse; she kept him n the line and tried t put supprts in place t help him deal with his situatin, but did nt refer him t smene trained in suicide interventin. 4. One interviewee, wh had als attended ASIST training, came acrss a wman crying n a bridge and asked her if she was thinking f suicide. She said she wasn t thinking f jumping but that she was drunk enugh t fall in. We had a chat and she thanked me fr talking t her and said that I had cheered her up. She was a traveller and nt that many peple speak t them. S 24
I was thinking t myself Well, I was wrng but at least I have cheered smebdy up. 5. Anther interviewee became cncerned abut her friend during a phne cnversatin in which her friend disclsed hw dwn she was. I asked her if she thught f harming herself, and was reassured that she didn t. She laughed it ff and we talked a bit. I think she was depressed, but she wasn t at risk f suicide. 6. One interviewee felt she used her skills when ne f her clients at wrk was feeling dwn; she emphasised the imprtance f talking abut ne s feelings and helped him recgnise the supprt that already existed in his life. 7. A few days after the curse, ne interviewee felt that smene was at risk f suicide and said that the curse gave her the script t fllw, which made her feel mre cnfident abut hw t respnd. As it happened there were n suicidal thughts present, but safetalk made it easier fr her t find the wrds with which t raise the subject. 8. One f the interviewees withut a mental health remit was apprached by smene she knew wh was wrried abut a friend. After discussing the situatin, they bth went t this friend s huse and, while it tk a lng time fr the dr t be answered, the persn in questin was kay. She felt that she wuld have prbably dne the same befre the safetalk curse, but that she wuld nt have been as aware f the pssible cnsequences f nt acting. Seven ther interviewees said that, while they had thankfully nt cme acrss anyne at risk f suicide, they were nw mre aware f this being a pssibility and mre sensitive t any pssible signs. I am mentally lking ut fr it mre; it s just never gt t the pint where I ve been alarmed enugh t d smething abut it. I did talk t peple t find ut hw they were, but I didn t get anywhere near t having t ask the questin. Nte: It is imprtant t nte the shrt timescale between attending safetalk and interview, given mre time, a larger number f interviewees may have had experiences t reprt. Mst useful aspects f the curse When interviewees were asked what they thught was mst useful abut the curse, challenging the stigma that surrunds suicide and the fear f braching the subject were bth emphasised again. Five peple felt that the main thing they wuld take away frm the curse was the ability t be pen abut suicide, t say the wrd lud and clear and the cnfidence t ask the questin directly. Five peple als said that the vides had been very helpful in that they shwed hw t ask peple abut suicidal thughts and gave examples f signs that are easily missed. 25
There was further praise fr the vides in that they prvked discussin and brught ut the questins that interviewees had but may have been t reluctant t ask therwise. They were als felt t be apprpriately shrt and easily related t different situatins. Tw interviewees mentined the mix f the participants as an imprtant cntributr t the success f the curse; having service users, mental health staff and thers there meant that many different perspectives culd be shared. Other interviewees said that they had fund the miss, dismiss and avid language f safetalk very catchy and easy t remember and that the rle-play had been very useful and impressive in that it incrprated different age grups and pssible reasns fr suicidal thughts. Suggested imprvements Perhaps surprisingly, given the praise fr the vides described abve, the mst cmmn suggestin fr imprvement als referred t the vide-scenaris; eight peple said that they shuld be changed t fit the Scttish cntext. We were watching vides that came frm America r Canada, and they didn t really ring true t life. Like peple were just meeting fr the first time and within three minutes were asking abut suicide. It didn t seem very realistic. Maybe it was a cultural thing, and it just wasn t the right theme fr Sctland. The way the peple were behaving I d think That wuldn t happen. It was a bit utdated t; it was bviusly an ld vide. Anther cncern abut the vides frm three interviewees was that they were t sanitised; that they made asking peple abut suicide lk easy, straightfrward and quick, rather than shwing sme f the cmplexities and the pssibility f peple respnding in unexpected ways. There was sme disagreement abut the usefulness f rle-play; tw f the interviewees said that they wuld have liked t have had mre f a chance t practice asking peple whether they are thinking f suicide, while tw ther interviewees fund the rle-play uncmfrtable and unrealistic because it was cnducted between clleagues. Three interviewees felt that there shuld be refresher curses, similar t thse in First Aid, because therwise peple wh d nt cme int cntact with peple at risk f suicide may lse their skills r frget the main messages f the training. One interviewee als felt that there was nt enugh time t reflect built int the training. The safetalk curse is described as nt apprpriate fr thse wh had been recently seriusly affected by suicide r suicidal behaviur and cannt fcus n hpe r helping thers wh are still alive. One persn thught that there shuld be systems in place t enable any participants wh may have been recently affected by suicide t leave in a discreet manner. It was suggested that an early break in the training wuld give peple the pprtunity t leave discreetly rather than having t walk ut in frnt f ther peple, which they wuld currently be required t d. 26