Impact case study database

( I1) UU’s research has been at the forefront of Northern Ireland’s suicide prevention strategies. Results from the NI suicide study ( R1, R2) and the NISHS ( R3) were shared widely with policy makers, politicians, service providers and those who deliver care. O’Neill developed a policy and practice briefing based on the research ( R1 - R4), met with the Department of Health, and led several knowledge exchange events for policy makers, elected representatives, and practitioners, including KESS (Stormont Knowledge Exchange) seminars and presentations at the Stormont All Party Group on suicide prevention. These engagement activities led to UU’s research shaping a refreshed version of Protect Life Strategy ( I1), NI’s suicide prevention strategy for the period 2012-2014 ( C1). The research on the link between the trauma of the Troubles and suicide ( R3) also prompted policy makers to highlight in the refreshed strategy a need for improved public awareness of PTSD, service pathways for people with trauma-related needs, enhanced mental health services to identify, assess and treat PTSD, and the screening for PTSD among those with depressive disorders ( C1).

UU’s research also forms the **evidence base for NI’s new suicide prevention strategy, Protect Life 2 ( C3), which was launched in September 2019. The draft Protect Life 2 consultation ( C2) provided the evidence base for the strategy and cites UU’s research based on Coronial data (citing R1: contained within the final report to the funder of the research; citing R2: research that recommends specifically targeting medication use; and, citing R3: contained within a report chapter written by O’Neill discussing intergenerational trauma). The budget for the implementation of Protect Life 2 is GBP8,700,000 annually ( C3). Therefore, from Sep 2019 to Sep 2020, the strategy resulted in the delivery of suicide prevention services to the value of almost GBP9,000,000. UU research specifically highlighted two risk factors for suicidal behaviour that are specifically targeted in the strategy as particular to NI: psychotrophic medication use ( R2) and the legacy of the Troubles conflict ( R3).

( I2) In response partly to UU’s suicide study ( R1, R2), and to address the persistently high levels of suicide in NI, all five of the region’s Health and Social Care Trusts (HSCTs) formed the mental health patient safety collaborative project “Towards Zero Suicide” (TZS). TZS promotes a system-wide commitment to best practice in suicide prevention at all levels of HSCT care delivery. The NI suicide study ( R1, R2) showed that 30% of those who died by suicide were under the care of mental health services; this UU research is cited in the TZS project initiation document ( R1, R2, R3, cited in C4) along with evidence from the National Confidential Inquiry into Suicide and Homicide. Whilst both studies investigated suicides in health care settings, the NI-specific study also reported on life events and service use prior to these deaths ( R1). The TZS initiatives are based on similar projects in Detroit, USA (which led to a reduction in suicide by 75%, C5) and more recently, Mersey Care in the UK. O’Neill is the academic advisor to the collaboration. The TZS collaboration has received funding of over GBP1,300,000 to date which has allowed the appointment of dedicated service improvement coordinators in each of NI’s HSCTs. As evidenced by the testimonial from the TZS Regional coordinator, this has led to regional and local action plans to improve specific areas of practice and services, and the selection and feasibility testing of a Collaborative Safety Plan Intervention. In addition, a Minimising Restrictive Practice Quality Improvement Project is integrating Trauma-Informed Practice with a suite of local changes to reduce the incidence of Restrictive Practices in inpatient settings ( C4).

( I3) The analysis of crisis line data ( R5) by a multidisciplinary team headed by O’Neill led to the introduction of a computer-mediated and telephony-based management system in Samaritans Ireland in 2017. This call management system using Automatic Call Distributor (CAD) resulted in a 50% growth in the answered call rate and a ten-fold reduction in the percentage of calls receiving the engaged message, leading to a “ significant increase” in successful call attempts ( C6). As a result, these callers received an intervention that has been shown to significantly reduce their level of distress, and support in the self-management of their own distress ( C6, C7). The analysis of caller behaviour through the pandemic ( R6) demonstrated that Samaritans was receiving longer calls and peak numbers of calls after specific events (e.g. government lockdown announcements). UU research led to changes in volunteer scheduling to meet demands and an advertising campaign to promote Samaritans as a source of support for people affected by the COVID-19 pandemic ( C6). Overall, as the Chief Executive Officer of Samaritans Ireland states, UU research has had considerable impact on the service on multiple levels:

“The research has influenced volunteer training and the thinking of senior volunteers on how to structure the service.”

“The Ulster University research programme has also shaped our response to the pandemic and … informed outreach and partnership strategies, for example with Alone who support older people.”

“By identifying the times and external events associated with an increase in calls the analysis also informed volunteer rotas.”