Suicidal Presentations to Emergency Departments in a Large Australian Public Health Service over 10 Years

Almeida-Crasto

et al. 2020

Aust N Z J Psychiatry

Self Cite

Objective: The Zero Suicide Framework, a systems approach to suicide prevention within a health service, is being implemented across a number of states in Australia, and internationally, although there is limited published evidence for its effectiveness. This paper aims to provide a description of the implementation process within a large health service in Australia and describes some of the outcomes to date and learnings from this process. Method: Gold Coast Mental Health and Specialist Services has undertaken an implementation of the Zero Suicide Framework commencing in late 2015, aiming for high fidelity to the seven key elements. This paper describes the practical steps undertaken by the service, the new practices embedded, emphasis on supporting staff following the principles of restorative just culture and the development of an evaluation framework to support a continuous quality improvement approach. Results: Improvements have been demonstrated in terms of processes implementation, enhanced staff skills and confidence, positive cultural change and innovations in areas such as the use of machine learning for identification of suicide presentations. A change to ‘business as usual’ has benefited thousands of consumers since the implementation of a Suicide Prevention Pathway in late 2016 and achieved reductions in rates of repeated suicide attempts and deaths by suicide in Gold Coast Mental Health and Specialist Services consumers. Conclusion: An all-of-service, systems approach to suicide prevention with a strong focus on cultural shifts and aspirational goals can be successfully implemented within a mental health service with only modest additional resources when supported by engaged leadership across the organisation. A continuous quality improvement approach is vital in the relentless pursuit of zero suicides in healthcare.

Section: Improvementioning

confidence: 99%

Implementing a systems approach to suicide prevention in a mental health service using the Zero Suicide Framework

Almeida-Crasto

et al. 2020

Aust N Z J Psychiatry

Self Cite

“…Cases were identified from ED administrative data through relevant diagnoses, presenting problems and keywords, followed by a manual investigation of triage narratives to exclude false positive cases, such as non‐deliberate injuries or poisonings. The numbers of ED visits between January and August 2020 were compared with the projected numbers, calculated by applying an annual increase of 13.5% 4 to presentations during the same period in 2019.…”

mentioning

confidence: 99%

Reduced suicidal presentations to emergency departments during the COVID‐19 outbreak in Queensland, Australia

Stapelberg

Medical Journal of Australia

2021

Self Cite

To the Editor: The coronavirus disease 2019 (COVID-19) pandemic has raised concerns of a subsequent increase in suicides, 1 but limited empirical data are available on this topic. 2,3 We analysed numbers of suicidal presentations (including suicidal ideation, non-suicidal self-injury and suicide attempts) to emergency departments (EDs) within the Gold Coast Hospital and Health Service before and since the spread of COVID-19 in Queensland, Australia. Cases were identified from ED administrative data through relevant diagnoses, presenting problems and keywords, followed by a manual investigation of triage narratives to exclude false positive cases, such as non-deliberate injuries or poisonings. The numbers of ED visits between January and August 2020 were compared with the projected numbers, calculated by applying an annual increase of 13.5% 4 to presentations during the same period in 2019.

“…approximately 600,000. 10 Two EDs with a total of around 180,000 annual presentations 11 were included in this study.…”

Section: Psychiatrymentioning

confidence: 99%

Suicide prevention during COVID-19: identification of groups with reduced presentations to emergency departments

Stapelberg

2021

Australas Psychiatry

Self Cite

Objective: Reductions in suicidal and self-harm presentations to emergency departments (EDs) since COVID-19 indicate changes in help-seeking behaviours, but it is unknown if hospital avoidance equally affects all population groups. Method: Socio-demographic and clinical information relating to suicidal and self-harm presentations to EDs in Queensland, Australia, were compared for the period before (March–August 2019) and since the COVID-19 outbreak (March–August 2020). Results: Since COVID, Indigenous Australians and persons with less severe suicidal and self-harm presentations had significantly reduced presentations, while persons younger than 18 years had more presentations. Less suicidal presentations resulted in an admission to inpatient care. Conclusions: Patterns of reduced attendance to ED in some groups suggest the need for innovative and community-based models of care to help prevent suicides during the pandemic.