Residential suicide crisis care: stopping people from dying or supporting people to live

Background and aims: Improving care for people in suicidal crisis remains high on the UK government agenda. Trauma-informed approaches (TIAs) have been advocated to address the concerns raised by service-users with psychiatric hospital services. This study explores service-users’ accounts of staying at a women’s trauma-informed crisis house and in hospital whilst experiencing suicidal distress.

Methods: Eight women were interviewed using a semi-structured interview schedule. Interviews were transcribed and analysed using thematic analysis within a critical realist framework.

Results and discussion: Seven themes were developed: the power of talking, the limitations of medication, managing emotional safety through trusting relationships, managing physical safety through coercion, a home rather than a hospital, fostering compassion and the benefits of gender sensitivity. Participants described hospital as being dominated by a medical and custodial approach, which they said could undermine therapeutic engagement and exacerbate distress. By reframing suicidal feelings as a reasonable response to events in people’s lives, the TIA was described as enabling participants to safely work through their suicidal feelings, whilst maintaining freedom and control. This research was carried out with a small sample and both recruitment and context likely privileged positive accounts of TIAs. Clinical implications and areas for further research are discussed.