Hanging out in emergency is no place for people experiencing psyche-ache

Susan Murray CEO Zero Suicide Institute of Australasia, 30th March 2019

https://www.zerosuicide.com.au/post/hanging-out-in-emergency-is-no-place-for-people-experiencing-psyche-ache

Having immersed myself over the last six years in suicide prevention, and to a degree mental health, I might be considered a bit of a “Johnny-come-lately” to this area, but it doesn’t make me any less concerned about how we can and should be improving services. Last week the Australian Institute of Health & Welfare (AIHW) released the report on Mental Health Services in Australia.It is full of stats and facts which can be used to guide decisions around programs, services and resourcing.

There are many who have been advocating for years to find better options for supporting those who are in crisis. Skimming the data in this report gives every good reason as to why we must move on this now.

In 2106-17 there were 276,954 people who arrived at emergency departments across Australia for mental ill-health conditions. A staggering 6 out of every 10 were not admitted to hospital ….that’s almost 158,000 who did not get admitted to the hospital they attended.

What this says to me is ……. if we provided alternative quality care to de-escalate the immediate crisis and then supported the person to get the right ongoing care we could make a real difference:……

  • To each of the 158,000 individuals
  • To the emergency department nurses and doctors who we all know are stretched to the hilt
  • To the distressed family members and carers
  • To the administrators who are constantly being told to cut costs

By transforming services to non-hospitalised professional care in a living-room style environment it has been demonstrated to focus the individual on recovery and to save health systems up to 45% of their current costs.

I visited one such centre on a recent study tour in the US. It takes a lot to set up and get the best results. But, the results speak for themselves – and are well worth the effort.

The Commonwealth Government has allocated $1.45 billion to the Primary Health Networks over the next three years. Surely the opportunity to transform the mental health services is there. Let’s grab it and run with some trials in urban, regional and rural areas.

I am happy to help. Let’s get things moving.

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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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

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