Current edition
Welcome to LIFE News – November 2008. In this edition we focus on primary care in suicide prevention, taking a look at the latest research and NSPS project updates. We also spotlight recent news including the formation of the new Australian Suicide Prevention Advisory Council and health care resources now available in the Northern Territory.
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Dr Tori Wade |
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General Practice and Suicide Prevention – a Vital Link
Dr Tori Wade
General practice is a key part of the health care system for suicide prevention. Research (De Leo, 2005) has shown that in Australia general practice is the most important source of help for people who are thinking of or planning a suicide. Whereas half of these people do not seek help, of those that do 60 per cent see their GP. This is compared, for example, to just over 10 per cent who phoned a helpline. When we look at the people who actually attempted suicide, more than half of them didn’t seek help either, but if they did they were most likely to go to an emergency department, and second most likely to see a GP. However, the people who attempted suicide gave GPs higher satisfaction ratings, both for providing treatment and for their supportive attitude.
The second reason why general practice is important is because of variability in suicide risk. Only 20 per cent of those who planned or attempted suicide said that their suicidality increased gradually over time. Most people (around 60 per cent) said that their degree of suicidality was very variable before their attempt. Reflecting on clinical practice gives some clues as to why this is so: most suicidal people are in a state of severe internal conflict, and their degree of suicidality can vary from day to day or even hour to hour. Also, some people are more impulsive than others, and can be feeling fine at one time; then a knock back when seeking help or a criticism from a friend can send them into a suicidal state quite quickly.
In addition, a suicide attempt is more likely to be made when the person is intoxicated with drugs or alcohol. Because of this variability, it can happen that by the time the person has been sent for a specialist mental health assessment, they may be judged to be at low risk and therefore it is hard to get them into the service. Specialist services have been set up to deal with chronic and severe mental illness and it is not surprising that they have found it hard to respond to fluctuating suicidality; they simply can’t see everyone, and it is difficult to predict ahead of time who needs specialist services. However, these people can be seen and helped through general practice.
Another important role of general practice is to assist those who have been bereaved by suicide. The same research I referred to above also found that people who have known someone who completed or attempted suicide were substantially more likely to be suicidal or to attempt suicide themselves. Many of these people will consult a GP in the days and weeks after a relative or friend has suicided, and therefore there is the opportunity to provide help to prevent a second tragedy.
Over the past six years general practice has done a great deal in this area. General practitioners themselves have taken up education about mental health to better assess and treat their patients. Increasingly, general practices have a visiting psychologist or other mental health professional on site, and also the Divisions and Networks of General Practice have employed or contracted teams of mental health clinicians who work closely and responsively with general practice in order to take GP referrals and see people quickly. This has been an important addition to the other public and private mental health services and has increased the ability of GPs and general practices to be truly vital links in the chain of suicide prevention.
Dr Tori Wade is a GP Advisor for the Adelaide Western General Practice Network and a former member of the National Advisory Council for Suicide Prevention.
References
De Leo D, Cerin E, Spathonis K and Burgis S Lifetime risk of suicide ideation and attempts in an Australian community: Prevalence, suicidal process, and help-seeking behaviour. Journal of Affective Disorders 2005; 86: 215 – 224
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Visit the AGPN page on primary mental health care.
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Dr Wade and six other suicide prevention experts took part in a discussion panel about the role of primary care in suicide prevention during LIFE’s free workshop Putting LIFE Into Practice. Podcasts of the discussion are available online.
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Visit the Professional Development Network (PDN) to have your say about the role primary care plays in suicide prevention, via the LIFE discussion forums. Not registered? Join the PDN today!
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Perth Primary Care Network rolls out training programs across WA
Promote Living is a suicide prevention training project run by the Perth Primary Care Network in collaboration with the Western Australian Ministerial Council for Suicide Prevention. From October 2008 to June 2009 the project will conduct a series of 18 intensive training programs, with the objective of improving community resilience in Western Australia by better equipping GPs and nurses in suicide prevention risk assessment.
‘What we’re attempting to do,’ says projector coordinator Allan Huggins, ‘is train large numbers of GPs and nurses to be more aware in terms of engagement, assessment and management of people at risk of self-harm and suicide.’
Promote Living recently expanded its objectives to include providing this training to 100 men from outside the health sector in four suburbs in Perth: Cannington, Girraween, Spearwood and Bassendean.
‘In each of these suburbs we know there are lower socio-economic communities and more people at risk,’ says Huggins.
‘Men are less articulate about their health needs than women and they tend to keep emotional issues to themselves. Therefore we have to attune doctors and nurses working in the community to why men do that and what is the best way to approach it.
‘We are actually bringing men in, laymen from the street so to speak, to give them a training program which is called SafeTalk. It attunes ordinary people in the community to issues surrounding self-harm and suicide.’
Huggins hopes that the men who attend the expanded training programs will in turn talk to other men and, over time, reach out to a large body of people in the community who may not have interaction with GPs and nurses.
’80 per cent of all suicides in Australia are males,’ says Huggins, ‘and therefore we need to become particularly focused on men’s issues.'
In the coming months, Promote Living plans to introduce new resources such as a mental health website designed to provide GPs with quick access to service providers.
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Square resource booklet |
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Square broadens horizons
Jointly funded by the Commonwealth Government and the Government of South Australia, Square (Suicide, QUestions, Answers and Resources) is a set of suicide prevention resources for people who work in primary care, specialist and community settings.
The project began its pilot phase in 2001 and since 2006 has been rolled out on a national level. Originally aimed at GPs with the intention of raising awareness and helping to increase skills around risk assessment and management, the project broadened its platform in 2008 to include social support services and non-GP health services.
Gretchen Scinta, who was appointed CEO of Square in April, says: ‘The original idea was that most people who have completed suicide have seen their general practitioner within the preceding weeks. But the problem is even though they might have seen the GP they didn’t go there saying I am thinking about suicide, so it is not necessarily the reason for presentation. It is difficult for GPs to be the only people expected to identify risks.’
In June and July Square produced four updated training modules. These modules include The Orientated Module (or Beginning Point), which instructs people on how to set up the Square model in any given community, and the Community Based Training Module, which teaches how to engage, assess and refer people who are at risk. Square works with Relationships Australia South Australia (RASP) to develop its training materials.
‘Square took on a whole new life and started focusing on providing information, support and skilled training to people who might come into contact with somebody who is at high risk of suicide in other areas related to health and social services,’ says Scinta.
During the previous few months Scinta has noticed a revival of interest in the project, partly due its revamped training modules.
‘There was a huge resurgence of activity and everybody was interested again,’ she says.
‘There has been overwhelming interest in people being able to use these tools to be able to set up strategies at a local level, which is really good.’
Download your copy today
The LIFE Framework is the latest in a series of national suicide prevention initiatives that began in the early 1990s. It provides national strategy for action based on the best available evidence to guide activities aimed at reducing the rate at which people take their own lives.
The LIFE materials aim to support population health approaches and activities that will assist in reducing the loss of life through suicide in Australia.
The LIFE Framework is based on the understanding that:
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suicide prevention activities will do no harm
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there will be community ownership and responsibility for action to prevent suicide
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service delivery will be client-centred.
The LIFE Framework is particularly aimed at academics, researchers, policy makers, health or community services professionals, service providers and community organisations.
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Logo of General Practice Network NT |
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Primary Health Care and Suicide Prevention in the NT: Overcoming Challenges through Collaboration
Kelly-lee Hickey
The Northern Territory has the highest completed suicide rates in Australia with 22.5 deaths per 100,000 people (LIFE Fact sheet 3, 2007). High levels of suicidality are present in Indigenous and non Indigenous populations, with suicides occurring in both urban and remote areas. The remoteness of many communities and townships, as well as the diversity of languages and cultures across the NT, present unique challenges to primary mental health care provision.
General practitioners play a key role in the identification and management of suicide risk. General Practice Network NT has developed resources and training to assist general practitioners in identifying and managing suicide risk in the unique NT primary health care environment. Due to practitioner shortages, territory GPs need to identify risk factors and develop management plans in a high-pressure and time poor-general practice environment. Recent federal government mental health initiatives, such as the Better Access Medicare items, have provided GPs with some capacity to spend more time with mental health patients. The Collaborations for Life resources and training encourage GPs to use these item numbers to routinely check in on patients’ mental health, and where necessary, develop collaborative care arrangements with community and mental health care providers to respond to the individual needs of patients.
The Collaborations for Life resources, designed to be used during consultation, incorporate locally and internationally developed risk assessment tools and local response protocols for general practitioners. The resource also contains a referral guide, listing community and mental health services, providing patients and clinicians with a wide range of clinical and non-clinical referral pathways including specialist mental health services, relationship counselling and youth services.
The resources are complemented by suicide prevention training tailored to the needs of primary health care providers. The Collaborations for Life training model works with local service providers to develop training that highlights local resources and response protocols for suicide risk. These multi-disciplinary training events are attended by GPs, practice nurses, psychologists and Aboriginal health workers to facilitate networking and information sharing.
The suicide prevention resources and training have been well received in the Top End of the Northern Territory, and the General Practice Network is currently developing resources and training for Central Australia.
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Kelly-lee Hickey is a Suicide Prevention Project Officer for General Practice Network NT
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The Collaborations for Life resources are available online at the General Practice NT website or by contacting Kelly-lee Hickey on (08) 8982 1043
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Bush Crisis Line and Support Services provides psychological support for health practitioners and their families adjusting to life in remote areas. People seeking assistance can receive free help by calling 1800 805 391.
MJA journal article discusses depression in primary care
Some of the strongest links associated with mental illness and suicidal behaviour are found in conditions such as depression. The Australian evidence base for studies of mental health and depression forms the subject of Professor Harvey A. Whiteford’s MJA journal article ‘Depression in primary care: expanding the evidence base for diagnosis and treatment,’ which was published in June.
According to the LIFE Framework (Fact sheet 7) ‘it is not possible to explain suicide as having a simplistic one-to-one relationship with mental illness, although mental illness is a significant risk factor for suicide.’
Whiteford discusses evidence needed to aid diagnosis and treatment of depression and provides a supplement bibliography of resources.
The article contextualises previous studies and bodies of evidence including the National Survey of Mental Health and Wellbeing (conducted by the Australian Bureau of Statistics in 1997) and the Australian Burden of Disease Study (conducted by the Australian Institute of Health and Welfare in 1999). Whiteford traces mental health policy in Australia forward to initiatives such as the Better Access program in 2006 and the Second National Survey of Mental Health and Wellbeing in 2007.
‘It is clear that the main focus of activity aimed at reducing the burden of common mental disorders in Australia is in primary care,’ he writes.
‘Specialist mental health services play a supporting, but not central, role. Ensuring the primary mental health care sector can reduce the burden of common mental disorders by increasing the number of patients receiving evidence-based interventions remains the challenge.’
WHO and WONCA collaborate on primary care report
In October the World Health Organisation (WHO) and the World Organisation of Family Doctors (WONCA) released a joint report outlining 10 broad principles to help guide countries to successfully integrate mental health provisions and primary care. These principles, which range from national policy directions and resource allocation to community commitment and capacity building, were developed after an analysis of best practice from 12 nations.
The report, titled ‘Integrating mental health in primary care – a global perspective’, found that while provisions for mental health are ‘globally insufficient’, integration, it claims, can still be achieved in a variety of contexts.
One of the key recommendations of the report
emphasises
the need to train primary care workers to better identify and respond to patients with mental disorders. To follow-up the training, the report also recommends ongoing supervision and support.
Dr Ala Alwan is the Assistant Director General for Non Communicable Diseases and Mental Health at WHO’s headquarters in Geneva. He says: ‘Many people present to primary care with a mental disorder but in many countries their problem is not
recognised
and treated. Untreated mental health problems cause suffering for individuals, can increase the risk of suicide, and impair family and social relations and overall productivity at work.’
Can a psychiatrist help you with your patient?
The GP Psych Support service provides GPs with patient management advice from psychiatrists within 24 hours. GP Psych Support provides advice in the following areas of psychiatry:
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General adult psychiatry
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Child and adolescent psychiatry
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Old age psychiatry
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Drug and alcohol psychiatry
For more information visit the GP Psych Support website or call 1800 200 588.
Do you work with people who may be at risk of suicide? Are you interested in developing your skills and knowledge about suicide prevention? If you are LIFE’s Professional Development Network is for you.
The Professional Development Network gives professionals from a diverse range of locations and occupations the chance to contribute expertise, network and stay up-to-date with the sector.
Members can register for free and view and contribute to discussion forums on a variety of topics such as Indigenous suicide prevention, bereavement, risk management and recovery. These forums are the perfect place to workshop ideas, ask questions and share resources. LIFE Professional Development Network members can also participate in live chats with experts in the sector and keep up-to-date on relevant news with email alerts.
Join the Professional Development Network today!
Prof Ian Webster speaking at Putting LIFE Into Practice in September. |
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Minister Roxon announces new Australian Suicide Prevention Advisory Council
To coincide with World Suicide Prevention Day on 10 September, Ms Nicola Roxon, Minister for Health and Ageing, announced the formation of a new Australian Suicide Prevention Advisory Council (ASPAC). The council, which will provide a forum for experts to contribute to national decision-making, will be chaired by Professor Ian Webster, Emeritus Professor of Public Health and Community Medicine at the University of New South Wales.
‘The government has ideas about what ought to be taken forward in suicide prevention, and it depends upon the council to offer advice about the practicalities and in particular the evidence that would support particular approaches,’ says Webster.
Ms Roxon says ASPAC will be a core element in a reinvigorated National Suicide Prevention Strategy Workplan that will include stronger emphasis on support for people in rural and remote communities, more targeted support for high-risk groups and developing more locally tailored projects.
Council members were selected from a broad range of organisations including the Australian Institute for Suicide Research and Prevention, SANE Australia, Crisis Support Services, Lifeline and Suicide Prevention Australia.
‘We have representations from people who research and practice and carry out work in the field of suicide and suicide prevention, as well as community agencies, representatives of people who are affected by mental illness and at risk of suicide, and in particular Indigenous people,’ says Webster.
‘I think it is a very representative group. It is smaller than the previous council but I think it’s all the more efficient because of that.’
The new Australian Suicide Prevention Advisory Council consists of Professor Ian Webster, Ms Dawn O’Neil (Lifeline), Dr Michael Dudley (Suicide Prevention Australia), Ms Wendy Sturgess (Crisis Support Services), Professor Diego de Leo (Australian Institute for Suicide Research and Prevention), Professor Brian Kelly (NSW Centre for Rural and Remote Mental Health), Ms Barbara Hocking (SANE Australia), Ms Janet Meagher (Consumers’ Health Forum of Australia) and Ms Adele Cox (National Indigenous Youth Movement).
The first meeting of the new ASPAC was held on November 11 and 12.
LIFE News focuses on Indigenous Australians
The third edition of LIFE News will feature projects, people and comment focusing on Indigenous Australians. LIFE Communications warmly encourages input and contributions. If you would like to contribute to this edition, please contact us with your idea.
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