Starting the Conversation – Compassion and Engaging Suicidal Consumers Bernie Stefan-Rasmus FACMHN BPSO Lead Mental Health Directorate Central Adelaide Local Health Network

Assessment and Care of Adults at Risk for Suicidal Ideation Best Practice Guideline recommendations Engaging in a therapeutic relationship with the patient/consumer Nurses use current treatments and approaches to assess and mitigate risk for suicidal patients/consumers Nurses seek support through clinical supervision or peer groups to acknowledging the emotional impact of working with suicidal patients/consumers

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General summary There were 3,027 deaths due to suicide in 2015 at an age- specific rate of 12.7 per 100,000. This equates to and average of 8.3 deaths by suicide in Australia each day. About 76% of those who died by suicide were male, a ratio of more than 3:1. There were 2,292 male deaths at a age- specific rate of 19.4 per 100,000. There were 735 female deaths at a age-specific rate of 6.2 per 100,000. Aboriginal and Torres Strait Islander peoples are approximately twice as likely to die by suicide than non- Indigenous people. In 2015, there were 152 Aboriginal and Torres strait Islander people who died by suicide, at a rate of 25.5 per 100,000. While age-specific suicide rates are lower than the most recent peak in 1997 (14.6 per 100,000) they have increased between 2013 (10.9 per 100,000), 2014 (12.2 per 100,000) and 2015 (12.7 per 100,000).

STANDARDISED DEATH RATES FOR SUICIDE, State/Territory of usual residence, 2006-2015

STANDARDISED DEATH RATES FOR SUICIDE, State/Territory -2015 Based on the age-standardised death rate from 2015 ABS 3303.0 – Causes of Death, Australia 15.0 per 100,000 21.0 per 100,000 13.4 per 100,000 15.7 per 100,000 10.6 per 100,000 11.6 per 100,000 10.8 per 100,000 16.3 per 100,000

Ages Specific Death Rates for Intentional Self Harm by Gender

Figure 1 – Number of suicide deaths by State and Territory Number of deaths In South Australia in 2015… 236 people died by suicide (174 male; 62 female), which was a slight decrease on the 240 recorded in 2014 The number of suicide deaths was fifth highest across Australia, following NSW (815), QLD (746), VIC (654) and WA 394 SA accounted for 7.8% of all deaths by suicide in Australia in 2015. Figure 1 – Number of suicide deaths by State and Territory

Age-standardised suicide rates South Australia 2015… Recorded the fifth highest age-standardised suicide rate (13.4 per 100,000) in Australia The suicide rate was lower than the average age- standardised rate for SA in 2014 (14.2 per 100,000) The rate was also slightly higher than the national age-standardised suicide rate (12.6 per 100,000). Figure 2: Age-standardised suicide rates in Australia (per 100,000)

Figure 3: Age-standardised suicide rate by place of usual residence South Australia 2015 Across all states and territories, the suicide rate was lower in capital cities compared to regions outside of the capital In 2015, the rate in Adelaide was similar to the rest of SA. Over the past 5 years…. The suicide rate has slightly increased Greater Adelaide and decreased in the rest of SA. Figure 3: Age-standardised suicide rate by place of usual residence

Aboriginal and Torres Strait Islander – South Australia 2015 Between 2011-2015 in South Australia… 43 (26 male, 17 female) Aboriginal and Torres Strait Islander people deaths have been attributed to intentional self-harm, which represents 5.3% of all causes of death For Indigenous Australians in South Australia, suicide is ranked 4th in the leading causes of death The suicide rate for Aboriginal and Torres Strait Islander people (25.4 per 100,000) in SA was considerably higher than the non-indigenous population (12.4 per 100,000).

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The philosophy underlying Connecting with People is that suicide is preventable with the appropriate tools, knowledge and confidence levels The Connecting with People approach aims to ensure that clinicians acquire the attitudes, knowledge, skills, competence and confidence required to deliver high quality health care to people at risk of suicide.

What makes Connecting with People different to other suicide prevention training? Connecting with People training is a paradigm shift that challenges the current practice of risk assessment. The Connecting with People philosophy places compassion, empathy and collaboration at the heart of every encounter with a person at risk of suicide. Every encounter is an opportunity to intervene to reduce their distress and, potentially, to save a life.

Close confidants Friends Suicide Awareness Suicide Response part 1 Health care Voluntary Sector Friends Close confidants Own resources Suicide Awareness Suicide Response part 1 Suicide Response part 2 How to Ask About Suicidal Thoughts Suicide Assessment Co-Authoring a Safety Plan Cultural change

Emotional Impact of Suicide on Nurses Emotional labour is the effort consumed by suppressing one’s own emotions to care for others effectively while also caring for oneself (Edward, Hercelinskyj & Giandinoto 2017)

Emotional Impact of Suicide on Nurses Experienced Mental Health nurses have an important role in recognizing suicidal cues reliving “psycache” and inspiring hope(Hagen, Knizek & Hjelmeland 2017) Mental Health Nurses need appropriate support to manage their own emotional responses(Linke, Wojciak & Day 2002) Clinical Supervision and Peer Support, appears to mitigate emotional response and traumatic impact on staff (Dransart et al. 2014)

Strategy Nurses will be trained by licenced Connecting with People Trainers The SAFETool is being embedded in CBIS electronic case note system for Mental Health Partnering with UniSA School of Nursing and Midwifery for training and Evaluation Creating a network of Practice Champions to support nurses in the workplace Encourage the uptake of Clinical Supervision

References Dransart, DA, Gutjahr, E, Gulfi, A, Didisheim, NK & Seguin, M 2014, 'Patient suicide in institutions: emotional responses and traumatic impact on Swiss mental health professionals', Death Stud, vol. 38, no. 1-5, Jan-Jun, pp. 315-321. Edward, K-l, Hercelinskyj, G & Giandinoto, J-A 2017, 'Emotional labour in mental health nursing: An integrative systematic review', International Journal of Mental Health Nursing, vol. 26, no. 3, pp. 215-225. Hagen, J., B.L. Knizek, and H. Hjelmeland, Mental Health Nurses' Experiences of Caring for Suicidal Patients in Psychiatric Wards: An Emotional Endeavor. Archives of Psychiatric Nursing, 2017. 31(1): p. 31-37. Harrison, J & Henley, G 2014, Suicide and hospitalised self-harm in Australia: trends and analysis, Canberra. Linke, S., J. Wojciak, and S. Day, The impact of suicide on community mental health teams. findings and recommendations, 2002. 26(2): p. 50-52.

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