Contact Labels PHA Plans To Change Lifeline 'Unsafe'

Contact, the charity which runs Northern Ireland's 24-hour crisis suicide helpline and counselling service, has labelled Public Health Agency (PHA) plans to change Lifeline as unsafe and unfit for purpose.

Contact, which has led Lifeline for 10 years, has also said that proposed changes to the vital service in a PHA briefing paper published in June are being driven by austerity.

The charity has stated that the PHA plans to restrict access to vital follow-on Lifeline counselling, depriving many vulnerable people from crisis support.

In its first ten years Lifeline received over 800,000 calls, providing direct helpline support to more than 50,000 people, with follow-on crisis counselling for 36,000 people in need. In NI 318 people died by suicide in 2015, the last year for which suicide statistics are available. The NI death rate is 19 per 100,000, more than 20% worse than any UK region or the ROI.

CEO Fergus Cumiskey said the PHA plan to alter the criteria for those who can access Lifeline follow-on counselling from "immediate help for anyone at risk of suicide" to only "those at immediate risk of suicide".

He said that 90% of people who contact Lifeline currently assessed at low or moderate risk of suicide would not be able to access counselling services under the new criteria, from April 2018 onwards.

"This fundamental change of purpose remains unexplained and was not subject to public consultation. This planned restriction to Lifeline support is unsafe, lacks credible evidence and is unfit for purpose.

"Every person identified at risk of suicide deserves immediate Lifeline counselling support. Only this guarantee will help drive down the suicide death rate for people seeking help at crisis point."

Suicide Prevention research expert, Professor Siobhan O'Neill also noted her concern. "It is difficult to understand how individuals at "imminent risk" would be identified. The research evidence indicates that risk assessment tools are NOT effective in predicting risk of suicide and NICE recommends clearly that they should NOT be used. The recent British Psychological Society position statement that myself and several eminent Psychologists released on World Suicide Prevention Day 2017 supports early interventions for all those who may be at risk, including people who have engaged in suicidal behaviour. I would recommend a risk mitigation approach, where the suicide-specific interventions which are showing promise in reducing suicidal thoughts and behaviour, are offered by highly trained staff to all those who present with suicidal ideation."

Contact also state that the PHA plans to separate Lifeline's crisis helpline from follow-up counselling services will add to delays, with multiple assessments. Contact currently provides both services.

Mr Cumiskey said a PHA business case for this radical change lacked credibility.

"The proposed fragmented model remains untested with zero evidence to offer confidence in future Lifeline safeguarding against suicide."

Contact has also stated that a PHA decision in 2014 to stop health and social care staff from referring patients to Lifeline services is linked to 30% fewer people receiving Lifeline support services since the PHA 2014 ban came into effect, at a time when N. Ireland reported the highest number of deaths by suicide on record’.

Mr Cumiskey said: "This briefing paper exposes evident dangers arising from PHA plans for Lifeline.

"In the absence of independent evidence and inexplicable exclusion of quality Lifeline client outcome analysis, the PHA plans for Lifeline (published 14 June 2017) are unsafe and unfit for purpose.

"We suggest this instance of unsafe public health planning has arisen in the polarizing context of public sector austerity."

The charity has offered five recommendations for the future of the Lifeline service:

• The PHA offers no credible evidence for plans to restrict and fragment the Lifeline service. The plan should be scrapped, procurement postponed and sincere co-design commenced.

• PHA Lifeline governance and the Lifeline service must be independently evaluated to revive and strengthen trust in Lifeline future capacity for suicide prevention safeguarding at crisis point.

• Commission a fully independent, Confidential Expert Panel Review of Lifeline client deaths by suicide (2016/17), to inform unhindered care continuity safeguarding culture change.

• In order to dissolve silo-working dangers, Lifeline must have accountable Crisis Care Concordat governance, including family lived experience, justice and NHS sector leads.

• Establish Lifeline as Ireland's pioneering health care system Zero Suicide pilot, strengthened and relaunched based on reliable, independent suicide safeguarding science.