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
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?
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
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.
teamwork approach when engaging those who are
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.
and implementation science deliver continuous
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.
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
World Health Organization: Preventing Suicide: a global imperative. Page 9. Luxembourg 2014
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
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
…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)
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
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
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
Mental health across a lifespan
Suicide and self-harm prevention
Exploring the stepped care approach
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