Evaluation, research & innovation

Prepared by the Australian Institute for Suicide Research and Prevention (AISRAP), WHO Collaborating Centre for Research and Training in Suicide Prevention School of Applied Psychology.

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Living Perspectives of Suicide is offered as a bespoke workshop that can be delivered over either a half or a full day. It is a suicide awareness and intervention skills workshop specifically for people who by nature of their workplace role, find themselves in a position of needing to support someone expressing suicidal thoughts and/or crisis. The content has been designed collaboratively and is delivered jointly by Roses in the Ocean and Lifeline Qld. Originally designed for people working within frontline call centre roles the program is also highly valuable for people working within mental health, suicide and social service areas. It is easily customisable to suit various workplace environments who are interested in gaining a new perspective of suicide and intervention skills

The workshop explores the complexity of suicide, the differing beliefs about suicide, and practical guidelines for engaging in the necessary difficult conversations with people in crisis, especially over the phone. This is particularly relevant for people in call centres, those who take incoming calls into a service etc. The concept of self-care is covered in detail, as are the practical steps to take when supporting someone in crises while professional help is sought for someone in imminent risk.

Imperative to being able to respond effectively to someone in crisis is using a person-centered approach. The person-centered approach is based on the premise that people are their own experts in experience in terms of what they might need in a suicide crisis. Carl Rogers’ person-centred theory in On Becoming a Person : A Therapist’s View of Psychotherapy is used to develop skills relating to understanding human relationships and connection (Rogers & Ransom, 1961)

Prior to discussing more in-depth topics some context setting is done to help orient participants as to why everyone in the community can and needs to be able to respond to someone experiencing a suicide crisis, whilst acknowledging that there is a need for developing some key skills. An introduction to the ABS cause of deaths data from 2018 is used to discuss the basic statistical data in Australia relating to suicide (Statistics, 2019).

To help participants understand safe, unsafe and stigmatizing language the workshop refer to the Why we shouldn’t use the ‘C’ word (Beaton et al., 2013) article. This is important foundational knowledge and helps prepare participants for those times when they are responding to someone in suicidal crisis. Through guided exploration, participants discuss language and how important using safe language can be and the significant positive impact on people who have a lived experience of suicide and perhaps encouraging their willingness to disclose. Understanding safe language also relates to the various differing beliefs that surround the topic of suicide. To support this knowledge we are able draw on the great work from Everymind (Myth Busting, n.d.). Both of these topics of safe language and understanding common differing beliefs about suicide is important for participants in having the confidence and skill to empathetically engage with anyone experiencing a suicide crisis.

Knowing how to use and apply different questioning techniques is critically important in order to be able to establish and maintain rapport with someone experiencing a suicide crisis. Participants work through a number of activities focusing on open, closed and direction questioning techniques including how and when to use each type of question. The various types of questions each have a role to play when talking with someone who is in suicidal crisis (‘Counselling Microskills’, 2009).

Workshop content also addresses the different types of life and situational events and circumstances that can lead to someone reaching a of suicidal crisis. Content material includes a Loneliness Survey conducted by Lifeline and a short video by a lived experience representative highlight what some of the barriers are to someone seeking help when in distress.

Participants are also introduced to brief crisis intervention strategies to assist them, exploring what it might mean to be courageous when encountering someone who may be experiencing emotional pain and thinking about suicide. To support this content, we draw on the work of John Kalafat’s Crisis Intervention Framework. In particular, his article An Evaluation of a School‐Based Suicide Awareness Intervention (Kalafat & Elias, 1994) provides sound evidence here. Closely related to understanding brief crisis intervention strategies participants are guided through content relating to high risk disclosures, detecting when someone is at imminent risk to suicide and being aware of the warning signs to imminent risk and knowing how to take the appropriate action to respond to someone in imminent risk.

Also addressed in the workshop are topics relating to both vicarious trauma and self-care. This is in recognition that responding to someone in suicidal crisis can lead to responders feeling emotionally heightened as effective intervention requires the use of deep listening, compassion, empathy and responding skills. Both vicarious trauma and self-care awareness are imperative and core concepts for participants to develop readiness skills. In particular, participants work through skill development relating to knowing the signs of vicarious trauma and how to manage any vicarious trauma. To illustrate what vicarious trauma is participants are shown a YouTube clip by Laurie Pearlman, Headington Institute (What Is Vicarious Trauma? – YouTube, 2012)

Reference List

What is Vicarious Trauma? – YouTube. (2012). https://www.youtube.com/watch?v=wVDSdta0mbM

Beaton, S., Forster, P., & Maple, M. (2013). Suicide and Language: Why we Shouldn’t Use the ‘C’ Word. In Psych, 35(1), 30–31.

Counselling Microskills: Questioning. (2009, July 10). Counselling Connection. https://www.counsellingconnection.com/index.php/2009/07/10/counselling-microskills-questioning/

Kalafat, J., & Elias, M. (1994). An Evaluation of a School‐Based Suicide Awareness Intervention. Suicide and Life‐Threatening Behavior. https://doi.org/10.1111/j.1943-278X.1994.tb00747.x

Myth busting. (n.d.). Everymind. Retrieved 19 May 2020, from https://everymind.org.au/suicide-prevention/understanding-suicide/messaging

Rogers, & Ransom, C. (1961). On Becoming a Person: A Therapist’sViev of Psychotherapy. Personne Houghton Mifflin Company.

Statistics, c=AU; o=Commonwealth of A. ou=Australian B. of. (2019, September 25). Main Features—Australia’s leading causes of death, 2018. c=AU; o=Commonwealth of Australia; ou=Australian Bureau of Statistics. https://www.abs.gov.au/ausstats/[email protected]/mf/3303.0

Voices of In-Sight (VoIS) is a two-day workshop designed to take people with a lived experience of suicide into a deeper-dive exploringtheir lived experience while learning how to share their lived experience story with others. It is important to note while this workshop can be seen as a standalone product, it is also intended to be the second workshop from a larger suite of training programs. To find out more about our full suite of workshops, please visit our workshops page.

The workshop outcomes for Voices of In-Sight include helping participants learn more about the various ways to express their own lived experience and to be able to do so in ways that are safe for both the individual and others. A wide-ranging number of theories, concepts and approaches are used to guide participants along this learner journey over the course of the immersive two days.

During the first day, participants are introduced to the concept of deep listening. ‘Deep listening is also called dadirri, a word from the Ngan’gikurunggurr and Ngen’giwumirri languages of the Aboriginal people of the Daly River region, 220 kilometres south of Darwin, NT. In the Wiradjuri language’ (Spirits, 2019). This culturally significant knowledge is of particular relevance in helping participants understand the potency of their lived experience stories. Additionally, this helps the participants understand that their story can have real purpose in helping to develop greater insight.

During the workshop Carl Roger’s person-centered theory is used. Rogers was an esteemed humanist and psychoanalyst, who developed this approach between the 1940s and 1960s. The person-centered approach is based on the premise that people are their own experts in terms of what might be needed to achieve personal growth and fulfilment in life. Relating to the content for this workshop, Rogers’ person-centred theory in On Becoming a Person : A Therapist’s View of Psychotherapy is used to develop skills relating to understanding human relationships and connection (Rogers & Ransom, 1961).

Participants are introduced to motivational factors underpinning storytelling. Videos of great speeches from Martin Luther King and Steve Jobs are also shared with the group. A classic Steve Jobs’ speech (Steve Jobs Stanford Commencement Speech 2005, 2005) conveys valuable lessons about the importance of understanding story structure and process. Participants are encouraged to look beyond the surface message of the speech and seek out underlying key themes relating to style, structure, the use of metaphors and defining key messages in storytelling.

Knowledge and skill development relating to non-judgemental acceptance and listening are introduced as way of helping participants understand the importance of establishing and maintaining contact with others to build rapport. We draw on number of works to expand participant’s knowledge around these skills. For example, parts of Management of Suicidal Behaviour (Morgan, 1981) and also that of (Henden, 2008, Chapter 6) both look at solution-focussed therapy including unconditional positive regard as a means of connecting deeply with others.

A large part of getting participants to understand the absolute power and value in each and every lived experience story, including their own, lies in coming to grips with Imposter Syndrome. Impostor syndrome is a psychological pattern in which individuals doubt their own accomplishments and results in developing a persistent internalised fear of being exposed as a ‘fraud’. To help participants understand this concept, and how it relates to them openly and confidently sharing their stories, we use a short YouTube clip (The Impostor Syndrome, 2016).

We also draw on a number of excellent TED Talks. We include these to facilitate participant’s understanding of the power of storytelling by using the most popular form of storytelling on the planet. One example used to help participants understand how to craft their own lived experience story is (How to Narrate Your Life Story, 2017). We also include a clip on some of the secrets of great public speaking presentations from the makers of TED Talks (TED’s Secret to Great Public Speaking | Chris Anderson, 2016).

To help participants understand the complexity of storytelling and its impacts on the listener, we also discuss pre-attentive processing, which is the subconscious accumulation of information from the environment. This is important knowledge for participants as they start to understand how people listen differently and make individual choices about the message they are tuned into (A Double Dutch | Brain Games, 2014).

To develop skills relating to empathy we draw on a number of sources including the TED Talk by Jeremy Rifkin called Empathetic Civilisations (Rifkin, 2010),

which addresses the fact that we are all empathic beings with an innate desire to connect and to share experiences. Similarly, we draw upon Brene Brown’s classic short video clip that is aimed at helping participants understand the difference between empathy and sympathy ((34) Brené Brown on Empathy – YouTube, 2013).

To expand this knowledge relating to developing empathy, we also share a video clip that focusses on the fact that when we are speaking about our lived experience, those who are listening and watching will experience similar emotions to those being described or exhibited (What Are Mirror Neurons?, 2017).

A number of therapeutic and social theories are also used during this workshop. A narrative therapy approach is used to support participants through the journey of retelling their own story while acknowledging that they are not in fact their stories reverse (Narrative Therapy | Psychology Today Australia, n.d.). This therapeutic approach to storytelling can lead to mastery in developing self-empathy. Being able to separate oneself from one’s own lived experience story empowers participants to control their stories and ultimately not letting the story define and control a person’s life. They may examine the story and look for other ways to tell it or to understand it. In telling the story, they are externalising it, separating themselves from the problem and looking at it through fresh eyes. They look for unique outcomes: positive events that are in contrast to a problem-saturated story and staying anchored in it.

A bounded rationality approach is also used during the workshop (Consoli, 2011). Bounded rationality relates to individuals making decisions and how their rationality is limited by the complexity of the decision problem, their cognitive limitations and the time available. This emphasises to participants the need to be mindful, and to use simple messaging and language in order for lived experience stories to be fully understood and for them to have positive impacts on those hearing the story.

Another couple of theories underpinning the workshops includes disclosure and social penetration theory. Social penetration theory states that the development of a relationship is closely linked to systematic changes in communication. Relationships generally begin with the exchange of superficial information and gradually move on to more meaningful conversations. In order to develop a more intimate relationship, we must increase the breadth and depth of what we talk about. Self-disclosure is about increasing the depth of the conversation and is linked to intimacy. When disclosure occurs, what normally follows is reciprocal disclosure (Social Penetration Theory – Communication Studies, n.d.).

Nudge theory is also drawn upon. Popularised by the 2008 book, ‘Nudge: Improving Decisions About Health, Wealth, and Happiness’, was written by American academics Richard H Thaler and Cass R Sunstein (Nudge Theory: A Complete Overview – BusinessBalls.Com, n.d.). At its core, nudging is a highly empathetic process. The trick in delivering the nudge lies in what the authors call ‘choice architecture’. This helps participants think critically about the structure of their stories, what to include and even what to leave out and why. The ultimate aim here is to ensure lived experience stories are well structured and inclusive of positive messaging and relaying of deep insights.

Reference list:

(34) Brené Brown on Empathy—YouTube. (2010). https://www.youtube.com/watch?v=1Evwgu369Jw

A Double Dutch | Brain Games. (2014). https://www.youtube.com/watch?v=iiEzf3J4iFk

Consoli, D. (2011). Bounded Rationality. In D. Southerton, Encyclopedia of Consumer Culture. SAGE Publications, Inc. https://doi.org/10.4135/9781412994248.n45

Henden, J. (2008). What is Solution Focused Brief Therapy? In Preventing Suicide: The Solution Focused Approach (pp. 67–108).

How to Narrate Your Life Story. (n.d.). Retrieved 17 May 2020, from https://www.youtube.com/watch?v=Brpk26Oq4aE

Morgan, H. G. (n.d.). Management of Suicidal Behaviour. 2.

Narrative Therapy | Psychology Today Australia. (n.d.). Psychology Today. Retrieved 13 May 2020, from https://www.psychologytoday.com/therapy-types/narrative-therapy

Nudge Theory: A Complete Overview – BusinessBalls.com. (n.d.). Retrieved 14 May 2020, from https://www.businessballs.com/improving-workplace-performance/nudge-theory/

Rifkin, J. (2010). The empathic civilization. https://www.ted.com/talks/jeremy_rifkin_the_empathic_civilization

Rogers, & Ransom, C. (1961). On Becoming a Person: A Therapist’sViev of Psychotherapy. Personne Houghton Mifflin Company.

Social Penetration Theory – Communication Studies. (n.d.). Retrieved 16 May 2020, from http://www.communicationstudies.com/communication-theories/social-penetration-theory

Spirits, J. K., Creative. (2019, May 30). Deep listening (dadirri). Creative Spirits. https://www.creativespirits.info/aboriginalculture/education/deep-listening-dadirri

Steve Jobs Stanford Commencement Speech 2005. (2005). https://www.youtube.com/watch?v=D1R-jKKp3NA

TED’s secret to great public speaking | Chris Anderson. (2016). https://www.youtube.com/watch?v=-FOCpMAww28

The Impostor Syndrome. (2016). https://www.youtube.com/watch?v=eqhUHyVpAwE

What are Mirror Neurons? (2017). https://www.youtube.com/watch?v=3_zTJYPwQ_0

TouchPoints is a three-hour workshop that has been co-designed, developed and is delivered by Facilitators with a lived experience of suicide. This informative workshop is designed to give community members an insight into suicide through the lens of people who have personally experienced it, and to equip them with the right knowledge and practical tools to reduce the emotional pain experienced by many around us and ultimately to save lives. This workshop differs from other Gatekeeper training in that its evidence-based content is interwoven with the expertise of people who have experienced suicide firsthand.

Research informed content

The research evidence underpinning the content development of the TouchPoints workshop is based on aspects of the person-centered approach developed by Carl Rogers. Carl Rogers was a highly regarded humanist and psychoanalyst, who developed this approach during the 1940s to 1960s. The person-centered approach is largely based on the premise that people are their own experts in terms of what might be needed to achieve personal growth and fulfillment in life. Specifically relating to the content for this workshop, Rogers’ person-centred theory in On Becoming a Person : A Therapist’s View of Psychotherapy is used to develop skills relating to relationships and human connection (Rogers & Ransom, 1961, pp.70).

Topics relating to social learning and self-efficacy are also explored during this workshop. To support this learning, the work of Albert Bandura, a living pioneer in social cognitive and social learning theories (Bandura, 2017) is used. His article, Self-efficacy: Toward a unifying theory of behavioural change (Bandura, 1977) correlates the importance of social learning and self-efficacy. This is important new learning for workshop participants as it helps them to understand the importance of their own unique intrinsic motivating factors for wanting to get involved in lived experience advocacy and how this can relate to their own journey of social and emotional healing.

Participants are introduced to concepts relating to suicide specific language and myths, which have been drawn from existing literature. In particular, the article Why we shouldn’t use the ‘C’ word (Beaton et al., 2013) provides a sound evidence base for helping participants grasp concepts relating to the use of stigmatising and safe language when discussing suicide. We also draw work from EveryMind Australia and Beyond Blue. It is perhaps important to note however, whilst we have and continue to draw on the great minds and work that already exists to inform our workshops, much of the content here is evidence -informed by people with a lived experience of suicide, over the ten years that Roses in the Ocean has been walking alongside and working with them.

Participants are also introduced to brief crisis intervention strategies to assist them while exploring what it might mean to be courageous when encountering someone who may be experiencing emotional pain or thinking about suicide. To support content relating to crisis intervention, the work of John Kalafat is used. In particular, the article An Evaluation of a School‐Based Suicide Awareness Intervention (Kalafat & Elias, 1994) provides evidence. Further supporting work is drawn from Conversations Matter, a practical online resource to support and effective community discussions about suicide at www.conversationsmatter.com.au. Once again, the actual voices of lived experience provide a strong evidence -informed platform for this material.

Reference list

Bandura, A. (n.d.). No Title. https://albertbandura.com/index.html

Bandura, Albert. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. https://doi.org/10.1037/0033-295X.84.2.191

Beaton, S., Forster, P., & Maple, M. (2013). Suicide and Language: Why we Shouldn’t Use the “C” Word. In Psych, 35(1), 30–31. http://www.psychology.org.au/Content.aspx?ID=5048

Kalafat, J., & Elias, M. (1994). An Evaluation of a School‐Based Suicide Awareness Intervention. Suicide and Life‐Threatening Behavior. https://doi.org/10.1111/j.1943-278X.1994.tb00747.x

Rogers, & Ransom, C. (1961). On Becoming a Person : A Therapist’s View of Psychotherapy. Personne Houghton Mifflin Company.

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