Alternatives to Suicide

1. Introduction

Version followed: the Wildflower Alliance (formerly Western Mass Recovery Learning Community, RLC) Alternatives to Suicide Group Charter ("August edits" version), its companion guidance for service-based "Alternative Conversations" groups, and the Alliance's current training descriptions (24-hour Group Facilitator Training; 16-hour When Conversation Turns to Suicide), plus the VCVC dialogue model as taught in an Alt2Su-based training licensed locally in Wisconsin. Clinician procedures are marked [synthesis].

What it is. Alternatives to Suicide (Alt2Su) is not a therapy and not something a clinician delivers. It is a peer-to-peer mutual-support practice: groups run by and for people who have themselves had thoughts of wanting to die, for voicing, sitting with, understanding and moving through those thoughts [source: Charter; LGBTIQ+ Health Australia]. The charter calls the groups "social groups and not medical treatment" [source: Cutler & Mazel-Carlton, communitypsychology.com]. It began in the Western Mass RLC (now the Wildflower Alliance). Most sources date it to 2008; one interview says 2009 [uncertain]. No individual founder is named [uncertain]. Groups now meet in New England, Pennsylvania, Wisconsin, Canada and Australia, in person and online. In Australia it was introduced by MercyCare in Western Australia, with Wildflower trainers visiting in 2017–18, and by Off The Wall and inside out & associates in New South Wales [source: MHAI slides; MercyCare; TheMHS abstract]. The approach has since been extended into a conversation framework for anyone, including providers, who supports a suicidal person [source: Wildflower Alliance Alt2Su page; Trainings page].

How change is thought to happen. Suicidal thinking is treated as an understandable response to painful circumstances, such as poverty, housing loss, trauma, isolation, shame and oppression. It is seen as an attempted solution rather than the core problem or a symptom of illness [source: MHAI slides; Charter]. Change is expected to come from connection and exploration. Being able to speak honestly, without fear of police, forced hospitalisation or behaviour contracts, lets people understand the context of their wish to die, their reasons for staying alive, and their own paths forward. Belonging to a mutual community is itself seen as protective [source: Cutler & Mazel-Carlton; Mazel-Carlton interview]. The approach presents itself as an alternative to three things: risk assessment (understanding instead of prediction), pathology (ordinary language instead of diagnosis) and coercion (no forced intervention) [source: Mazel-Carlton interview].

Where a clinician fits. The clinician's roles are to refer to and work alongside Alt2Su groups, to use Alt2Su-informed dialogue inside their own practice, and, in a service, to host an "Alternative Conversations" group that is transparent about its limits. A clinician's legal and professional duties around imminent risk do not go away, and Alt2Su's own guidance expects services to be open about this [source: Alternative Conversations guidance; synthesis].

2. Framework

No phases or protocol. Alt2Su publishes no stages, session plan, agenda, symptom goals or discharge criteria. Groups are open-ended and organised around values, not rules. Mazel-Carlton describes the outcome as many alternatives arising between people rather than a fixed sequence [source: Cutler & Mazel-Carlton; Charter].

Standard group format (as published) [source: MHAI slides; Charter; Mazel-Carlton interview; Wildflower Alt2Su page]:

Setting: community, non-clinical spaces, or online (Wildflower keeps a public online group calendar).
Frequency and length: usually weekly; about 90 minutes in the Wildflower description.
Facilitation: two co-facilitators who openly identify as having had suicidal thoughts or experiences. At least one should have completed the Alt2Su facilitator training. Facilitators do not have to be "past" their own suicidal thoughts.
Membership: anyone who wants to talk about, sit with, understand or move through thoughts of wanting to die. There is no intake, referral, discharge or service-use requirement, residence does not matter, and attendance is not recorded beyond total numbers. Observers such as students, media or providers are excluded unless they are attending to explore their own experience.
Privacy: what is shared stays in the group: "leave the names, take the lessons" [source: Charter]. Group members agree not to call police, crisis services or family to set off an involuntary intervention over anything said in group. The only exception is an act or direct threat of violence against someone in the group [source: Charter]. Facilitators are under no obligation to report attendance or content to funders or supervisors.
Governance: decisions are made by consensus where possible, responsibility for the group is shared by everyone, and the group states its own limits on privacy openly.

Use of the name. A group that cannot meet the charter conditions should not call itself Alternatives to Suicide. This applies to any group sponsored by a clinical service that must call emergency services when someone discloses suicidality. Such a group should run as an "Alternative Conversations" group, informed by Alt2Su values. It must give new attendees an information sheet setting out the limits of privacy and the right to come and go freely, along with places where they can speak more openly (warmlines, peer lines, Alt2Su groups). It must also repeat this framework verbally at the start of every meeting [source: Alternative Conversations guidance].

Training pathway [source: Wildflower Trainings page; event page; Safe Communities; MercyCare]:

Alternatives to Suicide Group Facilitator Training (24 hours; earlier described as three days). Anyone may attend, but you can facilitate groups only if you have personal experience of suicidal thoughts and are willing to talk about it.
When Conversation Turns to Suicide (16 hours, four Zoom sessions). This is a dialogue and systems-change training for providers, families, peers and first responders, framed as an alternative to ASIST and QPR. It covers myths about suicide, a framework for conversation, links between trauma, oppression and suicide, and power-sharing. To receive a certificate you can miss no more than two hours.
Shorter overviews exist, for example a two-hour Holding Space for Conversations about Suicide delivered by Safe Communities in Wisconsin.
No formal licensing, certification register or fidelity monitoring beyond the charter, the naming rule and training certificates is described [uncertain].

Clinician's working sequence [synthesis: no published clinical protocol exists]. This is a suggested order for a clinician working alongside Alt2Su, not a published phase model:

Assess and formulate. Carry out a standard psychosocial assessment (see 4.C3). Move on once you have a shared understanding of the person's circumstances, needs and safety plan.
Discuss fit and prepare. Explain what Alt2Su is and is not, and how its privacy differs from yours (4.C1–C2). Move on when the client makes an informed choice to try a group.
Run in parallel. Keep therapy going while the client attends. Bring what they learn in the group into sessions (4.C5). Review the arrangement whenever circumstances change.
Handle acute crises. You follow your own legal and professional duties and the least-restrictive principle. The group keeps its own (Section 5).

3. Guiding principles

From the Charter and Alternative Conversations guidance unless stated otherwise:

Responsibility to, not for or over. You owe the person honesty, transparency and presence, but you are not in charge of their choices. In practice: say what you think and what you will do, and do not try to control them.
Consent and choice. Suicidal thoughts are taken as valid responses to circumstances, and self-determination comes first. In practice: ask before acting, and offer options rather than instructions.
Responses to injustice. Racism, sexism, ableism, transphobia, poverty, psychiatric oppression and similar experiences are named and explored as context. In practice: ask about social circumstances, not only symptoms.
Healing in community. Belonging is something people choose, and it protects. In practice: help the person find relationships and communities, peer or otherwise [source: Charter; Cutler & Mazel-Carlton].
Relationships over fixing. Meet people as they are, with curiosity rather than fear or judgment. In practice: resist the urge to solve the problem. Stay, ask and listen.
Harm reduction. Make no assumptions when someone talks about self-injury, drug use or other ways of coping. Suicide, self-injury and other coping are treated as different things. In practice: ask what a behaviour does for the person before responding.
Ordinary, non-clinical language. Do not assume that suicidal thoughts mean mental illness. People use their own words. In practice: ask what a term such as "manic" means to the person [source: Mazel-Carlton interview].
Each person is the expert on themselves. People speak from their own experience and use "I" statements. In practice: no advice and no assessment unless someone asks for it [source: Wildflower Alt2Su page].
Vulnerability and mutuality. Facilitators share relevant parts of their own lives, and there is no helper/helped divide. In practice: for peers, considered self-disclosure. For clinicians, mutuality within professional limits [synthesis for clinicians].
Willingness to stay with distress. Do not rush to clinical or emergency intervention. In practice: tolerate intense feeling and silence before you decide anything.
Silence and witnessing count as participation. No one has to speak. In practice: let people simply attend.
Understanding over prediction. Explore why someone wants to die and why they stay alive, instead of scoring risk [source: Mazel-Carlton interview; Safe Communities].
Transparency about limits. Every group and every helper says plainly what they will and will not keep private. In practice: state your confidentiality limits before the person discloses, not after.
No failure narrative. A hospitalisation or a suicide attempt is not failure, and the person is welcomed back [source: Cutler & Mazel-Carlton].
Shared responsibility and low barriers. There is no intake, no records and no hoops to jump through, and the group is held by everyone in it. In practice: make it easy for people to come back.
Interrupting oppression. Oppressive words and actions in the group are interrupted when possible. In practice: name harmful remarks kindly and promptly.
VCVC as a dialogue stance: Validation, Curiosity, Vulnerability, Community, used in no fixed order [source: Safe Communities]. In practice: use these four as touchstones for any conversation about suicide.

[source for Section 3: Charter; Alternative Conversations guidance; Mazel-Carlton interview; Wildflower Alt2Su page; Safe Communities]

4. Intervention inventory

Part A covers the practices Alt2Su itself publishes. These are group and dialogue practices carried out by peer facilitators and members, described so a clinician can understand them, refer to them and support them. They are not a protocol for a therapist to run under the Alt2Su name. Alt2Su publishes no scripts, so all example wording is illustrative. Part B covers clinician procedures for working alongside Alt2Su, and is my own [synthesis] unless a source is given.

Part A. Published Alt2Su group and dialogue practices

A1. Opening a meeting with the values and privacy agreement

Purpose: makes it safe to speak openly, and makes sure no one is surprised by what happens to their words. The group is founded on people being able to say anything, including that they want to die, without fear of being forced into treatment [source: Charter; Wildflower Alt2Su page; MHAI slides].
Steps: (1) Welcome everyone. Say that attending, speaking, staying quiet or leaving are all up to each person. (2) Give a short summary of the shared values: responsibility to, not for or over, each other; self-determination; respect; non-clinical language. (3) State the privacy agreement: names stay in the room, lessons can be taken away, and no one calls police, crisis services or family over what is said. Then state the single exception: violence, or a direct threat of violence, against a group member. (4) Note that cross-talk is welcome and advice is given only when asked for. (5) In an Alternative Conversations group, repeat the service's privacy limits at this point, every meeting.
Example language (illustrative): "This is a space to talk about anything, including wanting to die. We don't call police or crisis services over what people say here. The one exception is if someone is violent, or threatens violence, toward someone in this group."
Watch for: newcomers who are visibly unsure whether they can be honest; members who repeat parts of the agreement to each other (a sign of ownership). If you are a clinician, never borrow this wording unless your service can actually keep it.

A2. Co-facilitation by two people with lived experience

Purpose: shows that people with suicidal experience can hold the space, and removes the helper/helped hierarchy [source: Mazel-Carlton interview; Charter].
Steps: (1) Two facilitators, each openly identifying with suicidal thoughts or experiences, and at least one trained. (2) Share leading the opening, keeping time and paying attention to the room. (3) Agree in advance how you will each look after yourselves, since facilitators' own thoughts may come back. (4) Debrief with each other after the group.
Example language (illustrative): "I'm one of the facilitators tonight. I've had times of wanting to die myself, and that's part of why I'm here."
Watch for: one facilitator taking over; a facilitator drifting into a clinical or monitoring role.

A3. Validation

Purpose: to recognise the person's pain, and their wish to die, as making sense in their circumstances. Validation is the first element of VCVC [source: MHAI slides; Safe Communities].
Steps: (1) Reflect the feeling you hear, such as anger, grief, isolation or exhaustion. (2) Connect it to the situation the person has described. (3) Do not argue with the wish to die and do not hurry to reassure. (4) Stay. Silence together is enough.
Example language (illustrative): "After losing the flat and then your job, it makes sense that dying feels like the only way out of this."
Watch for: validation that slides into agreeing that death is the right answer; you are validating the pain and its context, not the method. Signs it is working: the person keeps talking and adds detail.

A4. Curiosity: exploring the "why" instead of predicting the "whether"

Purpose: to understand the context of the suicidal thoughts. Questions about intent and plans are replaced with exploration of reasons, meanings and history [source: Mazel-Carlton interview; Cutler & Mazel-Carlton].
Steps: use four kinds of question, in any order. Source: where did a belief like "I'm worthless" come from (a person, an experience)? Meaning: what does worth mean to the person? Timeline: was there a time before they felt this way, and what changed? Language: what do their own words mean to them, for example "manic" or "breakdown"? The published examples in the Mazel-Carlton interview follow these kinds. Also ask what has been making life hard, what happened recently, what the person wants to escape, and what would make life more liveable [source: MHAI slides].
Example language (illustrative): "When you say you're a burden, whose voice does that sound like?" / "What would need to change for life to feel even a bit more liveable?"
Watch for: questions that turn into interrogation, or a risk checklist in disguise. A sign it is working: the conversation moves from "I want to die" to the specific things the person needs to get away from.

A5. Exploring reasons for staying alive

Purpose: the dialogue looks at why people choose to stay as well as why they want to die. Survival is linked to mutual relationships and to belonging to some kind of community [source: Cutler & Mazel-Carlton].
Steps: (1) Once the reasons for wanting to die have been heard, ask what has kept the person going until now. (2) Look for relationships, such as a pet, child or friend, and communities, such as a faith group, band, LGBTQ+ group or activist group. (3) Do not use these reasons as leverage ("think of your kids").
Example language (illustrative): "With all this going on, what's kept you here so far?"
Watch for: guilt-inducing framing; the person feeling their pain has been brushed aside.

A6. Vulnerability: considered self-disclosure

Purpose: to make the relationship mutual and show that surviving suicidal periods is possible. This is the third element of VCVC [source: Charter; Safe Communities].
Steps: (1) Share a short, relevant part of your own experience, using "I" statements. (2) Bring the attention back to the person. (3) Never use your own story to tell the person what they should do.
Example language (illustrative, peer): "I've had nights where I looked for reasons and couldn't find any. What helped me was having someone who didn't panic."
Watch for: disclosure that turns the attention onto the facilitator. For clinicians, this element is limited by professional self-disclosure norms [synthesis].

A7. Community: connecting the person outward

Purpose: the fourth element of VCVC. Healing in community, and belonging the person chooses [source: Safe Communities; Charter].
Steps: (1) Ask who or what the person feels connected to, or would like to be. (2) Offer to contact someone supportive together, if the person wants that [source: MHAI slides]. (3) Point to peer groups, warmlines or other communities.
Example language (illustrative): "Is there anyone you'd want to have with you in this? We could message them together now if you like."
Watch for: contacts made without consent. Make sure the person chooses who is contacted.

A8. No advice unless asked; "I" statements; welcome cross-talk

Purpose: keeps each person the authority on their own life, while still letting members learn from each other [source: Wildflower Alt2Su page; Mazel-Carlton interview].
Steps: (1) When someone shares, others respond with validation, curiosity or a link to their own story. (2) If advice is wanted, the person asks for it, or a member checks first. (3) Gently redirect "you should" into "what helped me was".
Example language (illustrative): "Before anyone jumps in, would you like ideas, or would you rather just be heard?"
Watch for: members correcting each other's beliefs; shame after receiving advice no one asked for.

A9. Staying with distress, silence and witnessing

Purpose: the charter commits facilitators to staying present with deep distress without rushing to clinical or other intervention, and it counts silence as participation [source: Charter].
Steps: (1) Slow down. Name what you notice. (2) Ask what the person needs right now (to talk, to sit quietly, to step out, to have company). (3) Accept quiet presence as a legitimate response.
Example language (illustrative): "We don't have to fix anything right now. What would help you get through the next little while?" (The question about what the person needs in the moment comes from the Wildflower slides, paraphrased.)
Watch for: facilitator anxiety that pushes toward an emergency response. If you are a clinician bound by duty-of-care rules, see Section 5.

A10. Responding when someone says they want to die or will kill themselves

Purpose: to respond with curiosity rather than an emergency protocol. Even the service-based guidance tells facilitators to explore what the person means rather than "jumping to conclusions or enacting any sort of emergency response protocol" [source: Alternative Conversations guidance].
Steps (as published, in outline): (1) Validate. (2) Ask what the person means, what is happening and what they want to get away from. (3) Ask what they need now. (4) Offer to bring in trusted people they choose. (5) Do not call involuntary services, unless violence toward a group member is involved. No more detailed crisis protocol was found [uncertain].
Example language (illustrative): "Thank you for saying it out loud. Can you tell me more about what tonight has been like?"
Watch for: clinicians: your duties differ. See 4.C3 and Section 5.

A11. Contextualising: connecting distress to life events and injustice

Purpose: suicidal thoughts are understood as responses to concrete pressures, such as debt, housing, rape culture, war, austerity or transphobia, rather than as individual pathology [source: Cutler & Mazel-Carlton; MHAI slides; Charter].
Steps: (1) Ask about circumstances: money, housing, safety, relationships, discrimination. (2) Name injustice as injustice. (3) Talk about practical and collective responses, including advocacy and activism.
Example language (illustrative): "It sounds like a lot of this is about how you've been treated, not about something being wrong with you."
Watch for: a person who finds a medical framing helpful. They choose their own words (principle: each person is the expert on themselves).

A12. Harm-reduction responses to self-injury, substance use and other coping

Purpose: the charter says not to make assumptions when people describe self-injury, drug use or other coping. Suicide, self-injury and other coping are distinguished from one another and respected [source: Charter; Alternative Conversations guidance]. Wildflower runs a separate training, A Harm Reduction Approach to Self Injury [source: Safe Communities].
Steps: (1) Ask what the behaviour does for the person. (2) Do not treat self-injury as a suicide attempt by default. (3) Explore what makes the coping safer or less needed, on the person's own terms. Do not discuss method details.
Example language (illustrative): "What does cutting do for you when it gets that bad?"
Watch for: method-sharing in groups. Steer away from it [synthesis].

A13. Interrupting oppressive words and actions

Purpose: protects members, in line with the commitment to respond to injustice [source: Charter].
Steps: (1) Name the remark briefly and without shaming. (2) Restate the shared values. (3) Check on the person it affected.
Example language (illustrative): "I want to pause there. That comment lands hard on some people here."
Watch for: escalation. Facilitators can consult the group about agreements using consensus.

A14. Group-led governance and shared responsibility

Purpose: the group belongs to its members [source: Charter].
Steps: (1) Make decisions such as format, privacy limits and topics by consensus where possible. (2) If a decision is made outside the group, explain it openly. (3) Keep no attendance records beyond total numbers.
Example language (illustrative): "Someone suggested a check-in round. How does everyone feel about that?"
Watch for: facilitators slipping into a staff role.

A15. Welcoming people back after hospitalisation or an attempt

Purpose: avoids a narrative of failure or relapse. Alt2Su explicitly rejects removing someone from a role because they relapsed [source: Cutler & Mazel-Carlton].
Steps: (1) Welcome the person back without asking for an explanation. (2) Let them share as much as they want.
Example language (illustrative): "Really glad you're back. Share as much or as little as you want."
Watch for: shame or withdrawal. Reach out if your group's agreements allow it.

A16. Creative tools

Purpose: Mazel-Carlton contrasts removing musical instruments from psychiatric wards with using music as a way to talk about pain [source: Cutler & Mazel-Carlton]. The broader Wildflower Alliance offers expressive arts and other activities, though these are not listed as Alt2Su components [source: MHAI slides].
Steps: No structured procedure was found [uncertain]. Groups may share songs, writing or art as a starting point for conversation.

A17. Training exercises: beliefs and attitudes, and rehearsing phrases

Purpose: in Alt2Su-based training, participants start by examining their own beliefs about suicide and how suicidal people are criminalised and pathologised. Later they rehearse phrases to use with someone who is thinking about suicide [source: Safe Communities]. Facilitator training focuses on holding space and unlearning conventional "suicide prevention" language [source: Mazel-Carlton interview].
Steps: The published descriptions give no exercise content beyond this outline [uncertain]. Get the training from the Wildflower Alliance or its local partners.

Part B. Clinician procedures alongside Alt2Su

These procedures are [synthesis] unless a source is given. Alt2Su publishes no clinical protocol. Where they rely on current standard practice, I cite NICE NG225 (2022) as summarised by members of the guideline committee (Mughal et al., 2023).

C1. Assessing fit and preparing a client for an Alt2Su group

Purpose: to help a client make an informed choice about a peer space where they can talk about suicide openly.
When to use: with clients who have recurrent or chronic suicidal thoughts, who hide them from services because of past coercion (police contact, forced admission, behaviour contracts are commonly reported [source: Cutler & Mazel-Carlton]), who are isolated, or who are marginalised (there are LGBTQ+ Alt2Su groups [source: LGBTIQ+ Health Australia; Safe Communities]).
Steps: (1) Ask what the client has found helpful or harmful when they have talked about suicide in the past. (2) Describe the group: run by peers with lived experience, non-clinical, no intake, the client can come and go freely, staying silent is fine, and online or local options exist. (3) Explain that it is not treatment and not a substitute for crisis care. (4) Find a current group through the Wildflower Alliance calendar or a local partner, and pass on the contact details. Do not make a formal referral, because none is needed. (5) Talk through what the client might want to say or keep back the first time. (6) Arrange to check in after the first session.
Example language (illustrative): "There's a peer group where people talk openly about wanting to die, run by people who've been there themselves. It isn't therapy and there's no sign-up. Would you want to hear more?"
Watch for: fit concerns. These include a person who needs structured treatment for a condition they want treated, a person who is easily overwhelmed by hearing others' suicidal stories, and a minor (no age criteria found [uncertain]; check the local group's practice). The decision is still the client's.

C2. Being transparent about the difference in confidentiality

Purpose: Alt2Su groups keep what is said private, with the single violence exception. A clinician usually cannot make the same promise. Alt2Su's own guidance requires service-based groups to state their limits [source: Charter; Alternative Conversations guidance].
Steps: (1) Before the client discloses anything, explain exactly when you would breach confidentiality or start an emergency response under your local law and employer policy. (2) Explain that the peer group works differently. (3) Make it clear that the client will not get into trouble with you for anything they say about the group, and that you will not contact the group.
Example language (illustrative): "Here's where I'm bound by my role: if I believed your life was in immediate danger and we couldn't agree on a plan together, I might have to involve emergency help. Most of the time, though, talking about suicidal thoughts with me leads to talking, not to me taking action."
Watch for: the client concealing things from you because of the difference. Go back to this conversation whenever you notice it.

C3. Alt2Su-informed psychosocial assessment, consistent with current standards

Purpose: to combine VCVC-style dialogue with a standard of care that focuses on needs rather than prediction. NICE NG225 advises against using risk assessment tools or scales to predict future suicide or self-harm, and against sorting people into low, medium or high risk categories to decide on treatment or discharge. It recommends a compassionate, collaborative psychosocial assessment of circumstances, strengths and needs, leading to a risk formulation that guides care [source: Mughal et al., 2023]. This overlaps substantially with Alt2Su's "understanding over prediction" principle, but a clinician still asks directly about current intent and safety.
Steps: (1) Validate before you ask questions (A3). (2) Explore context and reasons, using the source, meaning and timeline kinds of question (A4), including recent events, what the person wants to escape, and what makes life more liveable. (3) Ask directly and calmly about current suicidal thoughts, how intense they are, any plans or recent actions, access to means, substance use, protective relationships and reasons for living. Ask these as part of the conversation, not as a scored checklist. (4) Build a shared formulation of what is driving the distress and what is keeping the person safe. (5) Agree next steps together. (6) Record the formulation and plan rather than a risk category.
Example language (illustrative): "I'd like to understand what's been happening, not just tick boxes. Then I'll ask some direct questions about how close you've felt to acting, so we can make a plan together."
Watch for: the conversation turning into a checklist. A sign it is working: the person tells you more over time.

C4. Collaborative safety planning and lethal-means counselling

Purpose: NG225 says safety plans should be considered, developed together with the person, made accessible to them and to the supporters they choose, and reviewed regularly [source: Mughal et al., 2023]. Alt2Su does not use safety contracts or behaviour contracts and criticises them [source: Cutler & Mazel-Carlton]. A safety plan is the client's own tool, not a contract [synthesis].
Steps: (1) Ask the client what has helped in earlier crises. (2) Write down, in their words: their warning signs, things they can do themselves, people and places that help, people they can ask for help (a peer group, warmline or peer line can go here, if they want), and professional and crisis contacts. (3) Talk about making the environment safer during a crisis, with consent. This means limiting access to means by storing items securely, locking them away or having a trusted person hold or remove them temporarily. Do not discuss method details. (4) Agree who gets a copy. (5) Review it at every crisis or change in circumstances.
Example language (illustrative): "This is your plan, not a promise to me. What has helped you get through the worst nights before?"
Watch for: a plan that reads like a no-harm contract; a client who agrees just to get out of the room.

C5. Bringing group experiences into therapy

Purpose: to build on the connection and exploration the client gets from the group.
Steps: (1) Ask open questions about what the client took from the group (themes, not other members' details, which follows "leave the names, take the lessons"). (2) Connect group insights about context and injustice to the work in therapy. (3) Respect anything the client chooses to keep private. (4) Notice whether their isolation is decreasing.
Example language (illustrative): "Is there anything from group this week you'd like to bring in here?"
Watch for: the client becoming distressed by others' stories (Section 5); the client feeling you are monitoring their group attendance.

C6. Partnering with local Alt2Su groups and peer organisations

Purpose: to support the groups without taking them over.
Steps: (1) Find the local host organisation. (2) Offer practical support such as a venue, publicity or funding, with no strings attached, and do not ask for reports on who attends [source: Charter, "no pressure to report"]. (3) Do not attend as an observer. Clinicians may attend only to explore their own experience [source: Charter]. (4) Agree routes for people to self-refer in both directions.
Watch for: your service's policies pushing the group to change its practice. If it cannot meet the charter, it should use the Alternative Conversations name [source: Alternative Conversations guidance].

C7. Hosting an "Alternative Conversations" group in a clinical service

Purpose: to bring Alt2Su values into a service that cannot give up its duty to respond to risk [source: Alternative Conversations guidance].
Steps: (1) Facilitators should, ideally, openly identify with suicidal experiences (a core value). (2) Write an information sheet for new attendees covering: the limits of privacy, including what happens if suicidality is disclosed; the right to attend or leave without consequences; and other places where they can talk more freely (warmlines, peer lines, Alt2Su groups). (3) Read a summary of these limits aloud at the start of every meeting. (4) Keep the barriers low: no intake, no referral requirement, no attendance records beyond total numbers. (5) Respond to talk of suicide with curiosity first (A10). Escalate only on the basis of your service's real criteria, and tell the person first.
Example language (illustrative): "This group is run inside the clinic, so here's honestly what we can and can't keep private..."
Watch for: naming. Never call a service-based group with reporting duties "Alternatives to Suicide".

C8. Clinician training

Purpose: to learn the approach from its source.
Steps: (1) Take When Conversation Turns to Suicide (16 h), which is open to providers, or a shorter overview. (2) Take the 24-hour Group Facilitator Training only if you have personal experience of suicidal thoughts and are willing to share it, which is a requirement for facilitating [source: Wildflower Trainings page]. (3) Ask the Wildflower Alliance or a regional partner about trainings for organisations.

5. Handling problems

The Alt2Su sources describe values, not troubleshooting. Except where a source is cited, everything below is my own [synthesis].

Imminent danger in your own session (the clinician's dilemma). Alt2Su groups do not call involuntary services except over violence toward group members [source: Charter]. You still have legal and professional duties. Response: stay, validate and explore first (A3, A4, C3). Work with the person on the least restrictive option they will accept: staying with someone they trust, contacting a supporter together, revisiting the safety plan, a voluntary crisis service, or a peer respite or crisis alternative if one exists. Start an emergency response without consent only when you judge the danger to be immediate and your law or policy requires it. Tell the person what you are doing and why, stay involved, and repair the relationship afterwards. Never present this as something Alt2Su endorses.
The client hides suicidality because of past coercion. This is commonly reported [source: Cutler & Mazel-Carlton]. Response: name it directly and spell out your limits in advance (C2). Ask what happened last time and what would make honesty safer now. Show over several sessions that disclosure leads to conversation. Offer Alt2Su or a peer line as a space with fewer constraints.
The client wants the group instead of therapy. Respect their choice (consent and choice). Ask what they want from each. Offer to keep the door open, or to see them less often, and agree how they could come back.
The client becomes more distressed after group, or overwhelmed by others' stories. Explore what was hard. Remind them they can be silent or leave [source: Charter]. Suggest a different group, an online rather than in-person group, or pausing for a while. Help them plan how to look after themselves after a group. Do not pass your concerns to the group.
The client brings in method details or a pact heard in a group. Respond with curiosity about the meaning and the connection, not the method. Do a C3 assessment. The client may raise group dynamics with the facilitators. Clinicians do not contact groups about individuals, because that would break the charter's privacy [synthesis].
A facilitator's own suicidal thoughts return. This is expected and does not disqualify them [source: Cutler & Mazel-Carlton]. If the facilitator is your client, support co-facilitation, debriefs and their right to step back temporarily. Do not treat it as a relapse that means they must give up the role [source: Cutler & Mazel-Carlton, contrasting AA].
The client is hospitalised or makes an attempt. Avoid any language of failure [source: Cutler & Mazel-Carlton]. Reconnect the client with the group when they are ready. Review the formulation and safety plan together (C3, C4).
"Resistance" or non-attendance. Attendance is voluntary and nothing is wrong when someone stops going [source: Charter]. Ask what got in the way. Do not record it as non-adherence or make it a condition of therapy.
Oppressive remarks, or one person dominating the group. Facilitators interrupt oppressive words and the group decides how to handle it by consensus [source: Charter]. A clinician whose client reports this should help the client decide whether to raise it.
The service wants to run an Alt2Su group with reporting duties. Use the Alternative Conversations format: information sheet, a reminder every meeting, transparency [source: Alternative Conversations guidance].
Rupture after an emergency intervention you started. Acknowledge what it cost the person. Explain your reasoning once, without defending it. Ask what you could do differently next time. Write those preferences into the safety plan as an advance statement where your jurisdiction allows it.
Minors, people under compulsory treatment orders, and co-occurring risk to others. No Alt2Su guidance on these was found [uncertain]. Apply your usual safeguarding and legal duties. Check local groups' age policies before suggesting a group.
Your own anxiety. The approach asks you to tolerate distress without acting immediately. Use supervision, and consider When Conversation Turns to Suicide training (C8). If you have personal experience of suicidal thoughts, decide in supervision how much, if anything, to disclose.

Sources

Sources:

Guidelines cited (via the commentary above): National Institute for Health and Care Excellence (2022). Self-harm: assessment, management and preventing recurrence (NG225). [uncertain: guideline text]

Further reading (not drawn on): the Wildflower Alt2Su Group Info Sheet, training manuals and the Alt2Su NSW site. No published Alt2Su handbook was found. Facilitator training content beyond the outlines above is [uncertain].

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