Providing men at risk of suicide with emotional support and advice with employment, housing and financial difficulties: a qualitative evaluation of the Hope service

Figures & data

Figure 1. The Hope service.

Table 1. Staff roles and training.

	Hope project workers	Hope specialist advice workers
Job role and type of support given to service user	Emotional and practical support, providing a psychologically informed service, that encompasses a listening, non-judgemental, non-hierarchical, empowering and compassionate approach	Complex benefit applications, issues and appeals
	Suicide and risk assessments, safety planning, following Cole-King et al. (2013)	Finance planning, re-payment plans, formal insolvency process, management of debts, debt relief orders, bankruptcy
	Negotiating and discussing service user’s needs with other agencies as needed	Specialist housing, employment, financial, legal and other advice
	Supporting at meetings with housing, debt, benefit issues
	Signposting and referrals to other organisations
	Supporting service users with appointments and tasks, filling in forms, straightforward benefit applications
	Action planning
Training and support given	Training in safety planning, suicide assessment and interventions: techniques for how to work with someone saying they wanted to end their life imminently. Provided by a Master Trainer for Connecting With People (4 Mental Health)	Specific training in advice, such as housing, employment, relationships, benefits and debts
	Motivational interview training	Specialist debt case worker: debt intermediary authorised and regulated by the insolvency service to apply for debt relief orders
	Equality and diversity training	Funded by the debt and pensions advisory service
	Mental health training e.g. dual diagnosis, personality disorders	Auditing processes for specialist advice
	Conflict resolution	Specialist technical advice from head office
	Team reflective practice and informal team support	Emotional support from line managers, organisational systems of support. Hope managers provide ad hoc support if needed
	Regular supervision with line manager (case summaries, risk status, tasks and issues, emotional intensity of caseload)	Suicide prevention training, motivational interview techniques and solution focussed therapies
	Clinical supervision from a counselling psychologist (every month)
	Ongoing training and professional development as needed
	Ongoing managerial support as needed, including ad hoc incident support always available

Table 2. Analytic framework, specific codes and example quotes.

Themes	Specific codes	Example quotes (italicized text illustrates code)
Staff perspectives on what Hope does	What Hope support and advice staff do Structure of a Hope session from staff perspective Working with users in acute crisis Staff experience, support and supervision	Working with users in acute crisis: “We’ve had really extreme examples where, you know, one of the team’s had to sort of remove a rope from the boot of somebody’s car, go and collect a chainsaw [to be used for suicide]”. (Staff 2)
Service users situation on first talking with Hope	Suicidal attempts and feelings Loss of job Homelessness Addiction Finances and welfare benefit problems Family issues	Suicidal attempts and feelings: “The majority [of Hope referrals] come via the mental health triage team or they may be referred from the hospital… they’ve reached a place where they’ve felt they can no longer carry on living… They’ve overdosed or they have expressed intent to end their life and they do not meet the threshold for mental health services … I’m still at times frustrated and confused with just what you need to present with to get a service”. (Staff 2)
How referred/ found out about Hope	Mental health services GP Job centre Charity Self-referral	Mental health services: “If they don’t meet that threshold for secondary service, then for those people that are in psychological distress or have ongoing suicidal thoughts or self-harm, then we are quite limited in services that we can offer them. We’ve got Samaritans and the [NHS Trust] response line, but specific for self-harm and psychological distress, yeah we do rely on Hope quite a lot”. (Staff 25)
Characteristics and experiences of Hope sessions from service user perspectives	Non-judgemental “I could tell her anything” Better and beyond friends and family Personal affirmation Changing norms	Non-judgemental and “I could tell her anything”: “To tell you the truth my sort of age group people we don’t ever talk about our mental health situations I mean I was always brought up as a man don’t cry and you know a man gets on with it whatever’s thrown at him, so I never ever discussed with anybody up until not long back…. There’s no judgementalness at all and I found that very comforting… it’s the first time I’ve ever opened up in me life”. (Service user 17)
Contents of Hope sessions and getting what’s needed	How Hope helped manage the issues Organising and resolving problems Hope advice service Referrals/ signposting Enough sessions and long enough sessions? Face-to-face meetings Phone contact Trauma/ abuse	Trauma/ abuse: “I never told anyone…. I was able to talk all that through with (Project worker) and just, basically, unload it, unload everything that was just sitting on me in a way that I found comfortable. I’ve never been able to express that way before to anyone and I just found it comfortable…. it was getting the burden off me of the history, the past, how I felt”. (Service user 17)
Barriers	Service user perspectives Staff perspectives	Staff perspectives: “We are working with men that have got a history of trauma and abuse and perhaps we, frequently we are the first person that they may have gone into any detail around that and then we’re referring into services where the waiting list is anything up to two years. So, there are some real barriers in the work we do”. (Staff 2).
Impacts of Hope	Impact on suicidal feelings Housing Furniture, white goods, heating Debt and finance Welfare benefits Food Resolving addiction issues Managing emotions Well-being Resolving problems General situation now	Welfare benefits: “She came to my PIP [Personal Independence Payment] assessment when I was evaluated for mental health and I couldn’t have went there without her to be honest I really couldn’t because it was a terrifying experience for me…. I can’t say it went well, I mean it went okay and I am eligible for some money so that was a bonus but I couldn’t have done it without her, I just couldn’t have done it”. (Service user 12)
Comparison with other services/ uniqueness of Hope	Comparison with other support services Comparison with health services	Comparison with health services: “She made me feel like it was alright to feel the way I was feeling instead of being ostracised for feeling like I was in a hospital with everyone staring at me because I’d done something that they didn’t understand”. (Service user 19)
Completing Hope support sessions	Ending Hope contact/still seeing Hope? Any issues unresolved?	Any issues unresolved? “Maybe I could have had a little bit more but I didn’t want to be greedy and take other people’s time when I didn’t need it, so honestly now I feel a lot better than what I was but it could come back at any time. Having them there as some sort of safety blanket to help is a great help”. (Service user 21)

Table 3. Interviewee characteristics.

Interviewees	Numbers	Interview duration (mean)	Characteristics
Hope Service users	16	29	Men	16
			Ethnicity:
			White British	15
			Black	1
			Age:
			31–40	4
			41–50	4
			51–60	6
			61–70	2
Hope project workers and manager	6	48	5 women, 5 men (Where Hope project and advice workers are referred to below, the gender terms her/she are used to maintain the anonymity of specific workers)
Hope advice workers	2
Hope referral staff	2

Table 4. Impacts of Hope services on different aspects of people’s lives that they spoke of (each row relates to a separate service user interviewed).

Code	Mental health	Well-being	Housing	Benefits	Debt	Other finance	Employment	Addiction issues	Family relations	Legal issues
Not given for anonymity	Y	Y	Y	Y		Y	Y
	Y	Y	Y		Y			Y
		Y					Y
	Y		Y		Y				Y
	Y		Y					Y
	Y	Y						Y
	Y	Y	Y	Y	Y	Y
	Y		Y	Y
	Y	Y	Y						Y
	Y	Y	Y	Y			Y	Y
	Y	Y	Y	Y	Y	Y
		Y	Y	Y				Y
	Y	Y		Y			Y
	Y	Y		Y		Y		Y	Y	Y
	Y	Y	Y	Y	Y	Y		Y
	Y	Y	Y				Y

Cole-King, A., Green, G., Gask, L., Hines, K., & Platt, S. (2013). Suicide mitigation: A compassionate approach to suicide prevention. Advances in Psychiatric Treatment, 19(4), 276–283. https://doi.org/10.1192/apt.bp.110.008763

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Data availability statement

Data associated with this manuscript is accessible only to the research team and is not publicly available due to concerns about confidentiality in a study based in a specific locality and with a small sample size.