The Collaborative was established in 2015 and consists of representatives from over 40 organisations and lived experience advocates who are working together to reduce suicide rates in the region. The Safe Space program is a peer-led respite model that is being championed as a solution to the need for a non-clinical support option for people in psychological distress and at risk of suicide.
Suicidality is traditionally understood as a mental health crisis that requires a clinical response. Stressful and traumatic life events, poor living circumstances, the loss of a loved one, substance use and a lack of social support have all been identified as contributing to people experiencing distress. In some instances, this distress can result in people deciding to take their own life.
Research and the voice of people with lived experience of surviving a suicide attempt show that clinical treatments are not always the most effective in helping people in psychological distress to recover and can lead to more disruption and even trauma.
The Illawarra Shoalhaven region is impacted by suicide rates that are consistently higher than national and NSW averages. In 2016, there were 13.4 deaths per 100,000 people, compared to the NSW average of 10.3 deaths per 100,000 people. (Data source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health).
There are many organisations working to improve access to suicide prevention services in the area, but suicide rates remain high.
The Collaborative was established in 2015 as a way for organisations in the region, as well as lived experience advocates, to come together and work collaboratively to improve wellbeing outcomes for people and reduce suicidality in the community.
The Collaborative now meets monthly and includes over 40 organisations including Grand Pacific Health, University of Wollongong, Lifeline and NSW Department of Education.
The Safe Space initiative was born out of a fundamental element of the Collaborative – the voice of lived experience of suicide and recovery. The Collaborative identified a need for an alternate model to traditional clinical interventions, such as a non-clinical support option that is led and run by people who have their own lived experience of suicide and recovery and use that experience to support other people during times of distress (safe space model).
The initiative is based on a peer-run respite model that has been used effectively in Australia and internationally to support people during times of distress. This model is based on evidence that peer-to-peer relationships help to establish meaningful connections and can be a protective factor against suicidality.
The Safe Space model proposes a free and flexible service and will be largely determined by the person accessing the space. It would have the capacity for people to drop in for a cup of tea and a chat, participate in daily activities and groups, and potentially support overnight and short-term stays.
“It’s the sort of place where you might not feel great, but you can be around people… who have insight and understanding into how you’re feeling at that time and may be able to help you to reframe your thoughts and feelings and to help you come out the other side” - Bruce, Safe Space working group.
A peer-led working group meets regularly to design and develop a Safe Space in the Wollongong area. The group, which includes people with a lived experience of suicide and recovery, is in the process of securing funding.
“A few weeks ago…I had to run through the checklist of what my current risks and protective factors to suicide are and I actually realised that one of my proactive factors is my participation in the Collaborative. It really struck me that it’s not just that I get to be heard but that in itself has become one of my protective factors against suicide.” - Carrie, Safe Space working group.
Visit www.suicidepreventioncollaborative.org.au for more information.
Showcasing: Active8 Physical Health & Wellbeing Program
South Eastern NSW
NEAMI National Health and Wellbeing Team NSW, in partnership with other services including Flourish Australia and the Illawarra Aboriginal Medical Service.
Living Well domain
Providing the right type of care
Active8 is a physical health and wellbeing project that supports people in South Eastern New South Wales with lived experience of mental health issues, as well as physical health issues. The program offers a combination of one-to-one coaching for physical health delivered by a peer worker and a group program (Eat, Plant, Learn) promoting healthy and sustainable eating.
The program launched in March 2017 and is funded by Coordinare (the South Eastern NSW Primary Health Network). Nearly 160 people completed the program during 2017 and 2018 with a further 100 referrals received by the service.
People who have lived experience of mental health issues can have compromised physical health, including obesity and related chronic conditions. This can be for various reasons including smoking, alcohol and other drug use and medication side effects. It can also be challenging to maintain a healthy diet and exercise regime.
There is an increasing call on healthcare professionals to consider physical health needs when treating psychological wellbeing and vice versa.
However, there are limited programs available to the Illawarra-Shoalhaven community that are designed to help people make healthy choices while also improving mental health outcomes and literacy.
Active8 supports participants to identify and work on physical-health-related goals, as well as to improve their mental health literacy, engagement with health services and ability to manage their physical health needs.
NEAMI National developed the program in line with its existing recovery oriented practice framework. This ensured that the Active8 program is person centred, collaborative and designed to maximise opportunities for participants to build skills in self-management. Four mental health peer support workers help to run the project alongside people with lived experience of mental health issues who remain at the core of the program’s design, implementation, communication and evaluation.
The program is currently funded by Coordinare until end of June 2019.
The program has been successful because of the model of care used. The significant role that peer workers and people with lived experience of mental health issues have played in Active8’s formation, review and evolution has contributed to the success of this program.
An evaluation of the 2017-2018 program was done using several data collection methods including focus groups and questionnaires.
The findings revealed 123 people received coaching for physical health referrals – of which 81 engaged in sessions and of the 156 ‘eat plant learn’ referrals, 142 participated in three or more group sessions.
Participants report they now feel better equipped to make educated choices around food sourcing and selection, incorporating exercise as part of a daily routine and participating in local initiatives that prevent social isolation, enhance their personal wellbeing and allow them to feel they are making a positive contribution to the community in which they live.
“The peer health coach also looked at my diet with me – we looked at healthy foods I could buy cheaply. I had been running out of food before. My coach connected me with the local food pantry… I’m not running out of food now.”
“I work with individuals and see a lot of good news stories. Small change that I believe will ultimately have a huge impact on their lives.”
- Peer worker
The program has been created with the vision that it will eventually be available at all NEAMI sites across New South Wales and into other states. Once the program concludes, there is the hope that it will be incorporated as a core business within all community mental health services.
For more information, visit www.neaminational.org.au.
Showcasing: Next Steps Suicide Prevention Aftercare Service
South Eastern NSW
The Next Steps service operates in two regions of South Eastern NSW (SE NSW) led by Grand Pacific Health (GPH) in partnership with:
- Flourish Australia and South Coast Medical Service Aboriginal Corporation (Illawarra-Shoalhaven region)
- Katungal Aboriginal Corporation (South of Nowra region).
Living Well domain
Providing the right type of care
Next Steps offers a combination of clinical and peer-based support to assist people at risk of suicide after being discharged from hospital or after presentation to a hospital emergency department. Peer workers are people with a lived experience of mental health issues who offer one-on-one support and understanding.
Next Steps launched in July 2017 and to date has received around 260 referrals. The Illawarra Shoalhaven program is funded by the NSW Health Suicide Prevention Innovation Fund until July 2020 and the southern program is funded by Coordinare (the South Eastern NSW Primary Health Network) through to June 2019.
In NSW more than 850 people die from suicide each year and it is estimated that during that time another 25,000 will make a suicide attempt. Suicide has a huge impact on families, workplaces and communities.
Each day people present to emergency departments across NSW seeking help for issues related to emotional and psychological distress. The days and weeks after discharge from an emergency department or hospital stay are known to be a high-risk period for people experiencing suicidal thoughts. It is important to provide support in these early days to minimise the risk of suicide and reduce distress, however people are often discharged without access to follow-up support.
In 2018, the NSW Government released The Strategic Framework for Suicide Prevention in NSW 2018-2023, a collaboration between the Mental Health Commission of NSW and the NSW Ministry of Health. The Framework outlined one of three critical areas for immediate investment as effective follow-up care for people after a suicide attempt. Next Steps is part of the response to this need in South Eastern NSW.
People are referred to Next Steps who have presented to an emergency department with high risk of suicide and who do not require an inpatient admission. The program is designed to help people get the support they need in the community.
The support from Next Steps involves a collaborative planning meeting with the person and their identified support person after leaving an emergency department or hospital to set clear goals for their recovery aligned with the person’s individual values and needs. Contact is intensive over the first month and usually comprises three to four visits per week. Support can be provided to the person for up to an additional eight weeks, usually at less intensive intervals.
Support is provided primarily by a peer worker and a mental health clinician. The program gives participants the support they need to identify and work towards goals they have, while also looking at opportunities to connect with support services in the community.
While the Next Steps service is new, it is based on the emerging evidence for peer work in helping people with suicidality.
The program has shown positive outcomes with participants reporting reduced depression, anxiety and feelings of hopelessness. On exiting the Next Steps program, 100% of participants had met at least one of their short-term recovery goals and 66.7% met a long-term recovery goal.
Kristie had a history of mental health issues and recent personal circumstances caused her depression to worsen. She began to experience thoughts of suicide before making an attempt on her life in 2019.
She was referred to Next Steps in Bega. The team helped Kristie deal with her psychological distress by offering support from a clinician as well as a mental health peer worker.
Kristie reports feeling better than before: “I’m managing to get my mind focussed on what it’s meant to be focussed on and I’m getting out more.”
Feedback from carers indicated they have witnessed a noticeable improvement in the person’s attitude towards themselves and their future. Carers also receive support from the Next Steps team.
Showcasing: The Resolve Program
Nepean Blue Mountains
Flourish Australia, in partnership with Social Ventures Australia, Western New South Wales Local Health District, Nepean Blue Mountains Local Health District, NSW Health and the NSW Office of Social Impact Investment.
Living Well Domain
Right type of care
The Resolve program is Australia’s first social impact investment for mental health. The innovative and flexible program employs peer workers to support people with lived experience of mental health issues who have spent between 40 and 270 days in hospital in the previous year to live within the community. Peer workers use their own lived experience of mental health issues to encourage recovery, optimism and inspire hope.
Resolve began in October 2017 and expects to support approximately 530 people over a seven-year period across two sites. The three elements of the Resolve program include differing ways to support the people on the program:
- access to a 24-hour phoneline for one on one support
- psychosocial outreach services that include links to other support services
- care coordination and case management
- access to periodic residential care with 24/7 peer support at the Resolve Centres in Orange and Cranebrook.
Resolve is funded through a $7 million social benefit bond. Investor returns are based upon the NSW Government paying for an improved social outcome that results in public sector saving. The NSW Government also pays an upfront standing charge to cover some of the program operating costs.
In this case, the public savings are measured through reduced hospital use for the Resolve participants compared to a control group, by supporting their mental health and physical health in the community and reducing their need to go to hospital. The program is targeting a 25% reduction in hospital use.
For some people with lived experience of mental health issues their life is punctuated by frequent and repeated admissions to mental health units, this separates them from family, social networks and opportunities to participate and engage in the community. The factors contributing to a pattern of readmissions include a lack of the range of supports across the domains of their life to keep them mentally and physically well to stay in the community.
The challenge to provide options to keep people well and supported in the community to avoid hospital admissions, is one angle, the other is to ensure that mental health funding is spent most effectively to get the biggest health gain for the community. Reliance on hospital services requires a considerable financial investment from the NSW Government, absorbing funding that could be otherwise redirected to community-based mental health services or more effectively used across a range of mental health interventions.
Participants are referred to the Resolve program by Local Health District staff, who provide ongoing clinical support and governance in collaboration with peer workers.
As part of the Resolve approach, there are residential homes in Orange and Cranebrook, run by peer workers and designed to support participants to recover in the community, while acting as a central hub for group activities and services.
Peer workers are at the heart of the approach and success of this program. People with lived experience of mental health issues and caring have co-designed and implemented the Resolve program with clinical staff from the two Local Health Districts. The program is based on international evidence on crisis intervention, best practice residential programs and outreach programs.
The Resolve program is supporting people with lived experience of mental health issues to access the care they need in the community and avoid unnecessary hospital admissions. Feedback from clinicians and participants points to the positive impact the program is having.
The Flourish team has been collecting data every three months to evaluate the program. Of the 167 people who were referred, 165 have actively engaged in the program. Eight out of ten participants have participated actively for more than 80% of the time they have been enrolled.
Over the year prior to their enrolment, program participants spent an average of 84 days in hospital, 79 of them for mental health reasons. While the preliminary results should be treated with caution because they only cover a short period and a small group of participants, they estimate a 35% reduction in hospital admissions and a 20% decrease in emergency department visits compared to a control group (Resolve Social Benefit Bond annual investor report, available here).
Use of the Resolve centres for overnight stays has increased every quarter, while group activities aimed at developing participants’ life skills and enhancing their social connectedness have also been well attended.
“Being able to spend time at the house in Orange on two occasions has kept my wife out of hospital both times. Please continue this invaluable work.”
- Husband of participant
While formal evaluation results have yet to be released, it is hoped the program’s ongoing success will lead to it being replicated nationally.
For more information, visit https://www.flourishaustralia.org.au/.
Showcasing: Cognitive remediation therapy for young people with psychosis
Nepean Blue Mountains
Cognitive remediation therapy for young people with psychosis
Living Well Domain
Right type of care
Cognitive remediation therapy supports people to improve their cognitive functioning including attention, learning and memory through a series of games and mental activities. Psychosis is a broad term that describes psychological symptoms that affect an individual’s perception or understanding of reality.
Young people are drawn from headspace Early Psychosis and NBMLHD’s Early Psychosis Intervention (EPI) Program to participate in the jointly run cognitive remediation group. The project was implemented within existing funding of the two services and is part of a wider multi-site research study.
Planning commenced in late 2018, with the project delivered from March 2019. The first group of six participants are mid-way through the trial project.
Medical and psychological treatment can help some symptoms of psychosis, however neither the headspace Early Psychosis or EPI support programs specifically address cognitive functioning. The challenge was to address that gap.
A first occurrence of psychosis typically happens during late adolescence or early adulthood, at a time when young people are forming their identity and sometimes experiencing significant life changes. This can have a negative impact on physical health, mental health, wellbeing and cognitive functioning.
Psychosis in young people impacts their ability to learn as it affects memory, attention, concentration, processing speed, reasoning, and problem solving – all part of a person’s cognitive function which is important for succeeding in work, study and other goals.
The project was designed to use cognitive remediation therapy to assist young adults between the ages of 12-25 in the community who have lived experience of psychosis. The project supports young people to work towards their goals for work, study, social and independent living, so they can live well in the community.
The teams were trained to deliver both cognitive remediation therapy and social cognition and interaction training to improve social cognition, such as emotion recognition, by people who have experienced psychosis.
The Advantage Trial, led by Dr Anthony Harris, Western Sydney Local Health District, is a multi-site randomised controlled trial investigating impact for young people of adding social cognition and interaction training to cognitive remediation therapy. This trial enabled the two Nepean Blue Mountains organisations to receive training and support for implementation of a local project. Team leaders and managers of both organisations decided to pool resources and jointly deliver the trial project together.
To determine eligibility and individualise the program, young people referred by each organisation underwent a series of tests to determine their cognitive strengths and difficulties.
The program delivers cognitive remediation therapy twice weekly for one hour over 10 weeks, with each group requiring two facilitators and a maximum of six participants. The small number of participants allows facilitators to tailor their interventions to individuals.
iPads and games are used to support young people to develop their cognitive skills, such as attention, concentration, multi-tasking, memory, and processing speed, with all results recorded.
Although formal evaluation will be undertaken once the trial has ended, participant feedback has been positive.
Participants say they are now able to identify situations in which they may need to use strategies to compensate for their cognitive difficulties, such as using alarms on mobile phones as reminders if they experience memory difficulties.
They also report being able to apply strategies they learned to assist them in carrying out everyday tasks and say their confidence has improved as a result.
An average of four clients have attended each group session.
Program leads say given this early success they anticipate continuing to run the group after the research trial has ended.