Suicide: How to make a difference

Alis Fleming, Natasha Edwards and Preetee Hylton share the reasons why they embarked on a suicide awareness training course and why they are urging other dental nurses to do the same

According to The Samaritans, there were 5,691 suicides in England and Wales in 2019, that is 321 more compared to the year before. The suicide rate has remained the same as in 2018 – 11 deaths per 100,000 but the rates are still higher than in recent years.

There were 421 suicides in the Republic of Ireland in 2019, that is 69 more compared to 2018. The suicide rate has increasedby 19%. And there were 833 suicides in 2019 in Scotland. This is 49 more on 2018, increasing the overall suicide rate from 15.7 deaths per 100,000 in 2018 to16.6 per 100,000 in 2019.

The Zero Suicide Alliance (ZSA) is a collaboration of National Health Service trusts, charities, businesses and individuals who are all committed to suicide prevention in the UK and beyond. It is an alliance of people and organisations coming together around one basic principle: – that suicide is preventable.

Its online awareness course is free, takes no more than 30 minutes and participants get a certificate at the end.

There are three parts to the course:

The Step-up Module: This part gives a brief idea on social isolation – especially during the lockdown and takes approximately 5-10 minutes to complete.
The Gateway Module: This second part briefly shows us how you might approach someone who has displayed signs of being suicidal and takes about 5-10 minutes to complete.
ZSA Suicide Awareness Training: The third and main part encourages participants to talk openly about suicide and empowers to help anyone who might be at risk of self-harm. This takes approximately 20 minutes to complete.

Here, Alis Fleming, Natasha Edwards and Preetee Hylton share their experience and the reason behind their choices.

How did you learn about the course?

Alis Fleming, is a student dental nurse based in Aberystwyth, mid Wales (AF): During the first lockdown, it really hit home when I saw how the pandemic was affecting the mental health of many people. It was important for me to then research as much as possible about ways in which I could do my part to help and reach out.

I came across this course online and completed it. To spread awareness, I posted my certificate on all my social media platforms in the hope it would encourage other dental nurses to do the same course and also be able to recognise the signs.

Natasha Edwards, is studying Level 3 Diploma in Dental Nursing and is documenting it on Instagram at trainee_dental_nurse_life (NE): From my Instagram account, I saw that another trainee had posted a link and information about taking part in the course. It took me around 20 minutes to complete the course. It is definitely worthwhile spending the time to watch and listen to the videos.

Preetee Hylton, works at The No.8 Partnership, a specialist dental clinic in Chelsea, London and is an examiner with the NEBDN as well as a tutor with the Dental Nursing Academy (PH): Natasha Edwards posted her ZSA completion certificate on her Instagram feed and had tagged the ZSA profile and I was curious. So, I followed the link that led to me to their website, which has plenty of resources on suicide awareness along with training videos. We have a network of dental professionals on social media who share relevant content and who encourage one another in further enhancing our skills.

What prompted you to sign up to the course?

AF: The mental health challenges caused by the global pandemic really seemed to have affected me. It was important for me to play my part and do what I can to help. Working in health care can be very challenging, but it’s also hugely rewarding. The thought of being able to help someone really motivates me to keep on pushing for more awareness.

NE: I have heard many stories and seen so many articles on how people have taken their own lives and the struggles people have. Some people have nobody to talk to about how they are feeling. With the pandemic, even more people are feeling lonely and the things they used to enjoy are no longer accessible. The ZSA suicide awareness training enables me to have a better understanding of the signs to look out for and provides me with the skills needed to approach someone who may be struggling.

PH: I had severe post-natal depression 12 years ago, which landed me in a hospital ward with an almost damaged liver due to an overdose of painkillers – those were my darkest moments. Loneliness is a trigger and can be a killer, but it can be prevented. One in five people have thought about suicide at some point in their lives. The lockdowns during this pandemic have left many people isolated, without a support network and prone to poor mental health.

Past personal experiences, along with the lack of support and awareness regarding mental health during that time, prompted me to do this course. If I can be that person who becomes someone’s safety net by knowing which signs to look for and provide them with the assistance that they require, why would I choose not to help? I would never like anyone to feel how I once felt – lonely, hopeless and desperate. I would prefer people to feel that they are heard, they are supported, they are valued and that they matter.

Has mental health been a challenge for you, or anyone you know during the pandemic?

AF: I believe everyone has been affected in their own ways. It’s a very stressful time and there are a multitude of concerns. It’s important to look out for your friends, family, patients and even strangers.

NE: I’ve had my moments during this pandemic where my anxiety has been bad – worrying about catching COVID-19 and then passing it on to my family. Plus, the PPE we wear takes its toll – it’s so uncomfortable and you so feel hot and sweaty. This can get you down as well as cause skin sores, but I know it’s to keep us and our patients safe. I feel lucky to have my husband to talk to. He is able to tell when something is wrong and will just give me a big hug and is happy to talk it through with me.

PH: I am fortunate to have a support network of family, friends and colleagues. I also like to keep myself busy at all times, which I believe has helped. I have had friends confiding that the lockdowns, with their limitations on social interaction, have impacted them negatively. I am an NHS check-in-and-chat volunteer and the GoodSAM Responder app offers instant help to those in need. Some people who have been calling through have clearly been hugely affected – often because they have been denied the opportunities to talk or interact with others as often as they would like. Routines had been disrupted and they find it challenging to cope with these sudden changes.

Are dental nurses well placed to recognise the signs?

AF: Most definitely – and this course is designed to help us to understand the signs very clearly. It is so important for health care workers to do this course. During the lockdowns, patients may not get a chance to speak to anybody else but us. People have limited access to friends, family and socialising. They can only travel for essentials, such as visiting the dentist.

I had a patient tell me that I was the first person he has spoken to since March last year. I try to speak to the patient for as long as they need, even if it’s not dental related.

NE: I think a big part of the role of a dental nurse is to be empathetic and recognise the subtle signs of patients who may be struggling. We get to see such a spectrum of personalities that we have to be able to quickly identify what is going through a patient’s mind and react with empathy.

PH: Dental nurses are trained to monitor their surroundings at all times during a dental procedure – this means watching out for any subtle changes in skin tone, lip colour, body language, facial expressions and overall behaviour of not only the patient, but also of their clinician. Long-standing members of staff seem to have a better relationship with their patients, so are better placed to notice any changes in what is considered 'normal' behaviour. Dental nurses are more than well-placed to recognise signs of self-harming, too.

Is active listening a key part of what dental nurses do?

AF: Yes, I feel an important part of our job is to communicate with the patient. Communication allows me to convey empathy so that they feel more comfortable within the dental environment and can form a trusting bond with the dental nurse and the dentist.

Listening and understanding the patient is such an important part of our role – whether it’s about dentistry, their fears or even just general life, we listen.

NE: It’s definitely a key part of what we do. Not only do we listen to what the dentist is saying, but to the patient, too. Sometimes, I feel it’s just nice for the patients to be able to chat with us about how they have been feelingand what they have been up to during this difficult time. For some patients, it’s the only time they really get out so I think it’s important for us to listen.

PH: For a surgery to operate effectively, active listening is a must. Some dental nurses are jokingly labelled 'psychic' because they seem to be one step ahead of their clinicians most of the time. No, we are not able to read our team-mate’s mind, but we tend to listen actively and carefully to what is being communicated between the clinician and the patient. One aspect of the dental nurse’s role is to type notes whilst the dentist dictates (he or she has to ensure that the notes are accurate), and this is one way of gathering information and analysing it against past data from previous appointments. Active listening is indeed a key part of the dental nurse’s duties.

What other courses have you done in the past year?

AF: I have been doing a lot of research and playing my part. There have been rising cases of domestic abuse, which has led me to research this topic. I’ve been able to access free-to-print cards/stickers/posters from relevant websites to put up in our practice, which increases awareness and promotes conversation. Again, this might be the only time someone can leave their home so it’s important to create a safe place and help people as much as possible.

NE: I recently completed an Understanding First Aid within the Dental Environment course. I have also completed the Coronavirus (COVID-19) Awareness course to help equip us with further knowledge of the virus.

PH: I completed the COVID-19: Psychological First Aid course by Public Health England in July 2020, as part of my role as an NHS check-in-and-chat volunteer. It is available free of charge on the Future Learn platform. I did this course to further recognise signs of distress and to provide support to those in need of it. I also learned how emergencies may have an impact on people’s mental health, how to provide assistance to my colleagues if they needed someone to talk to and how to be a good listener. It is possible to encourage someone to reach out to their family, friends and community. I highly recommend it for those looking into providing mental health support during these challenging times.I also completed the Overcoming Imposter Syndrome: Identify Patterns Undermining Your Confidence on the Future Learn website, but that’s another story for another day.