Themes from Suicide Prevention Clinicians and Academics Consultation Workshops 2017

Background

During November and December 2016, six workshops and seven telephone interviews were held with a total of 34 academics and clinicians who have an interest in suicide prevention. The workshops were held in Auckland, Wellington and Christchurch. They were run in a semi-structured manner, with open discussion in addition to questions relevant to the academic/clinical sectors.

The themes and suggested actions resulting from these workshops are detailed below.

Overarching themes / Main subthemes / Suggested actions
Strategic approach to emergency department responses /
  • Emergency department (ED) protocols for suicide attempt patients. Standardised approach to the response within the ED for those presenting with attempted suicide.
  • Post-attempt follow-up. A minimum requirement protocol for following up people who present with attempted suicide. May include (for example) requirement for referral or ongoing contact.
/
  • Set up an ED-based team for those who make suicide attempts.
  • Pilot the ED ‘strategy’ in one DHB, include evaluation and analysis before national implementation.
  • Develop a DHB performance indicator of maximum length of wait for followup (postattempt) of seven days.

Research /
  • Enhanced use of the integrated data infrastructure (IDI) to better understand suicide in New Zealand.
  • Increased research and evidence-base building for suicide prevention.
/
  • Use the IDI to enhance the understanding of the history behind an attempt or completed suicide.
  • Convene an academic external review panel.

Treatment of mental health conditions /
  • Effective treatment of depression. Improve the capability of the primary and secondary health workforce to treat depression. This includes depression in young people.
  • Address the disproportionate number of suicide attempts by women.
  • Provide support for Children of Parents with Mental Health and Addiction conditions(COPMIA).
  • Addressing the connection between alcohol misuse and suicidal behaviour.
  • Provide high-quality and consistent post-attempt follow-up.
  • Improve the effectiveness of risk assessments, through consistency of follow-up with appropriate interventions.
  • Improve/increase access to secondary mental health support services.
/
  • Upscale depression.org, eg, include a suicide prevention module within ‘The Journal’ as well as a suicide screening tool on the website front page.
  • Target depression.org so that it is appealing to working age men, given that they comprise the largest number of deaths by suicide.
  • Find ways of bringing the content of depression.org to those who are not computer literate or who do not have internet access.
  • Update, promote and improve mobile device compatibility for SPARX (
  • Post attempt, provide access to resilience building programmes that include family/whānau.
  • Write crisis resolution plans as part of post-attempt follow-up.
  • Strengthen non-governmental organisation (NGO) services where there is a lack of community support.
  • Provide an appropriate response and intervention after a risk assessment.

Access to means of suicide /
  • Continue to work on reducing access to:
–guns
–pharmaceutical overdose
–bridges used as jump sites. /
  • Paracetamol prescribing and dispensing.
  • Gun access for farm workers.
  • Women and overdose.

Social determinants of suicide /
  • Build strong, supportive communities.
  • Improve social equity.
  • Child and youth deprivation.
  • Childhood trauma and neglect.
  • The impact of colonisation on suicidal behaviour.
/
  • Improve (agency and NGO) infrastructure and networks/connections to protect children.
  • Utilise connections with health services at the ante-natal stage for building emotional awareness, protective factors, mental health literacy.
  • Expand the number of infant mental health teams.
  • Investigate conditions of the WINZ job-seeker benefit (with medical exemption) with regards to limitations on part-time work, noting that employment is a protective factor for suicide.
  • Use the IDI data to investigate social determinants further.

Technology /
  • Use current technology effectively.
/
  • Examples:
–‘Aunty Dee’ app
–Telehealth for suicidality/suicidal behaviours.
Addressing stigma /
  • Have safe conversations about suicide, including but not limited to safe media reporting.
  • Improve the accessibility of resources.
/
  • Media, eg,
  • Teach parents of teenagers how to have safe conversations about risk and suicidal behaviour.
  • Promote support and resources (eg, Tihei Mauri Ora publication by Mental Health Foundation).

Workforce development /
  • Improve GP/primary health care physicians’ knowledge of suicide risk in older people and how to have conversations about their risk.
  • Address the consistency of standards and skills in:
–hospitals
–primary health care
–secondary/community workforce.
  • Māori competency for suicide prevention.
  • Risk-assessment competency standardised.
  • Ambulance officers.
  • Tertiary level studies in suicide prevention.
/
  • Use InterRAI assessment as a screening point for older people.
  • GP use of PHQ-9 with older people.
  • Ambulance officer training module for responding to suicide attempts.
  • Dedicated suicide prevention training for health professionals who are at the undergraduate level.
  • Career pathway described for suicide prevention coordinator roles.
  • Primary health care workforce skilled and confident with depression and suicide risk assessments/questioning with older people.

Integration/Inter-agency work /
  • Improve cross-agency communication.
  • Use existing structures more effectively.
  • Share post-attempt information.
  • Integrate agencies.
/
  • Connect Family Start with the Well Child Tamariki Ora Programme and Infant Mental Health.
  • Wrap around care approach in cases of child abuse.
  • Communication, links and access between primary health care physicians and WINZ.

Public health interventions /
  • Build resilience.
  • Work to reduce interpersonal violence.
  • Address alcohol and substance misuse.
/
  • Teach problem/stress solving skills at school.
  • Provide mental health first aid in workplaces.

Workshop attendance

1Auckland

  • 9 attendees

2Wellington

  • 11 attendees

3Christchurch

  • 7 attendees

4Telephone interviews

  • 7 interviews

Themes from suicide prevention clinicians and academics consultation workshops1