LifeSpan: A focus on preventing suicide

Australia’s suicide rate has risen to a deadly peak.
 
‘Before 2015 [the suicide rate] was quite stable, but we have reached over 3000 a year, both in 2015 and 2017,’ Dr Michelle Tye, National Health and Medical Research Council Early Career Research Fellow at the Black Dog Institute,  told newsGP.
 
‘The latest release from the Australian Bureau of Statistics [on intentional self-harm] was the worst we’ve seen in more than a decade.’
 
The Black Dog Institute believes suicide can be prevented, and is putting this belief into practice with LifeSpan, the largest-scale suicide-prevention trial in Australia.
 
‘The strategies in the model are what we coin “universal prevention strategies”, so they are delivered to the whole community, regardless of their risk for suicide,’ Dr Tye, Deputy Director of Research for LifeSpan, said.
 
‘The focus is on understanding the risks for suicide, to assist early identification of those who might be at risk. It’s also about encouraging people to seek help by de-stigmatising suicide.’
 
The LifeSpan trial, which uses a model adapted from existing suicide-prevention work in Europe, has been running in New South Wales for three years and was launched in the Australian Capital Territory (ACT) last week.
 
‘All the work in getting the model ready for the Australian context has been done, so the ACT will be in a really nice position,’ Dr Tye said. ‘All the strategies are ready to go.’
 
LifeSpan takes a multi-level approach, delivering nine evidence-based strategies into a local community. These strategies cover a range of aspects that influence suicide risk recognition and care, from building community awareness and engagement to training for frontline healthcare workers in treating people experiencing suicidal crisis.

Dr Michelle Tye from the Black Dog Institute is very pleased with the progress of the LifeSpan suicide prevention trial so far.
 
‘We have community awareness and school-based universal prevention training, but the model also deals with the pointier end of suicide,’ Dr Tye said. ‘We have strategies in the hospitals, emergency departments and aftercare services to mitigate future attempts in people who have made a previous suicide attempt or have risk factors that make them susceptible.’
 
One of LifeSpan’s nine strategies is focused on general practice and equipping primary care to identify and support people in distress.
 
The primary care-focused LifeSpan strategy involves implementation of a program called StepCare, which Dr Tye described as being ‘like a triage service delivery model within a general practice setting’.
 
‘We know that GPs are a key point of contact for people with health problems,’ Dr Tye said.
 
‘We also know that people who have died by suicide or who have attempted suicide have a reasonably high rate of contact with GPs at least once before those events, but they won’t have necessarily seen them for suicidal ideation or risk.
 
‘So these people are turning to their GPs for physical health concerns and are not feeling comfortable to disclose, and the evidence suggests GPs are not always confident to ask about suicidal risk.’
 
General practices participating in StepCare receive a tablet containing a mental health-focused screening system that patients can fill out while they are in the waiting room. The results are sent to their GP in real time, and the program provides scripts for GPs around what to say to patients who have flagged for mental health issues, as well as options for referral depending on severity.
 
‘That StepCare service provides GPs with a really straightforward, evidence-based way of dealing with people with mental health and suicidal thinking,’ Dr Tye said.
 
Preliminary evaluation of StepCare has already shown it to be successful in identifying patients who may have otherwise gone under the radar.
 
‘Two thirds of the patients who participated in the study did flag as having mental health problems, but were not attending GPs for mental health problems and had never disclosed them,’ Dr Tye said.
 
‘So it’s actually picking up quite a lot of people who have that mental health risk.’
 
Dr Tye is happy with the successes and teamwork the LifeSpan trial has already achieved, and has high hopes for more positive outcomes for patients in the future.
 
‘Nothing has ever been done at this scale with suicide prevention in Australia previously, so it is a learning curve for everybody,’ she said.
 
‘Despite that, it has been quite successful; we have been able to deliver on the nine strategies, and we have a great team who have worked relentlessly to make this happen.
 
‘The lead agencies for each site have been fantastic, those key points of contact we have with local site coordinators have found the right players in their area who are very invested in suicide prevention and really want to make this work.
 
‘It has been hard and a lot of work, probably more work than we ever imagined, but despite the difficulties, we have achieved quite a lot in a small space of time.’

Black Dog Institute LifeSpan mental health Suicide suicide prevention