Alys Cole-King: ‘Suicide in the NHS family is particularly resonant for me’ | Hélène Mulholland

Suicide prevention expert Alys Cole-King wants distressed NHS colleagues to seek support themselves during the winter crisis

Reports by overstretched NHS staff of the pressures of the winter crisis moved Dr Alys Cole-King to fire off a series of tweets last week:“You matter as much as your patients”, she said encouraging anyone struggling at work in the NHS to tell someone, with a link to online self-help material for those feeling suicidal.

“Struggling at work during #NHSCrisis?” Cole-King tweeted. “Extra important look after yourself when possible PLEASE reach out & tell someone If you can’t tell colleagues, family or friends then make a SafetyPlan. ”

“I like to look after my colleagues and I was just picking up on distress on Twitter,” explains Cole-King, who has worked in psychiatry for the past 26 years. No good study has yet been undertaken to prove a link between NHS workplace stress and suicide, says Cole-King; moreover, suicide is never caused by one single factor. But there is evidence that NHS professionals don’t always feel able to say when they are not coping. “There is huge secrecy about admitting if you are struggling when you are a professional working in the NHS. I think every suicide is a tragedy, but there is something particularly resonant for me about the NHS family. I suppose I can identify because I work with these people every day.”

Nurses and doctors are among occupational groups at increased risk of suicide, according to Office for National Statistics (ONS) figures for England and Wales. Common explanations include easy access to lethal drugs and knowledge of methods. Separate ONS figures published last year showed that in England, the risk among female health professionals of suicide was 24% higher than the female national average – largely down to a higher expected suicide rate among female nurses.

“You don’t have to be mentally ill to experience suicidal thoughts, which are far more common than people realise; feeling overwhelmed by one’s problems or situation and struggling to see a way out can be enough to set such thoughts flickering,” says Cole-King. Has she ever had suicidal thoughts? “I always say, I haven’t yet. Because I’m aware that if you gave me a few too many life events of the wrong sort, I might start thinking that life wasn’t worth living,” says Cole-King. She has made a “safety plan” and thinks everyone should have one. It includes a list of reasons for living, things you can do to lift your mood and that you know will help you – and if that doesn’t work, things that can distract you. If that still isn’t enough, then it lists who you can talk to – and that includes seeking help from professionals, she adds.

Doctor distressed
There is evidence that NHS professionals don’t always feel able to say when they are not coping. Photograph: Voisin/Phanie/Rex

Death by suicide is a death like no other. Despite all her years in the field, her eyes moisten as she recalls the time she attended a Papyrus conference – a charity set up by suicide-bereaved parents. “There were about 100 people in the room and I suddenly realised only four of them had not lost a child. The pain in that room was overwhelming.”

Her interest in the field began early in her first stint as a junior doctor when, ill-equipped and untrained, she was faced with a patient who had attempted suicide. Now 50, she opted to specialise in psychiatry, and devised training material for colleagues at the hospital where she worked in south Wales. This evolved to become Connecting with People, a training organisation she founded for UK health professionals. Informed by suicide survivors, who are among the trainers, Cole-King says above all it’s about conveying the power of compassion. “It’s that invisible thread that keeps someone alive when they think everything is lost.”

This means not dismissing someone talking of suicide as attention-seeking, or trying to play down how bad they say they are feeling. It moves away from the tick-box approach of risk assessment, to dealing with the unique distress of the individual. Healthcare professionals on the frontline are also taught the importance of self-care to mitigate burnout. Training is being delivered across the UK, Ireland, Jersey and Australia.

“The vision is that everybody can deal compassionately and safely with somebody at risk of suicide depending on their job role, their experience and their expertise,” says Cole-King. “Every single person has a role.” Does it make a difference? She cites the University of Wolverhampton, which commissioned training for some staff who in turn have trained almost 900 people across academic, non-academic and student ranks. “What they’ve shown is a huge reduction in the number of students being referred to mental health services because of suicidal thoughts,” says Cole-King. Timely access to mental health services, too, is key. Nevertheless, her message is one of hope. “Maybe there are small things we can do now. And a lot of small things added together can make the difference between someone feeling that they can live and that they can’t.”

Cole-King splits her week between Connecting with People, which has extended its remit to schools, universities and councils, and working as a consultant liaison psychiatrist at Betsi Cadwaladr university health board in north Wales. Her post involves a public health role linked to the Wales suicide and self-harm prevention strategy, Talk to Me 2. The latest available figures show suicide rates in Britain are down for the third year by 3.4% to 5,668. In England, the Department of Health and Social Care is pursuing its own suicide prevention strategy.

Cole-King was also the instigator of the U Can Cope coalition in 2012, which included the Professional Cricketers’ Association and the Rugby Players’ Association, to convey that it’s possible to overcome suicidal thoughts and feelings. She helped produce a film, U Can Cope, which has now been viewed more than 100,000 times. Her work has not gone unnoticed. Last year she was the first UK recipient of a prestigious award from the International Association for Suicide Prevention. Her advice to anyone contemplating suicide? “Try and see it as a sign to change something in your life, not end your life. It can be just about thinking how you can get through the next few minutes, the next half an hour, or next few hours – as much as you feel you can deal with at the time.”

• In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at

Curriculum Vitae

Age: 50.

Family: Married, teenage son and daughter.

Lives: Snowdonia.

Education: Tower House school, Barmouth; Penrhos college, Colwyn Bay; Howell’s School, Denbigh; University of Wales College of Medicine, Cardiff;diploma in geriatric medicine (DGM), Royal College of Physicians; MSc in clinical psychiatry, Cardiff; membership Royal College of Psychiatrists,fellowship, Royal College of Psychiatrists.

Career: 2008 to present: clinical director, Connecting with People/4Mental Health; 1999 to present: consultant psychiatrist, Betsi Cadwaladr health board, north Wales; 1999-2004: consultant psychiatrist, Mold community mental health team, Betsi Cadwaladr University Health Board: 1997: started developing the clinical assessment frameworks that are now the basis of Connecting with People; 1995-96: year-long “psychological autopsy” research project; 1993: delivered teaching sessions on suicide and self-harm to emergency department (A&E) colleagues; 1991-1999: junior doctor roles at various hospitals, now part of Aneurin Bevan University Health Board.

Public life: Contributes to all-party parliamentary group for suicide and self-harm prevention; member, RCPsych patient safety working group.

Awards: 2017: first UK recipient of the International Association for Suicide Prevention Ringel Service Award and one of the Medical Women’s Journal top 100 most influential women in medicine.

Interests: spending time with family, gardening, walking, picnicking in places with lovely views.


Hélène Mulholland

The GuardianTramp

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