When conversations matter but the evidence is missing

When conversations matter but the evidence is missing: Developing community resources for

suicide preventionconversationsmatter.com.au

The Hunter Institute of Mental Health is a leading national organisation dedicated to reducing mental illness and suicide and improving wellbeing for all Australians. For more than 20 years we have been

delivering successful, evidence-based mental health and suicide prevention programs from our base in Newcastle,

NSW. These have made a considerable contribution to the mental health and wellbeing of many Australians.

Project Overview• Funded under the NSW Suicide Prevention Strategy 2010-2015;

• Developed by the Hunter Institute of Mental Health;

• AIM: to develop resources to guide safe and effective conversations about suicide for educational settings, workplaces, families and communities to strengthen their capacity to participate in suicide prevention action.

• FOR: Aboriginal and Torres Strait Islander people; people from culturally and linguistically diverse backgrounds; gay, lesbian, bisexual, and transgender people; young people; older people; males.

Generate evidence through analysis of current approaches, consultation with experts and communities, and using a measurable approach to finalise resources

It has never been developed or evaluated before and the research evidence is limited and conflicting with many variables to be tested

The problem The approach

Talking about suicide• Suicide is an important issue of community concern;

• It is important that as a community we are engaged with the issue;

• Often confusion about what is meant by “discussing” or “talking about” suicide, and confusion about the evidence;

• Need to ensure we are not “too afraid” to talk about suicide, while respecting and understanding the risks.

The risk associated with the “discussion” seems to be related to: The focus of the information (about death, about how to cope with a

death, about the broader issue);

The status of the individual receiving the information (little interest, vulnerable, bereaved by suicide);

The format they receive the information (face-to-face, media);

The place they receive the information.

Lenses considered• Why? = Focus of discussion

• Prevention, Intervention or Postvention;

• How? = Format of discussion • One-on-one, small group, wide-scale (e.g. media);

• Where? = Setting • School, Workplace, Families, Community, Online, Media;

• Who? = Target groups to be considered • Carers, GLBTI, Young People, Older People, Aboriginal and Torres Strait

Islander People, CALD Communities, People with a mental illness, People Living in Rural and Remote Areas, Men, People Bereaved by Suicide.

LITERATURE REVIEW• Review of research evidence• Review and analysis of existing

resources and approaches

CORE PRINCIPLES Three review panels (experts, target groups, settings) review a series of ‘principles’ to guide prevention-focused, intervention focused, and postvention focused conversations.

ONLINE RESOURCES• New name and branding for the resources• Community resources for discussing suicide• Professional resources to support community discussion of suicide.

CONSULTATIONS• Service providers and key informants

across four settings• Consultations with community

Evidence review – general findings• There is very little research evidence to either support or refute a number

of common assertions when talking about suicide;

• While there is support amongst experts that discussing suicide does not increase risk, there is no scientific evidence that discussing suicide has either a positive or negative impact on actual suicidal behaviour;

• Emotional discomfort and sense of self-efficacy have been identified in the as obstacles to discussing suicide in clinical and educational settings;

• Evidence from specific settings is mixed with variable outcomes;

• Research suggests that people do want to discuss suicide despite it being difficult.

Review of Resources• 120 local, national and international approaches which assist people to

talk about or discuss suicide were collected and reviewed.

• Most resources were focussed in intervention (50%), followed by Postvention (41.7%) and a small number prevention focussed (8.3%);

• Most resources guided one-on-one conversations (67.5%) and less for groups (17.5%) and large audience (15%)

• There are major gaps – ie, prevention focussed resources, public speaking and recommendations for particular groups;

• Resources rarely address communication theory, motivations and other “skills” required to implement the recommendations.

Setting Based Consultation Forums• Four face-to-face consultations were held focussing on educational

settings, workplaces, families, and communities (including online);

• Apart from particular priorities across the four settings, recommendations for action focussed around:• The need for appropriate dissemination;

• Integration into existing programs and approaches;

• Training for gatekeepers;

• Addressing cultural, age and other differences but not making everything separate and complex.

Focus groups with communityResearch: “Community needs and views about discussing suicide in NSW”

• People generally stated that conversations about suicide don’t occur in the community, but they were able to identify lots of ways it did occur;

• Conversations were most likely to occur among people distally involved, rather than directly affected/experiencing;

• Most of the barriers related to fear of doing or saying the wrong things or not knowing when to take the issue seriously;

• There were different suggestions about settings and methodologies, with most consistency around increasing family and peer capacity (intervention & postvention) and the capacity of workplaces (prevention & postvention).

• The core-principles include a series of agreed statements to guide community conversations;

• Three sets of core principles, covering recommendations for prevention-focused, intervention-focused and postvention-focused conversations.

• 3 panels created to rate their level of agreement with each statement – experts; settings; target groups.

• Core principles finalised after two rounds and used to develop resources.

conversationsmatter.com.au


The resources will assist communities when:• They want to know how to talk about

suicide more generally.

• They are worried about someone and want to know what to say and do.

• There has been a death and they want to know how best to handle individual and community level conversations.

These resources have been designed for community level

conversations and not for clinical or health related

conversations.

Prevention-focused conversations

Intervention-focused conversations

Postvention-focused conversations

Five initial community resources:1. Conversations Matter when holding group discussions about

suicide prevention

2. Conversations Matter when you are worried someone may be thinking about suicide

3. Conversations Matter when communities are affected by suicide

4. Conversations Matter to those bereaved by suicide

5. Conversations Matter when needing to inform a child about suicide.


Conversations Matter website is a responsive website and resources are easily accessible online through computers, tablets and mobile devices.


Resources for:Communities

&Professionals

Each community resource can be accessed as:• Online presentation • Printed factsheet • Podcast in male or female voiceYou will also find:• Supporting information• Links to services, programs and

resources.


Following extensive community

consultation the resources have been

developed in multiple formats.

Next steps

The mental health, community services and other community sectors have a key role in disseminating messages to the community.

1. Identify gate-keepers and identify pilot organisations for more comprehensive support (and evaluation);

2. Develop Capacity building plan and get baseline information;

3. Implement Plan with targeted organisations, including professional develop and support for engaging communities;

4. Support ongoing communities of practice around the Conversations Matter resources.


www.conversationsmatter.com.au


All of the background reports are available online.You can register your interest in receiving Conversations Matter updates – just visit us!

Follow us on twitter @HInstMH

Questions?


When conversations matter but the evidence is missing

Health & Medicine

Transcript of When conversations matter but the evidence is missing