Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations

Objective: Successive suicide prevention frameworks and action plans in Australia and internationally have called for improvements to mental health services and enhancement of workforce capacity. However, there is debate regarding the priorities for resource allocation and the optimal combination of mental health services to best prevent suicidal behaviour. This study investigates the potential impacts of service capacity improvements on the incidence of suicidal behaviour in the Australian context. Methods: A system dynamics model was developed to investigate the optimal combination of (1) secondary (acute) mental health service capacity, (2) non-secondary (non-acute) mental health service capacity and (3) resources to re-engage those lost to services on the incidence of suicidal behaviour over the period 2018–2028 for the Greater Western Sydney (Australia) population catchment. The model captured population and behavioural dynamics and mental health service referral pathways and was validated using population survey and administrative data, evidence syntheses and an expert stakeholder group. Results: Findings suggest that 28% of attempted suicide and 29% of suicides could be averted over the forecast period based on a combination of increases in (1) hospital staffing (with training in trauma-informed care), (2) non-secondary health service capacity, (3) expansion of mental health assessment capacity and (4) re-engagement of at least 45% of individuals lost to services. Reduction in the number of available psychiatric beds by 15% had no substantial impact on the incidence of attempted suicide and suicide over the forecast period. Conclusion: This study suggests that more than one-quarter of suicides and attempted suicides in the Greater Western Sydney population catchment could potentially be averted with a combination of increases to hospital staffing and non-secondary (non-acute) mental health care. Reductions in tertiary care services (e.g. psychiatric hospital beds) in combination with these increases would not adversely affect subsequent incidence of suicidal behaviour.

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Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning

Psychological Medicine ◽

10.1017/s0033291713002122 ◽

2013 ◽

Vol 44 (8) ◽

pp. 1615-1624 ◽

Cited By ~ 73

Author(s):

I. Kelleher ◽

N. Devlin ◽

J. T. W. Wigman ◽

A. Kehoe ◽

A. Murtagh ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Suicidal Behaviour ◽

Health Clinic ◽

Psychotic Experiences ◽

Global Functioning ◽

Community Based Research ◽

Wide Range

BackgroundRecent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour.MethodThe investigation was a clinical case–clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services.ResultsPsychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59–49.83], anxiety disorder (OR 15.4, 95% CI 1.85–127.94) or behavioural disorder (OR 3.13, 95% CI 1.11–8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences.ConclusionsPsychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.

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Mental Health Services Use Intentions Among Canadian Military Recruits

Military Psychology ◽

10.1037/mil0000112 ◽

2016 ◽

Vol 28 (6) ◽

pp. 498-505 ◽

Cited By ~ 1

Author(s):

Jennifer E. C. Lee ◽

Deniz Fikretoglu ◽

Ann-Renée Blais ◽

Kerry A. Sudom ◽

Erin Beatty

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Health Services Use ◽

Military Recruits ◽

Mental Health Services Use ◽

Canadian Military ◽

Services Use

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Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland

Psychological Medicine ◽

10.1017/s0033291701004482 ◽

2001 ◽

Vol 31 (7) ◽

pp. 1181-1191 ◽

Cited By ~ 140

Author(s):

WEN-HUNG KUO ◽

J. J. GALLO ◽

A. Y. TIEN

Keyword(s):

Mental Health ◽

Suicidal Ideation ◽

Mental Health Services ◽

Health Services ◽

Psychiatric Disorders ◽

Suicidal Behaviour ◽

Suicide Attempts ◽

Community Sample ◽

Suicide Behaviour

Background. Utilizing a prospectively designed community sample, we set out to estimate the rate of newly-incident suicidal ideation and attempts (non-fatal suicide behaviour) in a community sample, to evaluate antecedent sociodemographic characteristics and psychiatric disorders, and to assess use of mental health services in relation to non-fatal suicide behaviour.Method. Prospectively-gathered data was utilized from 3481 continuing participants in the 13-year follow-up of the Baltimore sample of the NIMH Epidemiologic Catchment Area survey interviewed in 1981, 1982 and 1993/6.Results. The incidence of suicide attempts was estimated at 148·8 per 100000 person-years and ideation at 419·9 per 100000 person-years. Persons in the youngest age group, in the lowest socio-economic status, and previously married persons were at increased risk for non-fatal suicide behaviour during the follow-up interval. Persons who reported suicidal ideation at baseline were more likely to report having attempted suicide at follow-up (RR = 6·09, 95% CI 2·58–14·36). Psychiatric disorders, especially depression and substance abuse, were associated with new-onset of non-fatal suicidal behaviour. While persons who reported newly-incident suicidal behaviour were more likely to report use of mental health services, few said that suicidal ideation or attempts were the reason for the visits.Conclusions. Suicidal ideation is a common and important antecedent to suicide attempts and deserves more attention in community and general medical settings.

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Can we expect an increased suicide rate due to Covid-19?

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.46 ◽

2020 ◽

Vol 37 (4) ◽

pp. 264-268 ◽

Cited By ~ 9

Author(s):

Patrick Devitt

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Suicide Rate ◽

Suicidal Behaviour ◽

Economic Recession ◽

Vulnerable Groups ◽

Historical Paper ◽

Economic Recessions ◽

Insight Into

Human disasters come in all shapes and sizes including wars, terrorist violence, natural events, economic recessions and depressions as well as infection. As a species more fragile than we often allow, humans would be expected to adversely react to these types of disasters in terms of mental ill health and possibly suicidal behaviour leading to increased demands on the Mental Health services. This narrative historical paper examines relevant studies into how previous disasters affected mental health and suicidal behaviour. The characteristics of what is known of the current Covid-19 disease are analysed and compared to other types of disasters with a view to gaining some insight into what we might expect. Of all the types of disasters, economic recession appears most toxic. Mitigating the worst effects of recession appears to be protective. Particularly vulnerable groups are identified in whom we might expect an increase in suicidal behaviour.

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Qualitative investigation of relatives’ and service users’ experience of mental healthcare for suicidal behaviour in bipolar disorder

BMJ Open ◽

10.1136/bmjopen-2019-030335 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030335

Author(s):

Caroline Clements ◽

Navneet Kapur ◽

Steven H Jones ◽

Richard Morriss ◽

Sarah Peters

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

Mental Health Services ◽

Health Services ◽

Suicidal Behaviour ◽

Mental Healthcare ◽

Service Users ◽

Open Communication ◽

Increased Risk ◽

Health Services Need

ObjectivePeople with bipolar disorder are known to be at high risk of engaging in suicidal behaviours, and those who die by suicide have often been in recent contact with mental health services. The objective of this study was to explore suicidal behaviour in bipolar disorder and how this is monitored and managed by mental health services.AimsTo identify themes within relatives’ and service users’ accounts of mental healthcare, related to management and prevention of suicidal behaviour in bipolar disorder.DesignThematic analysis of 22 semistructured interviews.ParticipantsParticipants were aged 18 years or over, fluent in written and spoken English, and either had bipolar disorder with a history of suicidal behaviour, or were relatives of people with bipolar disorder who had died by suicide.SettingEngland, UK.Primary outcomeThemes identified from participants’ accounts of mental healthcare for suicidal behaviours in bipolar disorder.ResultsTwo main themes were identified. ‘Access to care’ was characterised by a series or cycle of potential barriers to care (eg, gate-keepers, lack of an accurate diagnosis) which had the potential to increase risk of suicidal behaviour if failure to access care continued over time. ‘Problems with communication’ captured the importance of maintaining open routes of communication between all parties involved in care to ensure successful monitoring and management of suicidal behaviours in bipolar disorder.ConclusionsMental health services need to be accessible and respond rapidly to people with suicidal behaviour in bipolar disorder. Open communication and inclusion of relatives in care, where appropriate, could help closer monitoring of changes in symptoms that indicate increased risk.

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An examination of suicidal behaviour among veterans receiving mental-health appointments in person versus clinical video telehealth

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20942041 ◽

2020 ◽

pp. 1357633X2094204

Author(s):

Sasha M Rojas ◽

Marilyn L Piccirillo ◽

Russell A McCann ◽

Mark A Reger ◽

Bradford Felker

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Suicidal Behaviour ◽

Treatment Modality ◽

Improvement Project ◽

National Leader ◽

Suicide Behaviour ◽

Va Health Care System ◽

Observation Period

Introduction The US Department of Veterans Affairs (VA) is a national leader in the implementation of clinical video telehealth (CVT) services. Despite the growth of mental-health services offered via CVT, it is unclear to what extent these services are offered and accessed by veterans with previous suicidal behaviour. Methods The current quality improvement project examined this question within a local VA health-care system using data from suicide behaviour reports (SBRs), the Veteran Health Administration’s official reporting and surveillance system. The frequency of SBRs was compared during two different time points among veterans who received individual mental-health appointments in person only or via CVT during the 2017 calendar year. Among veterans with a SBR, time in days elapsed from their first mental-health appointment to a SBR was examined as a function of treatment modality. Results Results indicated veterans who received in-person treatment only were more likely to present with a SBR six months prior to their first mental-health appointment compared to those who received CVT during the observation period. There were no differences in SBRs during the 12 months after the first appointment or the time from the first appointment to the SBR as a function of treatment modality used. Discussion Although veterans who received in-person mental-health services were more likely to have had a SBR six months prior to treatment, suicide risk throughout the observation period did not differ between groups. Clinical implications that arise from these findings are described in the discussion.

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Do Investments in Mental Health Systems Result in Greater Use of Mental Health Services? National Trends in Mental Health Service Use (MHSU) in the Canadian Military and Comparable Canadian Civilians, 2002-2013

The Canadian Journal of Psychiatry ◽

10.1177/0706743718760291 ◽

2018 ◽

Vol 63 (9) ◽

pp. 602-609 ◽

Cited By ~ 1

Author(s):

Deniz Fikretoglu ◽

Aihua Liu ◽

Mark Allen Zamorski ◽

Corneliu Rusu ◽

Rakesh Jetly

Keyword(s):

Public Health ◽

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Health Systems ◽

Mental Health Service Use ◽

Absolute Increase ◽

Canadian Military ◽

The Military ◽

Over Time

Background: Mental disorders constitute a significant public health problem worldwide. Ensuring that those who need mental health services access them in an appropriate and timely manner is thus an important public health priority. We used data from 4 cross-sectional, nationally representative population health surveys that employed nearly identical methods to compare MHSU trends in the Canadian military versus comparable civilians. Method: The surveys were all conducted by Statistics Canada, approximately a decade apart (Military-2002, Military-2013, Civilian-2002, and Civilian-2012). The sample size for the pooled data across the surveys was 35,984. Comparisons across the 4 surveys were adjusted for differences in need in the 2 populations at the 2 time points. Results: Our findings suggested that first, in the Canadian military, there was a clear and consistent pattern of improvement (i.e., increase) in MHSU over the past decade across a variety of provider types. The magnitudes of the changes were large, representing an absolute increase of 7.15% in those seeking any professional care, corresponding to an 84% relative increase. Second, in comparable Canadian civilians, MHSU remained either unchanged or increased only slightly. Third, the increases in MHSU over time were consistently greater in the military than in the comparable civilian sample. Conclusions: Our findings point to advantages with respect to MHSU of the military mental health system over the civilian system in Canada; these advantages have widened substantially over time. These findings speak strongly to the potential impact of analogous changes in other health systems, both military and civilian.

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