Angela Nicholas

Interventions to reduce suicides at suicide hotspots: a systematic review

Background‘Suicide hotspots’ include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention.MethodsWe searched Medline for studies that could inform the following question: ‘What interventions are available to reduce suicides at hotspots, and are they effective?’ResultsThere are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise.ConclusionsMore well-designed intervention studies are needed to strengthen this evidence base.

A review of social inclusion measures

Background: Social inclusion is crucial to mental health and well-being and is emphasised in Australia’s Fourth National Mental Health Plan. There is a recognition that a measure of social inclusion would complement the suite of outcome measures that is currently used in public sector mental health services. This paper is an initial scope of candidate measures of social inclusion and considers their suitability for this purpose. Methods: We identified potential measures through searches of PsycINFO and Medline and a more general Internet search. We extracted descriptive and evaluative information on each measure identified and compared this information with a set of eight criteria. The criteria related to the measure’s inclusion of four domains of social inclusion outlined in Australia’s Fourth National Mental Health Plan, its usability within the public mental health sector and its psychometric properties. Results: We identified 10 candidate measures of social inclusion: the Activity and Participation Questionnaire (APQ-6); the Australian Community Participation Questionnaire (ACPQ); the Composite Measure of Social Inclusion (CMSI); the EMILIA Project Questionnaire (EPQ); the Evaluating Social Inclusion Questionnaire (ESIQ); the Inclusion Web (IW); the Social and Community Opportunities Profile (SCOPE); the Social Inclusion Measure (SIM); the Social Inclusion Questionnaire (SIQ); and the Staff Survey of Social Inclusion (SSSI). After comparison with the eight review criteria, we determined that the APQ-6 and the SCOPE–short form show the most potential for further testing. Conclusions: Social inclusion is too important not to measure. This discussion of individual-level measures of social inclusion provides a springboard for selecting an appropriate measure for use in public sector mental health services. It suggests that there are two primary candidates, but neither of these is quite fit-for-purpose in their current form. Further exploration will reveal whether one of these is suitable, whether another measure might be adapted for the current purpose or whether a new, specifically designed measure needs to be developed.

The Sexunzipped Trial: Young People’s Views of Participating in an Online Randomized Controlled Trial

Background Incidence of sexually transmitted infections (STIs) among young people in the United Kingdom is increasing. The Internet can be a suitable medium for delivery of sexual health information and sexual health promotion, given its high usage among young people, its potential for creating a sense of anonymity, and ease of access. Online randomized controlled trials (RCTs) are increasingly being used to evaluate online interventions, but while there are many advantages to online methodologies, they can be associated with a number of problems, including poor engagement with online interventions, poor trial retention, and concerns about the validity of data collected through self-report online. We conducted an online feasibility trial that tested the effects of the Sexunzipped website for sexual health compared to an information-only website. This study reports on a qualitative evaluation of the trial procedures, describing participants’ experiences and views of the Sexunzipped online trial including methods of recruitment, incentives, methods of contact, and sexual health outcome measurement. Objective Our goal was to determine participants’ views of the acceptability and validity of the online trial methodology used in the pilot RCT of the Sexunzipped intervention. Methods We used three qualitative data sources to assess the acceptability and validity of the online pilot RCT methodology: (1) individual interviews with 22 participants from the pilot RCT, (2) 133 emails received by the trial coordinator from trial participants, and (3) 217 free-text comments from the baseline and follow-up questionnaires. Interviews were audio-recorded and transcribed verbatim. An iterative, thematic analysis of all three data sources was conducted to identify common themes related to the acceptability and feasibility of the online trial methodology. Results Interview participants found the trial design, including online recruitment via Facebook, online registration, email communication with the researchers, and online completion of sexual health questionnaires to be highly acceptable and preferable to traditional methods. Incentives might assist in recruiting those who would not otherwise participate. Participants generally enjoyed taking part in sexual health research online and found the questionnaire itself thought-provoking. Completing the sexual health questionnaires online encouraged honesty in responding that might not be achieved with other methods. The majority of interview participants also thought that receiving and returning a urine sample for chlamydia testing via post was acceptable. Conclusions These findings provide strong support for the use of online research methods for sexual health research, emphasizing the importance of careful planning and execution of all trial procedures including recruitment, respondent validation, trial related communication, and methods to maximize follow-up. Our findings suggest that sexual health outcome measurement might encourage reflection on current behavior, sometimes leading to behavior change. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 55651027; http://www.controlled-trials.com/isrctn/pf/55651027 (Archived by WebCite at http://www.webcitation.org/6LbkxdPKf).

The sustainability of an Australian initiative designed to improve interdisciplinary collaboration in mental health care

BackgroundThe Australian Mental Health Professionals Network (MHPN) is fostering a collaborative, interdisciplinary approach to mental health care through the establishment of local interdisciplinary networks of mental health professionals. This paper reports on those factors seen by MHPN participants and staff as having affected the formation and continuation of interdisciplinary networks, and therefore the likely sustainability of these groups.MethodThe paper draws on qualitative data from focus groups with mental health professionals participating in MHPN activities and MHPN staff.ResultsThe findings suggest that MHPN’s approach to establishing sustainable interdisciplinary networks has been influenced by a number of factors at the micro-, meso-and macro levels. At the micro-level, factors such as clarity and structure of ongoing meetings, individual dynamics and the role of ‘champions’ can promote or constrain sustainability of ongoing networks. Those networks that had established following an initial workshop and had continued to meet as an interdisciplinary network tended to be led by well-respected co-ordinators, involve members who are enthusiastic and keen to learn from each other, have a flexible structure and meet regularly for a well-defined purpose. These features are underpinned by good communication between network members and with MHPN administration. At the meso- and macro-levels, the key issue relates to resourcing, as well as the wider policy context.ConclusionsThe support and practical resources provided by MHPN have been crucial in guiding successful networks as they form and continue to meet on a regular basis. The networks have also required internal leadership and support, and a clear purpose in order to form and to continue their activities. These findings are consistent with the literature, which states that sustainability of programs is reliant on factors at the project design and implementation level, as well as on factors inherent within the host organization and at the wider community level.

An evaluation of an Australian initiative designed to improve interdisciplinary collaboration in primary mental health care

This paper reports on a multi-component evaluation of Australias Mental Health Professionals Network (MHPN). MHPN aims to improve consumer outcomes by fostering a collaborative clinical approach to primary mental health care. MHPN has promoted interdisciplinary communication and networking through activity in three inter-related areas: interdisciplinary workshops supported by education and training materials; fostering ongoing, self-sustained interdisciplinary clinical networks; and a website, web portal (MHPN Online) and a toll-free telephone information line. The evaluation showed that MHPNs workshops were highly successful; almost 1200 workshops were attended by 11,930 individuals from a range of mental health professions. Participants from 81% of these workshops have gone on to join ongoing, interdisciplinary networks of local providers, and MHPN is now supporting these networks in a range of innovative ways to encourage them to become self-sustaining and to improve collaborative care practices.

Predictors of Exercise in Individuals with Schizophrenia: A Test of the Transtheoretical Model of Behavior Change

INTRODUCTION Mortality in individuals with schizophrenia, including deaths not attributable to accidents and suicide, is at least twice that of the general population. While increasing physical exercise could promote positive mental and physical health outcomes in individuals with schizophrenia, only one other study of the determinants of exercise within this population has been reported. Our study attempts to resolve this void in knowledge by testing the applicability of the transtheoretical model (TTM) of behavior change to predicting exercise behavior in those with schizophrenia. METHODS Forty-nine participants (42 with schizophrenia and 7 with schizoaffective disorder) from three community mental health centers in Melbourne, Australia, completed a series of questionnaires, an interview, physical health measures, and had their medical records examined. These measures were used: TTM exercise stage, TTM mediators of change, health status, health-risk behaviors, use of antipsychotic medications, psychopathology, psychiatric history, and demographic information. Variables found to be significantly correlated with exercise stage were then included in a series of regression analyses to determine their relative predictive power for exercise stage. RESULTS The results demonstrated that the TTM and its associated measures may be valid for integration into interventions for promoting exercise in individuals with schizophrenia, despite high levels of psychopathology symptoms. CONCLUSIONS Routine clinical practice should promote exercise in people with schizophrenia and the TTM may be of benefit to this end. Strategies that promote exercise when self-perceived poor health is seen as a significant barrier are particularly important, as is the reduction of caffeine consumption and other health-adverse behaviors.

Suicide Prevention Public Service Announcements (PSAs): Examples from Around the World

ABSTRACT Media campaigns have received increased attention as an intervention for combating suicide. Suicide prevention campaigns involving public service announcements (PSAs) have not been well described and have been subject to minimal evaluation. This study aimed to identify suicide prevention PSAs from around the world and analyze and describe their content. We searched the Internet for short, English-language PSAs that had been screened as part of suicide prevention campaigns and identified 35. Most commonly, these PSAs focused on the general population and/or people who might be at risk of suicide, and had a particular emphasis on young people. Almost 60% promoted open discussion about suicide, around 50% indicated that the life of a suicidal person was important, about 40% acknowledged the suffering associated with suicidal thoughts and feelings, about 25% stressed that suicide is preventable, and about 20% focused on the devastating impact of suicide for those left behind. Most PSAs promoted some sort of support for people at risk of suicide, usually a helpline or website. Although these messages appeared appropriate and practical there is a lack of research on the impact that they may have on people with varying degrees of suicide risk. Further work is needed to ensure that they are consistent with theories of behavior change, and that they are having their desired impacts.

Improving access to primary mental healthcare for Indigenous Australians

Objective: To examine the uptake, population reach and outcomes of primary mental healthcare services provided to Indigenous Australians via the Access to Allied Psychological Services (ATAPS) program between 2003 and 2013, with particular reference to enhanced Indigenous ATAPS services introduced from 2010. Method: Utilising ATAPS program data from a national minimum data set and comparative population data, we conducted descriptive analyses, regression analyses and t-tests to examine the uptake of ATAPS services, provider agency level predictors of service reach, and preliminary outcome data on consumer level outcomes. Results: Between 2003 and 2013, 15,450 Indigenous client referrals were made that resulted in 55,134 ATAPS sessions. National Indigenous service volume more than doubled between 2010 and 2012, following the introduction of enhanced Indigenous ATAPS services. Non-Indigenous ATAPS service volume of primary care agencies was uniquely predictive of Indigenous service reach. Preliminary analysis of limited consumer outcome data indicated positive treatment gains and the need to enhance future outcome data collection. Conclusions: Concerted national efforts to enhance mainstream primary mental healthcare programs can result in significant gains in access to mental healthcare for Indigenous populations.

Improving access to primary mental health care for Australian children

Objective: This study examines the uptake by children aged predominantly 0–11 years of an Australian primary mental health service – the Access to Allied Psychological Services programme – which began in 2001. In particular, it considers access to, and use of, the child component of Access to Allied Psychological Services, the Child Mental Health Service, introduced in 2010. Method: Using routinely collected programme data from a national minimum dataset and regional population data, we conducted descriptive and regression analysis to examine programme uptake, predictors of service reach and consumer- and treatment-based characteristics of service. Results: Between 2003 and 2013, 18,631 referrals for children were made and 75,178 sessions were scheduled via Access to Allied Psychological Services, over 50% of which were via the Child Mental Health Service in its first 3 years of operation. The rate of referrals for children to the Child Mental Health Service was associated with the rate of Access to Allied Psychological Services referrals for consumers aged 12+ years. Conclusions: The Child Mental Health Service has increased services provided within the Access to Allied Psychological Services programme for children with emotional and behavioural issues and their families, and is potentially filling a service gap in the area of prevention and early intervention for children who have significant levels of need but are unable to access other mental health services. Our findings are policy-relevant for other developed countries with a similar primary mental health care system that are considering means of improving service access by children.

Development of the headspace Family and Friends Satisfaction Scale: Findings from a pilot study

The primary aim of this pilot study was to determine the psychometric properties of the 18‐item headspace Family and Friends Satisfaction Scale (hFAFSS).