Suicide Prevention Workshop 8th March 2016 Background Information In November 2015, the Australian Department of Health announced their response to the National Mental Health Commission report “Contributing Lives, Thriving Communities - Review of Mental Health Programmes and Services” which sees Primary Health Networks leading strategies in relation to mental health and alcohol and drug reform. The mental health reform include six key areas:      

Child and youth Indigenous Suicide prevention Hard to reach groups Low intensity services Service and complex mental illness.

Suicide Prevention A systemic and planned regional approach to community based suicide prevention builds on work to date in the area of suicide prevention in partnership with key stakeholders. An initial workshop led by the Gold Coast Primary Health Network (GCPHN), in partnership with the Gold Coast Hospital and Health Service (GCHHS) was held on 8th March 2016. The workshop was attended by 16 key local stakeholders and was co-led by the GCPHN Program Manager and the Clinical Director Gold Coast Specialist Mental Health Service, who set the scene by referring to the following documents:   

Gold Coast Mental Health and Specialist Service (GCMHSS) Suicide Prevention Strategy 2016-2018. The “Zero Suicide” plan is based on best practice principles and frameworks informed by the Henry Ford Health System in Detroit, Michigan and the Mersey Care NHS Trust. The National Suicide Prevention Summit 2015 describing the nine areas essential for systems based approach to suicide prevention.

The aim of the workshop was to determine the current state, the gaps and barriers and solutions to suicide prevention services on the Gold Coast. The nine National Suicide Prevention Summit areas that formed the structure of the workshop were: 1

Appropriate and continuing care once people leave Emergency Departments (ED), and for those at risk in the community at any one time: a. 24/7 call out emergency teams experienced in adult/child/adolescent suicide prevention; b. Crisis-call lines and chat services for emergency callers;

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c. Assertive outreach for those in the ED and discharged including those hard to engage with; d. E-health services of web programs through the Internet. 2

High quality treatment, such as Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT) for those with mental health problems (including online treatments).

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Training of GPs in detecting depression and dealing with suicide risk.

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Suicide prevention training of front line staff including police, ambulance and other first responders.

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Gatekeeper training for persons who are likely to come into contact with at risk individuals (teachers, youth workers, friends and family, clergy, counsellors). Provision of training in appropriate work places, in particular communities (Aboriginal communities) and across other services targeting particular populations, such as people who interact with those with a disability, or unemployed, or in financial crisis, people dealing with child trauma, rape, violence, etc.

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School-based peer support and mental health literacy programs.

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Community suicide prevention awareness programs about suicide.

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Responsible suicide reporting by the media.

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Reducing access to lethal means of suicide.

The diagrams below contain a synthesis of the comments that were generated by the workshop participants based on the nine areas above. Each response was discussed in relation to existing services in the community, gaps and barriers and possible solutions.

Area One: Existing resources: Lifeline, calls from family, referrals to Headspace, emergency services, ACT, HHOT, suicide call back, Q Life, Men’s Line, Parents Help Line, Veterans, Kids Help Line, AoD, Webinars for consumers and clinical staff. Gaps and Barriers:  Support outreach to people at risk but not yet at highest acute stage  No integrated services - outreach team/homelessness/acute  Lack of awareness, after hours service is limited, follow up for hard to reach homelessness and CALD  Finding the services to help people, not enough services, in lots of areas there is nothing.  No services supporting people who have been bereaved by suicide. Possible Solutions:  Safe space in community after hours (face to face) if not admitted but have suicidal ideation.  Continuing funding for NGO’s to provide support mechanisms.  More resources for those bereaved by suicide, care plans, supervision, a liaison role to contact – keep in touch with people –provide the human contact. Case workers need a clinician to support them – peer support workers –GP-dedicated case worker, greater access to education eg: accidental counsellor and mental health first aid.

Area Two: Existing Resources: 10 sessions Mental Health Care Plan, ATAPS, private practitioners – CBT, on-line resources Gaps and Barriers: GP’s have gaps in their knowledge of the appropriate treatment modality, access to information about CBT/DBT, not much DBT and restricted to private, limited under the EPC 10 sessions, the quality of some on line resources, services for CALD, LGBTI, Indigenous and veterans. Possible Solutions: MHN in each surgery to complete the care plans, education service to access support, education of GP’s, mental health modalities- what is the best one, more people in the public system with skills, better promotion of the benefits of these treatments.

Area Three: Existing Resources: On line training and resources, Headspace – two GP’s working, referrals from GP’s are not high, require mental health training, nurse based triage, GP’s sometimes attend training. Gaps and Barriers: Non-holistic approach, not listening to carers/family/workers, some services refused to listen to those that know most. Men don’t usually attend GP’s, stigma from GP’s pathologising, system of 10 minute appointments is not working, and skills gaps for suicide risk assessment. Possible Solutions: Increase training for service providers to assist marginalised groups, training is essential, more GP’s who bulk bill for hard to reach, more use of mental health care plans, Nurse based in GP’s, peer influence in the system, targeting audience with appropriate message, inclusive care approach, first responder training, community based, united synergies for bereavement.

Area Four: Existing Resources: ED in General Training (June), there is a police representative on the local Suicide Prevention Network, ambulance process/resource development, Aboriginal and Torres Strait Islander first aid for all staff at Kalwun. Gaps and Barriers: Communication of what’s happening in the police, ambulance, time table of training, online training available for frontline staff, flexibility of training access, DV task force starting to work in this area - link into police. Possible Solutions: Quick app for front line staff to find local support for screening tool - next steps community members that can support ATSI Elders, CALD leaders and churches training - who to contact when there is a crisis – connect with police liaison officers, in house meetings/training for police and ambulance, lived experience to visit/liaise with police, ED and ambulance when well to talk about what it meant to have a positive experience.

Area Five: Existing Resources: Mates in Construction (MIC) – peer based evidence based program, over 7000 gatekeeper positions on the Gold Coast across building sites – these ”connectors” have a green dot on their hard hat signifying they can be approached – make the “safe talk” program applicable for workplace culture. Gatekeeper training (connectors) needs to happen in the workplace – help is sought from people on the same level e.g. football clubs, surf clubs - becoming assets to the community. Every connector in MIC have numbers to call if need be – non-medicalised non-pathologised training. Gaps and Barriers: Adult learning diluted, gaps in training and learning in early identification. What’s not so great about training is some is not evidence based, not delivered by skilled people, delivered in a medical model framework not community, cost driven that is number of students not quality, information based but no skills. Possible Solutions:  Early identification training, need to get to individual early, community wide approach, for training creating access pathways, standardised training, evidence based training.  School based training – promote quality training. SAFE TALK – 4 hours, Assist 2 days, MHFA  Gate keeper with specific skills.

Area Eight: Existing Resources: Resources are available SANE and NSW organisations. Gaps and Barriers: How to engage the media on the effect of suicide, media conferences. Possible Solutions:  Communications develop a collaborative approach to the media  SANE media stigma – media watch reporting  Resources for media are available, DV Taskforce could have a media contact involved  Positive mental health stories, media release from multiple agencies regularly (social media has a larger voice)  Media conference, Journalist student course – through local media promote student champions e.g. ABC Radio, gatekeepers.

Area Six: Existing Resources: Headspace in school clinics – 3 day clinics – outreach, referral from school to clinician. Hosting school nurses for clinical supervision every week. Varsity Lakes - early detection and identification clinic being conducted by Headspace. ATAPS providers in relation to Headspace as a method of referral. Mates in Construction (MIC) do presentations to trades, schools and development of peer workforce. MIC workplace based apprentice training as peer gatekeepers to support those seeking help. Gaps, Barriers and Possible Solutions: Education for teachers – myth busting about suicide discussions, awareness raising in school community peer workforce, focus on teachers trust from students, basic first aid training for teachers (ensure it is de-medicalised). Respite based care for students, training for teachers to listen with understanding.

Area Seven: Existing Resources: Lifeline – occasional programs “safe talk” – ASSIST, Mental Health First Aid for professionals and front line carers, Suicide Prevention Day, social media, r u ok. Gaps and Barriers: Infrequency of programs offered, infrequency and limited training, infrequent events/community awareness/locations/promote broadly, evidence based programs delivered to young people school/street level/community. Possible Solutions: Increased training and community awareness e.g. safe talk –Assist, First Aid, investment in help seeking app/social media/technology for specific groups – youth, aged, CALD.

Area Nine: Existing Resources: Risk assessment in the home, observation in the home by a skilled worker, prevention of access to medication by having a locked box in the home that services administering medication (nurses) access and administer. Monitoring of fire arms in the home to prevent impulse related incidents. Gaps and Barriers: Out of hours support, ideas come from the internet/social media, gaps in information in the actual referral, monitoring of safety of firearms. Possible Solutions:  In home risk assessment training naming the issue  Resource to manage/monitor giving medication by a worker visiting, more liaison with the referrer and the organisation e.g. NGO adding in phone contact  Education for Pharmacists to be alert for stockpiling behaviour  Support for the bereaved. Broaden the National Program for the bereaved; develop more access to Pathways Programme  Develop a training programme for all mental health workers to ask key questions about reducing access to lethal means of suicide. All mental health consumers are asked questions like o Do you have firearms in the house? o Have you thought about a hanging point in the house?  This would normalise the questioning process. Models already exist for example Domestic Violence in terms of detection as part of normal screening in the antenatal setting. The aim is to skill up staff to ask the hard questions as part of an ongoing risk assessment process.

In summary This report will be distributed to all stakeholders with thanks and appreciation for their contribution. The next step will be determined in partnership and following consultation with relevant stakeholders. If you, or anyone you know, would like to provide the GCPHN with additional information to that provided above, please email [email protected]