Systems modelling and simulation to inform strategic decision making for suicide prevention in rural New South Wales (Australia)

2020 ◽  
Vol 54 (9) ◽  
pp. 892-901 ◽  
Author(s):  
Jo-An Atkinson ◽  
Adam Skinner ◽  
Sue Hackney ◽  
Linda Mason ◽  
Mark Heffernan ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Suicide Prevention ◽  
Suicidal Behaviour ◽  
New South ◽  
Decision Makers ◽  
Evidence Based ◽  
South Wales ◽  
Self Harm ◽  
Systems Modelling

Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government’s 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87−6.42%) and 5.45% (4.68−6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23−3.46%; suicide deaths: 4.38%, 95% interval 3.78−5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources.

scholarly journals Sustaining evidence-based practice for young people who self-harm: a 4-year follow-up

2004 ◽  
Vol 27 (2) ◽  
pp. 94 ◽  
Author(s):  
Stewart Einfeld ◽  
Margaret Tobin ◽  
John Beard ◽  
Elizabeth Evans ◽  
Richard Buss ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Health Service ◽  
New South ◽  
Evidence Based ◽  
Deliberate Self Harm ◽  
South Wales ◽  
Self Harm ◽  
Northern Rivers

Stewart Einfeld is at the School of Psychiatry, University of New South Wales; the late Margaret Tobin was the Director of Mental Health, South Australia; John Beard is Head of the Northern Rivers University Department of Rural Health, University of Sydney; Elizabeth Evans is a Research Assistant at the School of Psychiatry, University of New South Wales; Richard Buss is the Area Manager, Northern Rivers Area Mental Health Service; Michael Dudley is a child psychiatrist at Prince of Wales Hospital and the School of Psychiatry, University of New South Wales.This report is dedicated to our late co-author Margaret Tobin, to honour her contribution to advancing the quality of mental health services.Objective: In 1998 and 1999, two NSW Area Health Services conducted the Youth At Risk of Deliberate Self Harm (YARDS) project. The YARDS project was designed to implement evidence-based service enhancements for the clinical management of young people with Deliberate Self Harm. This paper examines the extent to which service enhancements implemented during YARDS were maintained 4 years after the conclusion of the project and compares service quality with another NSW Area Health Service that did not participate in the YARDS project.Method: Staff from mental health services and emergency departments completed the Service Activity Scale, a measure developed for the YARDS project to assess the quality of health service response to individuals who present following a suicide attempt.Results: Results indicated that the service improvements made during the YARDS project were maintained 4years after the project ended. Furthermore, a significant difference was found between scores for services that participated in YARDS and services that did not participate in YARDS.Conclusions: These results suggest that projects such as YARDS which support evidence based service nhancements may be useful in improving the management of young people with deliberate self-harm, and that these improvements may be long-lasting.

scholarly journals Self-harm and suicidal behaviour in Ghana: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053144
Author(s):  
Emmanuel Nii-Boye Quarshie ◽  
Kwaku Oppong Asante ◽  
Johnny Andoh-Arthur
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Global Health ◽  
Protective Factors ◽  
Suicide Prevention ◽  
Suicidal Behaviour ◽  
Observational Studies ◽  
Risk And Protective Factors ◽  
Prevalence Estimates ◽  
Self Harm

IntroductionSelf-harm and suicidal behaviour represent major global health problems, which account for significant proportions of the disease burden in low-income and middle-income countries, including Ghana. This review aims to synthesise the available and accessible evidence on prevalence estimates, correlates, risk and protective factors, the commonly reported methods and reasons for self-harm and suicidal behaviour in Ghana.Methods and analysisWe will conduct a systematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (2009) recommendations. Regional and global electronic databases (African Journals OnLine, African Index Medicus, APA PsycINFO, Global Health, MEDLINE and PubMed) will be searched systematically up to December 2021 for observational studies and qualitative studies that have reported prevalence estimates, correlates, risk and protective factors, methods and reasons for self-harm and suicidal behaviour in Ghana. The electronic database searches will be supplemented with reference harvesting and grey literature searching in Google Scholar and ProQuest Dissertations & Theses Global for postgraduate dissertations. Only records in English will be included. The Mixed Methods Appraisal Tool (2018) will be used to assess the methodological quality of included studies. Meta-analysis or narrative synthesis or both will be used, contingent on the extent of heterogeneity across eligible observational studies.Ethics and disseminationConsidering that this is a systematic review of accessible and available literature, we will not seek ethical approval. On completion, this review will be submitted to a peer-reviewed journal, be disseminated publicly at (mental) health conferences with focus on self-harm and suicide prevention. The important findings would also be shared with key national stakeholder groups in Ghana: Ghana Association for Suicide Prevention, Ghana Mental Health Authority, Ghana Psychological Association, Centre for Suicide and Violence Research, Accra and the Parliamentary Select Committee on Health.Prospero registration numberCRD42021234622.

Suicide Prevention in New South Wales Correctional Centres

Crisis ◽  
1997 ◽  
Vol 18 (4) ◽  
pp. 163-169 ◽  
Author(s):  
Simon Eyland ◽  
Simon Corben ◽  
Jenny Barton
Keyword(s):  
Suicide Prevention ◽  
Preventive Measures ◽  
New South ◽  
New South Wales ◽  
The Self ◽  
Prevention Measures ◽  
South Wales ◽  
Self Harm ◽  
Incarcerated Population

The New South Wales Department of Corrective Services has introduced a number of suicide prevention measures in order to deal with the problem of inmate suicides. This article describes the measures. The article also shows that the characteristics of the incarcerated population differ greatly from those in the community. Findings from the self-harm database 1991-1995 show that, nevertheless, there are some unique characteristics of the group of self-harmers and fatal self-harmers. These findings are discussed in relation to the preventive measures that are introduced in the NSW correctional centers.

scholarly journals Keeping COVID out: a collaborative approach to COVID-19 is associated with a significant reduction in self-harm in young people in custody

2021 ◽  
pp. 103985622110061
Author(s):  
John Kasinathan ◽  
Leigh Haysom ◽  
Helen Andriotis ◽  
Mike Wheaton ◽  
Trisha Lloyd ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
New South ◽  
Positive Interactions ◽  
Youth Justice ◽  
South Wales ◽  
Equivalent Time ◽  
Time Period ◽  
Fold Reduction ◽  
Self Harm

Objective: To describe the collaboration between Youth Justice New South Wales (YJNSW) and Justice Health and Forensic Mental Health Network (JHFMHN) during the early COVID-19 Response (CR) across the six Youth Justice centres in NSW, and the reduced incidence of self-harm noted over this period. Methods: Narrative article with analysis of self-harm incident data during the initial CR period of March to May 2020, compared to the same period in 2019. Results: During the initial CR period (March to May 2020), there was a highly significant, four-fold reduction in self-harming incidents recorded by both YJNSW and JHFMHN compared with the equivalent time period in 2019 ( p < .00001). Conclusion: The greater than four-fold reduction in self-harm by young people during the early CR may relate to the ‘interagency response’, with an increase in positive interactions between staff, and between staff and young people. The reduction in self-harm and improvements in mental health will be further explored through standardised interviews with the young people and staff.

An algorithm for managing adults who refuse medical treatment in New South Wales

2018 ◽  
Vol 26 (5) ◽  
pp. 464-468 ◽  
Author(s):  
Kylie Cheng ◽  
Anne Wand ◽  
Christopher Ryan ◽  
Sascha Callaghan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Medical Treatment ◽  
New South ◽  
New South Wales ◽  
Clinical Skill ◽  
Treatment Refusal ◽  
Academic Literature ◽  
South Wales ◽  
Decision Making Capacity

Objectives: The assessment and management of a patient who refuses medical treatment requires clinical skill, and consideration of the relevant law and the patient’s decision-making capacity. Psychiatrists are often asked to advise in these situations. We aimed to develop an algorithm describing the relevant legal pathways to assist clinicians, especially psychiatrists, working in New South Wales (NSW), Australia. Methods: We reviewed the academic literature on treatment refusal, relevant legislation, judicial rulings and NSW Health policy directives and guidelines. We consulted with clinicians and representatives of relevant tribunals. Results: We developed an algorithm for managing patients who refuse medical treatment in NSW. The algorithm emphases the evaluation of decision-making capacity and tracks separate pathways depending upon a person’s status under the Mental Health Act 2007 (NSW). Conclusions: The algorithm provides a clear decision tree for clinicians responding to a patient refusing medical treatment in NSW.

scholarly journals The Youth Aware of Mental Health program in Australian Secondary Schools: 3- and 6-month outcomes

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Lauren McGillivray ◽  
Fiona Shand ◽  
Alison L. Calear ◽  
Philip J. Batterham ◽  
Demee Rheinberger ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
Suicide Prevention ◽  
Help Seeking ◽  
New South ◽  
New South Wales ◽  
Trial Registration ◽  
Post Intervention ◽  
South Wales

Abstract Objective The evidence base for suicide prevention programs in Australian schools is limited. The aim of this study was to examine the impact of a universal, mental health promotion and suicide prevention program—Youth Aware of Mental Health (YAM)—on suicidal ideation, mental health, and help-seeking in Australian secondary school students from baseline to post-intervention and 6-month follow up. Methods Using a single-arm design, the YAM program was delivered to Year 9 students (13–16 years) in secondary schools located within four regions across New South Wales, Australia. A structured self-report questionnaire using validated scales was administered at each time point. Linear mixed-effects modelling was used to examine differences in suicidal ideation scores across time, while accounting for random effects of individual schools. Results Suicidal ideation reduced significantly from baseline to post, and from baseline to follow-up (p < 0.001). Depression severity declined (p < 0.001) and help-seeking intentions increased (p < 0.001) at post-intervention and 6- months following the intervention period. No suicide deaths were reported for any study participants. Conclusion The current findings provide preliminary evidence that the YAM program is a promising preventive intervention for Australian schools, particularly for reducing suicidal ideation, depression and increasing help-seeking intentions in young people. The implementation of YAM in a large number of schools across New South Wales demonstrates the feasibility, and acceptability by schools, of implementing this program at scale. Trial registration: ANZCTR, ACTRN12619000338167. Registered 5 March 2019—Retrospectively registered, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376989&isReview=true.

scholarly journals Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jo-An Occhipinti ◽  
Adam Skinner ◽  
Frank Iorfino ◽  
Kenny Lawson ◽  
Julie Sturgess ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Determinants ◽  
Suicide Attempts ◽  
Expert Knowledge ◽  
Population Level ◽  
Modelling And Simulation ◽  
Decision Makers ◽  
Public Health Issue ◽  
Coordinated Care ◽  
Systems Modelling

Abstract Background Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources. Methods Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period. Results A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3–30.8%) and suicide deaths by 29.3% (95% interval 27.1–31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that ‘more is not necessarily better.’ Conclusion Results indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources.

CAN BAYESIAN METHODS MAKE DATA AND ANALYSES MORE RELEVANT TO DECISION MAKERS?

2001 ◽  
Vol 17 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Steven H. Sheingold
Keyword(s):  
Decision Making ◽  
Bayesian Methods ◽  
Paradigm Shift ◽  
Relevant Information ◽  
Decision Makers ◽  
Evidence Based ◽  
Critical Importance ◽  
Bayesian Approaches ◽  
Bayesian Analyses ◽  
And Performance

Decision making in health care has become increasingly reliant on information technology, evidence-based processes, and performance measurement. It is therefore a time at which it is of critical importance to make data and analyses more relevant to decision makers. Those who support Bayesian approaches contend that their analyses provide more relevant information for decision making than do classical or “frequentist” methods, and that a paradigm shift to the former is long overdue. While formal Bayesian analyses may eventually play an important role in decision making, there are several obstacles to overcome if these methods are to gain acceptance in an environment dominated by frequentist approaches. Supporters of Bayesian statistics must find more accommodating approaches to making their case, especially in finding ways to make these methods more transparent and accessible. Moreover, they must better understand the decision-making environment they hope to influence. This paper discusses these issues and provides some suggestions for overcoming some of these barriers to greater acceptance.

The impact on clinical practice of the 2015 reforms to the New South Wales Mental Health Act

2016 ◽  
Vol 25 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Christopher James Ryan ◽  
Sascha Callaghan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Practice ◽  
Persons With Disabilities ◽  
Mental Health Act ◽  
Recovery Movement ◽  
South Wales ◽  
Management Plans ◽  
Decision Making Model ◽  
The Impact

Objectives: The Mental Health Act 2007 (NSW) ( MHA) was recently reformed in light of the recovery movement and the United Nations Convention on the Rights of Persons with Disabilities. We analyse the changes and describe the impact that these reforms should have upon clinical practice. Conclusions: The principles of care and treatment added to the MHA place a strong onus on clinicians to monitor patients’ decision-making capacity, institute a supported decision-making model and obtain consent to any treatment proposed. Patients competently refusing treatment should only be subject to involuntary treatment in extraordinary circumstances. Even when patients incompetently refuse treatment, clinicians must make every effort reasonably practicable to tailor management plans to take account of any views and preferences expressed by them or made known via friends, family or advance statements.

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