An Evaluation of Samaritans Telephone and Email Emotional Support Service

An Evaluation of Samaritans Telephone and Email Emotional Support Service Kristian Pollock, Sarah Armstrong, Catherine Coveney and John Moore. An Evaluation of Samaritans Telephone and Email Emotional Support Service 2010 Kristian Pollock, Senior Research Fellow1 Sarah Armstrong, Associate Professor in Medical Statistics2 Catherine Coveney, Research Associate1 John Moore, Research Fellow1 1 Department of Nursing, Midwifery and Physiotherapy, University of Nottingham 2 The NIHR Research Design Service for the East Midlands Address for correspondence: Kristian Pollock School of Nursing Midwifery and Physiotherapy Queen’s Medical Centre University of Nottingham Nottingham, NG7 2HA Tel: 0115 8230810 Email: [email protected] 2 Acknowledgements First of all, we would like to acknowledge the contribution of Martin Anderson (MA) who instigated and led this project as Principal Investigator until serious illness forced him to withdraw in January 2009. Michelle Stubley (MLS) worked on the study as full time Research Associate between January 2008 and June 2009. Kristian Pollock (KP) and Sarah Armstrong (SA) would like to acknowledge the input of John Moore (JM) and Catherine Coveney (CC) who joined the research team in September 2009 and have made an invaluable contribution to the process of taking the project through to completion. We would like to thank Sarah Chaudhary for her input into the history and policy of Samaritans and Kevin Harvey and Paul Crawford for helpful discussions about the analysis of the email data. We are very grateful to Julie Repper for taking on the task of critical reviewer of the report. Her input has done much to improve the clarity and focus of the content. Many thanks also to Patrick Callaghan, Mark Avis and especially Jacqueline Collier for their help and support throughout the project. We are grateful to all the Samaritans who have contributed to this study, especially the case study branches for their openness in allowing us to observe their work, and for the many hours spent in interesting discussions with the volunteers on shift. KP would like to acknowledge the input of her excellent SIT trainers in developing her insight and understanding of Samaritans principles and practice. Finally, we are grateful to the callers who took part in interviews, granted permission for access to texts and emails and responded to the online survey on a scale we had not anticipated. The result has been the collection of a very substantial body of data about callers’ expectations and experience of contacting Samaritans which we hope will extend the current understanding of its work and point to the best ways of developing this in future. Cover photograph courtesy of John Moore © to John Moore for cover image. 3 Note on Transcribing Conventions for Data Extracts As interview transcripts are already representations of data, the extracts reproduced in this report have been edited in places for clarity and conciseness. However, as ‘raw’ data, the email messages and responses and callers’ written responses to the open questions in the online questionnaire are reproduced exactly as they were written in the original sources. Prefixes V (V202) = volunteer interview respondent S (S110) = caller interview respondent ES (ES514) = extract from caller email message. The number in parenthesis indicates the position of the message in the exchange (ES514 (2)). EV (EV514) = extract from volunteer response to caller email message. The number in parenthesis indicates the position of the message in the exchange (EV514 (3)). EMFB = an extract from email correspondence sent by callers directly to the research team in which they comment on, or give an assessment of, their experience of contact with Samaritans (email feedback). ID (ID1125) = an extract from a caller’s written response to open questions in the online survey. 4 Contents Chapter One: Introduction 13 Introduction 13 Research Aims 14 Background: The Samaritans 15 Origins 15 Samaritan Befriending 15 Structure of the organisation 16 Volunteer training and recruitment 17 Nature of service 17 Suicide prevention 18 Accessing the service 19 Restrictions on who may call 20 Conclusion 20 References 21 Chapter Two: Design and Method 23 Introduction 23 Ethical approval 24 The project website and promotion of the study 24 The online survey 24 The interviews 25 Branch observations 26 SIT training 27 Email and SMS text messages 27 Data analysis 28 Survey data 28 Qualitative data 28 References 29 Chapter Three: The Volunteers 31 Introduction 31 The volunteers 31 Reasons for becoming a Samaritan 32 Section summary 35 Expectations and prior knowledge of the Samaritans 35 Section summary 36 Training 36 Additional benefits from training 38 Consistency 39 Elements missing from training 39 SIT versus training pre-SIT (‘Prep’) 40 Role plays (‘skills practice’) 41 Branch relationships with General Office regarding training 41 Ongoing training 42 5 Variance between branches 42 Section summary 42 The experience of volunteering 43 Being a Samaritan 43 Problems encountered by volunteers 46 Extra responsibilities 47 Volunteers’ time commitment 47 Age and experience 49 Section summary 49 Support for volunteers 49 Benefits of the volunteer support system 50 The role of the duty leader 51 Problems and issues in accessing volunteer support 52 Listening-in to calls as a method of support 53 Section summary 53 Volunteer turnover 54 Section summary 54 Chapter Summary 55 References 55 Chapter Four: The Online Survey: Callers’ perspectives on 56 Samaritans emotional support services Introduction 56 Samaritans data regarding annual callers and contacts 56 The online survey 57 Demographics 58 Use and experience of Samaritans’ services at the last time of contact 60 Means of contact 60 Sex of volunteer 63 Speed of response 64 Recency of last contact 64 Main reason for contact 65 Feelings before last contact with Samaritans 66 Feelings after last contact with Samaritans 67 Comparison of feelings before and after last contact with Samaritans 67 Comparison of how respondents felt at the time of completing the online 68 survey and how they felt after last contact with Samaritans Reactions to being asked about suicide during last contact 69 Positive feelings 70 Negative feelings 72 Feeling embarrassed or surprised 74 Other feelings 74 Previous experiences of Samaritans’ services 75 Reasons for past contact 76 Satisfaction with previous contacts 78 Expectations and evaluation of service 80 Expectations prior to contact 80 Extent to which expectations were met 84 6 Better than expected 84 Worse than expected 86 Neither better nor worse than expected 87 Experience of service 89 Emails 89 Good volunteers 89 ‘Moving on’ 91 Section summary 93 Perception of service and anticipation of future contact 93 Contact with other services 95 Voluntary organisations 96 Statutory Services 98 Alternative services 101 Section summary 102 Chapter Summary 103 References 104 Chapter 5: Callers’ perspectives in interviews and emails 105 Introduction 105 Demographics 105 Use of the service 106 Means of contact 106 Frequency of contact 108 Informal support networks 109 Section summary 112 Attitude to seeking help 112 Reasons for calling 112 Expectations of service 113 Email data 115 Good calls 116 Chapter Summary 116 References 117 Chapter Six: Handling Calls 118 Introduction 118 Individual approaches to handling calls 118 Reflection and self-appraisal 120 The Good Call 121 Beginning calls 122 Engaging with the caller 123 Establishing empathy 124 Listening to callers 125 Feelings 127 What to say and how to say it 128 Defining and categorising inappropriate calls 129 Callers with mental health problems 130 Judgement 131 7 Nature of service 134 Manipulative callers 135 Caller Care 137 Dependency 138 Self disclosure and exchange relations in the contact between caller and 139 volunteer Ending calls 141 Chapter Summary 142 References 143 Chapter Seven: Giving Advice and Exploring Options 145 Introduction 145 Samaritans emotional support service: giving advice versus exploring 145 options Aspects of advice-giving 147 Section summary 148 Analysis 148 Analysis of open survey questions 149 Section summary 151 Analysis of caller and volunteer interview data 151 Section summary 155 Analysis of email and text message data 156 Questions embodying advice 156 Using ‘hedges’ & ‘mitigations’ 158 Direct forwarding to other organisations 159 Other methods 160 Section summary 161 Chapter Summary 161 References 162 Chapter Eight: Suicide 163 Introduction 163 Analysis of volunteer interview data 164 The frequency of suicidality in contacts 164 Asking about suicide in contacts 165 Being suicidal 168 Handling calls from people who are suicidal 171 Suicide prevention and intervention 172 Samaritans’ policy of self-determination 173 Staying with callers to the point of death 175 Knowing what happens to suicidal callers 176 Being affected by suicidal callers 177 Section summary 179 Analysis of callers’ interviews and emails 180 Being asked about suicide in contacts 180 Reported reasons for acts of suicide 181 Being suicidal 182 8 Suicidal language, action, and intent 184 Caller issues when actively suicidal 187 Suicide and self-harm 188 The relationship between suicide and mental illness 189 Relationships with others while suicidal 190 Section summary 191 Chapter Summary 191 References 192 Chapter Nine: Mental health issues 195 Introduction 195 Volunteer perspectives 198 Samaritans services as filling a gap in mental health service provision 198 Samaritans

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