LIFE News issue 6: mental health (August 2009)
Welcome to LIFE News – August 2009. In this edition LIFE focuses on mental health and suicide prevention, taking a look at the latest research and projects including the Mindframe Stage & Screen Project, itsallright.org, the SANE Mental Illness and Bereavement Project, headspace and Multicultural Mental Health Australia. LIFE News contributors also report on mental health programs from organisations such as beyondblue and Mental Health First Aid. LIFE warmly encourages feedback on LIFE News - please contact us with your comments and suggestions.
By Harvey Whiteford
Kratzmann Professor of Psychiatry and Population Health
The University of Queensland
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| Above: Professor Harvey Whiteford |
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Statistics suggest that one in five Australians will experience a mental or substance use disorder in any 12-month period. In this sector comment Kratzmann Professor Harvey Whiteford discusses mental disorders and suicide risk factors, reviewing some of the data found in a recent study from the Australian Bureau of Statistics.
Statistics indicate that suicide is a more common cause of death among people who live with mental disorders compared to the general population. Therefore mental disorders such as depression, schizophrenia and bipolar disorder are considered major factors for those at-risk of taking their own lives.
Recently the Australian Bureau of Statistics (ABS) released data from the 2007 National Survey of Mental Health and Wellbeing (NSMHWB), a nationally-representative household survey of 8,841 individuals aged between 16 and 85 years. Included in this was information on the lifetime and 12-month prevalence of suicidal ideation, suicide plans and suicide attempts for Australian adults. In addition there was information on the health service use of those with suicidal thoughts and intentions.
The survey found that 45.5% of Australians will experience a mental or substance use disorder at some time in their life. Clearly these disorders are not something that happens to occasional individuals. They are among the most common of all health problems. One in five Australians will experience a mental or substance use disorder in any 12-month period, with anxiety disorders (14.4%) the most common class of mental illness following by affective (depressive) disorders (6.2%) and substance use disorders (5.1%). Mental disorders, particularly affective disorders, were found to be disabling, causing people to be unable to carry out many of their usual activities. However only 35% of people with a mental or substance use disorder used health services for their problem. An overview of the study can be found here.
The report found over 13% of those surveyed had suicidal ideation at some stage in their lives, 4% had made a suicide plan and more than 3% had made a suicide attempt. As would be expected from other studies, more females than males reported suicidal thoughts and behaviours in the ABS survey. They also tended to be more common in younger people. The study confirmed that protective factors such as being married or in a de facto relationship and having moderate levels of education were important.
The connection between mental disorders and suicidality was particularly strong. For example, among those with depressive disorders, nearly 17% had experienced suicidal ideation, 6% had made a suicide plan, and over 4% had made a suicide attempt in the 12 months leading up to the survey. To put this in perspective, the equivalent 12 month prevalence rates were for the general population were 2.3%, 0.6% and 0.4%, for ideation, plans and attempts respectively. If the person was experiencing suicidal thoughts or behaviours as part of their mental health problems they were more likely to access services. However a significant proportion did not receive treatment.
In a recent review of these findings Johnston, Pirkis and Burgess (“Suicidal thoughts and behaviours among Australian adults: findings from the 2007 National Survey of Mental Health and Wellbeing”, Australian and New Zealand Journal of Psychiatry,2009, 43:7,635 - 643) concluded that, compared to the 1997 ABS Survey of Mental Health and Wellbeing, the prevalence of suicidal thoughts in the Australian adult population has declined slightly. However the prevalence of suicide attempts has remained about the same. Essentially the same number of people attempted suicide in 2007 as did so in 1997 when population growth was accounted for.
They considered how this fits with the reduction in reported suicide in Australia over the same period. They suggested it may be that, even though the proportion of the population who attempt suicide has not reduced, those who do are making fewer or less severe attempts and/or using less lethal means. They recommended that the renewed LIFE Framework should ensure that adequate consideration is given to suicide attempts and should specifically target those at elevated risk, particularly those with mental disorders.
Johnston, Pirkis and Burgess suggest some interventions need to be clinically-oriented, and should involve ensuring that clinicians are able to detect, diagnose, assess and manage suicidal risk, especially in people with mental disorders. They recommend other interventions should be population-based and should draw on sectors outside health to reduce known risk factors (for example, unemployment).
In the same issue of the Australian and New Zealand Journal of Psychiatry, Whiteford and Groves argue for a better coordination of the activities of the National Mental Health Strategy and the National Suicide Prevention Strategy to help achieve the aim of getting more people with mental disorders and suicidal behaviours into appropriate treatment (“Policy implications of the 2007 Australian National Survey of Mental Health and Wellbeing', Australian and New Zealand Journal of Psychiatry, 2009, 43:7,644 — 651).
Clearly there is much to be done in the area of suicide prevention in Australia and particularly in the diagnosis and treatment of mental illness.
- Harvey Whiteford is the Kratzmann Professor of Psychiatry and Population Health at the University of Queensland.
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By LIFE Communications
The Mindframe Stage & Screen Project works to promote accurate and sensitive portrayals of suicide and mental illness. Managed by a partnership between the Hunter Institute of Mental Health, the Australian Writers’ Guild, SANE Australia and with the guidance of a group of nine Australian scriptwriters, Stage & Screen provides a range of incentives geared towards improving the quality of fictional portrayals in film, television and theatre. The project began in 2006 as part of the Mindframe National Media Initiative and in response to emerging research (published in 2005) that analysed current literature on the dramatic portrayals of mental illness and suicide in film and television.
According to Amy Laybutt, Stage & Screen Senior Project Officer, this research - undertaken by the University of Canberra and the University of Melbourne - argued not only that depictions of suicide had increased over the years but that they were becoming more graphic and romanticised.
‘The reports found that portrayals of mental illness tended to be negative and tended to be quite inaccurate. There are a lot of depictions of people with mental illness being violent or aggressive or being people who should basically be feared, which only serves to perpetuate myths and stereotypes,’ Laybutt says.
‘We encourage people to think about not just what the symptoms of the illness might be, because that is just scratching the surface. We try to get them to explore some of the complexities as well and some of the realities of actually living with mental illness.’
Stage & Screen distributes a range of print and electronic resources which discuss responsible ways screenwriters can develop characters who have a mental illness. Writers are encouraged to avoid stereotypes and clichés and to explore some of the complexities people face when living with a mental illness. Preferred portrayals do not glorify or romanticise suicide and do not provide visual details or spoken references to suicide methods; ideal portrayals depict the consequences for others and provide sources of help for vulnerable viewers.
Stage & Screen’s dissemination channels include the Australian Writers’ Guild, an organisation of over 2000 members who have each received the hardcopy resources. The ‘key issues to consider’ document includes questions for writers such as ‘why am I introducing mental illness into the story?’ and ‘will my character with mental illness be viewed as credible?’
Stage & Screen incorporates into their workshops an initiative known as ‘the Living Library,’ which, says Laybutt, is ‘like a normal library except the books are people.’ Each library session consists of four 15 minute sessions, during which scriptwriters can sit down to have a one-on-one conversation with different ‘books,’ the books being different people who have experienced mental illness. Stage & Screen also visits story departments for popular Australian televisions programs to engage with writers and introduce them to the resources; in the past these programs have included All Saints, Home and Away and Neighbours.
Writers are particularly aware that complex portrayals of mental illness and suicide do not necessarily fit easily within the rhythms and conventions required for interesting storytelling. There is an old scriptwriting adage that ‘drama is life with the boring bits taken out,’ and thus one of Stage & Screen’s great ongoing challenges lies in helping writers find a balance between interesting fiction and accurate representations. Laybutt believes this balance can often be found embedded in real life stories.
‘What we find writers discover through reading our resources is that quite often the best stories are the ones that come from reality,’ she says.
‘People sometimes say well, it’s not going to be a very interesting piece of drama if everything is really accurate and clinical. So it’s about finding that balance. We take a collaborative approach and work with writers, rather than just giving them a bunch of information and saying this is how you should do it.’
In May Stage & Screen collaborated with the Australian Writers Guild WA to conduct a script workshop in Perth, which engaged with a group of writers from television, theatre and documentary. As part of the workshop, acclaimed Australian scriptwriter Rob George worked with two actors to present a series of scripted scenarios illustrating different ways mental illness issues could be portrayed according to the level of research undertaken by the writer.
Stage & Screen will continue to provide similar initiatives intended to underscore the bedrock belief of the Mindframe Initiative: that representations of mental illness should be responsible, accurate and sensitive.
Engaging youth in innovative ways – itsallright.org
By LIFE Communications
SANE Australia’s recently redeveloped itsallright.org website disseminates information and advice about mental illness using innovative methods designed to engage young readers. Its key demographic is young people from ages 12-19 who live with a family member who has a mental illness.
Structured in the style of an online diary, itsallright.org profiles the personalities of four fictional characters (Jenna, Brett, Rani and Sarah) in a format that reflects the concepts of popular social networking websites such as Facebook and MySpace. Viewers can read about the characters’ activities, personality traits, diary entries, hobbies, distinguishing features, favourite music, and more. Each character has a parent or other family member with a mental illness. After identifying with one of the four characters, visitors are then provided pathways to relevant resources and services, such as Children of Parents with a Mental Illness (COPMI) support groups.
‘For any teenager who has a family member with a mental illness, there is probably at least one character they can identify with,’ says Dr Paul Morgan of SANE, who coordinated the project.
‘We did a lot of talking to young people in support groups with kids who have a family member with a mental illness, so everything on the website is authentic and relevant to young people in Australia today.’
The original itsallright.org site premiered in 2006. Its redevelopment in early 2009 (funded by a grant from the auDA Foundation) maintained the same underlining principle - that information is best provided through characters and storytelling - but completely redesigned the format. Images were redeveloped, the text rewritten to be pithier and punchier, the characters more finely honed and web development elements such as java script were incorporated to update the technology.
SANE is promoting itsallright.org by sending a mail-out to every high school in Australia. The package includes a specially themed issue of SANE News, a set of character postcards and a key ring. The project’s marketing faces the ongoing challenge of spreading awareness to a hard-to-reach group of teenagers who would benefit from visiting the website.
‘We discuss all the things that young people with a mentally ill family member told us worried them most,’ Morgan says. ‘For example, most teens dislike being made to feel ‘different’ or embarrassed at school. Now if you’ve got a mum who’s unwell with a psychotic illness like schizophrenia, and starts shouting about angels and demons in the shopping centre – you’re not only worried about her and involved in getting help, you’ve also got to go into school on Monday when everyone knows about it. It’s a hard place for these kids to be, especially if they’re not in touch with support services.’
itsallright.org seeks to engage young readers by avoiding ‘falling into traps’ and ‘doing the obvious thing’ in communicating with them. Morgan says these traps include things like incorporating an authority figure (such as a doctor or a professor) or attempting to be overly hip. The project team also resist overusing technological components such as extensive use of video or complex web elements, as these tend to be bandwidth-consuming and can pose difficulties for users with slow connections.
Morgan says there are several hundred thousand children and teenagers in Australia living with parents who have a mental illness, the majority of whom are not receiving any kind of formal support.
‘We are hoping through the power of the internet that we will be able to reach these kids. As we all know, sometimes all it takes is one phone number or one piece of advice and it can change someone’s life,’ he says. ‘We’re already getting feedback from young people who have visited the site and say they have identified with a particular character, and they say he or she is just like me. That’s when we say yes, we’ve got it right.’
By LIFE Communications
The SANE Mental Illness and Bereavement Project (SMIBP) successfully completed its second phase in June 2009, with the development and dissemination of resources to help family and friends of people with a mental illness who have died by suicide or are missing.
Established in April 2007 in response to research that suggested people who are bereaved may be more likely to take their own lives, the project is a prevention as well as postvention initiative that supports friends and family when someone dies by suicide or goes missing.
In November 2008, the project completed a 22-minute DVD, which it uses as part of a training package as well as a standalone resource. From brainstorming to finished product the DVD took around 6 months to create and captures the stories of four bereaved people who talk about their situation, how they coped and what might have helped them. The DVD opens with the caption ‘People affected by mental illness are at higher risk of dying by suicide than the general population’ and the interviews commence with a woman who explains that her brother has been missing for 15 years. SANE Australia sensitively approached possible participants, selecting families from a range of ages and circumstances who speak openly about this highly distressing time in their lives.
‘We’ve found the DVD to be a really powerful way of getting some of the messages across and the feedback we’ve had is that people really appreciate having a real-life perspective in a training setting’, says project coordinator Sarah Coker.
‘It can be quite confronting viewing, particularly if people are bereaved themselves. Whenever we show the DVD in a workshop there is a bit of a silence afterwards. It’s quite a lot to take in and I think it’s a powerful piece of media.’
Since its inception the SANE Mental Illness and Bereavement Project has trained approximately 250 people from around 50 organisations across Australia. Targeted organisations include government and non-government mental health services, bereavement services, help line services and peak mental health organisations such as VICSERV. SMIBP workshops are designed to train-the-trainer and the participants include managers, social workers, psychologists and counsellors, who take the SANE resources with them and in turn train others. As well as the DVD, the training package includes a manual, fact sheets, and guidelines for services. Podcasts of the fact sheets are also available on the SANE website.
Says Coker, ‘What we’re trying to do with the workshops is to increase people’s awareness and to encourage services to improve the way they support families, whether that’s by implementing policy or simply by improving understanding and getting participants to think about how can we offer better support.’
Coker says the Mental Illness and Bereavement Project has a primary focus on suicide bereavement, but will also be valuable in promoting support for families and friends of people who are missing – a group which is less likely to be in touch with services, and therefore harder to reach and help.
‘There aren’t a lot of services out there for families of missing persons,’ she says. ‘An important aim of this project is to raise awareness of their needs too.’
By LIFE Communications
headspace is Australia’s National Youth Mental Health Foundation. Established by the Commonwealth Government of Australia in 2006, it provides mental health and wellbeing support, information and services to young Australians. There are 30 headspace sites spread across the country (with at least one in each state or territory) where youth can access a range of resources and services.
'What we have essentially created in the headspace centres is a one-stop-shop for young people - a place they can go for a whole variety of issues including support with sexual health, physical health, mental health, drug and alcohol and vocational support,’ says headspace CEO Chris Tanti.
‘The idea behind the centres is that they are communities of youth services - a whole range of organisations that come together as a consortium to deliver and develop a headspace site with support from the national office.’
The sites’ four core areas of concern are primary care, drug and alcohol, mental health and vocational services. headspace’s main prerogative is to meet the mental health needs of young Australians, so the criteria for accessing a headspace site is simple: visitors simply need to be aged between 12 and 25. When they enter a headspace site visitors can request to see somebody about a particular problem or have an informal discussion with the receptionist to talk about their options. They are then moved into a specialist triaging system where staff can address how to meet their needs.
The headspace national office engages young people on how to best implement their services. Every headspace service has a youth reference group made up of 27 young people who provide advice and consultation.
One of headspace’s ongoing challenges is finding ways to meet the needs of people who don’t live in an area close to a headspace centre.
‘We only have 30 sites and we probably need to triple that,’ says Tanti. ‘The internet is going to be critical for us as we go forward and develop the capacity to offer online counselling and support.’
Suicide issues in CALD communities
By Georgia Zogalis
Georgia Zogalis is the National Program Manager of Multicultural Mental Health Australia
Migrants commonly experience events and emotions that can lead to risk factors for depression and suicide, including pre-migration experiences, acute and ongoing bereavement due to loss of social supports and cultural identity, and ongoing settlement issues such as inadequate housing, unemployment, and family dysfunction.
Between 1 January 2000 and 30 June 2006 almost 63,000 people arrived in Australia under the Humanitarian Migration Stream. Most of these were from countries experiencing war, dislocation and natural disasters including Sudan (30% of arrivals), Iraq (15%) and Afghanistan (10%). Despite this we do not know the prevalence of depression and other mental health outcomes associated with trauma in refugees because it has not been investigated in Australia.
The Framework for Implementation of the National Mental Health Plan 2003-2008 in Multicultural Australia identifies groups at particular risk of suicide because of trauma and loss. People who have either been victims of torture and trauma, or who have witnessed their family members as victims, can be at particular risk of future mental illness.
Despite knowing that societal and cultural frameworks on coping skills and resilience at the individual level are commonly recognised as playing an important role in suicide prevention, the absence of information on the scope and nature of the problem regarding migrant suicide means that it makes it difficult to develop and implement effective evidence-based prevention and response programs for this population.
Multicultural Mental Health Australia (MMHA) is the national program focusing on multicultural mental health and suicide prevention and is funded by the Commonwealth Department of Health and Ageing under the National Mental Health Strategy. MMHA provides national leadership in mental health and suicide prevention for Australians from culturally and linguistically diverse (CALD) backgrounds and works to promote better mental health and wellbeing for a diverse community. MMHA also works with both ethnic and mainstream media to promote good mental health to CALD communities using a number of mediums, including radio and print.
MMHA provides a range of mental health promotion, information and communication services including Synergy, MMHA's regular magazine, the MMHA website, e-mail bulletins and a clearing house and information service on multicultural mental health and suicide prevention. MMHA organises and supports conferences (including the national Diversity in Health Conference), workshops, symposiums and other educational programs around Australia to showcase new and creative responses to the challenges involved in providing quality mental health care to Australia’s multicultural communities.
MMHA also produces resources for CALD communities and the mental health workforce, last year producing brochures on suicide in 21 languages including Spanish, Italian, Greek, Korean, Vietnamese, Turkish, Cambodian, Croatian, Polish, Serbian, Dinka, Swahili, Ethiopian, Krio, Dari and Macedonian.
A series of audio CDs discussing mental health topics have been developed for the print challenged and for those who cannot read. These topics include suicide, anxiety disorder, bipolar mood disorder, depressive disorder, eating disorder, personality disorder, mental illness and schizophrenia. All the MMHA resources are free of charge for mental health consumers and carers from CALD backgrounds. Print copies can be downloaded from the MMHA’s website.
The Mental Health First Aid Guidelines
The Mental Health First Aid Guidelines have been developed over 3.5 years and have recently been launched on the world wide web. They contain information about how a member of the community can give initial help to someone who they think might be developing or experiencing a mental illness or a mental health crisis. Nine different guidelines are now available and include information on early intervention in the disorders of depression, psychosis, eating disorders, problem drinking and problem drug use. In addition, four mental health crisis situations are also covered: suicidal thoughts and behaviours, non-suicidal self-injury, panic attacks and assisting (adult or child) after a traumatic event.
By beyondblue
While some people may assume fit, healthy people are immune to mental health problems, this is not necessarily the case. Depression and anxiety do not discriminate and can affect any person, of any age and ability at any time.
Exercise is widely regarded as a good way to decrease the risk of developing depression and anxiety, however, many sportspeople – particularly those playing at an elite level – may be exposed to extra risk factors for depression and related disorders.
With this in mind, beyondblue: the national depression initiative works across many sports in Australia to tackle depression and anxiety in the sporting community. In 2006, beyondblue adapted its award-winning National Workplace Program to cater for the sporting community. Initially, the organisation began working with the AFL and the AFL Players’ Association by delivering depression awareness training sessions to players, coaches, umpires and administration staff.
Since then, beyondblue has partnered with Netball Australia, the Professional Golfers’ Association of Australia, Bowls Victoria and the South Australian Cricket Association to deliver training and tailored information to players, coaches, trainers and support staff.
Manager of beyondblue’s National Workplace Program, Therese Fitzpatrick, explains that there are many reasons why the organisation chose sport as a priority setting.
‘The sporting environment is really interesting because being fit does protect people from depression and anxiety,’ she said. ‘However, there are other factors which may play a role in the development of these illnesses. There’s a real sense of success and failure, particularly in professional sports. People may give up a lot of their time to become professional athletes and they may not make it to the elite level. That can take its toll on a person’s physical and mental health.
‘People who play high-profile sports have the added pressure of scrutiny by the media. In team sports, some people may think that they’re going to let the team down if they are experiencing mental health problems, so they may be reluctant to talk about it or seek help early.’
The added risk factors for depression and anxiety, to which elite sportspeople may be vulnerable include:
- an increased chance of physical injury and feelings of frustration, anger and tension while working on their rehabilitation and rebuilding fitness and recovery;
- overtraining, which can lead to poor performance in competition, inability to maintain training loads, fatigue, illness, sleep problems and excessive stress;
- an increased likelihood of developing an eating disorder compared to that of the general population;
- family history of depression/anxiety; and
- increased likelihood of being a perfectionist, which can heighten feelings of anxiety.
- For more information visit the beyondblue website.
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By LIFE Communications
This mini-literature review summarises some recent research on suicide and mental health issues, with a focus on working with people who present both matters in the professional setting.
People with mental health issues are at significantly greater risk of suicide attempts and suicide completion than the rest of the population (Department of Mental Health: World Health Organisation, 2000). As a consequence, it is this area of suicide that has received a large amount of attention within the research.
A study (Monkul et. al., 2007) compared the brain structures of people who had major depression who were or were not suicidal with a group that did not have depression. It was found that there were significant differences in the regions that are thought to involve goal-directed behaviour, judgement and decision making abilities for those people who had major depression and were suicidal compared with the groups who were not.
When considering the possible risk for suicide completion in people with borderline personality disorder, research (McGirr, Paris, Lesage, Renaud, Turecki, 2009) suggests those that present with affective instability and paranoid ideation-associative symptoms may be at less risk. This finding is in line with another study (Linqvist, Nimeus, Träskman-Bendz, 2007) that explored the relationship of symptoms of mental illness, suicidal intent and suicide completion. This study also found that there was no association between the Suicidal Intent Scale (SIS, Beck, Herman, Schuler, 1974; as cited in Linqvist et al., 2007) and future completion for this sample. Rather an assessment of psychiatric symptoms (as opposed to actual diagnosis) was more likely to predict the final outcome of suicide completion.
To some extent, suicide prevention requires the professional to have some ability to be able to assess a client’s suicide risk. However, as it has been observed, “risk assessment scientific basis remains imprecise” (Buckingham, Adams & Mace, 2008, p 299). In other words it is an inexact science.
Aside from the SIS, several other models for suicide and self-harm have been developed. Many of these follow the World Health Organisation’s recommendations (Department of Mental Health, 2000, 13-17), but with variation on how the assessment is implemented. These models also provide some guidelines on how to work with a client who is suicidal. The models that provide life and therapeutic goals (i.e. are included as a broader treatment plan) appear to be more effective in treating clients who are suicidal (e.g. Jobes, Moore, O‘Connor, 2007; Walsh, 2007).
An interview survey of mental health professionals (Buckingham, Adams, Mace, 2008) found that these professionals were more likely to rate someone as being high risk if the client had past episodes of risk, a family history of risk, a history of some form of abuse, current suicidal intention (as opposed to self-harm or ambiguous intent) and ideation. These were the top five out of 23 most commonly cited components that mental health professionals believe contribute to high suicide risk.
On a final note, the matter of the nature of the professional-client relationship is important. For instance frontline care in the emergency departments for those clients who have attempted suicide is considered a key factor for whether someone eventuality completes suicide (Suominen, Suokos, Lönnqvist, 2007).
One study found that the attitude towards people who had attempted suicide was considerably more negative and less empathetic amongst general staff in the emergency department than those held by the staff of the psychiatric hospital (Suokas, Suominen, Lönnqvist, 2008). The authors of this study suggested this may be attributed to the degree of training regarding suicide and mental health that the staff had received. Conversely, the study by Suominen and colleagues (2008) found that having psychiatric staff available for general hospital staff to consult about patients who attempted suicide actually seemed to increase negative attitudes. The authors were at something of a loss when trying to explain this, given it was not backed up by any previous studies. In the case where psychiatric staff were available, they primarily undertook mental health assessment, which could have meant the general staff had less contact overall than the hospital - where no psychiatric staff were available. It is suggested that this may have reduced the opportunities for empathy to develop.
Beyond the emergency departments of hospitals, primary health care providers are the professionals most likely to come into contact with people who have a serious mental illness (Department of Mental Health, 2000; Gold, Kilbourne, Valenstein, 2008). When a general practitioner is treating a client with mental health concerns, it is strongly recommended that they assess suicidal risk and encourage their client to feel safe to bring this up if and when they experience suicidal thoughts. The same is encouraged when working with clients who engage in self-harm, as they may become suicidal or engage in potentially lethal self-harm behaviour (Walsh, 2007).
- LIFE News readers are encouraged to start discussions in LIFE’s discussion forums regarding any of the topics covered in this review, including how you might approach working with clients who have mental health concerns and are suicidal. To gain access to the forums simply register as a member of the LIFE Professional Development Network.
References
- Buckingham CD, Adams A, Mace C (2008). Cues and knowledge structures used by mental-health professionals when making risk assessments. Journal of Mental Health 17, 299-314.
- Department of Mental Health: World Health Organisation (2000). Preventing suicide: A resource for primary health care workers. World Health Organisation: Geneva
- Gold KJ, Kilbourne AM, Valenstein M (2008). Primary care of patients with serious mental illness: Your chance to make a difference. The Journal of Family Practice 57, 515-525
- Jobes DA, Moore MM, O’Connor SS (2007). Working with suicidal clients using the Collaborative Assessment and Management of Suicidality (CAMS). Journal of Mental Health Counselling 29, 283-300
- Linqvist D, Nimeus A, Träskman-Bendz L (2007). Suicidal intent and psychiatric symptoms among inpatient suicide attempters. Nordic Journal of Psychiatry 61, 27-32
- McGirr A, Paris J, Lesage A, Renaud J, Turecki G (2009). An examination of DSM-IV borderline personality disorder symptoms and risk for death by suicide: A psychological autopsy study. The Canadian Journal of Psychiatry 54, 87-92
- Monkul ES, Hatch JP, Nicoletti MA, Spence S, Brambilla P, Lacerda ALT, Sassi RB, Mallinger AG, Keshavan MS, Soares JC (2007). Fronto-limbic brain structures in suicidal and non-suicidal female patients with major depressive disorder. Molecular Psychiatry 12, 360-336
- Suominen K, Suokos J, Lönnqvist J (2007). Attitudes of general hospital emergency room personal towards attempted suicide patients. Nordic Journal of Psychiatry 61, 387-392
- Suokas J, Suominen K, Lönnqvist J (2008). Psychological distress and attitudes of emergency personnel towards suicide attempters. Nordic Journal of Psychiatry 62, 144-146
- Walsh B (2007). Clinical assessment of self-injury: A practical guide. Journal of Clinical Psychology 63, 1057-1068.
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What's new?
MindMatters is a national mental health initiative for secondary schools, funded by the Australian Government Department of Health and Ageing and implemented by Principals Australia Inc (formerly APAPDC). MindMatters promotes a whole school approach to mental health, wellbeing and suicide prevention, focusing not just on individual students with identified needs but also on entire school communities.
A project profile page for MindMatters is now available on the LIFE website.