Guidelines for MS support volunteers

Listening and supporting people who express suicidal thoughts or are suicidal

Position Statement

These guidelines are written in line with the MS helpline position on suicidal callers:

We respect the right of all people affected by MS to choose whether to live or die. We provide information and support of an emotional nature for people with MS in such crisis.

As a support volunteer, your role is to be non-judgmental and neutral. This means you don’t dissuade or condone people’s suicidal intentions. It is not your role to provide assistance to aid or prevent suicide. However if the person explicitly asks you to call for emergency help and can’t make the call themselves, you can call on the person’s behalf.

Capacity Issues

Whilst your starting point is always that everyone has the capacity to make their own decision, if you have a ‘reasonable belief’that the person lacks the capacity to make the specific decision to call an ambulance for themselves at this specific time, you will need to assess their capacity to make this decision.(2 stage test).

If you assess that they lack the capacity to make the decision to call the ambulance, you will need to make a ‘best interests’ decision.This means making a decision in the person’s best interests if they are not able to make the decision for themselves. An example where this would be necessary is a person who has taken an overdose and is drifting in and out of consciousness or where a person does not understand the consequences of the action they have taken, or plan to take.

Purpose

As a support volunteer, follow these guidelines when you support a person affected by MS who expresses suicidal intent. These intentions may be expressed face-to-face, over the phone or by e-mail. Experience suggests that branch members affected by MS are most likely to express these feelings to people they already know.

The purpose of these guidelines is:

  • to ensure that the MS Society gives the most appropriate support to people affected by MS in these circumstances,
  • to ensure that MS support volunteers have a clear course of action that they can confidently follow, and
  • to make sure that we fulfil our duty of care to our volunteers who may deal with difficult and stressful situations.

Principles

All MS support should be undertaken with the following principles in mind, and they apply fully to the situation of supporting an individual who has suicidal intent. Support volunteers should always:

  • Provide sensitive support
  • Avoid giving advice as to a ‘right’ course of action
  • Be non-judgemental
  • Seek to signpost someone to the most appropriate form of help

As a Support volunteer:

Acknowledge the seriousness of the individual’s situation immediately and explicitly.

Be neutral in commenting on the value of the suicidal decision, and on any previous suicidal acts by the person or friends and family. Do not condemn a suicidal act or the individual’s intent.

Stay calm -it’s very important you stay calm, and respond with empathic statements delivered in a calm, slow, low voice (particularly important on the phone). Maintain a calm, warm and attentive manner throughout the call or meeting.

Judge the situation - use your judgement of how serious the individual is about committing suicide. We have developed some questions that you may want to ask, both to help your judgement, and to help the individual talk about their feelings. They can be found at the end of this section.

Signpost -

  • In all cases, explore whether the person has or would like to discuss their feelings with a health professional (GP, MS Nurse), who will be able to access further forms of support for them.
  • If you believe the individual remains at risk of suicide, sensitively suggest that they call Samaritans, who provide specialist support in this area - 08457 90 90 90, 24 hours a day. If people have online access they may find the Samaritans’ email support helpful – email
  • If you believe at the end of the call that the individual is likely to attempt suicide imminently, ask the person if they want to call the emergency services. If not ask them if they would like you to call on their behalf.

Record - After the conversation, record the state of the individual at the start and end of the conversation, your assessment of suicidal risk and any signposting or referral involved.

Seek Support - Dealing with such conversations often raises complex feelings in the helper. As an MS support volunteer, seek support from the MS Helpline as soon as possible so you can discuss the call confidentially and ‘debrief’. See the Support for Support Volunteers: at a Glance sheet.

Other issues

Where somebody you have supported commits suicide:

It is common for anyone involved in the life of a person who has committed suicide to experience complex and difficult feelings after their death. If you find yourself in this position, it is again important that you seek support from someone that you can discuss this with. The external telephone support service or MS Helpline (see ‘support for support volunteers’ sheet at the back of this document) can help you with this.

Personal Boundaries:

It is acknowledged that weekends and bank holidays can be particularly difficult or distressing for people especially if they are more isolated at these times. The MS Society does not expect support volunteers to be on 24 hour call. It is entirely appropriate for support volunteers to allow answerphones, with an appropriate recorded message, to pick up calls at times when they are not able or available to provide phone support. It is also appropriate to signpost people to the MS Helpline or another source of support such as the Samaritans if you are not able to manage the call.

Supporting Suicidal Callers: Possible questions

The questions below are aimed at helping you support someone who is talking about their suicidal thoughts or feelings. Some people may worry that by asking about suicidal feelings we might put the idea in someone’s head. That isn’t the case; research shows that you can’t “put the idea” into a person’s head, or suddenly make suicide seem like a good option. Instead, being able to talk about their feelings can make someone feel less isolated or lonely when they’re going through a tough time.

People can have a range of ‘suicidal’ feelings – some might talk about wanting to go to sleep and not wake up, or wanting all the bad

things to go away. It’s common for people in difficult situations to have these thoughts, but that does not necessarily mean they want to take their own life. One person might see suicide as one possibility amongst several, another might feel it is the choice they want to make and have planned how they want to take their own life.

Seek supportif you have dealt with someone who is talking about suicidal feelings; it’s important that you have time to talk through how it has made you feel and any concerns you have.

Using one or more of these questionsmay help you to support someone, to hear them and enable them to talk through their feelings honestly.

Choose questions which seem appropriate to the person and their situation.

You don’thave to use all these questions:

Possible questions

“When you say you wish you weren’t here/could go to sleep and not wake up, does that mean you feel suicidal?”

“Do you feel so bad you want to die?”

“Do you ever think of harming yourself / taking your life?”

“How long have you been having these thoughts / feelings?”

“Have you ever felt like this before?”

“Have you ever tried to end your life / kill yourself in the past?”

“You say you’ve been thinking of killing yourself. Have you made any plans about what you might do?”

“Have you thought about when you might do this?”

“How do you feel about death / not being here anymore?”

“Have you talked to anyone else about the way you’re feeling?”

“How do you feel sharing these thoughts with me?”

MS Support Toolkit ReferenceSection June 2011

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