Michelle Williamson

A Systematic Review of School-Based Interventions Aimed at Preventing, Treating, and Responding to Suicide- Related Behavior in Young People

BACKGROUND Suicide, in particular among young people, is a major public health problem, although little is known regarding effective interventions for managing and preventing suicide-related behavior. AIMS To review the empirical literature pertaining to suicide postvention, prevention, and early intervention, specifically in school settings. METHOD MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CCRCT) as well as citation lists of relevant articles using terms related to suicide and schools were searched in July 2011. School-based programs targeting suicide, attempted suicide, suicidal ideation, and self-harm where intent is not specified were included. No exclusion was placed on trial design. All studies had to include a suicide-related outcome. RESULTS A total of 412 potentially relevant studies were identified, 43 of which met the inclusion criteria, as well as three secondary publications: 15 universal awareness programs, 23 selective interventions, 3 targeted interventions, and 2 postvention trials. LIMITATIONS Overall, the evidence was limited and hampered by methodological concerns, particularly a lack of RCTs. CONCLUSIONS The most promising interventions for schools appear to be gatekeeper training and screening programs. However, more research is needed.

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.

Australia's Better Access initiative: an evaluation.

Background: Australias Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative involves a series of Medicare Benefits Schedule (MBS) item numbers which offer a rebate for selected services delivered by eligible clinicians. There has been considerable debate about the appropriateness and effectiveness of Better Access, much of which has been based on limited evidence. The current paper contributes to this debate by presenting the findings of a study which profiled the clinical and treatment characteristics of Better Access patients and examined the outcomes of their care. Method: We approached a stratified random sample of providers who had billed for at least 100 occasions of service under the Better Access item numbers in 2008 (509 clinical psychologists, 640 registered psychologists, 1280 GPs) and invited them to participate. Those who agreed were asked to recruit 5–10 Better Access patients according to a specific protocol. We collected data that enabled us to profile providers, patients and sessions. We also collected pre- and post-treatment patient outcome data, using the Kessler-10 (K-10) and the Depression Anxiety Stress Scales (DASS-21). Results: In total, 883 patients were recruited into the study (289 by 41 clinical psychologists, 317 by 49 registered psychologists and 277 by 39 GPs). More than 90% of participating patients had diagnoses of depression and/or anxiety (compared with 13% of the general population). More than 80% were experiencing high or very high levels of psychological distress (compared with 10% of the general population). Around half of all participating patients had no previous history of mental health care. Patients experienced statistically significant improvements in average K-10 and DASS-21 scores from pre- to post-treatment. Conclusions: The findings suggest that Better Access is playing an important part in meeting the communitys previously unmet need for mental health care.

Men's Sheds: A Community Approach to Promoting Mental Health and Well-being

This paper introduces an innovative community approach to promoting mental health and well-being for men: Mens Sheds. In Australia, Mens Sheds have provided an opportunity for men, and people who work with men, to engage their concerns in a partnership mode and in a non-pathologising manner. This has practical implications in the areas of social connectedness, mental health and suicide prevention. Mens Sheds benefit both older and younger men in Australian society. While so far Sheds have developed largely out of grassroots efforts, future planning and policy on funding such projects require further evidence-based exploration. This paper presents current knowledge pertaining to best-practice for Victorian Mens Sheds, including the bio-psycho-social and structural realms. Accordingly, the action areas of the Ottawa Charter for Health Promotion through a gendered approach to mental health are addressed.

Suicide Clusters in Young People Evidence for the Effectiveness of Postvention Strategies

BACKGROUND Suicide clusters have commonly been documented in adolescents and young people. AIMS The current review conducts a literature search in order to identify and evaluate postvention strategies that have been employed in response to suicide clusters in young people. METHODS Online databases, gray literature, and Google were searched for relevant articles relating to postvention interventions following a suicide cluster in young people. RESULTS Few studies have formally documented response strategies to a suicide cluster in young people, and at present only one has been longitudinally evaluated. However, a number of strategies show promise, including: developing a community response plan; educational/psychological debriefings; providing both individual and group counseling to affected peers; screening high risk individuals; responsible media reporting of suicide clusters; and promotion of health recovery within the community to prevent further suicides. CONCLUSIONS There is a gap in formal evidence-based guidelines detailing appropriate postvention response strategies to suicide clusters in young people. The low-frequency nature of suicide clusters means that long-term systematic evaluation of response strategies is problematic. However, some broader suicide prevention strategies could help to inform future suicide cluster postvention responses.

Application of Scan Statistics to Detect Suicide Clusters in Australia

Background Suicide clustering occurs when multiple suicide incidents take place in a small area or/and within a short period of time. In spite of the multi-national research attention and particular efforts in preparing guidelines for tackling suicide clusters, the broader picture of epidemiology of suicide clustering remains unclear. This study aimed to develop techniques in using scan statistics to detect clusters, with the detection of suicide clusters in Australia as example. Methods and Findings Scan statistics was applied to detect clusters among suicides occurring between 2004 and 2008. Manipulation of parameter settings and change of area for scan statistics were performed to remedy shortcomings in existing methods. In total, 243 suicides out of 10,176 (2.4%) were identified as belonging to 15 suicide clusters. These clusters were mainly located in the Northern Territory, the northern part of Western Australia, and the northern part of Queensland. Among the 15 clusters, 4 (26.7%) were detected by both national and state cluster detections, 8 (53.3%) were only detected by the state cluster detection, and 3 (20%) were only detected by the national cluster detection. Conclusions These findings illustrate that the majority of spatial-temporal clusters of suicide were located in the inland northern areas, with socio-economic deprivation and higher proportions of indigenous people. Discrepancies between national and state/territory cluster detection by scan statistics were due to the contrast of the underlying suicide rates across states/territories. Performing both small-area and large-area analyses, and applying multiple parameter settings may yield the maximum benefits for exploring clusters.

Predictors of suicides occurring within suicide clusters in Australia, 2004–2008

A number of studies have investigated the presence of suicide clusters, but few have sought to identify risk and protective factors of a suicide occurring within a cluster. We aimed to identify socio-demographic and contextual characteristics of suicide clusters from national and regional analyses of suicide clusters. We searched the National Coroners Information System for all suicides in Australia from 2004 to 2008. Scan statistics were initially used to identify those deaths occurring within a spatial-temporal suicide cluster during the period. We then used logistic regression and generalized estimation equations to estimate the odds of each suicide occurring within a cluster differed by sex, age, marital status, employment status, Indigenous status, method of suicide and location. We identified 258 suicides out of 10,176 suicides during the period that we classified as being within a suicide cluster. When the deceased was Indigenous, living outside a capital city, or living in the northern part of Australia (in particular, Northern Territory, Queensland and Western Australia) then there was an increased likelihood of their death occurring within a suicide cluster. These findings suggest that suicide clustering might be linked with geographical and Indigenous factors, which supported sociological explanations of suicide clustering. This finding is significant for justifying resource allocation for tackling suicide clustering in particular areas.

Not letting the ideal be the enemy of the good: The case of the Better Access evaluation

The Better Access programme involves a series of item numbers on the Medicare Benefits Schedule (MBS) which provide a rebate for selected services delivered by GPs, psychiatrists, psychologists, so...