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As part of a recent webinar to our funders and partners, Senior Clinical Advisor, Dr Fiona Pienaar talked about the role clinicians and volunteers on our Shout mental health text service play in suicide de-escalation for vulnerable texters. Underpinning the work they do is the importance of positive conversation.

In this blog, Fiona shares her clinical insight into suicide de-escalation, and how we can all play a role in helping guide someone to a state of calm.

Since the public launch of Shout in May 2019, the most common presenting issue that texters seek support for in conversations with us, has been suicide ideation. In the 1.8m conversations our volunteers have taken with people in distress, the issue is raised in 39% of all conversations, (followed by depression / sadness [31%]; anxiety / stress [30%], relationships [ 25%], loneliness / isolation [16%], and self-harm [15%].

Suicide ideation (SI), refers to ‘thinking about, considering, or planning suicide’ (NIMH, National Institute of Mental Health). It is a broad term used to describe a range of complications, wishes, and preoccupations with death and suicide (Harner et al, 2022). The charity Mind, describes suicide ideation as ‘having abstract thoughts about ending your life or feeling that the world would be better off without you, or it can mean thinking about methods of suicide or making clear plans to take your own life.’

How our Shout training model supports de-escalation

In Shout conversations, some texters talk openly about suicide (thoughts, plans, attempts), but some might not directly verbalise that they are feeling suicidal or thinking about taking action to end their lives. Sometimes the level of distress unfolds as the conversation develops. What is obvious to those working or volunteering in this field, is that this is complicated. The unpredictability, the fluctuating moods and thoughts, the clear signs of risk and the hidden risks, the many measures and assessments, and people’s struggle to open up about their thoughts, behaviours, and feelings.

Given the high percentage of Shout texters that talk about suicide ideation, the fact that we refer only a small percentage on to the emergency services is testimony to the training all volunteers and staff undertake and their skills in de-escalating the levels of stress people present with, under the supervision of our uniquely experienced clinical team.

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Safety planning with our texters

As a de-escalation service, our conversations at Shout aim to ‘help people from a hot moment to a cool calm’. We acknowledge that every single person who texts us has their own unique life challenges and history. Our primary focus is to help them to a calmer place so that they can consider their ‘next steps’. We co-create a safety plan with them, identifying who in their lives - personal or professional - they might talk to next, and then supporting them in developing a plan to keep themselves safe.

The purpose of de-escalation is to interrupt the highly charged emotional state people present with when they are trying to cope with challenges in their lives. Through the development of an ‘in-the-moment’ relationship with the person supporting them and the skills this person utilises, the aim is to help them regulate their emotions to a more functional state where they are able to consider how they can keep themselves safe.

It is in that de-escalation, that activation of specific life skills that we teach our Shout volunteers and staff, that we help as many people as possible, stay safe.

How we can all play a role in suicide prevention

Those skills are inherent in all of us. With awareness, we can utilise them to support people that we know, people that we don’t know but that we might notice, people that we come across in life, who are hopeful that someone will see that they are struggling; hopeful that someone will reach out to them and start a conversation.

These are skills that we can all learn to help people de-escalate when they are in a heightened state of distress:

Indeed it can be helpful to know when we ourselves need support in regulating our emotions so that we can reach a calmer state and plan our next steps in managing life’s challenges. Of course there are those who will need to be referred for emergency or professional support but for the majority of people who texted the Shout service, connecting with someone who has the skills to help them de-escalate was key to helping them manage their own wellbeing.