Monday, 3 August 2020

BEHIND-THE-SCENES OF A SUICIDE AWARENESS TRAINING SESSION WITH THE BRITISH TRANSPORT POLICE




I wasn’t sure how to blog about the training session I’ve just facilitated with the British Transport Police, and then I noticed that my ‘Behind-The-Scenes’ posts seem to do really well… I think a lot of that is about the naturally curious nature of people and the want to gain insight into something you may be interested in but have little or no experience of. So, here’s a bit about what goes on in training with the Police; from the initial discussions to the actual session…


How it came about

Over a year ago, I was on a train when a drunken man began giving a ton of verbal abuse to the Train Manager and myself. So much so that we ended up going to the British Transport Police (BTP) when we got off the train and gave our statements. The Officer who took charge of the entire incident; Richie, was really lovely and helpful and I ended up telling him all about my mental health problems and that I’d helped Steve Baker and Claire Andre deliver mental health training sessions for the new recruits of Northumbria Police. It didn’t take us long to start discussing the prospect of me facilitating some training for the BTP officers too.



My motivation

I’ve actually only had one interaction with BTP when I was climbing over a bridge that ran over a track for the metro train. Two Officers talked me back onto the other side of the railings and then promptly told me that had my foot touched the tracks, I would’ve been arrested for trespassing! I think that this one experience, and hearing the experience other mental health service users have had with BTP, really motivated my drive to do this training because I wanted to improve things so that – hopefully – no one else went through the same thing.


Creating the training

I’m usually pretty quick with creating PowerPoint presentations but knowing it was the first time I’d be leading the training and delivering it alone and to such a huge organisation, I took my time. I’ve always been a perfectionist, but that pressure becomes ten-fold when I’m working on something like this. I think that the level of importance I held to the project motivated me to put so much effort into the PowerPoint. Sort of fortunately, the pandemic and lockdown hit, and the training was postponed which meant that I had a lot more time to prepare the presentation and consider what I wanted to say.

Richie and I decided that 50 minutes was an adequate length of time for the training so I tailored the amount of content in the PowerPoint to that and considered how long I would spend on each slide to regulate how much information was on them. I’m a firm believer in not writing word for word what you’d like to say on the slides because then what’s the point in listening to someone speak if you could just read what they’re saying?! So, I kept the slides quite brief and just created a ‘note’ on my iPad to write, in more detail, the points in the slide that I’d like to expand on.

Even though I’ve created PowerPoints before, this was actually the first time I discovered the ‘Design Ideas’ feature! I found it really useful in creating more aesthetically pleasing slides that had varied layouts and were more original; so that they would therefore have a greater impact on the Officers.


The brief outline

Just before the training was due to take place, Richie asked me to create a brief outline of the content so that the Inspector could approve the entire session. Being a Blogger, I’m not that great at keeping things ‘brief’ because I’m so used to delving into every single aspect of something and discussing the entirety of a situation. I guess that being in the mental health industry, doing this is especially important because when you’re asking for help, you can’t really just talk about half of your struggles or share only a little piece of them if you really want to receive support for it. So, my ‘brief outline’ turned into a few paragraphs:

Having been on life support after a suicide attempt, I have developed a massive passion for life and for bettering services for others. This new-found passion has motivated me to work alongside services – which have varied from the NHS to Northumbria Police to the private sector – to increase their understanding and better their response to service users and someone in a mental health crisis.

In this presentation I’ll be covering the events in my life which led to my suicide attempt in the hope that this will educate Officers on how many reasons a person can have that will leave them feeling suicidal. I’ll also discuss what it’s like to actually feel suicidal with the intention of instilling a sense of empathy in Officers by illustrating how the person they interact with may be feeling and the thoughts they may be experiencing. I also hope that this part of the presentation teaches Officers that a person can be going through a lot more than one suicidal thought. The presentation then goes onto advice on what not to do and what should be done. The advice is very basic and can be adapted to any of the many situations an Officer may find themselves in relating to a mental health crisis. I’ll be elaborating on each piece of advice to illustrate why I feel this is applicable and how it has helped or hindered my own mental health. I’ll finish the presentation with time for Officers to ask questions.

I was so relieved that the outline was approved and the PowerPoint signed off on, because it meant that I could put all my concentration and focus on practicing delivering the presentation and considering everything I want the Officers to know.


Slide One

I started the training with the question: “in which picture do you think I was at my most suicidal?” I actually got a really interesting response from one Officer who suggested it was the photo of me smiling because he said that the one I was on life support was obviously taken ‘after’ a suicide attempt. I thought it was a really clever response but told them all that I think both photos were equal. My last words before I was put on life support were ‘I hope something goes wrong and I die anyway’ and in the picture of me smiling I had taken an overdose but gone out with a friend. I wanted these photos to illustrate that you never know what’s going on in someone’s head, and that appearances can be deceiving.


Slide Two




In this slide I discussed my diagnosis of Borderline Personality Disorder (BPD) and one Officer said that a lot of people in crises who they’d spoken with had this diagnosis but that he actually didn’t know that much about it. So, I went into more detail than I’d planned on this point and explained what the diagnostic criteria had been when I was originally given the diagnostic label in 2009. I also told the Officers about the professionals who told me that a diagnosis of BPD was ‘a death sentence’ because services had the attitude that someone with the Disorder was beyond help. I wanted Officers to know that as much as they often feel inadequate in mental health crises and believe they aren’t the ‘best’ people for the situation, actually; mental health professionals and services aren’t always that great either!

I then said a little bit about I’m NOT Disordered, when I’d created it, why I’d started blogging, and how many readers I have now (over three quarters of a million). I used this part as an opportunity to explain that everyone can find different things beneficial because I’d deem blogging as one of the few things to have saved my life. Whereas some may find a hobby or other passion really meaningful and be able to utilise it as a motivation to fight suicidal thoughts and feelings.


Slide Three


One key aspect of suicide that I really wanted to cover is how it all began for me, sort of a little bit of a history and the reasons why things got to the point they have. I think it’s important that the Officers appreciate they’re coming across this person in that moment and will probably have very little idea as to what has led them to it – unless the person is willing to confide their history in the Officers. And I think it should be recognized that a person can have so many reasons for their suicide attempt and it isn’t always about one particular trigger or one incident or trauma.

I explained a little about how my childhood was so idyllic and naïve that it meant the abuse came as a complete shock because I hadn’t realised that such terrible people existed in the world. I told the Officers how dissociating during the abuse had influenced my hallucinations and shaped them into having their own personalities and attitudes. I was then extremely surprised to have one of the Officers ask whether hearing voices is classed as an hallucination(!) and he ended up explaining that he had never thought of them in that way because growing up, he’d always heard of hallucinations being visual. I told him that hallucinations can actually affect all your senses and told the Officers about tactile hallucinations but admitted that I have no clue what the proper terminology is for other sensory hallucinations. I found it interesting that the Officer hadn’t known this but then considered why he’d really need to know… I mean, it wasn’t like he’d come across the subject on a daily basis!


Slide Four


I wanted to use this slide as a starting off point for illustrating that when a person is suicidal it isn’t about having one thought of a way to attempt suicide and one feeling that you want to be dead. There can be so much more going on in your head. I explained to the Officers the saying that suicide doesn’t only get rid of the chance of things getting worse, but also of them improving. I said that often professionals would reassure me that feeling suicidal wouldn’t last forever and that meant I shouldn’t act on it, but in that moment, it felt that it would never end and I developed the conviction that if the negative feelings wouldn’t last then neither would the positive, happy thoughts and feelings.

In this slide, I also touched on my belief that it takes strength and bravery (in an unhealthy, negative way of course) to attempt suicide because natural human instinct is to do all that you can to survive. To go against this basic rule takes a lot of courage and a very deep-rooted conviction that taking your own life is the best thing you can do for you. And ‘best’ is a whole other issue I discussed in the training about how a suicidal person can differentiate from believing they deserve death as a punishment for being a bad person, or as some sort of reward or relief from the hardship they’ve been through.


Slide Five


It's probably quite obvious the type of mental health crises that Transport Police would become involved in, but I wanted the advice to remain general and basic so that it could be applied to any crises. I was also careful in naming this slide because I didn’t want to say ‘you should do this’ because it’s easy enough for me to say now, but if I were them and in the crises from their point of view, would it be so straightforward? And also, I wanted to bear in mind that what has helped me may not help others – another reason why I chose such basic tips…

I started with a little bit on stigma and passing judgement because from my experience with Police, it’s been a huge barrier in encouraging me to co-operate with them when I’ve been reluctant to because I’ve felt judged by them. The two greatest stigmas around suicide are probably that the act is ‘selfish’ and that it is the ‘easy way out’ and as I’d spoke about earlier, I believe that the fact suicide is going against the human instinct of survival, illustrates the strength it takes to make such an attempt.

I added ‘interrupt’ to the list of what not to do because it feels like a really basic tip that’s actually quite easy to put into place, but which can make a huge difference. Interrupting a person is – I think – a big sign of disrespect. It makes it appear as though you don’t care what the other person is saying and aren’t allowing their words to have any impact on you whatsoever. In a mental health crisis this is especially rude because it often takes a lot of courage for someone who is feeling suicidal to open up and talk to someone – especially when that someone is the Police – and to feel at all dismissed in being interrupted, can be a massive cause to lose your flow of speech and motivation to talk.

The next bit of advice became a point of discussion for some of the Officers because my view was that whilst Police must become desperate in some mental health crises, they should avoid lying or making false promises. The example I gave was with Officers telling a person that they won’t section or arrest them, and they’ll just let the person go home and get on with their day. One Officer asked whether – in my opinion – telling a person ‘we’ll be sectioning you and taking you to hospital’ would help the situation. I told him that there was probably a way to phrase that in that maybe just saying ‘we’ll get you some help and take you somewhere safe’ would be a good balance between being open and not being too honest. Another Officer pointed out that they sometimes come across some people in a crisis who’ll say ‘I know you’ll 136 me’ (section 136 of the Mental Health Act 1983 is the Police’s power to detain someone under the Act and take them to a ‘place of safety’) and what should they do in that situation because they know that the person probably knows better than them what’s going to happen. I explained that it’s hard from my point of view because if you’ve had a bad experience of being sectioned then the prospect that it’ll happen again can be terrifying and extremely off-putting in terms of co-operating with the Police. I hoped that telling them that might encourage them to consider that a person may not be being ‘difficult’ simply to be difficult.

My point about being condescending came about because often a person who is suicidal is deemed as vulnerable – and that’s obviously more than correct, but sometimes that vulnerability is seen as a reason to talk down to someone and patronise them. It must be hard for someone to support someone through a crisis and have the worry that you’ll say something ‘wrong’ and something which will – unintentionally – make things worse for that person. However, tiptoeing can also be unhelpful.

My final ‘do not’ advice of being rushed and abrupt also became a huge talking point and I actually learnt a lot through it. Initially, my experience of Officers being rushed has been when they’ve had to sit with me for hours on end (once you’ve been detained under a section 136, you have to have an Act assessment by mental health professionals and sometimes that can take a while to organize especially if you aren’t medically fit) and their Sergeant has been going on telling them that they should be out on the streets dealing with incidents of crime. The BTP Officers, though, told me that they have the added pressure of the financial consequence of a lot of the mental health crises they deal with. Often a person is on the railway tracks and the Officers explained that for every minute a train is late, the railway company are fined and that if there’s even just a few trains held up for an hour that can amount to hundreds of thousands of pounds. So, inevitably, the Police are encouraged to get that person off the tracks as quickly as possible and they said they have people who regularly go onto the tracks and in the end, the Officers are pressured to arrest the person as a consequence for the money the incident has cost companies. I’d not been aware that this was a thing and so I can completely understand them being under pressure and I advised that maybe if they’re in that situation they make it clear to the person that they wish they hadn’t had to arrest them so that the person might be more likely to co-operate. I also told the Officers that it was worth considering the potential damage an arrest can have because I’ve had one person I know be talked down from a bridge and she was arrested for wasting Police time and when she was given her court date, she went on to commit suicide. This influenced me to ask the Officers whether they’ve ever let the pressure they’re under impact the way they treat the person who is in the crisis.


Slide Six


Again, with this slide of advice on what Officers should be doing, I tried to keep it basic and general so it could be applied to any scenario/crises. I mean, comfort is a really simple thing that can make a big difference and you can comfort someone without giving them a hug or crossing any kind of professional boundary.

I talked to empathizing because I’ve found it to be a helpful quality for professionals to have used with me when I’ve been suicidal. I think that a key worry for someone who is suicidal is that no one else understands or appreciates what you’re going through and why you’re feeling this way. So, to be shown empathy can be really reassuring but it’s also important not to relate to a person too personally. I’ve had professionals tell me they ‘understand’ because they’ve been abused too and on the one hand, I think ‘at least it’s not just me’ and on the other I’m triggered and upset to think someone else has gone through anything remotely similar to me. The other danger with relating to a person is that it can become competitive with a person feeling the need to sort of prove that they’ve been through worse in order to validate why they’re suicidal.

I wanted to include a little something about acknowledging a person’s courage too because it takes me a huge amount of bravery to open up to anyone when I’m feeling suicidal. I think that’s mostly because I’ve seen that confiding suicidal thoughts in someone allows them the right to stop you from doing anything to act on those thoughts.

My point around listening is that I believe there’s a difference between hearing someone and listening to them. You can sit there and hear a person without actually absorbing what they’re saying and taking it all in.

I then moved on to talking about control and explained that – for me, at least – suicide sometimes feels like the only way to take any control over my life/death because the hallucinations have been in charge so much. So, when you’re so desperate for control that committing suicide seems like a relief, being allowed to control the topics of a conversation can feel like a percentage of that relief. It can give you back some control at a time when you might feel like you’ve lost it all. It also means that you can steer away if a conversation becomes triggering or an Officer asks a question that you’re not ready to answer.

Validation is another key element in a mental health crisis and an Officer actually told everyone how he displays it through telling a person that he can’t even begin to understand what they’re going through. He explained that he worried it might be upsetting and leave a person feeling alone or it could just be a really honest notion that he genuinely can’t comprehend what the person is dealing with. Validation is usually meaningful because a key worry someone who is feeling suicidal experiences is that no one will agree with their motivations for feeling suicidal. I mean, who would turn around and say ‘yeah, no wonder you want to be dead?’ But you could phrase it in a way which illustrates your appreciation of the person’s experiences and how they’re affecting them.

I couldn’t not include the rabbit story in the training session and managed to add it in as a piece of advice… So, the story goes: I was under a 136 with a Police Officer in A&E and she noticed I was staring at a space beneath a plastic chair and asked what I could see. When I told her there was a rabbit, she lifted the chair and stamped her big, black boot all over that space until it was gone. Knowing she couldn’t see the rabbit meant that her behaving as though it were there really showed that she believed and trusted in me and what I could see. One of the Officers in the BTP training session asked whether I thought it better that they ‘play into’ a person’s hallucinations or spend their time trying to convince the person their experiences weren’t real. I told the Officers that the staff in a psychiatric hospital had once had this very argument over how they supported me with my hallucinations after a Nursing Assistant leaped around my hospital room with a net trying to guide the rabbits from the room. In the end, I thought that to try to convince someone things aren’t real might just be a waste of time, and there can be a balance between believing that these experiences are real for that person but admitting that you can’t see or hear or smell or taste or feel what they can.


Slide Seven


I finished the training with ten minutes for questions and probably the biggest one I was asked was whether I thought the Police had improved in their treatment of people in a mental health crisis. I didn’t have to think about it; ‘hell yes’ was my reply! I mean fortunately, I don’t have nearly as much experience with the Police as I used to with regular crises, but the few interactions I have had in recent years have largely been helpful (I talked about one negative experience here: www.imnotdisordered.co.uk/2019/01/if-you-choose-to-kill-yourself-after.html). I explained that – rightly or wrongly – each individual Officer represents the entire Force and so if one Officer leaves a negative impression on someone, it will shape that person’s view of the Police on a whole and impact the way they co-operate – or don’t co-operate – with them.


Feedback

I got an email the day after the training to say that Richie and the Inspector had been given really good feedback with one Officer saying it had been ‘really insightful and useful.’ In fact, they got such good comments that I’ve been asked to go back in to train the other shifts of Officers who hadn’t been there that day.


A message to Newcastle BTP

Thank you – your passion to change and improve, and your acceptance that it’s needed is incredibly inspirational and something that I believe a lot of Police forces could learn from.



If you’re a Police Officer reading this and would be interested in having me come along to do this training, please send me an email:

aimeewilson@live.co.uk