SUICIDE PREVENTION AWARENESS 59 Emergency department, hospitals, and follow-up care In many communities, hospitals play a pivotal role in medical care. Emergency departments (ED) offer brief, rapid interventions in times of crisis. Presenting at the ED does not necessarily lead to being admitted to in-patient care, and in-patient care is not always the appropriate setting for someone considering suicide. Therefore, it is important for hospitals to be connected to community care to provide smooth transitions for people in crisis (Centre for Suicide Prevention, 2017). Training and networks Varying levels of suicide prevention training are relevant for people playing different roles in a community. It is not exclusively for professional caregivers.Training helps break down stigma. It gives people language and license to talk about suicide. It can create a caring safety net among caregivers. Typically, social workers, first responders, healthcare workers, teachers, and other ‘caring professions’ receive some level of suicide prevention training. However, anyone can learn how to identify and support someone considering suicide. Skills training is effective suicide prevention because it equips community members to recognize and reach out to someone considering suicide.There are various levels of training available, from one-hour online learning modules that teach people how to recognize warning signs and have a conversation, to two-day workshops that train people to step in and intervene with a person who is actively thinking about suicide, and possibly even attempting suicide. Training is a key component of a larger suicide prevention strategy including other best practices – when training is the only best practice implemented, its effectiveness is limited. Gatekeeper training People considering suicide display warning signs, or, put out invitations, for help. Typically, these signs are communicated to people they trust – ordinary people in their lives. People are more likely to go to friends and colleagues when they’re struggling than to a professional. If we see a friend struggling, do we know what to do? Gatekeeper training provides people with the skills and knowledge to recognize someone considering suicide, and connect them to help.A gatekeeper can be anyone with the will and capacity to help. Community gatekeepers are people like first responders, social workers, healthcare workers, and teachers, who see lots of people, especially those who may be considering suicide, on a regular basis. Gatekeeper training has been shown, in studies, to be an effective form of suicide prevention (Shannonhouse et al., 2017; Coleman & Del Quest, 2015; Gould et al., 2003). Safety planning A safety plan is a document that supports and guides someone when they are experiencing thoughts of suicide, to help them avoid a state of intense suicidal crisis.Anyone in a trusting relationship with the person in crisis can help draft the plan; they do not need to be a professional. When developing the plan, the person experiencing thoughts of suicide identifies: • their personal warning signs • coping strategies that have worked for them in the past, and/or strategies they think may work in the future • people who are sources of support in their lives (friends, family, professionals, crisis supports) • how means of suicide can be removed from their environment • their personal reasons for living, or what has helped them stay alive A safety plan is written when a person is not experiencing intense suicidal thoughts. It may be written after a suicidal crisis, but not during. A person’s unique strengths, abilities, and support people are identified in the plan so that they can draw on them when they experience intense thoughts of suicide. See the next page for details on how to create a Safety Plan. What is intervention? (continued)