Participants Called to Join Study for Best Practice Guidelines for Suicide Prevention

A groundbreaking new study is set to be carried out in a bid to develop a set of best practice guidelines for crisis care and suicide prevention.

LifeSpan, an evidence-based approach to suicide prevention developed by the Black Dog Institute and the Centre for Research Excellence in Suicide Prevention, is calling on people with professional or lived experience of suicide or self-harm to participate in the survey.

Researchers will use the Delphi expert consensus method to draw on both lived experience and professional expertise in a bid to outline best practice for integrated crisis and aftercare for people who are displaying suicidal behaviour, ideation or self-harm.

In particular the guidelines will focus on improvements in the emergency department and hospital settings.

LifeSpan director Rachel Green told Pro Bono News she was excited about the study.

“There are things that have come out through our stakeholder interviews about what may or may not be a flag or a risk marker, or what may or may not make a difference in terms of prevention that are potentially new, so I’m interested in seeing how they are considered by the panel,” Green said.

“I am also particularly excited by the value we are placing on lived experience.

“Because I think, the retail sector knows how to send a mystery shopper in and see if retail workers are supporting all the functions that are expected of them and what the experience is like for the customer. There are obviously ethical problems in doing that in a healthcare setting, but this is one way of really valuing that lived experience and understanding what it feels like to be someone who’s sitting in an ED in crisis.

“I think that if we can understand that better, we’ll go a long way to understanding how to improve practice.”

It comes as the LifeSpan program, a $15 million research trial funded by The Paul Ramsay Foundation, is currently being implemented across four pilot sites in NSW – Newcastle, Illawarra Shoalhaven, Gosford/Wyong and the Murrumbidgee – with other Australian sites in the pipeline.

Green said LifeSpan was the name given to what they call the Systems Approach to Suicide Prevention.

“[It] is a multi-level program of intervention, so nine interventions, nine strategies, that when delivered together at the same time within a defined region aim to have a greater cumulative effect on suicide rates than piecemeal strategies do on their own,” she said.

“It is a pretty big deal, it is the first time it has been done in Australia.”

The first of the nine strategies focuses on crisis- and after-care, which Green said was expected to have a strong influence on suicide attempt.

“If someone makes a suicide attempt and gets good care and good follow up they are less likely to make a subsequent attempt and therefore less likely to die by suicide,” Green said.

“We actually think about 20 per cent of impact comes from that strategy alone, so it is a really important one but it is also the hardest area.

“What we found when getting into the research for this area was there are a lot of guidelines, there are a lot of studies that recommend things and often there is a gap in the area of what we call knowledge translation.

“So people have studied a particular approach and said it makes a difference but the detail that one would actually use to implement what was studied is often lacking.

“There is a real challenge in translating research into change in health care settings.”

Green said this latest study aimed to bridge the gap in “knowledge translation” and provide evidence to back practices that have not previously been researched.

“In our consultations with the sector and with people around the country and other researchers and clinicians, we heard a lot about different, good bits of practice people were doing but most things hadn’t sort of made it to being studied, so there wasn’t hard evidence we could go to to see if something works or not,” she said.

“There was a lack of clarity around some of the things the evidence recommended in around either how you would do them or how effective they might be in different sorts of contexts.

“There are things out of the evidence for example that tell you you should set up a suicide prevention team, and that’s a good idea, but what the literature does not necessarily then tell you is who’s in the team, what does the team do, what does the membership look like, how often do they meet, what is their interaction with a patient, so you can see where there is gaps in actually implementing things and often that is a common barrier to implementing guidelines.

“So what the Delphi consensus study does is it draws statements about what you should do from all different sources of evidence, from published literature but also from interviews with key stakeholders and conversations with people with lived experience… and then puts all that together in a survey type format.

“That is then issued in a way that is methodologically rigorous to develop consensus about which of the things that you could do, are actually most important. So in that sense we think it is quite an exciting piece of work.”

The study will include two panels, one for professionals and one for those with lived experience.

“What that means is that the lived experience of having been in the ED feeling suicidal or being a family member supporting someone or someone bereaved by suicide, who has been through that crisis experience, is weighted equally to that of a clinician within an emergency department,” Green said.

“So we are actually really able to balance that lived experience with professional experience, and out of it we aim to produce information that makes sense of some of the existing evidence and guidelines and produces guidance on what best practice might actually look like.”

Researchers are also calling on health professionals working within emergency settings to join the study.

“That’s really important because guidelines and well-meaning writers of guidelines can have a tendency to come up with long laundry lists of all the things that an ED nurse should do without necessarily being in touch with the reality of work on the ground for an ED nurse who might be casual, who might not have done any specialised training in methods of suicide prevention, might have come through a different stream of healthcare training,” Green said.

“Sometimes the expectations are wrong in terms of what’s actually possible, so a study like this actually gives those clinicians an opportunity to respond to all these different possibilities of what they could do and prioritise what they think is most important.”

The surveys will be run between February and March.

People interested in taking part in the study can find more information here.

If you or anyone you know needs help, call Lifeline on 13 11 14 or visit lifeline.org.au