Time Space Compassion in suicide prevention - practice stories - Volume 2

3. Stepping Out in East Lothian

Avoiding crisis and supporting people with severe and enduring mental ill health

Stepping Out is a community based project in East Lothian, supporting people with severe and enduring mental ill health. They offer group activities, drop in sessions, a lunch club, as well as person centred support. The charity’s aim is to help people live in the community - offering choice and an alternative to the isolation and loneliness that often comes with severe and enduring mental illness. The team are made up of peer, project, and volunteer workers, and has strong connections to the community and local statutory organisations.

“It’s still a common mistake to think people impacted by trauma or illnesses like psychosis will misuse public services. For most it’s the opposite. They’re less likely to seek help or disclose distress. Missed appointments, repeat attendances – these are often signals we’re not meeting their needs. Not failure on their part to engage.”

Nicky, Stepping Out

3.1 Our challenge

Helping people develop trust and engage with public services is a key part of what we do. It enables them to address practical issues before they add to their existing mental ill-health symptoms and can reduce the risk of distress and crisis. An example is some work we did a few years back with a local GP practice. New processes had been introduced to reduce primary care waiting times, and improve access to services for the local community. This included the GP’s reception team asking people why they wanted an appointment – as a way to help prioritise and direct people to the best possible response. The people we support told us they didn’t want to disclose that they were having suicidal thoughts and feelings, as part of a process to make an appointment, and that it made them feel exposed and vulnerable. For some, the anxiety of anticipating this question, was getting in the way of them seeking help.

Our response

Through our involvement in local planning meetings, we had connections with the local GP practice. We shared what we we’d learned and the GP practice team were keen to work with us to find a solution. We ran a short trauma informed practice workshop for the reception team, covering the ways trauma can show up for people, and supporting the team to think through what that meant for them and people seeking help. The practice team put in place a simple process, that gave the people we support the option to have their patient record flagged on the appointment system. We explained the options to the people we support and gave them the choice to opt in. When they called or dropped into the surgery to ask for an appointment, the reception team could immediately see they were linked with our project. This prompted the reception team to take a bit more time over the call, check in on how the person was doing, and ask if they needed an urgent GP appointment that day.

3.2 Learning from practice

Building relationship – As support providers, we were in the perfect position to hear what people had to say about the barriers they faced. By working in partnership with us, the GP practice was able to tap into those trusted relationships. Without that, it’s unlikely people would have opted in to using this system. People felt listened to, empowered and like they mattered. When it comes to partnering with other service providers, like the GP practice, building trusting relationships over time is just as important. It helps raise and work through issues, and move quickly to action when needed. We also learned that offering a small but tangible solution, like the trauma informed practice session for the reception team, can help open up the conversation and more opportunities to collaborate.

Being clear and consistent – We used trauma informed practice principles to help us get clear on what we would ask people to do, how the GP practice would use and manage personal data and ensure the people we support understood they had the choice to opt in and out at any time. We also spent time developing clear expectations for how people would use the urgent appointment system. It gave people on both sides of the relationship a simple framework, based on mutual trust.

Making connections. Being actively involved in community planning and local structures meant we had the relationships we needed to find the people who could help us address these barriers. Working together on a project deepened these connections in a really useful way.

3.3 Impact

“Everyone’s worry was that the same day access to a GP appointment would be over-run or overused. It’s just not happened. We’d like to see this or similar approaches adopted in more places.”

Nicky, Stepping Out

It feels important to say - this was not a big or time consuming piece of work. When there’s trust - simple actions can be effective. It doesn’t always take months of work. While the numbers of people impacted aren’t high, the scale of the impact on their wellbeing, their lives and the way they use services really adds up. This quote from one of the people we support, sums up this point nicely:

“I phoned the surgery this morning and the receptionist said, ‘I see you’re with Stepping Out… what’s your day been like….do you need an urgent appointment today?’ It was a just a run of the mill appointment I needed - I couldn’t believe she asked me and checked in that I was ok – it was so nice! I just said, ‘No I don’t need an urgent appointment, but thanks for asking’.”

Learn more about and contact the team through the Stepping Out website.