The Rotterdam Statement – Zero Suicide

moving beyond the tipping point

Preface

On September 3 – 4, 2018, more than 100 leaders from nearly 20 countries convened at the Zero Suicide International 4 summit in Rotterdam, the Netherlands. Here they designed the revision of the 2015 International Zero Suicide Declaration. The declaration you are about to read now clarifies the commitment of these leaders to improve healthcare suicide prevention as a complement to public health and community suicide prevention initiatives.

What is Zero Suicide Healthcare?

Rooted in universal human values and based on scientific evidence Zero Suicide Healthcare is a worldwide emergent transformative approach that aims for a shift of mindset in healthcare and society: from passive acceptance to active prevention. Its inspirational goal drives healthcare systems to continually improve the quality of care. Zero Suicide offers healthcare leaders clear strategies and principles to learn to protect ever more patients, relatives and staff against the tragedy of suicide.

For those who turn to healthcare Zero Suicide offers a better experience when feeling suicidal. They will experience that suicidality can be discussed openly, is treated directly and managed in a least restrictive, recovery-oriented way. As they transition through the system they have chosen, no person falls through the cracks. Zero Suicide Healthcare is not an isolated strategy. It is a complement to other community-based suicide prevention initiatives which will be running simultaneously.

Why is it important?

Because lives, many lives, are at stake. More than 800, 000 people die of suicide every year. Evidence shows that many more suicides are prevented in healthcare systems which provide better suicide prevention care. Radical system transformation can drive down suicide rates to zero. Knowing this, there is no time to lose. To make inroads we need systemic change.

Who is it for?

First, it is for healthcare leaders across the globe. They are the drivers of the Zero Suicide Healthcare model and within their system protectors of a safe and just culture of learning and improving. Second, it is for all staff working in healthcare. Working in a Zero Suicide organization they are well trained and supported to provide excellent suicide prevention care; and feel safe to find and repair root causes underlying adverse events. Last but not least, it is for all partners, for governments and politicians; media; industries and employers; public  health and suicide prevention organizations; persons with lived experience and scientists. With their force, expertise and willingness they partner together with healthcare systems to move the needle and drive down population suicide rates.

The Rotterdam Declaration

The Rotterdam Declaration is supported by healthcare leaders who attended the Summit. We urge all to join the growing international learning community and use this Declaration to find the tipping points in your healthcare system that will deliver the change you want to see. Bold visions have put a man on the moon and eradicated polio. There’s no more time for half measures. Only with insightful leadership committed to the pursuit of Zero Suicide, will we be able to make strides towards this important vision.

David W. Covington, LPC, MBA Dr. Jan Mokkenstorm
RI International, USA               113 Suicide Prevention, the Netherlands

                  

The Rotterdam Declaration    

Every minute of every day suicide impacts the lives of hundreds of people across the globe. It robs families of loved ones, young people of their future, workplaces of colleagues and communities of their most valuable resource – their people.

We, the participants at the fourth Zero Suicide International summit in Rotterdam September 2018, and representing a diverse group of healthcare leaders, academic institutions, civil society, the private sector, governments and persons with lived experience:

Accept: The World Health Organization Report: Preventing Suicide: a global imperative key message: Suicides are preventable. For national responses to be effective a comprehensive multi-sectoral suicide prevention strategy is needed and this should include making suicide prevention a core responsibility of health systems, with collaboration between health and non-health sectors at governmental and non-governmental levels.i

Acknowledge:  Article 25 of the Universal Declaration of Human Rights which says the enjoyment of the highest attainable standard of health is a fundamental human right.ii

Recognise: The United Nations Sustainable Development Goal (3) which targets by 2030, a reduction by one third of premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Measured by the suicide mortality rate.iii

Understand: The devastating impact that suicides have on the health workforce, families, workplaces and communities.

The Zero Suicide Healthcare Framework

The model offers both a realistic and effective approach to eliminating suicides. Zero Suicide Healthcare is a systematic, leadership-driven, continuous quality improvement approach to reducing suicides in care. The framework equips institutions with training, access to evidence-based treatments and supports and care pathways that have demonstrated exceptional results in healthcare systems.

We commit to:

Leadership centred on a just, safety-driven culture informed by evidence and lived expertise

  • Health systems leaders create a culture founded on a relentless pursuit to prevent suicide. We believe a suicide event (attempt or death) is an avoidable outcome of care in a modern healthcare setting.
  • Recovery, healing, learning and improvement after losing a patient to suicide are integral to the culture of the healthcare system. Blame, punishment or retribution is unacceptable
  • Hospital and healthcare staff are compassionate, confident and competent as they identify and care for those with suicidal behaviour.

A teamwork approach when engaging those who are suicidal

  • For those who seek help through healthcare systems, their pain and distress is acknowledged in a timely, respectful and caring manner, free from discrimination
  • Person-centred, treatment-oriented screening and assessment for suicidality is practised, including direct enquiry regarding suicidal thoughts and behaviours
  • Interventions include direct treatment for suicidality in the least restrictive settings using collaborative, research-informed practice techniques including safety planning and caring contacts.
  • Care management is determined through productive patient/staff interactions
  • Decisions from one level of care (e.g., hospital care) are communicated in a timely way to other necessary levels of care (e.g., intensive outpatient, private therapist, pharmacological therapy).

Active participation of patients, health professionals and family members or carers in safety planning and transition to aftercare

  • Active involvement in safety planning, including means restriction, ahead of being discharged from care. This will include where possible active engagement and education for family members and loved ones
  • Shared service responsibilities and communication between clinical staff within the hospital and providers in the wider community
  • Active outreach from the hospital before the next  appointment
  • Peer support offered from within the hospital system and through community-based support services.

Data and implementation science deliver continuous improvement

  • Continuous quality improvement has its foundations in data collection and analysis and importantly, its application
  • Open access to data is available within the constraints of privacy legislation
  • Clinicians and teams use data to monitor ongoing performance, refine services and evaluate impact, always with a view to enabling improved outcomes
  • Learning is facilitated through expansion of new and ongoing implementation approaches across the world and a commitment to shared learning through publication of outcomes
  • New approaches are explored and supported through increased investment in research, particularly translational & implementation science research for real-world relevance.

Synergy in collaborative networks with general and public healthcare or community suicide prevention initiatives.

Conclusion

For healthcare systems: efficiency without quality is unthinkable. Quality without efficiency is unsustainable. The Zero Suicide Healthcare model represents quality and efficiency – it is the synthesis of ambition and science.

Zero Suicide Healthcare represents joined up care so that no person need die alone and in despair from suicide.

Need more information

ZeroSuicide.org for global learning community.

ZeroSuicide.com for fidelity toolkit & resources

  1. World Health Organization: Preventing Suicide: a global imperative. Page 9. Luxembourg 2014
  2. Universal Declaration of Human Rights; http://www.un.org/en/universal-declaration-human-rights/
  3. United Nations Sustainable Development Goals https://sustainabledevelopment.un.org/sdg3#targets
  4. Kruk M et al; The Lancet Global Health – High-quality health systems in the Sustainable Development Goals era: time for a revolution, The Lancet Vol 392, September 2018.

The Ozzies

#Lucinda Brogden, #Jacinta Hawgood, #Mathew Large, #Sue Murray, #Alan Woodward #Helena Christensen

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

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A Peer Support Response to Thoughts & Feelings of Suicide

Alternatives to Suicide Peer Support Groups

Mental Health Academy on line presentation 12 April 2019

Joe Calleja

BA BSW GAICD Life Member Australian College of Social Work

joe.calleja@recoverymatters.com.au

Learning Objectives

  • Understand the constraints of the current suicide prevention system
  • Review some of the myths and research about suicide
  • Understand the peer to peer approach
  • How this is being introduced in Australia

Lived Experience & Peer Support

  • Roses in the Ocean is a key organization in Australia which is harnessing lived experience as an education force in the suicide prevention sector http://rosesintheocean.com.au/
  • They define lived experience as . . . having experienced suicidal thoughts, survived a suicide attempt, cared for someone who has been suicidal, or been bereaved by suicide.
  • Rose House in the US : …Peer Support refers to the role of a person with lived experience using that experience directly to support another person who is experiencing the same distress

Peer To Peer Support

What is a peer?

A peer is a person with his or her own lived experiences with mental health conditions, psychiatric labels, emotional issues, and/or trauma histories.                                     

A peer is a person who has made significant progress working towards his or her own recovery… and who wants to help others in similar need. http://rosehousererspite.org/

Peer to peer support is provided by peers without clinical intervention.

The Current System

  • Assumes knowledge lies almost exclusively with professionals
  • Is based on a risk assessment and diagnostic approach
  • Little emphasis on early intervention and prevention
  • Poorly targeted expenditure
  • Some potential change with the 5th Plan

Why Introduce a New Strategy for Suicide Intervention?

  • What we are doing isn’t reducing the rate of suicide
  • There is a need to change the narrative
  • Our approach to what constitutes evidence blocks important input
  • As researchers and service providers need to remember our origins in the community
  • New approaches can be complementary and fill existing gaps

Professionals on Tap not on Top

The Aces Study

ACES findings on suicide:

  • Only 1% of those with and ACES score of less than 4 had attempted suicide
  • Almost 20% with and ACES score of 4 or more had tried to end their life
  • Someone with and ACES score of 4 or more was 1220% more likely to attempt suicide than someone with and ACES score of 0. (Nakazawa 2015

The question becomes “What happened to you”
Not “What’s wrong with you”.

Myths of Suicide

Myth # 1.           Talking about suicide is a bad idea

  • Talking shows you care and will share the pain
  • Talk About It campaign alliance
  • Deep listening not risk assessment

Myth # 2.           We should use risk assessments

Dr Matthew Large University NSW School of Psychiatry

…it is simply not possible to predict suicide in an individual patient, and any attempt to subdivide patients into high-risk and low-risk categories is at best unhelpful and at worst will prevent provision of useful and needed psychiatric care…

https://www.mja.com.au/journal/2013/198/9/suicide-risk-assessment-where-are-we-now

Researchers report that 60% of people who died by suicide denied having suicidal thoughts to medical professional (McHugh et al UNSW research January,  2019)

Myth # 3.           We will be liable

Myth # 4.             Forced hospitalization helps people

…feeling of powerlessness dominated my experience of mental health services.   And this feeling was at its worst when I was sectioned. Sectioning replicated aspects of the  traumatic experience that initially caused my suicidal crisis. I felt trapped, captive and utterly out of control. I couldn’t escape. . .Joy Hibbins, Suicide Crisis Centre (U.K.)

Elevated suicide rates can last for up to two years after hospitalization. People learn to stop talking about suicidal thoughts.

Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry   62: 427-432

Myth # 5.             Suicidal people must be mentally ill

  • Suicidal thoughts and feelings are not always connected to a diagnosed mental health problem.  There are many situational factors that can contribute to suicidal thoughts and ideation.
  • Suicidal people become suicidal when they are in unbearable psychic pain. Suicidal people often believe that their psychic pain is greater than that of the average person. Suicide is seen as an escape. The suicidal person disconnects from memories of loved ones

Myth 6: Suicide Prevention is the aim

We can adopt a life promoting approach rather than a risk averse approach, and respond to the distress rather than to a perception of risk

  • When you say you want to kill yourself, what do you mean by that?
  • What is leading you to the point of wanting to die?

Why Peer Support?

  • Emerging and evolving workforce in mental health services
    • More effective engagement, personalised service(empowerment)
    • reduction of stigma (Gallagher and Halpin 20140
    • Reduction in hospital admission rates (Health Workforce Australia 2014)
    • Produce outcomes similar to non peers (Pitt 2013)
    • Feelings of acceptance, belonging, hope, motivation, reduced isolation (Bell et al 2014)
    • Benefits to peer workers, services and service system, families and carers (Bell et al 2014, O’Hagan 2011, Kippax 2013, Mendes 2014)

Peer Support in Suicide Prevention

  • “The role of Peer Support in Suicide Prevention”

Paul N Feiffer MD,       13 July 2015 HSR & D Cyberseminar https://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=989

  • Peers for Valued Living (PREVAIL)

Development and Pilot Study of a Suicide prevention Intervention Delivered by Peer Support Specialists

Pfeifer et al Online First Publication, November 1 2018. http://dx.doi.org/10.1037/ser0000257

Peer Support In Suicide Prevention

Zero Suicide And Peer Support (USA)

  • Peer To Peer Support is an Evidence-Based Practice
    • Promotes Crucial Protective Factors Such As Connectedness and Hope
  • Promotes Recovery & Resilience
    • Promotes Choice & Voice in Treatment
    • Challenges Negative Stereotypes

The Gap that Exists in Our System

  • Lack of peer to peer support -There are insufficient non clinical alternatives – role of peers is underplayed
  • The need for listening rather than assessing – peer to peer responses
  • The failure to understand “psychache”. (Shneidman: The Suicidal Mind 1985)

Origins of the “Alternatives to Suicide” Approach?

  • Based on the Hearing Voices peer support approach to psychosis
  • Western Massachusetts Recovery Learning Community – peer run community group
  • Impact of system response to requests for help for feelings of suicide
  • Creating a safer space for people to talk about their feelings of suicide

How Does the “Alternatives To Suicide” Approach Work

  • Peers only (Lived Expertise) – either have made an attempt or have ideation
    • Self referred, no formal system referral process
    • Two facilitators, both Peers, trained in the approach
    • No clinicians unless they are there as peers (lived Expertise)
    • No risk assessment
    • Safe non-judgemental environment
    • Ninety minute sessions in non-clinical environment
    • Referral to other services only with the person’s permission

The “Alternatives to Suicide” Peer to Peer Support Group Philosophy

  • responsibility to – not for, or over
  • honouring everyone’s unique journey
  • empowering through shared experience
  • community building
  • meaning making
  • social justice focus
  • challenging preconceived judgements

the groups are life promoting

Introducing this Approach to Australia

  • MercyCare February 2017 showcase in Western Australia
  • Formation of a Steering Committee in August 2017 and the March 2018 visit to Perth, Melbourne and Sydney – Facilitator training
  • Evaluation outcomes
  • Suicide Prevention Australia National Conference July 2018
  • Steering Group now led by Helping Minds in WA with MercyCare involvement
  • Proposal for 2019/20 visit
  • City Rotary, Perth
  • Lotterywest application – suicide prevention peer workforce focus
  • ConnectGroups supervision support
  • Steering Group enlarged
  • New groups emerging

Current Groups

  • DISCHARGE –Alternatives to Suicide group – Transfolk, Perth, Western Australia since May 2018
    DISCHARGE – Deserving of Inclusion, Support, Community, Hope, Authenticity,Respect, Growth, Empathy, and Determination. – email Deservingof.ISCHARGED@outlook.com
  • Alternatives To Suicide Inner West Sydney since September 2018 http://www.offthewall.net.au/contact-us/

Further Information

https://www.mercycare.com.au/alternatives-to-suicide http://www.westernmassrlc.org/alternatives-to-suicide
http://www.sprc.org./resources-programs/manual-support-groups-suicide-attempt-survivors

Joe Calleja +61433821214 joe.calleja@recoverymatters.com.au alternativesforum@mercycare.com.au

THANK YOU



20th International Mental Health Conference

31 July – 2 August 2019 | RACV Royal Pines Resort, Gold Coast, Queensland

The 2019 International Mental Health Conference will be held from Wednesday 31 July – Friday 2 August at Royal Pines Resort, Gold Coast.

https://anzmh.asn.au/conference/

Abstracts Close: Monday 15 April 2019

https://anzmh.asn.au/conference/submit-abstract/

Featuring Australia and New Zealand’s leading clinical practitioners, academics, and mental health experts, the 2019 International Mental Health Conference continues in its 20th year to network, share research, projects and formulate ideas for change for those living with mental health conditions.

Enjoy a three-day program of inspiring keynote addresses, speaker presentations, workshops, poster presentations and ample networking opportunities.

2019 Featured Speakers

Confirmed

  • Ms Susan Anderson, Deputy CEO, Beyond Blue
  • Ms Lucy Brogden, Chair, National Mental Health Commission
  • Dr Barbara Disley, Chief Executive, Emerge Aotearoa
  • Mr Ivan Frkovic, Commissioner, Queensland Mental Health Commission
  • Mr Craig Hamilton, Mental Health Advocate, Broadcaster, Author, ANZMHA Ambassador
  • Commissioner Scott McDougall, Anti-Discrimination Commission Queensland
  • Mr Shaun Robinson, Chief Executive, Mental Health Foundation of New Zealand
  • Professor Chris Stapelberg, Professor of Mental Health, Bond University and Gold Coast Hospital and Health Service
  • Ms Samantha Wild, Director, Awakening Cultural Way

Conference topics

  • Mental health across a lifespan
  • Suicide and self-harm prevention
  • Exploring the stepped care approach
  • Technology
  • Clinical challenges
  • Physical wellbeing, mental wellness
  • Mentally healthy workplace

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

Suicide Can’t Be Predicted by Asking About Suicidal Thoughts

Summary: Researchers report 60% of people who died by suicide denied having suicidal thoughts to medical professionals.

Source: University of New South Wales.

The majority of people who die by suicide deny having suicidal thoughts when asked by doctors in the weeks and months leading up to their death, a ground-breaking UNSW Sydney study has found.

Catherine M. McHugh, Amy Corderoy, Christopher James Ryan, Ian B. Hickie, and Matthew Michael Large in BJPsych Open. Published January 30 2019.

The research questions a widely held belief that suicide can be accurately predicted by psychiatrists and clinicians by assessing a patient’s risk, especially in the short-term.

The meta-analysis, co-authored by clinical psychiatrist and Conjoint Professor Matthew Large from UNSW’s School of Psychiatry, is published today in the journal BJPsych Open.

The review of data from 70 major studies of suicidal thoughts shows that, as a stand-alone test, only 1.7% of people with suicidal ideas died by suicide. About 60% of people who died by suicide had denied having suicidal thoughts when asked by a psychiatrist or GP.

“We know that suicide ideas are pretty common and that suicide is actually a rare event, even among people with severe mental illness,” said Professor Large, an international expert on suicide risk assessment who also works in the emergency department of a major Sydney hospital.

“But what we didn’t know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly,” he said.

The study showed that 80% of patients who were not undergoing psychiatric treatment and who died of suicide reported not to have suicidal thoughts when asked by a GP.

“This study proves we can no longer ration psychiatric care based on the presence of suicidal thoughts alone. Hospital and community care teams in Australia are extremely under-resourced, and this needs to change. We need to provide high-quality, patient-centred care for everyone experiencing mental illness, whether or not they reveal they are experiencing suicidal thoughts.”

“Doctors sometimes rely on what is known as suicidal ideation – being preoccupied with thoughts and planning suicide – as a crucial test for short-term suicide risk, and it has been argued it could form part of a screening test for suicide,” said the study’s lead author, Dr Catherine McHugh, a registrar psychiatrist. “Our results show that this is not in the best interests of patients.

Professor Large said that clinicians should not assume that patients experiencing mental distress without reporting suicidal ideas were not at elevated risk of suicide. Asking about suicidal thoughts was a central skill for health professionals, he said, but clinicians should be not be persuaded into false confidence generated by a lack of ideation. NeuroscienceNews.com image is in the public domain.

“Some people will try to hide their suicidal feelings from their doctor, either out of shame or because they don’t want to be stopped. We also know that suicidal feelings can fluctuate rapidly, and people may suicide very impulsively after only a short period of suicidal thoughts.”

The main message, said Professor Large, was that clinicians should give less weight to suicidal ideation than had been the case. “It means trying to better understand the patient’s distress and not making patients wait weeks for treatment or denying treatment in the absence of suicidal thoughts.”

There was also an important message for people bereaved of a loved one after a suicide, said Professor Large. “Even if they knew their relative was suicidal, the risk of death was low. And it was not their fault if they did not know someone was suicidal.”About this neuroscience research article

Source: Lucy Carroll – University of New South Wales
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Open access research for “Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value” by Catherine M. McHugh, Amy Corderoy, Christopher James Ryan, Ian B. Hickie, and Matthew Michael Large in BJPsych Open. Published January 30 2019.
doi:10.1192/bjo.2018.88 Cite This NeuroscienceNews.com Article

University of New South Wales”Suicide Can’t Be Predicted by Asking About Suicidal Thoughts.” NeuroscienceNews. NeuroscienceNews, 32 February 2019.
<http://neurosciencenews.com/suicide-prediction-10677/&gt;.University of New South Wales(2019, February 32). Suicide Can’t Be Predicted by Asking About Suicidal Thoughts. NeuroscienceNews. Retrieved February 32, 2019 from http://neurosciencenews.com/suicide-prediction-10677/University of New South Wales”Suicide Can’t Be Predicted by Asking About Suicidal Thoughts.” http://neurosciencenews.com/suicide-prediction-10677/ (accessed February 32, 2019).

Abstract

Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value.

Background
The expression of suicidal ideation is considered to be an important warning sign for suicide. However, the predictive properties of suicidal ideation as a test of later suicide are unclear.

Aims
To assess the strength of the association between suicidal ideation and later suicide measured by odds ratio (OR), sensitivity, specificity and positive predictive value (PPV).

Method
We located English-language studies indexed in PubMed that reported the expression or non-expression of suicidal ideation among people who later died by suicide or did not. A random effects meta-analysis was used to assess the pooled OR, sensitivity, specificity and positive predictive value (PPV) of suicidal ideation for later suicide among groups of people from psychiatric and non-psychiatric settings.

Conclusions
Estimates of the extent of the association between suicidal ideation and later suicide are limited by unexplained between-study heterogeneity. The utility of suicidal ideation as a test for later suicide is limited by a modest sensitivity and low PPV.

Declaration interest
M.M.L. and C.J.R. have provided expert evidence in civil, criminal and coronial matters. I.B.H. has been a Commissioner in Australia’s National Mental Health Commission since 2012. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates an early-intervention youth services at Camperdown under contract to Headspace. I.B.H. has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) projects focused on the identification and better management of anxiety and depression. He is a Board Member of Psychosis Australia Trust and a member of Veterans Mental Health Clinical Reference group. He was a member of the Medical Advisory Panel for Medibank Private until October 2017. He is the Chief Scientific Advisor to, and an equity shareholder in, InnoWell. InnoWell has been formed by the University of Sydney and PricewaterhouseCoopers to administer the $30 M Australian Government Funded Project Synergy. Project Synergy is a 3-year programme for the transformation of mental health services through the use of innovative technologies.

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families



Mental Health Practitioner Research Participants Wanted

Western Sydney University is seeking mental health practitioners to share their experiences related to the death of a client as a result of suicide.

The research team would like to invite you to make contact with us, if you are: a nurse, psychologist, social worker, doctor or occupational therapist currently working in mental health services and have experienced the death of client as a result of suicide.

If   you   would   like   further  information  or   like to participate in the study, please make contact with:

Dr. Gill Murphy, Lecturer, School of Nursing & Midwifery, Western Sydney University. Tel: (02) 4570 1280

Email: g.murphy@westernsydney.edu.au

All enquires are confidential

Human Research Ethics Committee approval number: H12485

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

FREE Online Suicide Prevention Summit April 12-14, 2019

MHA_2019_Suicide_Prevention_Summit_Schedule-V4 (1)

Join the largest Suicide Prevention online conference for mental health professionals ever held in Australia

https://www.mentalhealthacademy.com.au/suicideprevention

PURPOSE

To equip every practicing mental health professional in Australia with global best-practice knowledge and skills on suicide prevention, thereby making a tangible reduction on suicide rates.

Dear Mental/Allied Health Professional,

Suicide remains the leading cause of death for Australians aged between 15 and 44.

As a mental health professional, you are the frontline of defence, and you will be required to work with suicidality.

You must be prepared.

The purpose of this Summit is to equip practicing mental health professionals in Australia with the most up-to-date, advanced knowledge and treatment options on suicide prevention.

To achieve that, we’ve assembled 15 of the most highly respected global experts on suicide into one online specialised Summit.

Over 3 days, April 12-14, you’ll have free access to all Summit sessions, live online. You will then have on-demand streaming access for an additional two weeks, from April 15 to April 28.

One of the most powerful resources we have to reduce suicide is our front-line mental health workforce. We believe that by providing every mental health practitioner in Australia with global best-practice know-how and skills, we can tangibly reduce suicide rates in Australia.

We see our role as bringing global best-practice education to Australian practitioners – for free. Your role is taking the time to learn and apply.

As we endeavour to save valuable lives, we look forward to seeing you at the online 2019 Suicide Prevention Summit.

An Unprecedented Body of Knowledge

The Summit brings together an unprecedented body of knowledge on suicidology and suicide prevention.

Australian mental health practitioners have this extraordinary opportunity to learn global best-practice strategies to treat and manage suicidal behaviour.

The 2019 Suicide Prevention Summit is streamed direct to your computer. All you need is an internet (preferably broadband) connected device with speakers to access the highest-quality CPD training available anywhere.

And if you can’t attend the event in real-time (we understand you have a busy schedule), you can access ALL the session content for a full 14 days (15-28 April) after the event, at your convenience.

Snapshot of the Summit

The 2019 Suicide Prevention Summit will be delivered via 15 live webinar sessions from Friday 12th April to Sunday 14th April and will continue as an on-demand event (i.e. you can watch recorded versions of the live
sessions) until Sunday 28th April.

Free Access

Registration for the Summit is entirely free

Live Webinars

Access live*, interactive webinars facilitated by global experts on suicide

Recorded Sessions

Recorded, on-demand sessions – so you don’t miss out on anything

Live Q&A

Interact with presenters through live Q&A sessions

Best Practices

Learn global best practice in suicide prevention

Specialised Areas

Including youth, Aboriginal health, technology, lived experience, and more

15 CPD Hours

Accrue CPD hours as a mental health professional

Proceeds Go to Charity

All funds raised will be donated to Lifeline Australia

*Each live webinar can hold a maximum of 2,000 concurrent participants.

There is no charge and there are some great speakers and topics. Please register at the the webpage (above) to be kept updated and reminded closer to the event.

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

Reflections from the Brisbane North PHN LGBTI Suicide Prevention Trial

Mindout

MindOUT: LGBTI Health Alliance Webinar Invitation

Monday 18th March, 2019

NSW, Victoria, ACT & Tasmania: 1 pm to 2 pm
South Australia: 12.30 pm to 1.30 pm
Queensland: 12 pm to 1 pm
Northern Territory: 11.30 am to 12.30 pm
Western Australia: 10 am to 11 am

Description
This webinar will provide an overview of the work of the Brisbane North Primary Health Network (PHN) has been undertaking in the delivery of the National Suicide Prevention Trial. With 12 sites nationally, the National Suicide Prevention Trials are part of a regional approach to suicide prevention in Australia funded by the Commonwealth Department of Health. Brisbane North PHN is one of only two trial sites that are focusing on LGBTIQ+ people as a priority population.  Adopting the the Black Dog Institute’s LifeSpan Framework, this work has utilised a community driven collaborative co-design process with LGBTI people and communities who are central to this work.

Presenter
Ged Farmer is the Suicide Prevention Officer from the Brisbane North Primary Health Network working on the National Suicide Prevention Trial with the identified priority groups, Aboriginal and Torres Strait Islander, LGBTIQ+, and Young to Middle Aged Men. Ged has been working in the health arena for around 20 years and has a background in Community Development, Health Promotion and Mental Health. Ged has extensive experience working with Aboriginal and Torres Strait Islander communities and LGBTIQ+ communities embedding health promotion and community development philosophies. Ged has developed and delivered LGBTIQ+ training and has delivered system reform across the Brisbane North PiR Consortium creating the inclusion of gender, sex, and sexuality in data capturing.

Register for Webinar

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

Community-led solutions are key to reducing Aboriginal youth suicide

The Guardian Australian Edition By 

“Latest coronial report must not simply ‘gather dust’ like the last 42 reports on Aboriginal wellbeing,” Pat Dodson says

Pat Dodson

Photograph: Mick Tsikas/AAP

Pat Dodson says community-led solutions are needed to ‘address the clear sense of suffering, hopelessness and disillusionment that is being felt.’

Pat Dodson has joined Aboriginal organisations in the Kimberley in calling for action on reducing youth suicide, following the release of a long-awaited coronial report into the deaths of 13 children and young people.

Senator Dodson said the report showed that “little or no progress” had been made on reducing suicide rates in the Kimberley since a previous inquest was handed down in 2008, and that the latest report “must not join the 42 reports into Aboriginal well-being delivered over the last 15 years that simply sit and gather dust”.

“This report must lead a paradigm shift that leads to community-led solutions that address the clear sense of suffering, hopelessness and disillusionment that is being felt,” he said.

The 372-page report was delivered by the state coroner Ros Fogliani in Perth on Thursday and investigated the deaths of 13 people aged 10 to 24, who died in the Kimberley region from 2012 to 2016.

Five of the children whose deaths were considered in the inquest were aged between 10 and 14, three were aged 16 or 17, and five were aged between 18 and 24.

Fogliani said the “profoundly tragic” deaths were “shaped by the crushing effects of intergenerational trauma and poverty upon entire communities”.

“That community-wide trauma, generated multiple and prolonged exposures to individual traumatic events for these children and young persons,” she said.

The inquest was called in 2017, one year after the shocking suicide of a 10-year-old girl at Looma, and heard from 91 witnesses over 27 days of hearings in Perth, Fitzroy Crossing, Broome, Kununurra and Halls Creek.

In four of the cases, Fogliani criticised the department of child protection for failing to undertake an assessment of the child’s wellbeing, despite having cause to do so, and in one case she criticised the department of justice for failing to send a 12-year-old girl to mental health service, despite receiving a referral before her death that she may be vulnerable.

The Kimberley Aboriginal Law and Culture Centre (KALACC) said its findings were welcomed but not groundbreaking.

“It affirms what we have been saying for 35 years – that culture needs to play a crucial role if any initiatives are to be successful,” the KALACC chairwoman, Merle Carter, said.

Many findings were similar recommendations made in another mass coronial report into suicides in the Kimberley in 2008.

However, Folgiani’s report includes a requirement in most recommendations that any new reforms, be they alcohol restrictions, mental health services, or cultural programs, be co-designed with community members.

The 42 recommendations include:

  • Introducing new laws to allow video statements to serve as evidence in chief in court in domestic violence cases, similar to laws governing evidence in sex abuse cases.
  • Introducing the role of commissioner for Aboriginal children and young people , similar to the office that exists in Victoria.
  • Investigating the creation of a banned drinkers register.
  • Making the entire Kimberley region eligible for voluntary participation in the cashless welfare card scheme.
  • Building a new mental health facility in the East Kimberley.
  • Introducing mandatory screening for foetal alcohol spectrum disorder (FASD) and ensuring FASD is covered by the National Disability Insurance Scheme (NDIS).
  • Expanding the adopt-a-cop and Elders reference group programs that currently operate in Halls Creek to build trust between community and police.
  • Developing a statewide Aboriginal cultural policy and ensuring all programs and policies relating to Aboriginal people are built on principles of self-determination.

Fogliani said all of the children and young people who formed part of the inquest had grown up in homes where there was a high level of alcohol abuse and seven had experienced significant periods of alcohol abuse prior to their death. Two had high blood alcohol levels when they died; others had no alcohol in their system upon death.

She said a number of the children had also lost family members to suicide: two girls aged 10 and 13, both included in the inquest, were half-sisters; two boys in the inquest were cousin/brothers.

The inquest heard evidence that the high level of grief, constant funerals and sorry business, could cause a “clustering” effect of suicide among young people with limited coping skills.

The WA health minister, Roger Cook, said the government would consider all 42 recommendations “in the coming weeks and months”, but said the report highlighted the role alcohol played in each of the deaths.

“I think alcohol is devastating these communities and we need to take a stronger stand … we need to see what is the best way to respond,” Cook told reporters.

 

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

Numbers tell devastating story in latest Aboriginal youth suicide inquest

coroners report

Photograph: Grant Faint/Getty Images

The Coroner’s Report

The youngest of the 13 people whose deaths formed the basis for the most recent coronial inquiry into Aboriginal youth suicides in Western Australia was just 10 years old when she took her life on 6 March 2016.

They were born between 1991 and 2006, in communities around the Kimberley region of Western Australia and in the Northern Territory. They died between 20 November 2012 and 24 March 2016 at Halls Creek, Kununurra, Broome, Wyndham and in smaller remote Aboriginal communities in between.

But it was the suicide of a 10-year-old girl in 2016 which shocked the nation and motivated state coroner Ros Fogliani to call a joint inquest in June 2017 to address why, after dozens of previous inquiries, rates of suicide among Indigenous children and young people in the Kimberley appeared to be worsening.

By some estimates, 2018 will be the worst year on record for Indigenous youth suicides. This year alone, eight Aboriginal children have taken their lives; two of them were 12-year-old girls.

But the long-awaited inquest findings, which will be handed down in Perth on Thursday, won’t include these deaths. It won’t include the names of the children, whose names have been suppressed for cultural reasons. Instead, it will refer to the children and young people by number.

And the numbers are devastating. Here are some more.

Two of the boys and one of the girls had a reported history of child sexual abuse. Four had been hospitalised as infants with failure to thrive, meaning they had fallen drastically below expected growth and weight percentiles.

Almost all had been exposed to alcohol abuse and significant domestic violence.

One boy had a full academic scholarship to leave his home community for a boarding school in Victoria. He was to leave two weeks after the date when he, without warning or any previous known self-harm attempts, took his own life a week before his 13th birthday.

Five: the number of deaths in this inquest that concern the suicide of someone aged between 10 and 13.

Forty: the number of government and non-governments reports into Aboriginal suicide in Western Australia delivered between 2002 and 2016.

Seven hundred: the number of recommendations made in those reports, most of which, according to a WA parliamentary inquiry released in November 2016, have not been fully implemented.

Eight: the number of Aboriginal and Torres Strait Islander people aged 17 and younger throughout Australia who have killed themselves so far in 2019.

That last number could be higher, said Gerry Georgatos, the coordinator of the National Indigenous Critical Response Service. He has supported the families of four more people who have attempted suicide.

“There are more attempts than ever before and more attempts by young people than ever before,” he said. “If that [coronial report] does not come back with a call for mass investment or a reallocation of funding for more outreach services, it’s going to fall as usual a long way short.”

Georgatos represents one side of the argument on suicide response, saying the driving cause is poverty and a sense of hopelessness, not a lack of connection to culture.

“We are seeing the highest suicide rates in the most culture-rich areas – the Kimberley region, the central desert region,” he said. “Poverty is the number one issue. People who live above the poverty line who are First Nations people are not taking their own lives.”

That is not to say that culture is not important – only that, in Georgatos’s argument, it is not absent.

“They have got culture … they need opportunity,” he said.

The Kimberley Aboriginal Law and Culture Centre (KALACC) said that culture is the missing ingredient in previous attempts to manage the suicide crisis. There is extensive research on the role of culture healing intergenerational trauma, and extensive research on the influence of intergenerational trauma on disproportionate suicide rates.

The rate of suicide among Indigenous people in the Kimberley is three times the national Indigenous suicide rate and seven times the national non-Indigenous rate, according to a 2016 report in the Medical Journal of Australia.

Nationally, Indigenous people die from suicide at twice the rate of non-Indigenous people. Indigenous children aged five to 17 die from suicide at five times the rate of non-Indigenous children.

It was declared a “national tragedy” in a Senate inquiry into mental health in rural and remote areas, which released its final report in December.

The 2016 WA parliamentary inquiry into Indigenous suicide quoted in its introduction a scathing comment from the Telethon Kids Institute director, Professor Jonathan Carapetis, who said but for the physical and societal distance between policymakers in Perth and children killing themselves in the Kimberley it would be considered a “state emergency”.

Even when an emergency is declared – such as when the previous WA coroner, Alastair Hope, handed down a damning report on the deaths of 22 young people in the Kimberley in 2008, and again on the deaths of five young people in 2011 – reforms are either not made or not followed through.

Even specific programs intended to address Aboriginal youth suicide have been slow. The Kimberley Suicide Prevention Regional Trial will hold its first evaluation meeting on Thursday, two-and-a-half years after it was first established. A working group meeting will be held with the federal Aboriginal health minister, Ken Wyatt, at the end of the month. Those meetings have been regularly scheduled, but were only recently upgraded from a half-day to a full.

Wyatt has committed to addressing the issue. Speaking to Guardian Australia in 2017, as the first hearings to the inquest were getting under way, he said he was frustrated that there had been so many recommendations and so little action.

“What disappoints me is 10 years ago the Hope coronial inquiry was handed down, and then 10 years later we’ve having another coronial inquiry into the very same issue,” Wyatt said. “So you’ve got to ask the question: what emphasis and focus was given by various government agencies and equally our communities in addressing the issues within the recommendations?”

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

 

Reducing suicide risk after psychiatric hospitalization

Suicide risk assessment prior to discharge is one in a ‘bundle’ of preventive measures

Tony Salvatore, MA is the suicide prevention specialist for Montgomery County Emergency Service, Nor­ristown, Penn.

E-mail Tony at tsalvatore@mces.org.

Reference: http://www.behaviouralnet; July-August, 2012

reducing risk after hospitalisation

One of the ironies of suicide prevention is that inpatient psychiatric care,  the principal means of as­suring safety and stabilization to acutely suicidal individuals, leaves them at high risk of suicide after discharge. One source put it this way: “The risk of suicide is higher during the period immediately following discharge… than at any other time in a service user’s life.” (1) Post-discharge risk even accrues to patients not suicidal at admission.2

There is little data on suicides after a psychiatric hospital discharge in the US, though suicides chat occur within 72 hours after psychiatric hospitalization are tracked by The Joint Commission. Such deaths rose from fewer than 60 in 2005 to just over 100 in 2008.(3) These “sentinel events” trended downward through 2010, which was good news given that total US suicide numbers rose for the same period. However, suicide victims who were inpatients within days of their deaths should have better prospects for survival.

This well-documented risk does not seem to have attracted much attention from providers or public policy makers and administrators.(4) A greater concern is that patients and families may not be aware of the possible danger that may follow some consumers home. The problem of suicide risk after an inpatient  psychiatric  stay and what can be done about it warrant examination.

What is the source of post-discharge suicide risk?

Reasons for suicides after hospitalization include re-exposure to community stressors­, non-adherence, non-engagement with outpatient providers, relapse, and the return of insight regarding the consequences of the mental illness.(5) At discharge the protective factors the hospital offers-around-the-clock structure, supervision, caring, and support are abruptly lost.

Myopic discharge planning can add to risk.   Decisions based  on “stabilization” may overlook risk factors that led to the admission as may discharge planning that focuses more on psychiatric diagnosis than suicidality.

Suicide risk  assessment may not be as thorough prior to discharge as it is at the time of admission. This is problematic as many suicide risk factors specific to serious mental illness are not affected by inpatient treatment. High risk is associated with early stage of illness, good pre-illness functioning, and frequent exacerbations and remissions.(6) Many consumers have a history of suicidal behavior, self-injury, suicide loss, and multiple prior admissions.(7)

Why do post-discharge suicides happen?

There is no evidence that inpatient care prevents suicide after discharge, nor any that it causes suicide. Discharge planning and pre-discharge risk assessment deficits are not causes, either. So what accounts for lethal suicidal behavior in some consumers at a time when they should be on a path to recovery?

The   “Interpersonal Psychological Theory of Suicide”(8) gives insight  into post-discharge suicide. This theory developed by Thomas Joiner, Ph.D., posits that a potentially fatal suicide attempt requires: 1. a sense of burdensomeness, 2. a sense of loneliness and isolation, 3. a sense of fearlessness about lethal self-harm. All three of these conditions rarely occur simultaneously, which is why there are comparatively few suicides. However, they, especially the first two, may be common in those with serious mental illness and especially in those who have received inpa­tient psychiatric care.

Joiner asserts that an intense desire for death may come from the belief that one is a burden to others and/or the belief that one does not belong. Burdensomeness­ arises from sense that one is a liability and not fulfilling expectations or obligations. This may lead to thinking that one’s death may be more valued than one’s life.. Failed belongingness may flow from a strong unmet need for social relationships and a perception that one is not cared for by others. These variables may be exacerbated by hospitalization and may persist in the community.

More than a desire to end one’s life is necessary for a suicide, Joiner  adds. An individual must also be able to take his or her life. This requires overcoming fear, pain, self-injury, and the instinct for self-preservation. This ability is acquired through experiences such as abuse, trauma, and a history of violence and self-harm. It is a by product of past attempts and may also be developed by mentally practicing a suicide plan and rehearsing it by holding means such as a weapon or pills.

The desire to die may lift during hos­pitalisation, but  the capability for lethal self-harm is permanent. Past attempts, abuse, trauma, and violence create a risk baseline that may escalate after discharge. Risk may be amplified be weak supports, rejection by others, and being faced with seemingly unresolvable psycho-social or environmental stressors, as well as folding relapse, resuming alcohol and drug use, and limited engagement by outpatient providers.

What can be done about post­-discharge suicide risk?

Many sound recommendations for addressing suicide risk after hospitalisation have been offered . Immediate treatment, follow-up, and closer monitoring of at-risk consumers returning to the community are most often urged.(9)

A recent review of the National Suicide Prevention Strategy included this recommendation: “Expand efforts to provide effective follow-up care after inpatient discharge of suicidal persons.”(10) Another national report was more specific: “Adopt nationally recognized policies and procedures that best match patients at risk for suicide to follow-up services that begin at or near the time of discharge from … an inpatient psychiatry unit.”(11)

A national suicide prevention organisation issued a broader advisory:(12)

  • Assess suicide risk at admission and again, thoroughly, just prior to discharge
  • Identify sources of support and their willingness and ability to provide
  • Give patient and family instruction about sui­cide risk at discharge and period
  • Explain how patient, family, or supports can access crisis intervention and other help.

Bumgarner and Haygood call  for  the use of a “risk reduction pathway” involving a “bundle” of suicide prevention practices provided to every patient,which at discharge would include:(13)

 

  • Suicide risk assessment to inform the discharge decision
  • Communication of risk/prevention measures to patients and family members
  • Follow-up with patients after discharge
  • Supports and services in place after discharge

Other resources that come to mind are:

  • Preparation of personal suicide prevention of safety plans at discharge.
  • The availability of peer-run warm lines for use by newly discharged consumers.
  • Access to therapies that have demonstrated suicide prevention potential (e.g., Cognitive Behavioral Therapy).
  • Peer-led or co-led support groups for those who have made suicide attempts or had an acute episode of suicidality.
  • Training peer specialists as ” gatekeepers”to identify possible warning signs of suicide in other consumers

Inpatient providers must do more to reduce the risk of ‘(outpatient” suicide. Montgomery County Emergency Service, a 73-bed nonprofit psychiatric hospital (Norristown,  Penn.),  has   inaugurated a number of easy-to-replicate practices in recent years. These include a range of suicide prevention education materials for consumers and families, a peer-led inpatient suicide prevention support group, “special discharge instructions” on  suicide  risk, and tighter pre-discharge risk assessment. 

Community-based providers must also help make post-discharge suicide what the National  Action Alliance  for Suicide Prevention recently called a “never event.”(14) In this regard , the Alliance  has called for suicide risk screening to be universal in all behavioral health care settings and that suicide risk be seamlessly addressed along the care continuum until eliminated. This would extend a “risk reduction pathway” from inpatient admission to recovery.

In addition to reducing consumer mortality, a post-discharge suicide prevention effort may reduce readmissions and involuntary hospitalizations, both of which are driven heavily by suicidal  behavior. Of course, it can also improve recovery prospects for inpatients while helping them maintain the hopeful outlook needed to motivate  and maintain  greater  personal wellness.

References

  1. Crawford, M. “Suicide following discharge from in-patient psychiatric care” Advances in Psychiatric Treatment 2004(10) 434-438.
  2. Dennehy,J ., Appleby, L ., and Thomas, “Case control study of suicide by discharged psychiatric patients” British Medical Journal 1996 (312).
  3. The Joint Commission, Sentinel Event Data, Event Type by Year, 1995 -Third Quarter 2011. Retrieved on November 30, 2011 from http://www. jointcommission.org/assets/1/18/ Event_ Type_Year_ I995_3Q201I.pdf
  4. Litts, D., et al. (Eds.) Suicide Prevention Efforts tor Individuals with Serious Mental Illness: Roles for the State Mental Health Authority. Alexandria, Vi-..: National Association of State Mental Health Program Directors, 2008.
  5. Meehan, J., et al. “Suicide in mental health inpa­tients and within 3 months of discharge” British Journal of Psychiatry 2006 (188) 129-13 4.
  6. Bongar, (Ed.), Suicide; Suicidal behaviour: Personality Assessment; Risk factors; Diagnosis; Prevent ion New· York, Oxford University Press, 1992.
  7. Combs, S., and Romm, H. “Psychiatric inpatient suicide : A literature review” Primary Psychiatry 2007(14) 67-74
  8. Joiner, Why People Die by Suicide Cambridge, MA: Harvard University Press, 2005.
  9. Priola, S., Sohlman, B., and Wahlbeck, K. “The characteristics of suicides, within a week of discharge alter psychiatric hospitalization – a nationwide register study” BMC Psychiatry 2005(5).
  10. Litts, D., (Ed.), “Charting the Future of Suicide Prevention: A 2010 Progress Review of the National Strategy and Recommendations for the Decade Ahead.” Newton, MA: Education Development Center, Inc., 2010.
  11. Knesper, D., Continuity of Care for Suicide Prevention and Research: Suicide Attempts and Suicide Deaths Subsequent to Discharge from the Emergency Department or Psychiatry Inpatient Unit . Newton, MA: Education Development Center, Inc. 2010.
  12.  American Association for Suicidology, Recommendations for Inpatient and Residential Patients Known to be at Elevated Risk for Suicide. Washington, DC, 2005.
  13. Bumgarner, S., and Haywood , “Suicide prevention outside the psychiatry department: A bundled approach” Patient Safety & Quality Healthcare 2009 (September-October).
  14. National Action Alliance for Suicide Prevention, Suicide Care in Systems Framework. Newton, MA, 2011.

 

For help in Australia

CAPS – Talk Suicide Support Service – Free telephone and face to face support      1800 008 255

Salvation Army Care Line     1300 36 36 22

Reach Out     http://au.reachout.com/tough-times

Headspace     Register and chat now at eheadspace, or call 1800 650 890  Headspace

Lifeline    13 11 14

Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)

Beyond Blue 1300 22 4636

Mates in Construction: 1300 642 111

QLife        1800 184 527    Phone & Chat  3.00 pm – 12.00 pm everyday

SANE Australia help

SANE Australia Helpline  –  Talk to a mental health professional (weekdays, 10 am-10 pm AEST) 1800 18 72 63

Helpline chat – Chat online with a mental health professional (weekdays 10 am-10 pm AEST)

Kids Help Line 1800 55 1800 (24 hour phone counselling)

Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)

Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families

 

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