23 August 2018

For immediate publication

Journey of Hope: admissions avoidance project delivers results

With World Suicide Prevention Day coming up on 10 September, we look at a project involving a CNWL service and a mental health charity that is delivering results:

James Hughes, the Service Manager of CNWL'sPsychiatric Liaison Services at St Mary's Paddington, cannot speak highly enough of Journey of Hope (JoH), the voluntary organisation led by Emer O'Neill. Emer was CEO of the Depression Alliance for a decade and has worked in mental health for 33 years.                  

In the last year 90 people who attended St Mary's A&E with suicidal acts serious enough to need medical treatment, were helped by JoH and that keeps them out of A&E. It's taken a year to develop the model, finessing it on the actual experience of people and how they behave.

Says James: "You can feel a bit helpless when the person in front of you is clearly acting out of overwhelming desperation; trapped. I knew Emer from previous work so we had pre-existing trust but I had to be convinced that they could handle risk - and they have!"

In the last 12 months CNWL Psych liaison at six hospital A&Es had 21,230 contacts; St Mary's had 4,974; Northwick Park in Harrow had 5,580 contacts.

James, a nurse by background, says: "Psych Liaison is a very busy service - attendances are up 20% - we probably do more assessments than any other part of CNWL. About 30% of people are known to us; so most aren't. And for a number of them, their suicidal acts, their crisis, often comes out of social desperation rather than a mental illness.

"We are very thorough and in many cases people do not need further medical or psychiatric support or specialist help from Community Mental Health Teams, or Home Treatment. So we have to make plans with them - we can refer to organisations we have googled or ask them to try various sources of support - which can include food banks or emergency finance.

"But many simply people don't follow these leads up and then there's a danger of escalation - a larger overdose, deeper cuts. It sounds odd that someone who has been suicidal is not mentally ill enough for clinical support but that's true in all services; the issue was how to help these people and Journey of Hope is one very good answer.

"Now we ask the patient's permission to pass their contact details to Journey of Hope, which is easy to do and saves treatment time for us too."

In 99% of cases JoH text the person and arrange to meet. There are no forms to fill out and no patient information is shared.

In physical health services a huge effort goes into treating people who need medical help but then making arrangements to have them supported at home; better for them but also freeing up a medical bed for more urgent cases. JoH is doing the same on mental health but wholly around social support.

This is an innovative client-led approach to suicide prevention. Emer says: "It's come from listening and talking to people about what brings them to the point of despair and what would help; often time to talk, practical help to sort out issues around money, relationship breakdown, bereavement, a network to break the loneliness and isolation that people feel."

Other innovative aspects are: JoH staff being integrated into the Psych Liaison team makes referrals easy and efficient; contacting clients within 12 hours and letting them decide where and when they want to meet, often in parks and cafes at a time that suits them.  JoH keep cases open for as long as there is a need, and inviting people to call if they relapse.

Emer says: "While patients at hospital receive excellent health care, they are often discharged without additional support, perhaps to a blood-stained flat, and remain in danger. Although their life has been saved, they can be discharged to the same circumstances that had caused them to despair, with an added burden of shame - only a fifth of people seek help from family, friends or neighbours following an attempted suicide.

"We work in partnership with the A&E Psych Liaison Service, funded by CNWL's Charitable Trust and Awards for All. Our approach is informal, friendly and flexible. This project has supported over 90 people through crisis, one to one, providing intensive emotional and practical support to resolve benefit issues, reducing isolation and loneliness and connecting people with other agencies."

These are anonymised case studies of real situations.

•"Jane"

Former banker Jane has had a long history of depression and anxiety. Over the past year her symptoms became more severe and contributed to a relationship breakdown, losing her job, feeling very isolated and drinking more than she should. She had spent most of the summer on holiday alone and came back to London feeling very low. One evening she felt it was too much and took an overdose. Psych liaison referred her to Journey of Hope.

We began meeting regularly for long walks by the canal or in Regents Park.

Jane said, "It was just so nice to have someone who contacts you when your own friends and family have given up. Losing confidence is very frightening and not knowing what to do with your day when you don't think you will ever be able to work again is awful. You (Journey of Hope) are so good at listening."

The motivation to get back on track after a suicide attempt is different for everyone. Jane wants to work, she needs to have a job, but over the months that we have been involved she has come to appreciate how she also needs to give herself time to recover and to learn about her trigger points and ways of building resilience. 

She says, "I would love to be back at work, to fill my day, and to stop myself just lying around and drinking, but I know I'm not ready yet, but it's so nice to keep the contact with Journey of Hope, just knowing that someone cares and we can meet up for a coffee is great, it's so informal."

•"Ahmed"

Ahmed, 54, is an accountant who lost his job three years ago.  He has experienced a series of traumatic life events that have left him with physical and mental health issues. He lives alone and is without friends or family.

Ahmed says, "I live in a rented flat. Over the years of unemployment I have been unable to keep up the rent payments, I accrued debt and had become so overwhelmed by everything that I could see no other way but suicide. This was not my first time, I have tried to kill myself a few times, I am so alone."

We began to develop trust over long walks in Regents Park. We slowly unravelled the many issues were that had become so overwhelming, that Ahmed felt unable to cope.

Ahmed says, "I didn't know how or where to ask for help. The benefit system was completely new to me. I had no idea how to fill in the forms and how to explain my health conditions on paper.  You were so kind to help me with all of that, and to come with me to those appeal meetings."

Over many months, Ahmed managed to work through his financial and benefit issues. He is feeling mentally stronger but still struggling with poor physical health. Journey of Hope is continues to support Ahmed in building resilience and in his dream of retraining as a counsellor.

•"Peter"

Peter is 70 years old.  Two years ago he lost his wife to cancer. He describes his marriage as being a part of a very close team, and was utterly devastated by his wife's passing.  Peter struggled on alone, and although part of a small church community, he saw his role to support them and not ask for help. Over the years he had fallen into debt, his support network dropped in numbers, he became depressed, isolated and felt unable to ask for help.

Peter says, "Last month it all got too much and I rang an ambulance as I was sure I was having a heart attack, it later turned out to be an anxiety attack. When A&E staff at St Marys asked what I thought had brought this on, I simply said, ‘I can't cope any more, I want to kill myself.'"

Peter talks a lot about his church community. Together we called a contact in the church and had an honest conversation about how he was feeling. They have agreed to help with financial problems, he has been to his GP and feels ready to talk to his friends about how lonely and isolated he has become.

Peter says, "Thank you for everything you have done for me. It all got better from having just dumped my story on you.  I needed help. I felt so much stronger knowing that you were with me. It is so good to talk to someone who didn't know me; there's only one more thing I need from you (after three visits) - a very big hug!"

JoH, having identified what works, are now making applications for funding to keep going and to increase their reach across other A&Es.

James adds: "This is a great initiative and should be expanded to other A&Es. I think it's great work and is an admissions avoidance service that helps the NHS as well as people in crisis."

Further information from: emer@journeyofhope.uk

https://journeyofhopeuk.org/

For more details:

Both Emer O'Neill and James Hughes are available for interview. Contact: Senior Communications Officer Jeremy Dunning on 0203 214 5756 or emailJeremy.dunning@nhs.net.

Central and North West London NHS Foundation Trust
Stephenson House, 75 Hampstead Road, London NW1 2PL
Tel: 020 3214 5756 e-mail:communications.cnwl@nhs.net