Kate is a Clinical Nurse Consultant working at Uniting MSIC. She has 12+ years nursing experience in a variety of settings and services both in the UK and Australia Kate has a Masters in Public Health and is a passionate advocate for holistic care in mental health service provision.

Introduction:
Risk of suicide is 14 times greater for people who inject drugs (PWID), compared to the general population. Existing guidelines for identifying suicide risk include factors that are highly prevalent among PWID, and often necessitate involving police, ambulance and Emergency Department admission, which may increase harm. A targeted protocol, codesigned with clients, is needed. We sought to gather evidence to support development of an appropriate, client-centred suicide protocol.

Method:
Two focus groups (FGs) were conducted within a mixed methods codesign process. One FG included clients of the Sydney Medically Supervised Injecting Centre (MSIC) with lived experience of suicidal ideation or self-harm (Client-FG). The second included MSIC clients and experts from local mental health and alcohol and drug services (Multidisciplinary-FG).
An experienced external facilitator led the groups. Client-FG participants discussed their suicidality/ self-harming experiences, perceived needs, and interactions with services in times of crisis. Multidisciplinary-FG participants discussed solutions to problems that built on themes identified in the Client-FG. The groups were audio-recorded. Themes were analysed using an inductive thematic analysis.

Findings:
Seven of 12 clients who indicated interest in the Client-FG participated. Key themes: loss of power/autonomy, fear of persecution, and involuntary incarceration, often resulting in non-disclosure of important information; a strong desire to be validated/heard; the quality of interactions with staff.
All six staff and one of four clients who expressed interest in the Multidisciplinary-FG participated. Key themes were: trust as integral to staff practice/client experience; client retention of control and autonomy in their care; concern that service models can devalue the perspectives and experience of clients when suicidality is identified.

Discussions and Conclusions:
Findings contributed to the development of a protocol that acknowledges suicide risk as dynamic; bases response on compassion, empathy, transparency, and collaboration; aims to build trust and validate clients’ experience; presents streamlined processes for staff.