Raising suicide awareness: a UK nurse and an Australian physio tell PhysioUpdate about their work
An article by Oxfordshire-based nurse specialist Karen Lascelles, arguing that suicide prevention is ‘everybody’s business’ (including physiotherapists’), appeared in Frontline (a publication for members of the Chartered Society of Physiotherapy) in 2014.
In a Q&A, PhysioUpdate editor Ian A McMillan, who was Frontline’s deputy editor at the time, caught up with Karen, who recently launched a survey on the support needs of family members and carers who have a relative or friend who has suicidal thoughts.
Karen's column caught the attention of Australia-based physiotherapist Ryan McGrath and the pair are collaborating on a training webinar this month. Later in this article, Ryan tells us more about his work in the suicide field.
Q Karen: your Frontline article gained worldwide interest! Tell us more about your collaboration with Ryan
Ryan contacted me in 2018 to ask about the survey I’d referred to in the Frontline column. He was studying the experiences and role of physiotherapy in recognising and referring patients in crisis and was keen to understand the literature around physios and suicide awareness/suicide prevention, of which there was little at the time.
We noticed was that ... a small number of musculoskeletal physios responded, stating that they frequently encountered patients experiencing suicidal thoughts but had no training at all in how to respond [Karen Lascelles]
I carried out the survey referred to in the Frontline column in 2013. This looked at people’s confidence, knowledge and support with regard to working with suicide risk (unfortunately, the results were not written up)
What we noticed was that – unexpectedly as the survey was targeting mental health professionals – a small number of musculoskeletal physios responded, stating that they frequently encountered patients experiencing suicidal thoughts but had no training at all in how to respond. Ryan has noticed a similar theme in his clinical and professional work in Australia and is interested in improving training provision for physiotherapists.
Q Tell us about your involvement with Ryan’s webinars for Australian physios?
Ryan developed this idea with colleagues with a view to providing interactive opportunities for physios to learn by reflecting on cases involving suicidality. Two physios will be sharing anonymised cases in which they worked with people who expressed suicidal thoughts or intent, or where these were inferred.
My role will be to explore the cases with the physios through dialogue, and as part of that draw on relevant evidence, knowledge and theory to help frame the case and consider possible interventions.
Q Can physios get involved in your survey – and, if so, how?
I am investigating the experiences and support needs of adults in England who care for an adult family member or friend they consider to be at risk of suicide. To do this I am carrying out an anonymous online survey and semi structured interviews. I hope to be able to use my research findings to develop resources for carers and improve education for clinical staff.
My motivation for this research has come from many years of nursing and encountering carers who do not receive adequate preparation for managing loved ones’ suicide risk – and are often given little or no support. In the same way that anyone of us can experience a suicidal crisis, any one of us can find ourselves supporting someone we care for who we think may be at risk of suicide.
Suicidality is not confined to those who are in touch with mental health services. So there will be physios caring for someone in their personal life who might be interested in taking part in the survey, or who know of others in their social networks who may be interested.
Q Is more information available?
Karen Lascelles is a nurse consultant with Oxford Health NHS Trust
Ryan McGrath's Q&A: Ryan tells Ian A McMillan about his role and how he become interested in conducting research in the suicide field
Q What is your job title and remit?
Currently, I am working one day a week as a clinical physiotherapist in the refugee physiotherapy clinic at a not-for-profit called Primary Care Connect and the rest of my week, I am a PhD student at Charles Sturt University in Albury, New South Wales.
My clinical work primarily involves supporting refugees and survivors of torture who present looking for help managing their persistent pain. My PhD research involves investigating the practices and experiences of physiotherapists with clients experiencing psychological distress. I am one year into my PhD and I am hoping to start data collection in the next few months.
When a physiotherapist says to me that they are uncomfortable talking about suicide or mental health I explain to them that discomfort is a very normal response [Ryan McGrath]
Q What sparked your interest in suicide prevention?
I am fortunate that my interest in suicide prevention did not stem from lived experience of suicide. However, I recognise that it is a privilege to have not been directly touched by suicide.
During my first semester at university studying physiotherapy, Lifeline Australia was recruiting for volunteer telephone crisis supporters, so I went to an information session and then started training. From that day forward I’ve been as interested in supporting those experiencing distress as I have been with people whose physical health is limiting their wellbeing.
Q Tell us about studies in the field
My research into suicide prevention in physiotherapy began at the very end of my second year of university. I was only ‘somewhat’ interested in research at this point, but the school of community health at Charles Sturt wasn’t offering any honours topics on suicide or mental health in the area of physiotherapy.
I was told if we had an idea for a research topic, we could pitch it to a few of the academics to see if anyone was interested in supervising it. I did a brief literature review and couldn’t find much on the topic out there except for Karen's Frontline article, titled ‘Suicide Watch'. Karen’s article was instrumental in me being able to convince four supervisors that more research in this area was needed. My honours research led to two publications (a qualitative study and a literature review) which both investigated encounters between physiotherapists and clients with suicidal thoughts and behaviours.
Q How do you integrate this interest into your everyday work?
My PhD study and my honours research has had a significant impact on the way I practise. While my clinical skillset is similar to most physiotherapists, I am very comfortable talking about mental health and suicide with my clients.
I start my consults with Professor Peter O’Sullivan’s ‘tell me your story’ interview prompt and just sit and listen to what the client wants to talk to me about. My research experience in mental health and suicide means that when a client discloses that they are feeling distressed, overwhelmed, worried, or hopeless that, instead of changing the topic, I ask them to ‘tell me more’.
Unlike some physios I am not worried about ‘opening a pandora's box’ because I know that what to do and I know that listening empathetically and non-judgmentally is well within the scope of physiotherapy.
Q What do you say to physios who say suicide prevention is not part of their role – or that they feel uncomfortable with the topic?
No matter what our expertise is as a physio, we can always ask if someone is doing okay, listen to their story and help them to decide what the next step should be [Ryan McGrath]
When a physiotherapist says to me that they are uncomfortable talking about suicide or mental health I explain to them that discomfort is a very normal response. Talking about suicide is a difficult conversation, especially when you are not well prepared for it.
I completed suicide prevention training with LivingWorks Australia which required me to roleplay and get used to asking people ‘Are you having thoughts of suicide?’ The first time I had to ask someone that was extremely difficult – even though it was just a role play. The more you talk to people about it, the easier it becomes. That is why training is so important so that physiotherapists are ready when a client invites them to have a conversation about suicide.
On the rare occasion that a physiotherapist says suicide prevention is not a part of our scope of practice, I use that as a conversation starter to ask what they believe their scope of practice is. Worldwide, the scope of individual physiotherapists is incredibly diverse. Some physiotherapists work in mental health wards, some implement basic body awareness therapy with people with major depressive disorder, and some people focus on the conventional physiotherapy approaches that help people to learn to walk again or pick up their children without pain.
No matter what our expertise is as a physio, we can always ask if someone is doing okay, listen to their story and help them to decide what the next step should be.
Q Tell us about your webinars on the topic – can UK physios get involved, and, if so, how?
Karen and I are currently planning a pilot webinar with two clinical physiotherapists involved in the ‘Pain Revolution’. We are having a practice of this interactive pilot webinar at the end of this month (July). The plan is to offer an interactive webinar where Karen, who has volunteered her time, will explore a few real-life cases that these clinical physiotherapists have been involved in.
This pilot webinar is not meant to be a substitute for training, but instead the aim is to:
- raise awareness about suicide prevention
- acknowledge that encounters between physiotherapists and clients experiencing suicidal thoughts and behaviours is something many physiotherapists face
Unfortunately, the first webinar is just a pilot and is targeted to the Pain Revolution group. We might be able to release the recording of the webinar more broadly but that is yet to be determined. If it is well received, we hope to repeat this webinar with other groups and other physiotherapists, including UK physiotherapists! We also hope to keep these webinars free to access.
Q How does Karen’s involvement make a difference?
Karen’s involvement is pivotal to the webinar. Karen brings with her over a decade of experience supporting people experiencing suicidal thoughts and behaviours. Additionally, Karen has previous experience talking to physiotherapists about suicide prevention and their experiences.
While I have completed research on the topic and have some experience supporting people in crisis, I am the first one to admit I am not an expert in this area. Even though I am going to be the moderator for the pilot webinar, I will very much benefit from hearing Karen explore the experiences of the two clinical physiotherapists volunteering their time.
Ryan McGrath is a clincial physiotherapist with Primary Care Connect and a PhD student at Charles Sturt University in Albury, New South Wales
For further information, see the following publications:
McGrath, R L, MacDonald, JB, Verdon, S, Parnell, T, & Smith, M (2021). Encounters between physiotherapists and clients with suicidal thoughts and behaviours: A narrative literature review. New Zealand Journal of Physiotherapy, 49(2), 70–81. https://doi.org/10.15619/NZJP/49.2.03
McGrath, R L, Parnell, T, Verdon, S, MacDonald, J B, & Smith, M (2020). Trust, conversations and the ‘middle space’: A qualitative exploration of the experiences of physiotherapists with clients with suicidal thoughts and behaviours. PLoS One, 15(9), e0238884. https://doi.org/10.1371/journal.pone.0238884
Author: Edited by Ian A McMillan