Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Procedure
2.3. Ethical Approval
2.4. Data Analysis
3. Results
3.1. Feeling Safe and Valued
I felt really safe in there. I felt comfortable with the nurses—they always looked after me and made sure if I wanted something to eat or if I was comfortable or if I was too cold they would grab me a blanket. So, they were very respectful and just made sure I was okay at all times.(Female consumer: experience with hospital staff)
She was pretty respectful. Caring in a general sort of a way. I mean, it wasn’t overly gushy, pat on the back and look after you. It wasn’t touchy-feely, but there was a—there was a respect there which was quite good.(Male consumer: experience with community follow up)
Stigma and Shame
One of the nurses was a bit abrupt with me, so I think she was like ‘oh, another nutcase has come in’ you know? She wasn’t very warm and fuzzy.(Female consumer: experience upon waking in hospital)
That’s what you’re made to feel it is [a crime] and that’s one of the drawbacks… you’re just coming around, you’re coming to terms with you’re actually still alive, which is a shock, because you don’t want to be. You go from that transition to a stark cell; you’re being punished for a crime that you didn’t commit…That’s where prejudging, making such a quick, snap judgement about somebody is also wrong.(Male consumer: experience of mental health staff during observation)
3.2. Intersection of Consumer and Staff/Organisational Needs
I kind of put it down to—you know, they’ve got a job to do at the end of the day and they probably see this kind of stuff on multiple levels kind of thing. But at the same time, I kind of felt as if it was just kind of just like—oh another one of ‘these people’.(Male consumer: experience with hospital staff)
I was just a bit uncomfortable how many people came out each time to see me. I had four different appointments with four different paired workers came out each time and it was just uncomfortable because I had to introduce myself again and I was telling them pretty much what I’m going through.(Female consumer: experience with community follow up)
Taking Time and Reduced Self-Disclosure
He was sort of just like every other psychiatrist, trying to get through each patient as quickly as you can and move on to the next. There’s a lot of people that they’ve got to get through and unfortunately that’s just how it is sometimes, which I understand.(Female consumer: experience with inpatient mental health assessment)
They were definitely caring, the psychiatrists that came. They were definitely… if I had said I need help I know they would have given me help, but I just wanted them to go away at that stage.(Female consumer: experience with inpatient mental health assessment)
3.3. Importance of the ‘Whole Picture’
They assumed straightaway it was a spontaneous act. They didn’t ask about any of the lead-up or the triggers or anything else. At some point in the conversation, I explained that a lot of this is frustrations through my medical history, through the system with Centrelink that forces you into poverty.(Male consumer: experience with mental health assessment)
Maybe to just have people that would listen to you and actually ask you questions, ask you why you’re there and why this happened, not just how, and actually care I guess… I feel like I probably would have felt better faster, I probably would have got this big, heavy weight lifted off of me [had the consumer been able to share their story].(Male consumer: experience with hospital staff)
4. Discussion
Strengths, Limitations and Future Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. Preventing Suicide: A global Imperative; World Health Organization: Geneva, Switzerland, 2014; 79p. [Google Scholar]
- World Health Organization. Suicide Worldwide in 2019. Available online: https://www.who.int/publications/i/item/9789240026643 (accessed on 12 March 2020).
- Australian Bureau of Statistics. Causes of Death, Australia 2019. Available online: https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release (accessed on 20 May 2020).
- Canner, J.K.; Giuliano, K.; Selvarajah, S.; Hammond, E.R.; Schneider, E.B. Emergency department visits for attempted suicide and self harm in the USA: 2006–2013. Epidemiol. Psychiatr. Sci. 2018, 27, 94–102. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shand, F.L.; Batterham, P.J.; Chan, J.K.; Pirkis, J.; Spittal, M.J.; Woodward, A.; Christensen, H. Experience of health care services after a suicide attempt: Results from an online survey. Suicide Life-Threat. Behav. 2018, 48, 779–787. [Google Scholar] [CrossRef]
- Kõlves, K.; Crompton, D.; Turner, K.; Stapelberg, N.J.; Khan, A.; Robinson, G.; de Leo, D. Trends and repetition of non-fatal suicidal behaviour: Analyses of the Gold Coast University Hospital’s Emergency Department. Australas. Psychiatry 2018, 26, 170–175. [Google Scholar] [CrossRef]
- Stapelberg, N.J.; Sveticic, J.; Hughes, I.; Turner, K. Suicidal presentations to emergency departments in a large Australian public health service over 10 years. Int. J. Environ. Res. Public Health 2020, 17, 5920. [Google Scholar] [CrossRef] [PubMed]
- Brodsky, B.S.; Spruch-Feiner, A.; Stanley, B. The zero suicide model: Applying evidence- based suicide prevention practices to clinical care. Front. Psychiatry 2018, 9, 33. [Google Scholar] [CrossRef] [Green Version]
- Mokkenstorm, J.K.; Kerkhof, A.J.F.M.; Smit, J.H.; Beekman, A.T.F. Is it rational to pursue zero suicides among patients in health care? Suicide Life Threat. Behav. 2017, 48, 745–754. [Google Scholar] [CrossRef] [PubMed]
- Stapelberg, N.; Turner, K.; Mok, D.; Welch, M.; Walker, S.; Woerwag-Mehta, S.; Rouhani, L.; Gill, N.; Taiwa, L.; Krahe, M.; et al. Service Suicide Prevention Strategy 2016–2018. Journey to Zero through Leadership, Support and Continuous Improvement; Gold Coast Hospital and Health Service: Gold Coast, QLD, Australia, 2016; pp. 1–32. [Google Scholar]
- Turner, K.; Krishnaiah, R.; Sveticic, J.; Stapelberg, C. Zero Suicide in Mental Healthcare: The Gold Coast Experience. Aust. N. Z. J. Psychiatry 2019, 53, 53. [Google Scholar]
- Turner, K.; Sveticic, J.; Almeida-Crasto, A.; Gaee-Atefi, T.; Green, V.; Grice, D.; Kelly, P.; Krishnaiah, R.; Lindsay, L.; Mayahle, B.; et al. Implementing a systems approach to suicide prevention in a mental health service using the Zero Suicide Framework. Aust. N. Z. J. Psychiatry 2020, 55, 241–253. [Google Scholar] [CrossRef]
- Queensland Government. Gold Coast Health Journey to Zero. 2019. Available online: https://clinicalexcellence.qld.gov.au/improvement-exchange/gch-journey-zero (accessed on 15 March 2020).
- Turner, K.; Stapelberg, N.J.; Sveticic, J.; Dekker, S.W. Inconvenient truths in suicide prevention: Why a Restorative Just Culture should be implemented alongside a Zero Suicide Framework. Aust. N. Z. J. Psychiatry 2020, 54, 571–581. [Google Scholar] [CrossRef]
- Stapelberg, N.J.; Sveticic, J.; Hughes, I.; Almeida-Crasto, A.; Gaee-Atefi, T.; Gill, N.; Grice, D.; Krishnaiah, R.; Lindsay, L.; Patist, C.; et al. Efficacy of the Zero Suicide framework in reducing recurrent suicide attempts: Cross-sectional and time-to-recurrent-event analyses. Br. J. Psychiatry 2020, 219, 427–436. [Google Scholar] [CrossRef]
- Baker, S.T.; Nicholas, J.; Shand, F.; Green, R.; Christensen, H. A comparison of multi-component systems approaches to suicide prevention. Australas. Psychiatry 2018, 26, 128–131. [Google Scholar] [CrossRef]
- Hogan, M.F.; Grumet, J.G. Suicide prevention: An emerging priority for health care. Health Aff. 2016, 35, 1084–1090. [Google Scholar] [CrossRef]
- Collins, A. Measuring What Really Matters. Towards a Coherent Measurement System to Support Person Centred Care; The Health Foundation: London, UK, 2014; pp. 1–20. [Google Scholar]
- Comans, T.A.; Clark, M.J.; Cartmill, L.; Ash, S.; Sheppard, L.A. How do allied health professionals evaluate new models of care? What are we measuring and why? J. Healthc. Qual. 2011, 33, 19–28. [Google Scholar] [CrossRef]
- Creswell, J.W. Qualitative Inquiry and Research Design: Choosing among Five Approaches, 3rd ed.; Sage: Thousand Oaks, CA, USA, 2013; pp. 145–178. [Google Scholar]
- Bradbury-Jones, C.; Breckenridge, J.; Clark, M.T.; Herber, O.R.; Wagstaff, C.; Taylor, J. The state of qualitative research in health and social science literature: A focused mapping review and synthesis. Int. J. Soc. Res. Methodol. 2017, 20, 627–645. [Google Scholar] [CrossRef] [Green Version]
- Braun, V.; Clark, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef] [Green Version]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hom, M.A.; Albury, E.A.; Gomez, M.M.; Christensen, K.; Stanley, I.H.; Stage, D.R.L.; Joiner, T.E. Suicide Attempt Survivors’ Experiences With Mental Health Care Services: A Mixed Methods Study. Prof. Psychol. Res. Pract. 2019, 51, 172. [Google Scholar] [CrossRef]
- Hill, N.; Halliday, L.; Reavley, N.J. Guidelines for Integrated Suicide-Related Crisis and Follow-up Care in Emergency Departments and Other Acute Settings; Black Dog Institute: Sydney, NSW, Australia, 2017; pp. 5–19. [Google Scholar]
- Hill, N.T.; Shand, F.; Torok, M.; Halliday, L.; Reavley, N.J. Development of best practice guidelines for suicide-related crisis response and aftercare in the emergency department or other acute settings: A Delphi expert consensus study. BMC Psychiatry 2019, 19, 6. [Google Scholar] [CrossRef] [Green Version]
- Economu, M.; Madianos, M.; Peppou, L.E.; Theleritis, C.; Patelakis, A.; Stefanis, C. Suicidal ideation and reported suicide attempts in Greece during the economic crisis. World Psychiatry 2013, 12, 53–59. [Google Scholar] [CrossRef] [Green Version]
- Corrigan, P.W.; Bink, A.B.; Schmidt, A.; Jones, N.; Rüsch, N. What is the impact of self- stigma? Loss of self-respect and the “why try” effect. J. Ment. Health 2016, 25, 10–15. [Google Scholar] [CrossRef]
- Rimkeviciene, J.; Hawgood, J.; O’Gorman, J.; de Leo, D. Personal stigma in suicide attempters. Death Stud. 2015, 39, 592–599. [Google Scholar] [CrossRef] [PubMed]
- Shahar, G.; Rogers, M.L.; Shalev, H.; Joiner, T.E. Self-criticism, interpersonal conditions, and biosystemic inflammation in suicidal thoughts and behaviors within mood disorders: A bio-cognitive-interpersonal hypothesis. J. Personal. 2020, 88, 133–145. [Google Scholar] [CrossRef] [PubMed]
- Oexle, N.; Herrmann, K.; Staiger, T.; Sheehan, L.; Rüsch, N.; Krumm, S. Stigma and suicidality among suicide attempt survivors: A qualitative study. Death Stud. 2019, 43, 381–388. [Google Scholar] [CrossRef] [PubMed]
- Stang, A.L.; Earnshaw, V.A.; Logie, C.H.; van Brakel, W.; Simbayi, L.C.; Barré, I.; Dovidio, J.F. The health stigma and discrimination framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019, 17, 31. [Google Scholar]
- Thornicroft, G.; Brohan, E.; Rose, D.; Sartorius, N.; Leese, M. Global pattern of experienced and anticipated discrimination against people with schizophrenia: A cross-sectional survey. Lancet 2009, 373, 408–415. [Google Scholar] [CrossRef]
- McGill, K.; Hackney, S.; Skehan, J. Information needs of people after a suicide attempt: A thematic analysis. Patient Educ. Couns. 2019, 102, 1119–1124. [Google Scholar] [CrossRef] [PubMed]
- Sullivan, C.; Staib, A.; Khanna, S.; Good, N.M.; Boyle, J.; Cattell, R.; Heiniger, L.; Griffin, B.R.; Bell, A., Jr.; Lind, J.; et al. The National Emergency Access Target (NEAT) and the 4-hour rule: Time to review the target. Med. J. Aust. 2016, 204, 354. [Google Scholar] [CrossRef]
- MacDonald, S.; Sampson, C.; Turley, R.; Biddle, L.; Ring, N.; Begley, R.; Evans, R. Patients’ Experiences of Emergency Hospital Care Following Self-Harm: Systematic Review and Thematic Synthesis of Qualitative Research. Qual. Health Res. 2020, 30, 471–485. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fountoulakis, K.N.; Kawohl, W.; Theodorakis, P.N.; Kerkhof, A.J.F.M.; Navickas, A.; Höschl, C.; Lecic-Tosevski, D.; Sorel, E.; Rancans, E.; Palova, E. Relationship of suicide rates to economic variables in Europe: 2000–2011. Br. J. Psychiatry 2014, 205, 486–496. [Google Scholar] [CrossRef] [Green Version]
- Nordt, C.; Warnke, I.; Seifritz, E.; Kawohl, W. Modelling suicide and unemployment: A longitudinal analysis covering 63 countries, 2000–2011. Lancet Psychiatry 2015, 2, 239–245. [Google Scholar] [CrossRef]
- O’Connor, R.C.; Lundy, J.M.; Stewart, C.; Smillie, S.; McClelland, H.; Syrett, S.; Gavigan, M.; McConnachie, A.; Smith, M.; Smith, D.J.; et al. SAFETEL randomised controlled feasibility trial of a safety planning intervention with follow-up telephone contact to reduce suicidal behaviour: Study protocol. BMJ Open 2019, 9, e025591. [Google Scholar] [CrossRef] [PubMed]
- Ferguson, M.; Rhodes, K.; Loughhead, M.; McIntyre, H.; Procter, N. The effectiveness of the safety planning intervention for adults experiencing suicide-related distress: A systematic review. Arch. Suicide Res. 2021, 1–24. [Google Scholar] [CrossRef] [PubMed]
- Nuij, C.; van Ballegooijen, W.; de Beurs, D.; Juniar, D.; Erlangsen, A.; Portzky, G.; O’Connor, R.C.; Smit, J.H.; Kerkhof, A.; Riper, H. Safety planning-type interventions for suicide prevention: Meta-analysis. Br. J. Psychiatry 2021, 219, 1–8. [Google Scholar] [CrossRef]
- Stanley, B.; Brown, G.K.; Brenner, L.A.; Galfalvy, H.C.; Currier, G.W.; Knox, K.L.; Chaudhury, S.R.; Bush, A.L.; Green, K.L. Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry 2018, 75, 894–900. [Google Scholar] [CrossRef]
- Choo, C.C.; Ho, R.C.; Burton, A.A.D. Thematic Analysis of medical notes offers preliminary insight into precipitants for Asian suicide attempters: An exploratory study. Int. J. Environ. Res. Public Health 2018, 15, 809. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bantjes, J. ‘Don’t push me aside, Doctor’: Suicide attempters talk about their support needs, service delivery and suicide prevention in South Africa. Health Psychol. Open 2017, 4, 1–9. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hom, M.A.; Bauer, B.W.; Stanley, I.H.; Boffa, J.W.; Desse’Rae, L.S.; Capron, D.W.; Schmidt, N.B.; Joiner, T.E. Suicide Attempt Survivors’ Recommendations for Improving Mental Health Treatment for Attempt Survivors. Psychol. Serv. 2020, 18, 365–376. [Google Scholar] [CrossRef] [PubMed]
- Gold Coast Hospital and Health Service. Gold Coast Crisis Reform 2021–2024: Responsive, Effective, Compassionate and Connected Care; Gold Coast Hospital and Health Service: Gold Coast, QLD, Australia, 2020; pp. 11–37. [Google Scholar]
- Looi, J.C.; Maguire, P. Surviving the Heart of Darkness: Reflections on the experience of psychiatrists working in public mental health services in Australia. Australas. Psychiatry 2019, 27, 634–636. [Google Scholar] [CrossRef]
- Carise, D.; Love, M.; Zur, J.; McLellan, A.T.; Kemp, J. Results of a statewide evaluation of “paperwork burden” in addiction treatment. J. Subst. Abus. Treat. 2009, 37, 101–109. [Google Scholar] [CrossRef] [Green Version]
- Pirkis, J.; John, A.; Shin, S.; Del Pozo-Banos, M.; Arya, V.; Analuisa-Aguilar, P.; Appleby, L.; Arensman, E.; Bantjes, J.; Baran, A.; et al. Suicide trends in the early months of the COVID-19 pandemic: An interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry 2021, 8, 579–588. [Google Scholar] [CrossRef]
- McIntyre, R.S.; Lui, L.M.W.; Rosenblat, J.D.; Ho, R.; Gill, H.; Mansur, R.B.; Teopiz, K.; Liao, Y.; Lu, C.; Subramaniapillai, M.; et al. Suicide reduction in Canada during the COVID-19 pandemic: Lessons informing national prevention strategies for suicide reduction. J. R. Soc. Med. 2021, 1–7. [Google Scholar] [CrossRef]
- Kapur, N.; Clements, C.; Appleby, L.; Hawton, K.; Steeg, S.; Waters, K.; Webb, R. Effects of the COVID-19 pandemic on self-harm. Lancet Psychiatry 2021, 8, e4. [Google Scholar] [CrossRef]
- Tanaka, T.; Okamoto, S. Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nat. Hum. Behav. 2021, 5, 229–238. [Google Scholar] [CrossRef] [PubMed]
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Ross, V.; Mathieu, S.; Hawgood, J.; Turner, K.; Stapelberg, N.J.C.; Welch, M.; Davies, A.; Sveticic, J.; Walker, S.; Kõlves, K. Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study. Int. J. Environ. Res. Public Health 2021, 18, 10634. https://doi.org/10.3390/ijerph182010634
Ross V, Mathieu S, Hawgood J, Turner K, Stapelberg NJC, Welch M, Davies A, Sveticic J, Walker S, Kõlves K. Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study. International Journal of Environmental Research and Public Health. 2021; 18(20):10634. https://doi.org/10.3390/ijerph182010634
Chicago/Turabian StyleRoss, Victoria, Sharna Mathieu, Jacinta Hawgood, Kathryn Turner, Nicolas J. C. Stapelberg, Matthew Welch, Angela Davies, Jerneja Sveticic, Sarah Walker, and Kairi Kõlves. 2021. "Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study" International Journal of Environmental Research and Public Health 18, no. 20: 10634. https://doi.org/10.3390/ijerph182010634