SALT Approach to mental health & suicide prevention

[Kausar Skhan]

Hello All,

I am currently in discussion with possible partners for 2 interventions : (a) mental health (b) suicide prevention in two sites in Pakistan where many suicides are reported.

I am proposing SALT approach for these two initiatives. I would love to hear from those who have taken SALT approach in these areas.

[Birgitta Schomaker]

Wonderful, Jan, to read your experience.

Your query is thought provoking, Kausar. The question reminds me of traditional mental health approach in an american indian reservation that I know. When someone suffers from post-traumatic stress disorder, the whole community (can involve 100+ participants) are involved in a ritual that takes a couple of weeks, with at least 4 days fulltime participation of lots of people. Healing is considered a community effort. It is really impressive.

Also, in native american church ceremonies and in traditional sweat lodge ceremonies, everybody prays for the 'patient'. I have visited a rehab facility in New Mexico where native americans with substance abuse problems were treated with traditional community based approaches. 

The combination of SALT and a community effort is really powerful, in my opinion. Not only for realizing community dreams, but also for healing and well being of individuals. Inclusion in the community is key for recovery and prevention. SALT can assist in overcoming shame as to addressing mental health problems. 

[Jan Somers]

Although I am not a doctor, and have not yet applied SALT & CLCP in the specific domains of mental health and suicide prevention, I can imagine that the approach has various fields within these domains that it can be applied in a very effective way. Let me share some of my thoughts on it here: 

Salt is a way of connecting and approaching people to honour their identity, their strengths and their context. So in the domains of mental health and suicide prevention one can look at it on an individual level - the specific patient or person that is directly affected by mental issues or suicidal thoughts & plans. But one can also look at it on a community level - like the family community that can be empowered on handling the person and context to be supportive - or like the broader community that can be empowered to take away the domains from the taboo sphere. 

I remember last year when doing some workshops on poetry writing with some people that were residing in a clinic for mental health issues. I facilitated them, as a poet myself, in writing their own personal poem on the topic of 'experiencing holliday'. They did a great job and were proud afterwards. We took it step by step by allowing them to share stories, selecting some words or sentences, and helping them to bring them in a poetical sequence. Their participation in the authoring process was much appreciated by the individuals and the staff of the clinic.

Happy to elaborate on this should you wish. 

Jan Somers - Belgium 

 

[Birgitta Schomaker]

Hi Kausar,

I have not used SALT in this context, but I do know there is evidence of success in solution-focused psychotherapy that focusing on strengths and solutions works well for a variety of mental health issues. 

Solution Focused Therapy Research

handbook on evidence based Solution Focused therapy

"Therapy is frequently miscast as requiring an enormous amount of time and financial commitment, but helpful, goal-oriented therapy can produce positive results after only a few sessions. Solution-focused brief therapy (SFBT) has been gaining momentum as a powerful therapeutic approach since its inception in the 1980s. By focusing on solutions instead of problems, it asks clients to set concrete goals and to draw upon strengths in their lives that can help bring about the desired change for a preferred future. Chapters review the current state of research on SFBT interventions and illustrate its applications—both proven and promising—with a diverse variety of populations, including domestic violence offenders, troubled and runaway youth, students, adults with substance abuse problems, and clients with schizophrenia. This text also includes a treatment manual, strengths-based and fidelity measures, and detailed descriptions on how to best apply SFBT to underscore the strengths, skills, and resources that clients may unknowingly possess.

Let me if I can assist.

[Rituu B. Nanda]

Dear Dr Kausar, I want to share a message which Thuon Nary, SALT facilitator from Cambodia had sent me recently. She works in Mobile Team for Mental Health.

Actually, my team use regularly Salt method in our work. We stimulate communities strength especially with the authority by training them on general psychological condition and Helping skills. After training they take action and do advocacy with family to free psychotic clients from chain and refer for medical treatment effectively. We also work with client family by using salt to encourage them for supporting client.

 

[Madhuri Dutta]

Hi

We were interested in reaching out to the urban community around our institute and have them talk about depression. Our long term objective is to have the community in India talk openly about taboo topic such as mental health. To understand what mental health entails and also find appropriate resources within reach as per their need.

We will begin a project shortly on a baseline survey on depression which will feed into a community project later on using CLCP and SALT.

We will reach out to you for your experience in your study.

-Madhuri

[Laura Simms]

Like so many of the good responses, I agree that being engaged in finding and articulating one's strength basically renews a sense of possibility into one's life.  The act of speaking one's strength changes an inner stuck narrative.  The development of a plan of action in one's life, either individually or in community, takes one with support through a step by step (not overwhelming) opportunity to make some changes and make a difference.  To be concerned with others and feel that you have impact is often a key path toward giving meaning beyond what root causes have deepened hopelessness.  IN my work as a storyteller sometimes it is the telling of a story where someone is drawn out of self preoccupation into the unfolding narrative in an inclusive responsive way is helpful as well. From a Buddhist or mindfulness point of view, what is often ignored in individuals (hence in community) is that there is a territory inherent in our minds that is always untarnished by events, even thoughts, and finding skillful ways to access and feel that place can unfix some suicidal thoughts.  Soemtimes allowing someone to tell a projected story (this has to be done with great knowledge and kindness) of their suicide and its consequences gives space enough to see beyond the intensity of a deep despairing compulsion.  SALT methodology is relational and draws people out of habitual patterns of thinking into a more fulvent and creative shared realm of possibility.  (thinking out loud).  Laura

[Bobby Zachariah]

Mental health and suicide are quite related issues and it is great to see that you have linked the two as you initiate the program.

Keeping SALT as a strategy will keep us grounded in understanding the feelings, thoughts and behaviors of people in emotional distress and their loved ones and adapting our program strategy.  The expanding circles of care by intentionally including the home, neighborhood (at place of living, work, faith etc.) and professional centres will help in cultivating responses at these levels.

We started with the listening helpline along the lines of Befrienders International where trained volunteers listened to people in distress.

SALT took us to schools, hospitals (where people were admitted after a suicide attempt), police stations (where police men/women become part of the response and directed us to homes where people died by suicide), corporates (where we were asked to support co workers of the one who died by suicide) and University contexts in Netherlands, American Foundation for Suicide Prevention (AFSP) etc.

Actions were designed to prevent, intervene and for postvention.  As other contributors to this post have pointed out, you can start anywhere and then gradually include other elements as new avenues are explored and opened.  My experience is that due to the stigma, fear and shame associated with suicides, you have to be quite intentional and consistently pursue opportunities, for doors to open.

Taking care of the team who is involved in the work is quite important to prevent burn out and emotional backlash (trauma, guilt, drop out of team members).  Hence listening approaches, mentoring, cultivating bonding between team is important, to provide mutual support.

We worked with quite a large number of volunteers (nearly 135) who did activities that suit their personality (some were involved in publicity for the helpline, on volunteer raising, others listened to people in distress on the helpline, a team worked with cultivating students in schools on a peer education program, some visited hospitals and listened to suicide (attempt) survivors and their relatives, some visited suicide death survivors (loved ones of those who died by suicide) at their homes and many worked in cultivating relationships at police stations / industries etc.

We found it quite useful to work with the media to educate the public via news articles.  Since we systematically documented our work and outcomes, the synthesis of data provided useful insights which we were able to share with the news papers who would publish it to bring focus to the issue of suicide prevention and survivor support.

Quite encouraged to see several team mates who are interested in this initiative.

[Ellie Rae Wilson]

Hello. I saw this on an e-mail from the Community Life Competence website.

I have been through mental health issues and have experienced depression and a past suicide attempt. I've had issues such as psychosis, trauma, and major depression.

I live in the United States, and I've had some extremely negative experiences with the mental health system in my country. Often treatment is inaqequate, pushes diagnoses very quickly, and relies heavily on medication over more effective methods like therapy.

One of the most critical issues that I've dealt with is lack of patient decisions, or use of manipulation or physical force by the mental health and hospital systems to take away a patient's right to choose - something that is against the constitution of our country, but is more often than not something disregarded in this day and age.

"You put the robes on, or we put them on you," is a phrase that I've actually heard from a hospital staff member as a description of their policies on mental health patients.

Thus, as a mental health patient, I've learned that going through the mental health or medical systems for treatment are not always a safe place, and that becomes a problem for many people who end up refusing treatment entirely.

Mostly, I've had to recover from mental health using hesitation, accepting only natural medicines, and using self-therapy or a counselor who is not attached to a psychiatric drug prescriber.

If you'd like to talk with me about mental health from a personal first-person perspective, feel free to message me.

[Rituu B. Nanda]

Hi Ellie, thanks for sharing your experience. I would like to get in touch with you and learn further. Warm new year greetings.

Rituu