Abstract
Suicide is a global concern with rates in Australia continuing to increase. Effective post-suicidal care is critical for reducing persistent suicidal behaviour. One model of care is that adopted by Alfred Health, delivering a multidisciplinary, hybrid clinical and non-clinical (psycho-social support), assertive outreach approach. This study measured improvements in resilience and wellbeing, changes to distress and suicidal ideation at least 6-months post-discharge from care. Thirty-one consumers participated including a one-on-one interview to gather qualitative feedback. There was a significant change on all outcome measures with large effect sizes. Participants had significantly reduced suicidal ideation and distress and increased coping self-efficacy, hope and well-being. The qualitative findings indicated that a key component to recovery was the staff. Limitations included a low sample size, and broad time range of follow-up data collection. Providing assertive, multidisciplinary, collaborative and outreach-focused post-suicidal care can increase and sustain protective psychological factors and reduced suicidal ideation in most individuals.
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02 December 2022
A Correction to this paper has been published: https://doi.org/10.1007/s10597-022-01060-3
References
Andersson, N., & Ledogar, R. J. (2008). The CIET Aboriginal youth resilience studies: 14 years of capacity building and methods development in Canada. Pimatisiwin, 6(2), 65.
Australian Bureau of Statistics (2018). Causes of Death, Australia, 2018. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2018~Main%20Features~Intentional%20self-harm,%20key%20characteristics~3.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
Brooks, B., & Hirsch, K. H. (2017). State HOPE Scale. In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences (pp. 1–4). Cham: Springer.
Byrne, S., Barry, D., & Petry, N. M. (2012). Predictors of weight loss success. Exercise vs. dietary self-efficacy and treatment attendance. Appetite, 58(2), 695–698. https://doi.org/10.1016/j.appet.2012.01.005
Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital management of self-harm patients and risk of repetition: Systematic review and meta-analysis. Journal of Affective Disorders, 168, 476–483. https://doi.org/10.1371/journal.pone.0089944
Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006). A validity and reliability study of the coping self-efficacy scale. British Journal of Health Psychology, 11(3), 421–437. https://doi.org/10.1348/135910705X53155
Department of Health and Human Services (2016). Victoria’s 10-year mental health plan: Victorian suicide Prevention Framework 2016–25. State of Victoria Melbourne. Retrieved from https://www2.health.vic.gov.au/about/publications/policiesandguidelines/victorian-suicide-prevention-framework-2016-2025; 2016.
Dunster-Page, C., Haddock, G., Wainwright, L., & Berry, K. (2017). The relationship between therapeutic alliance and patient’s suicidal thoughts, self-harming behaviours and suicide attempts: A systematic review. Journal of Affective Disorders, 223, 165–174. https://doi.org/10.1016/j.jad.2017.07.040
Fosse, R., Ryberg, W., Carlsson, M. K., & Hammer, J. (2017). Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward. PLoS ONE, 12(3), e0173958.
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187.
Grewal, P. K., & Porter, J. E. (2007). HOPE Theory: A framework for understanding suicidal action. Death Studies, 31(2), 131–154. https://doi.org/10.1080/07481180601100491
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82. https://doi.org/10.1177/1525822X05279903
Gwaltney, C. J., Metrik, J., Kahler, C. W., & Shiffman, S. (2009). Self-efficacy and smoking cessation: A meta-analysis. Psychology of Addictive Behaviors, 23(1), 56. https://doi.org/10.1037/a0013529
Isaac, V., Wu, C. Y., McLachlan, C. S., & Lee, M. B. (2018). Associations between health-related self-efficacy and suicidality. BMC Psychiatry, 18(1), 1–8. https://doi.org/10.1186/s12888-018-1705-z
Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50(6), 613–621.
Krysinska, K., Batterham, P. J., Tye, M., Shand, F., Calear, A. L., Cockayne, N., & Christensen, H. (2016). Best strategies for reducing the suicide rate in Australia. Australian & New Zealand Journal of Psychiatry, 50(2), 115–118. https://doi.org/10.1177/0004867415620024
Miller, S. D., & Duncan, B. L. (2000). The Outcome Rating Scale. Author.
NHMRC Centre of Research Excellence in Suicide Prevention (n.d.). Care After a Suicide Attempt: A report prepared for the National Mental Health Commission. Retrieved from https://www.mentalhealthcommission.gov.au/getmedia/1f87b145-987e-4bc8-95af-6c4157de074f/CAASA-report.pdf.
Organisation for Economic Cooperation and Development (OECD) (2020), Suicide rates (indicator). Retrieved from https://www.oecd-ilibrary.org/social-issues-migration-health/suicide-rates/indicator/english_a82f3459-en. doi: https://doi.org/10.1787/a82f3459-en
Ryan, C. J., Large, M., Gribble, R., Macfarlane, M., Ilchef, R., & Tietze, T. (2015). Assessing and managing suicidal patients in the emergency department. Australasian Psychiatry, 23(5), 513–516.
Schrank, B., Stanghellini, G., & Slade, M. (2008). HOPE in psychiatry: A review of the litera- ture. Acta Psychiatrica Scand., 118, 421–433. https://doi.org/10.1111/j.1600-0047.2008.01271.x
Schuckard, E., Miller, S.D., 2016. Psychometrics of the ORS and SRS. Results from RCT’s and Meta-Analyses of Routine Outcome Monitoring & Feedback: The Available Evidence Retrieved Oct 10, 2018, from http://www.scottdmiller. com/wp-content/uploads/2016/09/Measures-and-Feedback-2016.pdf .
Schwarzer, R., & Warner, L. M. (2013). Perceived self-efficacy and its relationship to resilience. In Resilience in children, adolescents, and adults (pp. 139–150). Springer, New York, NY.
Shand, F., Woodward, A., McGill, K., Larsen, M., Torok, M., et al. (2019). Suicide aftercare services: an Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health. Retrieved 25th November 2019 from https://www.saxinstitute.org.au.
Shand, F., Vogl, L., & Robinson, J. (2018). Improving patient care after a suicide attempt. Australasian Psychiatry, 26(2), 145–148.
Slade, M. (2009). The contribution of mental health services to recovery. Journal of Mental Health, 18(5), 367–371. https://doi.org/10.3109/09638230903191256
Snyder, C. R., Sympson, S. C., Ybasco, F. C., Borders, T. F., Babyak, M. A., & Higgins, R. L. (1996). Development and validation of the State HOPE Scale. Journal of Personality and Social Psychology, 70, 321–335.
Soysa, C. K., & Wilcomb, C. J. (2015). Mindfulness, self-compassion, self-efficacy, and gender as predictors of depression, anxiety, stress, and well-being. Mindfulness, 6(2), 217–226.
Stallman, H. M. (2018). Coping planning: A patient-centred and strengths-focused approach to suicide prevention training. Australasian Psychiatry, 26(2), 141–144. https://doi.org/10.1177/1039856217732471
State of Victoria (2019). Royal Commission into Victoria’s Mental Health System, Interim Report, Parl Paper No. 87 (2018–19). Retrieved from https://rcvmhs.vic.gov.au/download_file/view_inline/2179.
State of Victoria (2020). Suicide prevention Program for Goulburn Valley. Office of the Premier for Victoria, Melbourne. Retrieved from https://www.premier.vic.gov.au/suicide-prevention-program-for-goulburn-valley/.
Stene-Larsen, K., & Reneflot, A. (2019). Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scandinavian Journal of Public Health, 47(1), 9–17.
Tew, J., Ramon, S., Slade, M., Bird, V., Melton, J., & Le Boutillier, C. (2012). Social factors and recovery from mental health difficulties: A review of the evidence. The British Journal of Social Work, 42(3), 443–460.
Turecki, G., & Brent, D. A. (2016). Suicide and suicidal behavior. The Lancet, 387(10024), 1227–1239. https://doi.org/10.1016/S0140-6736(15)00234-2
Van Spijker, B. A. J., Batterham, P. J., Calear, A. L., Farrer, L., Christensen, H., Reynolds, J., & Kerkhof, A. J. F. M. (2014). The Suicidal Ideation Attributes Scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide and Life-Threatening Behavior, 44(4), 408–419.
Wallace, G., Bird, V., Leamy, M., Bacon, F., Le Boutillier, C., Janosik, M., & Slade, M. (2016). Service user experiences of REFOCUS: A process evaluation of a pro-recovery complex intervention. Social Psychiatry and Psychiatric Epidemiology, 51(9), 1275–1284.
World Health Organization (2019). Suicide. World Health Organization, Geneva, Switzerland. Retrieved from https://www.who.int/news-room/fact-sheets/detail/suicide.
Wright, A. M., Lee, S. J., Rylatt, D., Henderson, K., Cronje, H. M., Kehoe, M., & Stafrace, S. (2021). Coordinated assertive aftercare: Measuring the experience and impact of a hybrid clinical/non-clinical post-suicidal assertive outreach team. Journal of Affective Disorders Reports, 4, 100133.
Acknowledgements
We would like to acknowledge the participants who trusted the first author in sharing their experiences of the HOPE team.
Funding
The Victorian Government Department of Health & Human Services provided funding for the Alfred HOPE program. Aspects of this project were funded by the Barbara Dicker Brain Sciences Foundation. Stuart Lee was supported by an Early Career Fellowship (APP1111428) from the Australian National Health and Medical Research Council.
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Appendix
Appendix
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Kehoe, M., Wright, A.M., Lee, S.J. et al. Provision of a Multidisciplinary Post-Suicidal, Community-Based Aftercare Program: A Longitudinal Study. Community Ment Health J 59, 680–691 (2023). https://doi.org/10.1007/s10597-022-01051-4
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DOI: https://doi.org/10.1007/s10597-022-01051-4