Skills Training On Risk Management
Submitting InstitutionUniversity of Manchester
Unit of AssessmentPsychology, Psychiatry and Neuroscience
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
In 2011 there were 6,045 suicides in people aged 15 and over in the UK.
Training health and social care professionals is an essential component of
suicide prevention strategies across the world. The University of
Manchester (UoM) has developed and evaluated a method of training health
and other frontline professionals in suicide risk assessment and
management skills (STORM). The STORM project, now incorporated as a social
enterprise with 2 permanent members of staff, has provided training to 670
training facilitators who have subsequently trained around 230,000 workers
in the UK and overseas. In the first year of trading as a social
enterprise, the majority of customers of Storm CIC were NHS Trusts with an
annual turnover of £250k in 2012-13.
See section 3 for references 1-6. UoM researchers are given in bold.
The impact is based on research that took place at UoM from 1995, with
the first major publication in 2000.
Linda Gask (Senior Lecturer, 1995-1999; Reader, 1999-2004;
Louis Appleby (Professor, 1996-date)
Richard Morriss (Senior Lecturer, 1995-2003)
Gillian Green (Research Fellow, 2003-date; STORM Project
The STORM research programme incorporated a number of linked projects.
The key steps were:
- We demonstrated that it is possible to significantly improve the
attitudes, confidence and skills of a range of health and social care
professionals (including doctors, nurses, psychological and social
workers, occupational therapists, health care assistants and other
allied workers) in assessing and managing people at risk of self-harm
and suicide. These improvements are achieved through interactive
educational methods, consisting of: brief, focussed presentation of the
key knowledge required by the frontline workers; demonstration of
specific tasks to be carried out; and skills to assess and manage
suicide risk. This is followed by discussion, role- play and
video-feedback of recorded therapist-patient interactions in small
- The training has been delivered successfully in a range of health and
social care settings, including mental health services, accident and
emergency, primary care and the prison system (1, 2, 4, 5).
- STORM was disseminated successfully across South Lancashire by
training and supervising a team of trainers (two mental health nurses
and a psychologist) to deliver it locally in general practices,
hospitals and community settings (2).
- Research into dissemination across the North West of England and
Highland Region in Scotland identified a number of organisational
barriers to the dissemination and implementation of training (4, 6).
These barriers included the level and type of support provided within
health and social care organisations for the delivery of skills training
- We concluded that training alone is insufficient to change the suicide
rate (3). However it is a necessary component of any suicide prevention
strategy, providing the essential skills for professionals both to
communicate effectively with people who are in crisis and engage in
Extensive national and international dissemination has now taken place
References to the research
The research has received funding from the NHS in the North West and the
MRC. The research has resulted in several academic outputs in highly rated
journals in the field of health services research.
1. Morriss R, Gask L, Battersby L, Francheschini A, Robson M.
Teaching front-line health and voluntary workers to assess and manage
suicidal patients. Journal of Affective Disorders.
1999;52(1-3):77-83. DOI: 10.1016/S0165-0327(98)00080-9
2. Appleby L, Morriss R, Gask L, Roland M, Perry B, Lewis A,
Battersby L, Colbert N, Green G, Amos T, Davies L, Faragher B. An
educational intervention for front-line health professionals in the
assessment and management of suicidal patients (The STORM Project). Psychological
Medicine. 2000;30(4):805-12. DOI: 10.1017/S0033291799002494
3. Morriss R, Gask L, Webb R, Dixon C, Appleby L. The
effects on suicide rates of an educational intervention for front-line
health professionals with suicidal patients (the STORM Project). Psychological
Medicine. 2005;35(7):957-60. DOI: 10.1017/S0033291705004502
4. Gask L, Dixon C, Morriss R, Appleby L, Green G.
Evaluating STORM skills training for managing people at risk of suicide. Journal
of Advanced Nursing. 2006;54(6):739-50. DOI:
5. Hayes AJ, Shaw JJ, Lever-Green G, Parker D, Gask L.
Improvements to suicide prevention training for prison staff in England
and Wales. Suicide and Life-Threatening Behavior.
2008;38(6):708-13. DOI: 10.1521/suli.2008.38.6.708
6. Gask L, Lever-Green G, Hays R. Dissemination and
implementation of suicide prevention training in one Scottish region. BMC
Health Services Research. 2008;8:246. DOI: 10.1186/1472-6963-8-246
Details of the impact
See section 5 for corroborating sources S1-S10.
Suicide is amongst the top 20 leading causes of death globally for all
ages. Every year, nearly one million people die from suicide. Innovative
approaches have been sought to reduce suicide rates and the provision of
training for health and social care professionals and frontline workers
has been a key component of national suicide prevention strategies. In
designing STORM, our group at UoM built on extensive experience in the
development and delivery of skills training in mental health and primary
Pathways to impact
Following publication in peer-reviewed journals and recommendation of
STORM training in national guidance in 2004 (`The training has been
shown to improve risk management skills in a range of staff from health
care and other agencies', p. 33) (S1), requests were received from
health and social care organisations for dissemination of the training
reported in research publications. Initially training was supported by
pump-priming funding from NHS North-West to employ one of the original
trainers. With further public endorsement (`Training in the assessment
and management of suicide risk can be delivered to 90% of targeted
mental health professionals. The training package can improve confidence
and attitudes and is well accepted', p.37) (S2), dissemination
became self- funding through a network of `consultant facilitators'. The
STORM team also worked with UMIP to create the relevant IP, (background
IP, copyright, Registered Trade Mark). As a result of these steps to
impact, STORM training is now recommended by UK Government agencies and
the Royal College of Psychiatrists (S3-S5).
Reach and significance of the impact
Scope of the STORM project
- STORM uses a cascade model in which training is provided within a
licensed organisation by staff trained as STORM facilitators who are
supported and supervised by 15 specially-trained and experienced
- STORM became an independent social enterprise in 2012 and currently
employs two full-time staff.
- The STORM team has continued to research the impact and dissemination
of STORM training, through re-investment of profit (now in excess of £1
- STORM has also developed and evaluated training models and materials
for different settings, including criminal justice and younger persons'
UK and international reach
- 160 licence agreements have been now been completed with health and
social care organisations. Through the cascade model, an estimated 230,000
frontline workers have been trained by the 580 STORM Facilitators
across the UK, Channel Islands, Republic of Ireland, Malta and
Australia. This figure represents a conservative estimate and is based
on the average number of frontline staff employed by STORM's main
customers (NHS Trusts) and the number of STORM licence agreements and
contracts in place. If each trained person has mitigated risk of suicide
in only 2 people, this will have resulted in an impact on 460,000
people at risk of suicide and over 2.5 million people within their
- STORM is included in Scotland's Choose Life initiative to
train 50% of frontline staff in suicide prevention nationally.
- Training on a non-profit basis has been provided internationally,
including training general practitioners in Northern Russia in
collaboration with the government of Norway, and mental health workers
in Pakistan (S6), where STORM training has been effective in
de-stigmatising suicidal behaviour and developing confidence in
exploring hopelessness and suicidal risk.
- A 2013 collaboration with the University of Melbourne has researched
the impact of STORM gatekeeper training in secondary schools across
Australia as part of the Headspace suicide prevention and postvention
initiative. Headspace is Australia's National Youth Mental Health
Foundation and Headspace School Support has a specific brief to support
Australian secondary schools around suicide prevention and postvention
(support for impact of suicide on the bereaved). The STORM collaboration
played a central role in its rollout. This unique collaboration led to a
number of outcomes, including the development, implementation and
evaluation of specifically-designed and evidence-based training
programme. This programme will be delivered to school staff throughout
Australia to assist in their management and support of students at risk
- STORM CIC forecasts a profit of £1m over the next 5 years which will
be reinvested in the community by funding further research, development
Significance of STORM
- STORM was a Level 2 UnLtd `Dare to be Different' winner in 2010. STORM
also won a HEFCE and UnLtd HE Social Entrepreneurship Champions of
Change Recognition Award for its `Outstanding Social Impact' in 2011.
- STORM training: enables frontline health and social care staff to
acquire the talking skills needed to communicate with people who are at
risk of harming themselves; it promotes a more positive approach to
suicide prevention; and, it provides participants with the skills to
assess and mitigate risk.
- Organisations report positive and specific benefits on attitudes,
skills and confidence in relation to suicide prevention. The Ballyfermot
Advance Project in Dublin reports that: `Fear of working with someone
who may be suicidal has been replaced with a sense of security because
there is now a clear process through which people can work' (S8).
Plymouth Community Healthcare comments that: `STORM has had a
positive impact in the organisation in relation to our practitioners'
approach to suicide ideation, individuals who have survived an attempt
and also post completed suicide for both families, providing better
understanding of suicide and effects, confidence in managing
situations that are very difficult. The skills learnt have been
transferred to other areas of practice where communication is an
essential skill' (S9).
- Some organizations have made training mandatory for staff.
- The impact of STORM training reaches beyond its intended goal as a
training programme. The key task and skills have been incorporated
formally into treatment pathways, record keeping and the development of
local risk assessment tools (S8-S10).
Sources to corroborate the impact
S1. Appleby L. National Service Framework: Five Years on. London:
Department of Health; 2004.
S2. Wale S, Roe C, Butler M, Finn E, Moore K. An educational intervention
for front-line mental health professionals in both the assessment and
management of suicide and self-harm (Phase 1: The STORM Project). National
Institute of Health Sciences Research Bulletin. 2004;2(3):36- 38.
Presented at the 34th Annual Psychological Society of Ireland (PSI) 23
November 2003, Bunratty, Co Clare.
S3. NIMHE. Best Practice in Managing Risk: Principles and evidence for
best practice in the assessment and management of risk in mental health
services. London: Department of Health; 2007.
S4. National Patient Safety Agency: Preventing Suicide: A toolkit for
mental health services. NHS, National Reporting and Learning
Service, Reference 1133; 2009.
S5. Royal College of Psychiatrists. Self-harm, suicide and risk: Helping
people who self-harm. London: Royal College of Psychiatrists; 2010.
Report No.: CR158.
S6. Corroborating statement from Psychiatrist, Dudley and Walsall Mental
Health Partnership NHS Trust and Royal College of Psychiatrists.
S7. Corroborating email from Research Fellow, Centre for Youth Mental
Health, The University of Melbourne.
S8. Corroborating email from STORM Coordinator, Ballyfermot Advance
Project, Dublin, Ireland.
S9. Corroborating email from Training and Development Manager, Plymouth
S10. Corroborating email from Senior Charge Nurse in Psychological
Therapies, NHS Lanarkshire.