East Sussex County Council access to means: a design-led approach

In 2018 almost double the number of people died at one location in East Sussex than the previous year. And for each life lost another eight people come to the location in crisis. The dedicated intervention team at the location have held almost 500 conversations with persons at risk of suicide in the same year. These statistics have shown a year on year increase since 2015.

We worked collaboratively with a wide range of stakeholders to take a new design led approach to the issues surrounding suicides at a nationally known location and to explore possible new solutions.

In 2015 the University of Exeter were commissioned to undertake a review of prevention at this location. The resulting recommendations were aligned to Public Health England Preventing suicide in public places guidance. Due to the complexity of the site many of the recommendations were never implemented and there was a need to bring people back together, involve other stakeholders and reframe the issues.

The aim of this new work was to work collaboratively to review the issue and find opportunities for new solutions that could be implemented.

We commissioned the Design Council to run a programme of workshops in 2019 using their Framework of Innovation model. They facilitated five one-day workshops and two coaching sessions; 37 participants from 17 organisations participated. During these workshops and sessions everyone learnt about design methodologies to explore the issue and test the emerging ideas.

We had three sets of stakeholders:

• Those whose focus is life preservation and responding to those in crisis, including emergency services, NHS, RNLI, Coastguard and the local Chaplaincy Team.
• Those who work on the management and conservation of the land, including the land owners and land managers, the National Trust and the planning authority for the location.
• Those involved in tourism and the promotion of the site which is a major attraction with about a million visitors every year. This group had not historically been engaged in suicide prevention at the site. 

Each of these groups had a role to play in identifying and implementing potential solutions. Stakeholders who hadn’t been involved before often brought new thinking which worked alongside the historical knowledge and experience of organisations who have been part of the risk management group for this location for some time. For example, the local Chaplaincy Team are a faith-based charity who are on patrol across the location from 9am to midnight every day and work closely with the police. They spend more time at the location than anyone, observing and supporting people, and were able to describe the area and what happens in detail to the group of stakeholders. 

The workshops led to us looking at three areas impacting on suicide:

• Culture and folklore; the location is in the national psyche and is often used as a metaphor for despair
• Land and the place; the physical infrastructure
• People and services who are involved in the response; a key issue is that responding organisations are doing their best but are at risk of burnout due to the number and frequency of incidents.

Two teams researched each of the areas over four months, and identified assets, challenges, opportunities and potential solutions. The focus was not to rush to a whole set of solutions; we were sharing what we knew and challenging what we thought. Implementing the solution is an ongoing process of which we are working on with our partners.

The programme was evaluated very positively: 80% of participants reported having a shared understanding of the issue, 75 per cent reported better local relationships, 94% felt the collaboration was beneficial, and 75 per cent said we have moved towards a longer-term outlook. It feels like a much stronger stakeholder group following this work.

As a result of the project, partners have reported that they have made or will be making the following changes:

• Improved partnership working with a wider range of organisations
• Ensure health and wellbeing is embedded in existing projects and partnership work
• Apply design techniques to other work
• Feel more confident to engage with people at risk
• Ensure positive images of the location are used in publicity
• Improve debrief of incidents at the location
• Broaden remit of the site Risk Management Group.

Some of the areas of opportunity to develop may be more feasible on a lower budget through collaboration, whereas others need more significant resource, but all are ideas we can work on.

In summary, the design-led approach has built a strong commitment to work together to ensure the location will thrive as an asset where all visitors can return home safely and with the support they need.

• The Design Council’s pragmatic tools and techniques enabled us to consistently consider issues from numerous perspectives. Breaking into small groups around key themes enabled us to focus our efforts and build on what we know in an iterative process. From a public health perspective, being facilitated by an external organisation added another helpful layer of objectivity.
• The four month working period allowed for people to build strong relationships within their mixed groups.  This gave newer stakeholders the confidence to challenge those with more knowledge and experience and offer a different view.
• We ensured the workshops were safe and supportive.  We set the scene carefully at the beginning of each session, fostered understanding that it was a very sensitive issue, and helped those newer to the subject to understand appropriate language. We also had a Samaritans listener available for anyone who needed support.

• We needed to challenge opinions and expectations formed around previous work; for example, previous suggestions had included changing the physical infrastructure of the location and restricting vehicles to reduce access to the means, which for some were unrealistic and not feasible. This project and the new approach re-energised people once we had addressed preconceptions.
• Initially we spent a lot of time engaging senior leaders to ensure they committed to release their staff for what would be a considerable amount of time. We recognised that it was a big ask for a lot of organisations who have already been working on this issue for several years.  However, the doubling of incidents in a year meant many people felt compelled to commit the time and resources needed, particularly first responders who have direct experience of the impact of such an increase. We held a launch event at the start aimed at senior decision makers to set the scene and highlight the issue to help gain buy-in to this approach.

It has become very clear that this is not just a local issue: 80 per cent of people who die by suicide at the location are non-East Sussex residents, who we believe travel there for that specific purpose, including 5 per cent traveling from outside the UK. We have recently run a LGA Sector Led Improvement workshop with a range of suicide prevention experts to explore how to raise this as an important national issue that needs adequate resource and support to address long-term.

The partners involved identified one-year and five-year aspirations, and we plan to establish a programme management team to support the operational development of all outcomes. We have refreshed the terms of reference of the existing site risk management group to support the programme management team and oversee actions on the outcomes of our work to reduce suicide at the location. We also plan to establish new lines of research to address some of the gaps in our understanding about this tragic issue.

More broadly, we want to change the culture and folklore around the location. We want to keep it safe for vulnerable people who go there but also see it evolve as a natural asset for wellbeing.

• Think far and wide about potential stakeholders who have an interest in this area, whether suicide related or not
• Engage stakeholders early and invest the time in working collaboratively to understand and reframe the issues before jumping to solutions
• Consider a creative approach to really unpick and understand the issue, using a method such as the Design Council’s Framework for Innovation. These methods really engage all people and help align their objectives.

• Design Councils Framework for innovation
• Design Councils Design in the Public Sector Programme

This case study was done jointly with the National Suicide Prevention Alliance and forms part of our suicide prevention resource.