STORM® Skills Training Science steps in to prevent suicides

Suicide is the quiet killer that gets national attention only when a celebrity dies of overdose or some form of self-injury. For decades, the issue has been taboo and therefore, largely unaddressed. Finally, a research programme at the University of Manchester put together evidence-based skills training to equip people to detect and address suicidal tendencies.

By the time you finish reading this—if you are an average reader—10 people would have died by suicide. In that same time, about 200 more would have tried to kill themselves.

This is how alarming the world’s suicide rate is, according to Dr. Gill Green, co-founder and Chief Executive Officer of STORM® Skills Training Community Interest Company, a social enterprise that trains frontline workers like nurses and teachers to detect and manage suicidal tendencies at first sight.

‘One death is one too many,’ says Green. ‘With one person dying by suicide, there are probably about 20 or so people who have attempted suicide, and many more have thought of it.’ Unfortunately, she says, frontline workers who come face to face with these people have always found it difficult to ask sensitive questions such as, ‘Are you feeling suicidal?’ and ‘Do you want to kill yourself?’

Bridging the gap

Since moving into research at the University of Manchester, Green has been specializing on studies concerning mental health and suicide prevention. Her interest in these subjects stemmed from her interaction with both patients and health workers when she was a nurse. For 12 years, she observed how hospital staff was unable to handle the suicidal tendencies of people they engaged.

‘When I was a clinician, I nursed a lot of people who had depression and who were suicidal. Even though I knew about suicide, I really didn’t know what I should be doing and how I should do it,’ Green says.

‘The only training that I had in suicide prevention was a lecture on what suicide is and how to help one that is suicidal. But that actually did not help me find the confidence and competence to do that well.’

With STORM®, there is now a science-based methodology to equip people to detect and address suicidal tendencies.

This gap in what could be life-saving intervention sparked Green’s interest in finding a science-based methodology to train people, especially frontline staff, to detect and respond to a suicidal crisis. Frontline staff is defined as anybody who is working in a role that engages with another person. Teaming up with Professor Linda Gask of the University of Manchester’s Institute of Population Health and other researchers, Green reviewed extensive literature on suicide prevention and risk assessment. From this, the team created a skillsbased training model that builds on adult education theories. ‘We put together in a package all the methods that are known to develop the required skills for suicide and self-harm assessment and intervention, and worked out a study to determine if it actually works,’ she says.

Thus STORM® began. From being a research programme in the 1990s, it evolved into The STORM® Project in 2003, a not-for-profit venture within the University of Manchester that was set
up to make the STORM® training commercially available. STORM® training is a flexible programme designed to reach many audiences including those in healthcare, social care, education, criminal justice, defence forces, veterans services, human resources, occupational health, and personnel responsible for mental health and well-being in the workplace. The programme is delivered either via a Cascade model (Train the Trainer) or Direct-to-Participants model. It can be adapted to meet a particular group’s needs.

‘The training is very adaptable. Teachers work in a slightly different environment compared to, say, health workers in a hospital, so the training has been adapted to their culture of working,’ Green says.

Since 2003, The STORM® Project has provided suicide prevention training to organizations in the United Kingdom, Republic of Ireland, Malta, Australia, and the Channel Isles. STORM® trainingis recommended by the National Health Services, and the English and Scottish governments. STORM® facilitators have also brought the training to psychiatrists and mental health workers in Russia, Pakistan and Bangladesh, free of charge.

Compassionate chat

In the last decade, STORM® has created ripples in communities where suicide has been a problem.

With its pool of 1200 trained facilitators, the project offers evidence-based training on suicide prevention, postvention and self-injury mitigation. Suicide prevention focuses on skills needed to help a person at risk of suicide or self-injury; postvention training works with closed communities, such as the workplace and schools, to create a responsive strategy that would help those affected by a person’s death by suicide.

‘The impact of suicide is felt across the community. It is not just those close to the person but where that person went to school, works, shops, and involves himself.’

She describes the STORM® approach as compassionate, emphatic, and collaborative while being evidence-based. ‘We are not the only suicide prevention training provider but we are the first one
that has been researched within the university,’ Green says.

STORM® uses interactive methods such as role rehearsal, filmed role rehearsal, and discussions to engage its training participants and build their confidence in asking difficult questions.

Green shares a story of a woman who attended one of the STORM® courses and ended up saving the life of a colleague with suicidal thoughts. The colleague at risk has been off work for weeks, and the woman could see that she was not looking good. ‘How about we go for a cup of coffee and a chat?’ the woman asked. During their conversation, she asked her colleague if she was thinking of suicide. When the colleague said yes, she convinced her to see a general practitioner about it.

Another STORM® attendee shared how he sensed something wrong when he saw his neighbour taking out the rubbish one morning. The guy said ‘Hi’ and engaged the neighbour in conversation. Using
strategies he learned in STORM® training, the guy asked his neighbour if he was thinking about suicide. The man said he was, and he agreed to see a doctor.

Social business

With the STORM® training a success—having earned over £1M—Green sought the help of Dr. Sonia Nikolovski of the University of Manchester Intellectual Property (UMIP) xto develop a sustainable
business model that would allow the project to operate independently of the university.

In 2012, the STORM® Skills Training Community Interest Company (STORM® CIC) was established. It was important for the team to remain a non-profit venture so its business model and legal framework adopted the philosophy of the STORM® project: ‘No one should profit from another person’s distress.’

Despite its success, STORM® CIC has no specific marketing strategy. It relies heavily on word of mouth. As it has been running as a social enterprise, its community engagements have helped the business reach a wider audience. STORM® CIC also maximizes the use of social media to inform the public about its work and advocacies. ‘We are getting a lot of interest through that platform,’ Green says.

Green has won three awards for STORM® training: two HEFCE/UnLtD Social Enterprise awards in 2010 and 2011, and the UnLtD Fast Growth Award in 2015, all of which have helped the company in terms of business management support, mentorship, and pro bono expertise.

STORM® CIC uses part of its income to fund community projects with the aim of reducing the number of suicide cases and changing society’s attitude towards suicide.

An example of its community work is #HeyAreYouOK?, an educational campaign raising awareness of distress, which is considered the main precursor of suicidal thinking.

‘This is a big campaign on the back of STORM®. We want to help people identify distress before someone becomes distressed. This is so that you will ask for help before suicide becomes an option,’Green says.

The company is also hoping to develop an online version of the STORM® training packages so the training can reach remote and rural communities. That step is proving to be a challenge. ‘The thing that stops me is the technology to replicate this in an online setting. We have to do it much the same as what we do face to face. That is tricky,’ Green says.

STORM® CIC’s ultimate goal is to make STORM® training available worldwide. The company plans to expand to the United States, China, and India soon. The easiest thing to do, according to Green, is to establish a presence in English-speaking countries first before they move into with different cultures and languages.

In the spotlight

Popular places to be

Some of the world’s top tourist attractions are also popular spots for committing suicide. The Golden Gate Bridge, which spans the strait connecting San Francisco Bay and the Pacific Ocean, draws its share of people who want to end their lives in a beautiful place.

A person jumps to death from the Golden Gate every two weeks on the average. In 2014, 38 people died there.

Another popular suicide location is Japan’s Aokigahara, the 3, 500 ha forest located at the base of the iconic Mt. Fuji. About a hundred suicides take place there every year, earning it the name ‘Suicide Forest.’ Since the 1970s, authorities have been conducting an annual body search in the area. Signs have also been posted along the trails to prevent more suicides. One of
them in Japanese reads: ‘Your life is a precious gift from your parents… Don’t agonize over problems yourself—please seek counseling.’