Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 11, pp 1185–1195 | Cite as

Confidence and attitudes of pharmacy students towards suicidal crises: patient simulation using people with a lived experience

  • Evelyn A. Boukouvalas
  • Sarira El-Den
  • Timothy F. Chen
  • Rebekah Moles
  • Bandana Saini
  • Alison Bell
  • Claire L. O’ReillyEmail author
Original Paper



Health care professionals, including pharmacists, have the potential to recognise and assist those at risk of suicide. The primary aim of this study was to assess the impact of utilising people with a lived experience of mental illness as simulated patients on final year pharmacy students’ attitudes toward and confidence in caring for people at risk of suicide after first receiving Mental Health First Aid (MHFA) training.


A parallel group repeated measures design was used. People with a lived experience of mental illness enacted patients experiencing a mental health crisis, including possible suicidal ideation. Following MHFA training, the first group directly participated in the simulation, the second group observed, and the final group had no exposure to the simulation. Validated surveys measuring student attitudes and confidence were conducted at three time points; pre and post MHFA, and then at 2–4 weeks follow-up.


Full datasets of survey responses were received from 34/40 direct participants (85%), 104/146 observers (71%) and 50/66 comparison students (76%). Mean confidence scores significantly improved for all groups post MHFA training (p < 0.05). At follow-up, all 8 confidence items for the direct participant and observer group maintained significance from baseline to post intervention (p < 0.05). Mixed results in relation to attitudes towards suicide were evident at each time point and among each participant group.


Utilising people with a lived experience of mental illness as simulated patients has a positive effect on sustaining pharmacy student confidence in discussing suicidal behaviour post MHFA training. The inconsistency in attitudes towards suicide suggests that attitudes are complex in nature, involving multiple dynamic influences.


Suicide Healthcare personnel Attitudes Confidence Simulated patients 



The authors thank the study participants and are grateful to One Door Mental Health for their assistance in developing and implementing the mental health consumer-led patient scenarios.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Mathers C, Stevens G, Ma Fat D, Ho Wahyu J, Mahanani R (2014) WHO methods and data sources for country-level causes of death 2000–2012. World Health Organisation. Accessed 29 October 2016
  2. 2.
    Australian Bureau of Statistics (2016) Causes of death, Australia, 2015. Accessed 29 October 2016
  3. 3.
    Sher L (2012) Teaching medical professionals and trainees about adolescent suicide prevention: five key problems. Int J Adolesc Med Health 24:121–123. CrossRefPubMedGoogle Scholar
  4. 4.
    Murphy AL, Gardner DM, Chen TF, O’Reilly C, Kutcher SP (2015) Community pharmacists and the assessment and management of suicide risk. Can Pharm J 148:171–175. CrossRefGoogle Scholar
  5. 5.
    Murphy AL, Hillier K, Ataya R, Thabet P, Whelan AM, O’Reilly C, Gardner D (2017) A scoping review of community pharmacists and patients at risk of suicide. Can Pharm J 150:366–379. CrossRefGoogle Scholar
  6. 6.
    Black E, Murphy AL, Gardner DM (2009) Community pharmacist services for people with mental illnesses: preferences, satisfaction, and stigma. Psychiatr Serv 60:1123–1127CrossRefGoogle Scholar
  7. 7.
    O’Reilly CL, Wong E, Chen TF (2015) A feasibility study of community pharmacists performing depression screening services. Res Soc Adm Pharm 11:364–381. CrossRefGoogle Scholar
  8. 8.
    Kirschbaum M, Peterson G, Bridgman H (2016) Mental health first aid training needs of Australian community pharmacists. Curr Pharm Teach Learn 8:279–288. CrossRefPubMedGoogle Scholar
  9. 9.
    Hawgood JL, Krysinska KE, Ide N, Leo DD (2008) Is suicide prevention properly taught in medical schools? Med Teach 30:287–295. CrossRefPubMedGoogle Scholar
  10. 10.
    Jorm AF, Blewitt KA, Griffiths KM, Kitchener BA, Parslow RA (2005) Mental health first aid responses of the public: results from an Australian national survey. BMC Psychiatr 5:9. CrossRefGoogle Scholar
  11. 11.
    O’Reilly CL, Bell JS, Chen TF (2010) Pharmacists’ beliefs about treatments and outcomes of mental disorders: a mental health literacy survey. Austr N Z J Psychiatry 44:1089–1096. CrossRefGoogle Scholar
  12. 12.
    Jorm AF, Kitchener BA (2011) Noting a landmark achievement: mental health first aid training reaches 1% of Australian adults. Austr N Z J Psychiatry 45:808–813. CrossRefGoogle Scholar
  13. 13.
    O’Reilly CL, Bell JS, Kelly PJ, Chen TF (2011) Impact of mental health first aid training on pharmacy students’ knowledge, attitudes and self-reported behaviour: a controlled trial. Austr N Z J Psychiatry 45:549–557. CrossRefGoogle Scholar
  14. 14.
    El-Den S, Chen TF, Moles RJ, O’Reilly C (2017) Assessing mental health first aid skills using simulated patients. Am J Pharm Educ 82:6222. CrossRefGoogle Scholar
  15. 15.
    Bond KS, Jorm AF, Kitchener BA, Reavley NJ (2015) Mental health first aid training for australian medical and nursing students: an evaluation study. BMC Psychol 3:11. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kato TA, Suzuki Y, Sato R, Fujisawa D, Uehara K, Hashimoto N, Sawayama Y, Hayashi J, Kanba S, Otsuka K (2010) Development of 2-hour suicide intervention program among medical residents: first pilot trial. Psychiatr Clin Neurosci 64:531–540. CrossRefGoogle Scholar
  17. 17.
    O’Reilly CL, Bell JS, Chen TF (2010) Consumer-led mental health education for pharmacy students. Am J Pharm Educ 74:167CrossRefGoogle Scholar
  18. 18.
    Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, Koschorke M, Shidhaye R, O’Reilly C, Henderson C (2016) Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet 387:1123–1132. CrossRefGoogle Scholar
  19. 19.
    Miller GE (1990) The assessment of clinical skills/competence/performance. Acad Med 65:63–67CrossRefGoogle Scholar
  20. 20.
    Mental Health First Aid Australia (2016). Accessed 29 October 2016
  21. 21.
    Renberg ES, Jacobsson L (2003) Development of a questionnaire on attitudes towards suicide (ATTS) and its application in a Swedish population. Suicide Life Threat Behav 33:52–64. CrossRefPubMedGoogle Scholar
  22. 22.
    Field AP (2009) Discovering statistics using SPSS, vol 3rd. SAGE, LondonGoogle Scholar
  23. 23.
    Pettigrew TF, Tropp LR (2006) A meta-analytic test of intergroup contact theory. J Pers Soc Psychol 90:751–783CrossRefGoogle Scholar
  24. 24.
    Knaak S, Modgill G, Patten SB (2014) Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies. Can J Psychiatry Revue Can de Psychiatrie 59:S19–S26CrossRefGoogle Scholar
  25. 25.
    Bond KS, Jorm AF, Kitchener BA, Reavley NJ (2016) Mental health first aid training for australian financial counsellors: an evaluation study. Adv Mental Health 14:65. CrossRefGoogle Scholar
  26. 26.
    Seale C (2009) Legalisation of euthanasia or physician-assisted suicide: survey of doctors’ attitudes. Palliat Med 23:205–212. CrossRefPubMedGoogle Scholar
  27. 27.
    Hains C-AM, Hulbert-Williams NJ (2013) Attitudes toward euthanasia and physician-assisted suicide: a study of the multivariate effects of healthcare training, patient characteristics, religion and locus of control. J Med Ethics 39:713–716. CrossRefGoogle Scholar
  28. 28.
    Kopp SW (2009) The influence of death attitudes and knowledge of end of life options on attitudes toward physician-assisted suicide. OMEGA J Death Dying 58:299–311. CrossRefGoogle Scholar
  29. 29.
    Nordstrand MA, Nordstrand SJ, Materstvedt LJ, Nortvedt P, Magelssen M (2013) Medical students’ attitudes towards legalisation of euthanasia and physician-assisted suicide. Tidsskrift For Den Norske Lægeforening Tidsskrift For Praktisk Medicin Ny Række 133:2359–2363. CrossRefGoogle Scholar
  30. 30.
    Fairman N, Thomas LP, Whitmore S, Meier EA, Irwin SA (2014) What did I miss? A qualitative assessment of the impact of patient suicide on hospice clinical staff. J Palliat Med 17:832–836CrossRefGoogle Scholar
  31. 31.
    Osafo J, Knizek B, Akotia C, Hjelmeland H (2012) Attitudes of psychologists and nurses toward suicide and suicide prevention in Ghana: a qualitative study. Int J Nurs Stud 49:691–700CrossRefGoogle Scholar
  32. 32.
    Sun FK, Long A, Boore J (2007) The attitudes of casualty nurses in Taiwan to patients who have attempted suicide. J Clin Nurs 16:255–263. CrossRefPubMedGoogle Scholar
  33. 33.
    Bearman M, Nestel D (2014) Learning theories and simulated patient methodology. In: Simulated patient methodology. Wiley, New York, pp 31–38. CrossRefGoogle Scholar
  34. 34.
    Kalaniti K, Campbell DM (2015) Simulation-based medical education: Time for a pedagogical shift. Indian Pediatr 52:41–45. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The University of Sydney School of Pharmacy, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
  2. 2.One Door Mental HealthGladesvilleAustralia

Personalised recommendations