PROTECT | Suicide Prevention Training Podcast

Celebrating Men's Mental Health Month with the launch of - Safe Life Guide. Download from Apple App Store and Goolge Play Store. Also there are details for our Instagram page which has #KISS; Key Images Simple Statements Also a huge thank you to Adamosoft.The episode provides and overview of the 5 sections: Hope View: To support resilience and wellbeing through valuesSafe View: To support safety through contemporary safety planningSubs View: Subscription to Suicide Prevention Training and Safety Documentation SuiteLogs: A range of trackers for a healthier lifeResources: news, videos, blogs, podcasts, books#safelifeguide #progressguide #suicideprevention #suicideprentiontraining #suicideprentiontrainingprogram #suicideprentiontrainers #safetyplan #resilience #mentalwellbeing #mobileapplication #freesafetyplanningapp #safetyplanningapp #protect #safetyplanningapp #safetyplanningsaveslives #suicidepreventionawarenessConnect with Assoc Prof Manaan Kar Ray at https://www.linkedin.com/in/drmanaankarray/ Follow us on www.progress.guide

ConnectionYou may have picked up Healing for Healers because you are supporting a colleague who has lost a patient to suicide. Do not forget to offer your unconditional support. I am here for you, you can call me any day anytime if  you want to talk things through or just a shoulder to lean on. Saying something doesn't make it better, what makes it better is connection. If you have your own story to share, do so without making it about yourself. To be truly empathic one has to reach within and connect with that place that knows that feeling.Everyone comes to work to do a good job. But sometimes bad things happen. When they do, its time to take time to H - E - A - L.H - Hindsight HurtsHindsight strips away all the complexity and simplifies cause and effect. Thinking how did I not see this is unfair. Be kind to your self.E - Event ~ Non-eventThe significant event reminds us of the gravity of our work. Take time to remember the daily small wins when we steer people's lives for the better. As “non-events” we generally take them for granted.A - Accept, AffirmThe emotions you experience today are nature's signal to you that you are a kind and compassionate human being, accept and affirm these feelings.L - Look, Listen, LearnLook after yourself, you cannot pour from an empty cup, listen to your colleagues, many have been on this journey and use this adversity to grow.H - E - A - L your S - O - U - L is the combined wisdom of errors in judgement I, Assoc Prof Manaan Kar Ray, have made over two decades while supporting self and colleagues who lost a patient to suicide, mistakes you dont have to make...Connect with Assoc Prof Manaan Kar Ray at https://www.linkedin.com/in/drmanaankarray/ Follow us on www.progress.guide

In the third recap episode for ESF, we cover the STEPS model, the Validity techniques of Shawn Shea, the Narrative method and the B4Now approach from PROTECT.

In conversation with Tracey Chitty, the AWARE framework has been contextualised into the educational setting in this podcast episode.The recap begins with a discussion on rational vs rationalising and then goes into each of the factors:AnxietyWeightingAgendaResourcesExperienceIn particular the agendas of parents and principals are discussed in details. Clearly all parties want the same in terms of a flourishing young person, but their approach might be different and there are different balancing acts to be aware of.

A special episode to mark the 10th of September - World Suicide Prevention Day.Humor Heals #LOL @the Sound of Hope provides 3 exercises of therapeutic humour.  Pile ‘o PunchlinesThe Comedy of ComplaintsThe Comedy of ContradictionsIts a collaboration with Mallori DeSalle and Lodge McCammon. By brining humour to one of the most serious of topics, "suicide", they are providing an avenue for people who work in mental health care to fill their cups. Supporting people in suicidal distress over a lifetime is a marathon, not a sprint, humor may be one of the answers to maintain energy in the long run and even a way to connect with a person in deep distress. Sounds risky, but is rewarding. Give it a try. I did...A bit about our invited guests:Mallori DeSalle, MA, LMHC, NCC, CMHC, MATS, CPS, CHPTherapist, Trainer, Humorist, Indiana UniversityMallori DeSalle is a licensed mental health counselor, an internationally certified prevention specialist,motivational interviewing trainer and a certified humor professional. As a speaker and trainer, she has sparked curiosity in both the young and young-at-heart. Her passion for creating a lasting impact led her to the public health field and for the past 14 years she has worked at Prevention Insights, a center within the School of Public Health at Indiana University, Bloomington.  Mallori works with people all over the world. She served on the Board of Directors for the Association for Applied and Therapeutic Humor and in 2021 became a TEDx speaker. Her credentials don't impress her family, but occasionally her corny jokes do make them laugh.  https://malloridesalle.com/Lodge McCammon, PhDHumorist, Musician, Educator, SpeakerDr. Lodge McCammon is a therapeutic humorist, instructional designer, author, musician, and international education consultant who provides professional services, including keynote speeches, workshops, curriculum development, and a variety of training programs. He works with school districts, universities, nonprofits, and businesses (e.g., Palm Beach Schools, University of the West Indies, Discovery Education, Microsoft, Amazon). Most recently, Lodge facilitated a month of therapeutic humor for the Nourished Teachers Community, which is a Facebook-funded initiative focused on helping educators cope with work stress and avoid burnout. He uses a program that he designed called “Laugh It Off!" to help his clients transform their daily frustrations into humor. https://lodgemccammon.com/

In the second of the Recaps we go through the four chapters in the CORE module and pin down the key messages:Care Compass - Risk vs Recovery - without risk there is no recovery, with the right care the person has more controlOptimise Pain Relief - Dig deep to establish the need and interests that lie beneath the position of dying, help them see that they want to be pain free and our role is to help them be pain free.Risk Rethink - High - Medium - Low are static categories to characterise risk which is inherently dynamic, move to a more nuanced approach of thinking about risk in terms of longitudinal risk, cross sectional risk and unaddressed risk - that will help us formulate an opinion on clear and / or imminent risk.Empathy in Action - Move from what's the matter with you to What matters to you, use the equation of Empathy in Action

In the first of this sequence of guest episodes with Tracey Chitty, we share ESF's (Hong Kong) whole of school approach to suicide prevention after an intensive four days of training for school counsellors and teachers.In the upcoming episode, we will be summarising the key messages from the training for the attendees to recap what was taught and how they could incorporate into their practice the theoretical constructs they have gained.

A unique perspective to establish common ground between the Health Regulators and the practitioner under investigation is the basis for this episode. It builds on the previous episode of why Health Regulators need to be trained in Suicide Prevention and how Doctors and Nurses and Allied Health are an ultra high risk group when a notification happens.In this episode, Manaan shares how the practitioner considers the Health Regulator to be the problem where as the Health Regulators consider themselves to be the solution. These positions are incredibly divergent and the interests are different too, but at the needs level the doctors or the nurse wants to be a doctor or a nurse again and the health regulators role is to help them be one and practice safely in the long run. There is common ground to be found but the role of the health regulator in an investigation needs to be clearly articulated. 

Joiner's model of desire and capability is used to explain the high risk period that health practitioners face when they have had a notification to AHPRA (any health regulator for that matter). Manaan explains the training that is on offer for health regulators in this episode.We also take the opportunity to welcome listeners from the English Schools Foundation in Hong Kong as we start a 12 month journey to support 22 schools embellish their suicide prevention pathway through skills training for school counsellors, Principals, Heads of Years and Teachers. 

In the third of the 5 Critical Crisis Conversations, Manaan explores how the person's agenda of ensuring short term safety through admission may be quite different to the long term focus of resilience for the professional.Both want safety but the route to it is different. Being able to show the similarity of the overarching goal amidst the dissimilarity of the immediate outcome is a critical conversation to have with the person in distress. If they are able to understand that the professional is not rejecting their needs or abandoning them and on the contrary is selecting a much longer harder route to walk with them one can bring the person on board for safety planning and taking charge of maintaining their safety. Or else a person with BPD will feel the pressure to prove the professional that they are in deep distress and the risk will escalate as the threats to harm oneself intensifies.

The second of the Borderline AWARE conversations relates to Weighting (Diagnosis, Course, Social Causation - how these factors may influence the weighting that we put on a person's suicidality). The conversation is named Empowerment vs Containment. The episode builds on the Advice vs Action conversation and goes a step further providing the listener a thorough understanding of the different approaches to take and when to take those approaches.Based on whether the presentation is acute, chronic or acute on chronic the professional needs to make an informed and mindful approach regarding the focus of therapeutic action. Essentially they need to answer the question, is this a situation that needs containment or is it one where my focus needs to be on empowering the person to believe that these suicidal urges can be navigated.

In this sequence of nuanced conversations, listeners will be guided through some of the most sensitive issues that they will have to navigate while supporting a person in suicidal distress. This episode captures the essence of Advice vs Action. The advice we give - face your fears, applies to us as well when we make decisions regarding whether we admit or not. We must role model the advice we provide to have credibility. Listeners will learn the in-parts conversation to put on the table the dilemma that the mental health practitioner is facing. This is part of the Borderline Conversation AWARE program that is taught as an advanced training for mental health practitioners.

Jill presents to the Emergency Department in a suicidal crisis, she has Borderline Personality Disorder and believes that the only way her safety can be maintained is through an inpatient admission. This is not an infrequent occurrence for those working in an ED setting. Dr Kar Ray talks you through the different AWARE factors that can influence the decision you make.Also learn about the criterion for Borderline Personality Disorder in this episode. 

Understanding splitting is essential to supporting people in Borderline Personality Disorder (BPD), particularly when they are in suicidal crisis. In this episode Dr Kar Ray shares some foundational constructs as well as some practical tips that can help a health care professional or even family members provide the most appropriate support. 

Following two days of 7 SAFE Steps training, we caught up with our four professional actors who brought to life Sandeep in the simulations. They are the fabulous 4: Tegan Braithwaite, Charlie Baz, Sami Afuni and Kyra Thompson. This is an opportunistic recording of the debrief and the feedback they provided.7 SAFE STEPS is a 7 session safety protocol for mental health inpatient wards and community settings. The theoretical underpinning and practical skills are from the PROTECT suicide prevention training framework.An overview of the conversationsConversation 1: What Matters to Me (HOPE)·       Identify source of pain·       Identify source of hopeConversation 2: Scenario Planning (Safe)·       Identify upcoming challenging scenarios·       Use risk response balance sheet to navigate difficultiesConversation 3: Access to Means, Alcohol and Other Drugs (sAfe)·       Identify means availability, lethality and restriction feasibility·       Use risk response balance sheet to reduce accessConversation 4: Family, Friends, Follow up (saFe)·       Conduct the LOVE exercise to firm up support·       Identify difficulties for disclosure and how to navigate them Conversation 5: Emergency Plan (safE)·       Populate the coloured components of the safety plan·       Provide guidance on how to fill in the restConversation 6: Make SAFE SAFER·       Identify Scenarios (Triggers)·       Identify Appraisals (Early Warning Signs - Thoughts)·       Identify Feelings (Early Warning Signs - Moods)·       Identify Endurance strategies (Internal - External)·       Identify Response (Actions – Behaviour) Conversation 7: 1-2-7 Safety Conversation·       Connect the dots of from all the work that has been done so far·       Crosscheck safety plan to ensure that the person can maintain their safety.

In the lead up to a case study, Manaan delves deep into Personality Disorders and talks about all 10 conditions covering clusters A, B and C in this episode.Cluster AThese personality disorders are characterized by odd or eccentric behaviour. People with cluster A personality disorders tend to experience major disruptions in relationships because their behaviour may be perceived as peculiar, suspicious, or detached.Cluster BThe cluster B personality disorders are characterized by dramatic or erratic behaviour. People who have a personality disorder from this cluster tend to either experience very intense emotions or engage in extremely impulsive, theatrical, promiscuous, or law-breaking behaviours.Cluster C Cluster C personality disorders are characterized by anxiety. People with personality disorders in this cluster tend to experience pervasive anxiety and/or fearfulness.

Yvette Bonilla, LMSW, is the Owner and CEO of Suicide Care Consulting Services. She has seen firsthand the fateful effects of the revolving door effect and how it can rattle the lives of clients, the work and motivation of providers, the cost labor for leaders, and the reputation of the hospital system. Mrs. Bonilla is a thought leader in the suicide care space, a keynote speaker at mental health summits about post-crisis responses, an active contributor to the state of Connecticut Zero Suicide Learning Community, and an Advisory Board Member of her local region's Community Crisis Response Team.In the 5th of our Guest Episodes Yvette share with our listeners her own lived experience and how her insider knowledge shapes the work she does with transitions from inpatient care, perhaps the most high risk period in a person's recovery journey. 

Building on the qualitative theme of Experience in the AWARE framework is the phenomenon of Creep Crash Crawl. The episode describes how risk taking gradually creeps up due to suicide being a rare event, rare events cause confirmation bias, what I decided clinically was the right decision...This results in a Creep up of risk taking which is inevitably followed by a Crash down of risk taking when an untoward incident happens, after that risk taking Crawls along for a while. Reflective practice and mindful supervision of one's risk taking is the key grounding one's risk threshold.

Experience is the final AWARE factor. In this episode Manaan explores in detail the different ways in which experience generalises:Experience of the same patient over timeExperience of a diagnostic groupExperience of a demographic groupExperience of supporting people in suicidal distressIn the final half Manaan shares how the professional or personal experience of losing a patient to suicide impacts counsellors, psychologists, psychiatrists etc.

Dr Miguel de Seixas, Head of Psychiatry at Family Medical Practice in Vietnam shares valuable insights from his journey (Cambridge to Saigon).Miguel talks about how Psychiatric practice in Cambridge and Saigon are similar but also different. The foundation of our practice i.e. connecting with kindness and compassion with the pain that the person is suffering with does not change wherever in the world a mental health professional may be. He talks about the impact of COVID and some of the nuances of telehealth and how once can support someone experiencing a suicidal crisis irrespective of modality (telehealth or face to face).

Are you eliciting an agenda in the referrer, patient or carer? And whatever you elicit is that impacting the way in which you listen to the person's story i.e. does it affect your clinical decision. Agenda is the third of the five AWARE factors and it was quite obvious that assessors were responding to agendas they perceived, sometimes positively but often negatively as well.Resources is the fourth AWARE factor and rationalizing resource led decisions was a key theme that came out in the AWARE study. One may arrive at the same decision in a rational way but the journey to the decision is very different. Learn all about it in the fourth of the AWARE framework podcasts.For more information visit us at https://www.progress.guide 

Episode 16 explores how assessors rate suicidality in different kinds of presentation i.e. weighting. The AWARE study established that the weighting of suicidality could be impacted by:Diagnosis (Personality Disorder and Substance misuse counted for less)Course (Acute trumped acute on chronic, which trumped chronic) Social Causation (Carried less weight than biological presentations)These factors influenced the way in which the professionals would view the person's suicidality and ultimately impact clinical decision making and care allocation

Neurodivergent people in a neurotypical world face unique challenges when navigating a suicidal crisis. The busy, bright, noisy Emergency Department does not serve as a safety scaffolding, if anything could perpetuate the crisis or actually cause a melt down while waiting. Shazzy shares many such insights both from her lived and carer experience as well her quarter century of professional expertise.Shazzy Tharby is a UK trained and credentialed Counselling Psychotherapist and Mental Health Nurse. Shazzy is autistic and ADHD herself and has autistic and ADHD children and therefore understands the neurodivergent (ND) experience from both a personal and professional point of view from many angles. Shazzy works from a neurodivergent affirming perspective. Learn more about Shazzy and her services at https://positivelyliving.com.au/ We apologize for the poor sound quality at certain parts of the recording but we have retained it in the podcast given the strength of the content. The episode teases out different approaches in crisis care that professionals ought to take when supporting Autistic people.

This episode introduces the listeners to a key concept, the 2 mental spaces in which an assessor operates in an assessment.Rational - facts followed by decisionRationalizing -  decision followed by fact selectionManaan uses a range of practical examples to elaborate decision making processes including Festinger's original research from 1954 and the fascinating story of scientology believers. Listen in :)

Professionals need a good understanding of self before they can understand others. AWARE protects against undue influences in the act of clinical decision making. Intended to make practice safer, its use in clinical supervision or multidisciplinary case reviews should bolster practice by making individuals and/or teams who assess people in suicidal crisis, mindful of the implicit effect of the AWARE factors. The five factors are:Anxiety (generated/diffused in): ●Patient●Family/carer/friend●Referrer●Triaging/assessing practitionerWeighting (of symptoms elicited):●Diagnosis (comorbidity - personality disorder/alcohol or substance misuse)●Course of illness (acute/chronic/acute on chronic)●Factors considered outside core remit (relationships/finances/accommodation/employment/family - carer availability)Agenda (elicited in):●Referrer●Patient●Family●Practitioner●TeamResources (identified or not):●Beds●Home treatment capacityExperience (generalised from):●Same patient to different presentation●Other patients from the same diagnostic group ●Other patients from the same demographic profile●Past adverse eventsThese episode dives deep into Anxiety and discusses why we see what we want to see.

Episode 13 introduces the ASSESS module and provides a broad overview of the 6 chapters in ASSESS. It then dives into attitudes towards suicide. The key messages to remember are:Stop – PauseAttitudes towards suicide influence decisions, Attitudes towards suicide influence rapport and empathy,  Attitudes towards suicide influence care and support we offer.Reflect – Rewind Recognise your attitudesRecognise how these might have influenced decisions and care you have providedEngage in open, candid discussion within your team, be prepared to learn from the pastStart – Play If your attitudes are adversely influencing care provision seek helpPersonal therapyAdditional supervisionMonitor through ongoing reflective practice

Dr Stan Steindl is an Australian clinical psychologist with over 20 years experience as a therapist, trainer and researcher. He is has an active clinical practice and is passionate about motivational interviewing (MI) and compassion focused therapy (CFT). And he teaches and presents on these topics around the world!Stan shares some deep insights about Motivational Interviewing and how it can be used to navigate the delicate ambivalence that exists in the mind of a person in suicidal distress, the fight between reasons for living and reasons for dying. Stan talks about advanced listening and how some of the core MI skills of Open Questions, Affirmations, Reflections and Summaries can be used evoke change talk. You can learn more about Stan at Clinical Psychologist | Dr Stan Steindl

In this episode Manaan reveals the 3 practice shifts that lie at the foundation of a new program called 7 SAFE Steps. The are:Prediction to PreventionPast to FutureDeficits to AssetsThese 3 shifts will bring progress to the practice of care provision for those in suicidal distress, they are an automatic consequence of the mindset shift from top to TAP. 

Meet Ashley P Evans, Psychiatric Mental Health Nurse Practitioner from Waco, Texas.Here is a bit about Ashley in her own words:I am from Auburn, Alabama...WAR EAGLE! I received my Bachelors degree from Florida State University...GO 'NOLES! When I initially went to college, I was Pre-Med Psychology, but it didn't take me long to convince myself that I was not "good enough" in math and science, so I quickly changed my major to something completely different - International Affairs with a minor in Religion.  I moved back to Alabama after graduation and began working in the insurance industry. I convinced myself that climbing the corporate ladder was "good enough" for me, so I obtained a Masters in Healthcare Administration to make myself more marketable for the company.  After changing roles several times within the company, I noticed that something was gnawing at me. Something deep inside my heart was yearning for something far greater than what my employer could offer me. My heart wanted to care for people. I wanted to truly touch lives from a clinical perspective. Read more at https://www.psychlifeteeco.com/

The episode brings together the key messages from all 10 episodes. It can be used as a refresher or for someone new to PROTECT it will provide a quick overview of the CORE module

Episode 10 will be diving deep into the 5 values of Relational Safety:CourageCuriosityCompassionCollaboration and Commitment and translating these values into action. Episode 10 is full of catch phrases, some of the highlights are, patient is not in the way, patient is the way, listen with fascination, mind open – mouth shut, cant walk through water without getting wet, an explicit promise of recovery, things will get better and soon. What was yours? Get in touch at www.progress.guide . 

Part 2 of Empathy in Action introduces the Values of Relational Safety: Courage: to be present and suspend the desire to help Curiosity: in taking the time to listen and recognizing reasons and emotions  Compassion: in sharing the person's darkness without judgement  Commitment: to reframe suicidal thoughts and acts as a desire to be pain-free Collaboration: to coproduce the journey ahead based on mutual respectThe listener also learns about the Equation of Empathy in Action and the Pain Relief Dialogue

In part 1 of Empathy in Action, the listener is introduced to the key mindset shift that underlies Relational Safety, from TOP to TAP. This supports a transition from attempting to establish "what's the matter with you" to "what matters to you".Providing healthcare professionals contemporary knowledge about how the forms they fill can actually serve the real function for which they were designed is crucial in suicide prevention. Remember paperwork for proper work. The real function is to guide a conversation, a conversation that is at the heart of relational safety. This can be achieved by moving from top to tap. Don't seek to establish what's the matter with you, rather what matters to you. You can be a vector for spreading this knowledge at your work, do share the podcast. You can access all the information at www.progress.guide. We would love to hear your thoughts, email us at admin@progress.guide. 

The episode provides a novel way to describe risk and steers professionals away from high, medium and low risk stratification. The listener will be introduced to:Longitudinal RiskUnaddressed RiskCross-sectional RiskOn the way to formulating an opinion of clear and imminent risk. This is a far more nuanced approach and a meaningful attempt at conducting a person centered risk assessment. The listener will also be presented with the evidence base which leaves very little doubt about the futility of risk categorisation.

Proactive Detection of Clear and Imminent Risk of SuicideIn the first past of Risk Rethink, the listener is introduced to Shneidman's cubic model and the three psychological forces of: Psychache - Press - PerturbationThis lays the foundation for a discussion about the continuum of risk. Listeners are also urged to allow their knowledge of warning signs to trump those of empirical risk factors and focus on clear and / or imminent risk rather than longer term risk

Optimise Pain Relief introduces a pain based narrative as a conversational strategy to discover common ground. The person in suicidal distress wants to be pain free and the professional wants to help them be pain free. Despite this common ground why do so many professionals end up in a power struggle with the person they are supporting?The episode will guide professionals through the positional statements, interests and needs and a way of digging deep to see the other person's perspective and truly empathise with their pain and in the process create relational safety.

The episode describes the different ways in which the Care Compass can be used:To capture hopeTo gain a better understanding of risk and safetyTo find common ground when there is a difference of opinionTo address cultureThe episode finishes with a discussion on the challenges of recovery oriented care in community mental health care and how the care compass can be used to conceptualize recovery as well as circumvent some of the challenges.

Episode 03 introduces the Care Compass, a conceptual visual conversation aid to talk about recovery and current care delivery.The difficult balancing act between risk and recovery intensifies many folds in a suicidal crisis. This can only be struck in partnership with the person and their family and to get them on board and to understand the finer nuances of recovery oriented practice we recommend using the Care Compass, it's a theoretical construct with a number of practical uses that helps in finetuning “Control in Care”.The Care Compass has two axes: x represents resilience in the distressed individual (East or the right end of the axis: resilient; +5 and West of the left end: fragile; -5), and y represents the principal focus of care delivery for the professional (North or the top end: self-reliance; +5 and South or the bottom end: safety: -5). The numbers + or – 5 does not indicate right or wrong, it is just to graphically demonstrate the degree of resilience in the person on the y axis and the clinician's primary focus on the x axis. The two axes gives rise to four care quadrants, bottom left or south west: Prudent Care, top right or north east: Permissive Care, bottom right or south east: Prescriptive care and top left or North West: Precarious Care.

Episode 02 introduces the four chapters in the CORE Module and the nautical metaphor: Navigating Rocky WatersNavigating Rocky Water is about recovery. We all need hope, it is central to our mental health and well being. Recovery for those with mental illness (depression, anxiety, schizophrenia, bipolar disorder, anorexia, bulimia, borderline personality disorder) has its ups and downs but with the right support at the right time people can captain their own lives. There is a fundamental contradiction at the heart of mental health services between care and control. In the first chapter in CORE, Care Compass we grapple with this dilemma, this is particularly the case when supporting someone in suicidal distress. Worldwide mental health services have been guided by the recovery philosophy on their transformation journey. Capturing hope, creating agency and realizing a life beyond illness underlie all that we do. We are acutely aware that there is no place for force in recovery. However the use of force continues, we believe that proactive systems of care can help us navigate through the choppy waters of the care and control contradiction. PROTECT stands for PROactive deTECTtion. We led a project called PROMISE to collate and replicate all such proactive initiatives and make the use of force redundant. Navigating Rocky Waters was written as part of that project. We have come to believe that seemingly binary positions like risk and recovery or care and control are part of a spectrum, without risk there is no recovery, with the right care the person in distress will have more control. So to help our colleagues draw inspiration from individual recovery journeys of our patients we have used a nautical analogy. This brief film is full of life jackets, lifeboats, anchors, lighthouses, maps, compasses, etc. So, we hope you enjoy being at sea.

Episode 01 introduces Relational Safety, the golden thread through PROTECT:A person with suicidal ideation is often trapped in an overwhelming sense of despair (Beck, 1986). Stemming from entrapment, suicide may become the salient solution to life circumstances (O'connor, 2011) and intense psychological pain (Shneidman, 1993). Suicide is a major public health problem, with over 800,000 people dying annually worldwide, and for each completed suicide, there may have been 20 other attempts (World Health Organization, 2014). To support those in suicidal distress, professionals, families and friends strive to establish new and alternative ways of coping (Jobes, 2006, p. 122; Owens et al., 2011). However, there is a dissonance between the reality of those experiencing a crisis, for whom suicide is the perceived solution, and those that are caring, who view suicide as the problem (Duffy, 2006). Reconciling these positions is difficult as professionals have to understand the person's pain before they can form a collaborative partnership on the road to recovery (Michel & Jobes, 2011). In a serious suicidal crisis, recovery-oriented practice is often sacrificed on the altar of safety, and care becomes prescriptive. In our previous work in reducing coercion in care in the acute setting (PROMISE), staff and patients highlighted the difficulties in striking this balance. They described the restrictive practice as “it never is very nice… but it is a necessary evil” (Wilson, Rouse, Rae, & Kar Ray, 2017). 86% of study participants highlighted the importance of enhancing relationships through empathic communication as a way of overcoming the challenges posed (Wilson, Rouse, Rae, & Kar Ray, 2018).