How Wollongong's suicide crisis centre is keeping people in distress out of ER

It's almost 2pm on a Thursday, and Emma and Renee are waiting to start their shift at Wollongong suicide crisis centre Safe Haven.

They know someone usually knocks on the door right on opening time, but despite being somewhere that deals with people in distress, everything is calm.

The afternoon sun streams in through the window of the front room, which looks out to Mount Keira. In the room across the hall, where the surfaces are covered in plush mats and blankets and a giant cocoon-like bean bag take up most of the floor, the blinds are drawn and a star projector light shines on the walls.

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In the kitchen of the converted cottage at the edge of Wollongong's medical precinct, a scented candle flickers and there's tea, coffee and art supplies laid out ready for the first "guest" - a person in suicidal crisis - to arrive.

"It's a really difficult thing to seek help but if you can just make your way up those stairs, if you can ring that doorbell, a peer worker will greet you," Emma says.

"I'll usually ask people if they want a cup of tea, and they'll find this soft, welcoming, warm, inviting place where they can talk, maybe play a game or write or draw, or just sit with their emotions."

Kirsty, a 22-year-old University of Wollongong student who has repeatedly sought help for mental illness and suicidal thoughts, is struck by the contrast between Safe Haven and the main alternative for people in crisis: the Wollongong Hospital Emergency Department.

"I think we can appreciate the existence of the emergency department as a place that can keep you safe, but it is loud and overstimulating, metallic and medical and clinical," she says.

"The understaffing and underfunding is a pretty severe issue, and sometimes there isn't space for empathy."

At Safe Haven, on the other hand, empathy is its raison d'etre. It is staffed by peer workers, like Emma and Renee, who all have their own experiences with suicide.

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"All of us here at Safe Haven have a lived experience of suicidal distress of some sort," Emma, the team leader of the service, says.

"They may have been a carer for someone in suicidal distress, they may have had suicidal thoughts of their own, or lost someone to suicide - and for some people it's all of those things together."

"We use that experience to garner a really safe place for someone to sit and be in their emotions. It's also a point of connection, and people feel a sense of trust with you, and it gives people a sense of hope and inspiration."

For Kirsty, who discovered Safe Haven at the start of the year, being able to speak to someone who understands has been vital.

"They showed me that you can struggle with suicidal thoughts and self-harming mental illness and still turn out to be a capable, confident person," she said.

"You can read about people talking about their stories, or see these phrases about life improving, but that it pales in comparison to having someone in front of you displaying compassion and intelligence, while having a deep connection of that shared pain."

"It cements that there is a life without that constant battle.

"You can go up and it's not weird or wrong or messy or inconvenient to exist just as you are in that space. It's totally okay and they can see you're a great person, you still have strengths, but you are just struggling at that moment.

"It's not like talking to a stranger - it's talking to someone who has existed in that realm with you - and that feels very rare."

Safe Haven is part of a multi-pronged approach from the Illawarra Shoalhaven Local Health District to prevent suicide.

There are 19 other similar services around NSW, but the Clinical Director of the region's mental health service, Dr David Alcorn, says Wollongong's decision to take a unique non-clinical approach is paying off.

Using funding from the state's Towards Zero Suicides program, the district engaged community organisation Stride to set up Safe Haven last May.

"The idea of Safe Haven is that they should provide non-clinical care for people who are in suicidal crisis," Dr Alcorn said.

"People are allowed to not identify themselves if they wish, they can drop in during the opening hours just to have a chat with a peer worker. It might include just spending time in a quiet space, listening to music, writing, drawing, using a massage chair or even using a sensory room.

"It's completely free, there is no impost on the individual consumer who goes there. People who go there are not even called consumers, they are called guests. So it is very much a non-clinical model."

He said people who needed more help could be referred to the hospital's mental health team, but that this was "quite a rare occurrence".

"I'd say that happens once a month or two months," he said.

"Most of the people at Safe Haven who have suicidal crises meet with the people who have a lived experience of suicide - the peer workers - and that seems to be what they really value."

This has the dual benefit of helping these individuals, and the health system as a whole.

"Going into an emergency departments can involve waiting, it can involve being exposed to scenes of illness and sometimes even death, so it's not a great environment to go unless they actually need to," Dr Alcorn said.

In recent months, patients - especially those who might not have acute physical symptoms - have faced record wait times at the ED.

"To go up to an emergency department, it means going up and introducing yourself to the triage nurse who will ask you about symptoms that you have and what you are experiencing," he said.

"They will then assign a triage category to you, between one and five, and these categories carry a recommended time for when people should be seen. Most mental health patients, who haven't taken an overdose and haven't physically harmed themselves, will spend some time in the waiting room before being called through."

They might then see an initial staff member - a doctor or a nurse practitioner - and then be referred to mental health staff, before being assessed and admitted, or discharged to be followed up by the acute care team at home.

In combination with a program where police and paramedics work with an after-hours mental health team to go to the homes of people facing suicidal crises, Dr Alcorn says more than 1000 people have been kept out of the ED since Safe Haven opened.

"Through the range of measures over the last 18 months we've had about 1000 less presentation to Wollongong Hospital emergency department than we otherwise would have," he said.

"In most of the other [LHDs] mental health presentations have spiked up, but in Wollongong it has been generally consistent and hasn't shown those big leaps."

"Safe Haven has had a big part to play in that, it sees around 60 people a month, and the results they are getting are very positive."

"We are really pleased about that, because keeping emergency departments for emergencies is really important for the whole community, because they deal with a vast variety of issues and we're also really aware of the potential for traumatising people further."

He would like to see the service, which is open Wednesday to Saturday between 2-10pm be able to expand to include Sundays - "the day after the night before" which is a trigger for many in suicidal crisis.

He's also keen to let more people know that it exists, as data shows that over 80 per cent of people in suicidal crisis don't have a mental illness and are therefore not connected to any mental health supports.

Renee has been a peer worker for just over a year and says there are two main types of people who tend to make their way up the Safe Haven cottage steps.

"There are the people who live with ongoing suicidal thoughts, and they are the guests who return and use us as part of their safety plan," she said.

"Then we have people who may only present once of twice, and they are people who are in a situational crisis - they might have had a marriage breakdown they might have lost their job, become homeless or had a loss in their life and might be grieving.

"There are certain times of the year when we get busier - like Christmas, holiday periods and traditional family periods like mother's or father's day.

"But it's a very flexible service, there are no appointments and people can come when they need. I've really learnt over the last 12 months is that a suicidal crisis can happen to anyone - any age, any demographic."

For Kirsty, the normalisation of mental illness that Safe Haven provides has helped to take away stigma and shame she's felt in the past.

She has also been able to transport some of what the services offers - like sensory stimulation tools including fidgets toys, lights and soft tactile furnishings - into her own life, and use the strategies she has learnt to help other people in times of distress.

"For example, I thought fidget toys were a phase for for high school kids, but I went there and tried them and now all my friends have fidget toys or weighted blankets, and I think, in a small way, that's reflective of Safe Haven," she said.

"It's changed the way I interact with my loved ones, and it has demonstrated to me the power of silence - sometimes that slice of company is all someone needs to get through a hard moment."

She also said Emma helped her to channel her thoughts into writing, which has been important for her recovery, and believes the peer worker system is so powerful that she hopes to one day come full circle.

"I wish so deeply Safe Haven existed when I was younger and really, really struggling," Kirsty said.

"So I hope that one day I will be able to give the same way I have received - maybe I could become a peer worker and be what I needed for someone else who is 12 or 13 years old.

"If someone is reading this and they are struggling, it's okay if they don't know how to talk about it, sometimes just sitting in the space is enough. I think heroes don't wear capes, they talk about their battles with mental illness - and I think peer workers are form of hero that the world really needs."

Safe Haven is located at 55 Urunga Street Wollongong, and is open from Wednesday to Sunday from 2-10pm. The service is free and does not require a Medicare card, but people aged under 16 need to be accompanied by an adult.

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