Collaboration across sectors and services has enabled the development of an innovative suicide prevention program in regional Victoria, Marie McInerney reports.
This is her latest article for the Croakey Conference News Service from the recent 15th National Conference for Rural and Remote Allied Health.
Marie McInerney writes:
Locally-driven research into an increase in suicides several years ago in the regional Victorian city of Mildura has led to a new service model of holistic, client-centred aftercare for a period of up to 12 weeks.
The new model is also addressing regional health workforce shortages, the recent 15th National Conference for Rural and Remote Allied Health was told recently.
Chris Harvey, former Suicide Prevention Program Manager at Mildura Base Hospital, said the development of the Mildura Suicide Prevention Program in 2020 underscored the importance of relationships, collaboration, multidisciplinary approaches, place-based research and of translating research findings into action.
The hospital has been seeing early signs of success in reducing readmissions for suicide attempts, and Harvey is now looking to apply the lessons – in particular the development of a ‘one stop shop’ suicide prevention entry point – in primary care.
“Opportunities like this do not come along very often in rural areas,” Harvey said, in a joint presentation with Dr Sean MacDermott, Senior Lecturer in Social Work at La Trobe University and Director of the John Richards Centre for Rural Ageing Research.
In 2018-2019, a worrying number of suicides were reported in the Mildura local government area, with the city recording regional Victoria’s highest suicide rate at 35.5 deaths per 100,000 residents.
That prompted the local Murray Primary Health Network to commission a study to investigate and map local emergency care and follow-up for people at risk and to make recommendations for system improvement.
The researchers looked at 11 years of data on emergency department presentations and found that 2,327 people presented 4,326 times, including 1,999 re-presentations. The primary risk factors were age (being older), gender (male) and Aboriginal and Torres Strait Islander status.
Calls to action
The study also mapped the current system of emergency care and follow-up, making several findings and recommendations:
- The emergency department was overused, overburdened and under-resourced.
- Few services were available to patients who had attempted suicide after discharge from hospital and there was no clear pathway to follow-up care.
- Services were focused on immediate health needs and not the social determinants driving people into crisis.
- Attracting and retaining a skilled workforce was an ongoing challenge, impacting service access.
- There was need to improve community awareness about mental illness to reduce stigma.
- A model of care was needed to address both the clinical and social needs of patients.
Among the researchers’ final recommendations were the establishment of a Way Back Support Service and the creation of a sustainable and an ongoing process to monitor, review and improve the experience of people presenting to the Emergency Department in a suicide crisis.
A third recommendation was to explore the concept of early intervention through a ‘one stop shop’ approach to accessing support.
“That was probably one of our more important recommendations, but it was also probably the one that we thought, ‘will anybody do this or not?’” MacDermott said.
So often such reports and evaluations sit on shelves and “gather dust”, he told the conference.
But this time, a strong and unique collaboration was born between La Trobe and the Mildura Base Public Hospital, due to the existing relationship between MacDermott and Harvey, who lectured on a sessional basis in social work at the Mildura campus.
It turned out to be the kind of research that Harvey had been waiting for and was able to benefit from targeted funding, particularly for professional development, in the wake of Victoria’s Royal Commission into the state’s mental health system.
The hospital “took the recommendations on board and ran with them,” MacDermott said, describing it as a “win-win-win” scenario, where “rural-based, real-world research can significantly benefit universities, participating organisations and the communities where this research occurs”.
Relationships matter
Harvey later told Croakey that, from his perspective, the pre-existing relationships he had with La Trobe were a game-changer.
He had previously observed that allied health, and particularly social work, was not at the forefront of research, “particularly in a rural and regional context, let alone in the suicide prevention space”.
That was not about lack of interest, he said, but a combination of people being very busy in their roles, and not having the capacity or the institutional pathway to conduct research.
Over 12 years at Mildura Base, he was the first staff member to commence and progress through a PhD. He was well supported by an “extremely accommodating” hospital executive, but it was an untrodden path until then.
For rural and regional areas, “unless there’s someone there that has an interest in research and academia, the reality is that it won’t progress”, he said.
Importantly, the study was conducted by MacDermott, “an academic that I had an association with, in an area [of practice] that was of interest to me, and that made recommendations that could be implemented in my own workplace”.
With state and federal funding, the hospital established the Mildura Suicide Prevention Program in 2020.
Staffed by mental health professionals, including social workers, it includes the Hospital Outreach Post-suicidal Engagement (HOPE) program and the Way Back Support Service — “one of the few locations to get both”.
Where HOPE provides proven clinical assessment and therapeutic care that actively involves the consumer in their own treatment plan, Way Back provides practical non-clinical support to help manage life situations and challenges.
All staff are required to undergo First Nations Cultural Safety and Responsiveness Training, and Aboriginal and Torres Strait Islander people referred to HOPE are offered the additional support of an Aboriginal Liaison Officer.
An Aboriginal Liaison Officer also attends weekly clinical review meetings for input, advice and guidance in the ongoing care of Aboriginal and Torres Strait Islander consumers, who are offered a choice between referrals to community controlled or mainstream services.
Like most other presenters at the SARRAH conference, Harvey said one of the key issues for the new services was attracting and retaining a skilled rural and remote allied health workforce — an ongoing challenge that “ultimately impacts on service access”.
So the program developed a defined professional development process, aided by specific HOPE funding, that embeds opportunities for career progressions so that a team member can progress efficiently from student to clinical and management roles.
Part of that involves the employment of allied health university students, particularly those in psychology and social work, as Wellbeing Support Workers. They not only get hands-on skills development and the opportunity to work directly with clients, but are charged with developing external partnerships and to coordinate services linkages so they begin to know how the system works.
“By the time they graduate, they’re already quite advanced…having their finger on the pulse of who’s who and what’s what around town…being that little bit more advanced [in skills development] and in connection [to the local community]”, he said.
Staffing levels rose from one 0.5 position to nearly 12 full time positions within a multidisciplinary team over four years.
Primary care focus
Harvey also developed a partnership with the Australian Association of Social Workers, that sponsored people to become accredited mental health social workers, “so once you achieve the accreditation of a mental health social worker, that gives you eligibility to go out and work in private practice under the Medicare Benefits Scheme”.
That caused some contention, he said, around the risk of training people up in order for them to leave the hospital and go into private practice.
“That’s what I was wanting,” he said. “Because the reality is, is that we only have X amount of private practitioners, where it’s anything up to three month waiting list for a consumer to get in.”
“People are going to go out [into private practice, being] very heavily skilled and heavily trained up. How is it not going to benefit the community? And take that little bit of a burden off the tertiary mental system?” he said.
Harvey is among those who have now made the transition, moving in recent weeks into private practice as an accredited mental health social worker in a local general practice.
He wants to “determine ways in which we can replicate a similar model of care in the primary care sector”, given that a high proportion of Australians who have died by suicide had access with their GP, versus a tertiary mental health service, in the lead-up to their death.
While it’s early days yet, he said the “red carpet has been rolled out” for him by GPs in the clinic, who recognise the benefit of having someone with his experience “on tap”.
Like the hospital program, “the client doesn’t have to go from here to there navigate different systems, because that is one of the big problems…navigating the system,” he said.
• See more details from the presentation.
Services
Lifeline
13 11 14
Lifeline.org.au
Suicide Call Back Service
1300 659 467
Suicidecallbackservice.org.au
Defence Member and Family Helpline
1800 624 608
MensLine Australia
1300 789 978
Mensline.org.au
ReachOut
au.reachout.com
Aboriginal and Torres Strait Islander peoples
13 YARN (13 92 76)
healthinfonet.ecu.edu.au
LGBTIQ+ community
1800 184 527
Qlife.org.au
Kids Helpline
1800 551 800
Kidshelpline.com.au
Head to Health
Headtohealth.gov.au
headspace
1800 650 890
headspace.org.au/
Open Arms
1800 011 046
openarms.gov.au
Culturally and linguistically diverse communities
embracementalhealth.org.au
Beyond Blue
1300 224 636
Beyondblue.org.au
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