One of the things I enjoy most about speaking with colleagues internationally is the moment when someone describes a difficulty in their service and I think: “Oh yes, we know that one too!” The scale, resources, legislation and culture may be different, but there is often something very familiar in the challenge itself. Then comes the more useful question: how have they approached it, and what might we learn? Those are conversations I always appreciate.
This IACFP Bulletin brings together contributions from the United States, Australia, the United Kingdom and Ireland. Reading them prompted me to think about the gap between what we think we see and the reality on the ground. A person may appear to cope well while struggling considerably. A service may exist but remain difficult to access. A policy may be clear on paper but tell us little about what happens in practice (a particular bugbear of mine!). These are questions with consequences for care, safety and rehabilitation.
Joseph Obegi’s 4-Square Model, used in California, broadens our thinking about suicide prevention to include prevention, treatment, preparedness and quality. In South Australia, Kimberley Gilson describes work to improve access to care for people with borderline personality disorder across custodial and community settings, connecting treatment, consultation, workforce development and research. Tassie Ghilani takes lived experience beyond consultation, describing how it can shape care, service design, recruitment and policy and how His Majesty’s Prison and Probation Service are approaching this in England and Wales. From Ireland, Richard Booth and Rachel Egan describe adapting Group Radical Openness for prisons, including work with people whose difficulties may be less apparent because they present as highly controlled.
International learning becomes worthwhile when it helps us make better decisions in our own services. This requires more than simply finding an appealing programme elsewhere. We need to understand why it was developed, what it asks of staff and participants, and what needed to change along the way. Shared principles can guide us, but local needs, resources and culture must shape application in a particular jurisdiction.
My sincere thanks to our contributors for sharing their work. For colleagues receiving this Bulletin at the ICPA conference, and for our readers elsewhere, I hope you find something here worth pursuing. Ask the authors about the difficult parts as well as the progress. Those conversations can help us move from recognising a familiar challenge to deciding what we might do differently about it.
Dr Emma Regan
IACFP President
