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Roth B, Chen JI, Nagarkatti-Gude DR, Pfeiffer PN, Newgard CD, Hynes DM, Boudreaux ED. Adapting the Zero Suicide framework to the adult emergency department setting: Strategies for nurse leaders. Arch Psychiatr Nurs 2024; 51:76-81. [PMID: 39034098 PMCID: PMC11261162 DOI: 10.1016/j.apnu.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/01/2024] [Accepted: 05/18/2024] [Indexed: 07/23/2024]
Abstract
The ED has been increasingly recognized as a key setting for suicide prevention. Zero Suicide (ZS) is an aspirational goal to eliminate suicide for all patients within a health care system through utilization of best practices. However, there has been limited exploration of ZS implementation within the ED. As ED nurses play an important role in suicide prevention through their close contact with patients at risk for suicide, ZS implementation would benefit from tailored strategies for ED nurse leadership. We describe the ZS framework and provides strategies for nurse leaders to adapt each ZS component in the adult ED.
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Affiliation(s)
- Brandon Roth
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW US Veterans Hospital Road, Portland, OR 97239, United States of America; Portland VA Research Foundation, 3710 SW US Veterans Hospital Road, Portland, OR 97239, United States of America; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW US Veterans Hospital Road, Portland, OR 97239, United States of America; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - David R Nagarkatti-Gude
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Paul N Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, 1135 Catherine Street, Ann Arbor, MI 48109, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Health Care System, U.S. Department of Veterans Affairs (VA), 2215 Fuller Road, Ann Arbor, MI 48105, United States of America
| | - Craig D Newgard
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW US Veterans Hospital Road, Portland, OR 97239, United States of America; Health Management and Policy, School of Social and Behavioral Health Sciences, College of Health; Health Data and Informatics Program, Center for Quantitative Life Sciences, Oregon State University, 2750 SW Campus Way, Corvallis, OR 97331, United States of America; School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States of America
| | - Edwin D Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, United States of America
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Hibbert PD, Raggett L, Molloy CJ, Westbrook J, Magrabi F, Mumford V, Clay-Williams R, Lingam R, Salmon PM, Middleton S, Roberts M, Bradd P, Bowden S, Ryan K, Zacka M, Sketcher-Baker K, Phillips A, Birks L, Arya DK, Trevorrow C, Handa S, Swaminathan G, Carson-Stevens A, Wiig S, de Wet C, Austin EE, Nic Giolla Easpaig B, Wang Y, Arnolda G, Peterson GM, Braithwaite J. Improving health system responses when patients are harmed: a protocol for a multistage mixed-methods study. BMJ Open 2024; 14:e085854. [PMID: 38969384 PMCID: PMC11227800 DOI: 10.1136/bmjopen-2024-085854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION At least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm ('adverse events'). When a patient is seriously harmed, an investigation or review is undertaken to reduce the risk of further incidents occurring. Despite 20 years of investigations into adverse events in healthcare, few evaluations provide evidence of their quality and effectiveness in reducing preventable harm.This study aims to develop consistent, informed and robust best practice guidance, at state and national levels, that will improve the response, learning and health system improvements arising from adverse events. METHODS AND ANALYSIS The setting will be healthcare organisations in Australian public health systems in the states of New South Wales, Queensland, Victoria and the Australian Capital Territory. We will apply a multistage mixed-methods research design with evaluation and in-situ feasibility testing. This will include literature reviews (stage 1), an assessment of the quality of 300 adverse event investigation reports from participating hospitals (stage 2), and a policy/procedure document review from participating hospitals (stage 3) as well as focus groups and interviews on perspectives and experiences of investigations with healthcare staff and consumers (stage 4). After triangulating results from stages 1-4, we will then codesign tools and guidance for the conduct of investigations with staff and consumers (stage 5) and conduct feasibility testing on the guidance (stage 6). Participants will include healthcare safety systems policymakers and staff (n=120-255) who commission, undertake or review investigations and consumers (n=20-32) who have been impacted by adverse events. ETHICS AND DISSEMINATION Ethics approval has been granted by the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH02007 and 2023/ETH02341).The research findings will be incorporated into best practice guidance, published in international and national journals and disseminated through conferences.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Louise Raggett
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Farah Magrabi
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney and Australian Catholic University, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Mike Roberts
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - Patricia Bradd
- Clinical Excellence Commission, St Leonards, New South Wales, Australia
| | - Steven Bowden
- Clinical Excellence Commission, St Leonards, New South Wales, Australia
| | - Kathleen Ryan
- Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Mark Zacka
- Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Kirstine Sketcher-Baker
- Clinical Excellence Queensland, Health Innovation and Research Branch, Queensland Health, Brisbane, Queensland, Australia
| | | | - Lanii Birks
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - Dinesh K Arya
- ACT Health, Canberra, Australian Capital Territory, Australia
| | | | - Suchit Handa
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
| | - Girish Swaminathan
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
| | - Andrew Carson-Stevens
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Siri Wiig
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Carl de Wet
- South West Hospital and Health Service, Roma, Queensland, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- School of Nursing, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ying Wang
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Larkin C. Implementation of Suicide Prevention Activities at Acute Care Discharge: Time for Change? Jt Comm J Qual Patient Saf 2024; 50:391-392. [PMID: 38644154 DOI: 10.1016/j.jcjq.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
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Branjerdporn G, McCosker LK, Jackson D, McDowell S, Williams P, Chand S, Joshi H, Pisani AR, Stapelberg C, Welch M, Turner K, Woerwag-Mehta S. The implementation of a zero-suicide framework in a child and youth mental health service in Australia: processes and learnings. Front Psychiatry 2024; 15:1370256. [PMID: 38818025 PMCID: PMC11138260 DOI: 10.3389/fpsyt.2024.1370256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/16/2024] [Indexed: 06/01/2024] Open
Abstract
Suicide in children is a significant and growing problem. The "zero suicide" framework (ZSF) is one approach to suicide prevention used in health services for adults and children. This paper reports on the introduction of the first suicide prevention pathway (SPP) based on ZSF at a Child and Youth Mental Health Service (CYMHS) in Australia. It begins by describing the adaptations made to elements of the SPP originally designed for adults to meet the needs of children. Lessons learned in applying the SPP in the service are then discussed. The aim is to inform and improve practice in the use of zero suicide approaches in child and youth mental health settings in Australia and worldwide.
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Affiliation(s)
- Grace Branjerdporn
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Laura K. McCosker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Derek Jackson
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Sarah McDowell
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Philip Williams
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Sandeep Chand
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Hitesh Joshi
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Anthony R. Pisani
- Departments of Psychiatry and Pediatrics, Center for the Study and Prevention of Suicide, University of Rochester, New York, NY, United States
| | - Chris Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Kathryn Turner
- Mental Health and Specialist Services, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Sabine Woerwag-Mehta
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
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Grumet JG, Jobes DA. Zero Suicide - What About "Treat"? CRISIS 2024; 45:167-172. [PMID: 38698717 DOI: 10.1027/0227-5910/a000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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Haylor H, Sparkes T, Armitage G, Dawson-Jones M, Double K, Edwards L. The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis. BJPsych Bull 2024:1-13. [PMID: 38174424 DOI: 10.1192/bjb.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
AIMS AND METHOD Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. RESULTS Recent literature proposes a safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted. CLINICAL IMPLICATIONS Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare.
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Affiliation(s)
- Helen Haylor
- First Response Crisis Service, Bradford District Care NHS Foundation Trust, UK
| | - Tony Sparkes
- Faculty of Management, Law and Social Sciences, University of Bradford, UK
| | - Gerry Armitage
- Research and Development Department, Bradford District Care NHS Foundation Trust, UK
- Faculty of Health Studies, University of Bradford, UK
| | - Melanie Dawson-Jones
- Library and Health Promotion Resources Centre, Bradford District Care NHS Foundation Trust, UK
| | - Keith Double
- Patient and Carer Experience and Involvement Team, Bradford District Care NHS Foundation Trust, UK
| | - Lisa Edwards
- Faculty of Health Studies, University of Bradford, UK
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Sawin G, Klasson CL, Kaplan S, Larson Sawin J, Brown A, Thadaney Israni S, Schonberg J, Gregory A. Scoping Review of Restorative Justice in Academics and Medicine: A Powerful Tool for Justice Equity Diversity and Inclusion. Health Equity 2023; 7:663-675. [PMID: 37786530 PMCID: PMC10541936 DOI: 10.1089/heq.2023.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose Restorative Justice (RJ) as a practice and mindset is growing within academic medicine and health care. The authors aim to categorize the extent to which RJ training and practices have been researched, explored, and applied within health care, medicine, and academic contexts. Methods In July 2021, the authors conducted a scoping literature review, searching four databases for peer-reviewed articles and book chapters discussing RJ. Authors also used bibliography searches and personal knowledge to add relevant work. Reviewers independently screened article titles and abstracts, assessing the full texts of potentially eligible articles with inclusion and exclusion criteria. From each included article, authors extracted the publication year, first author's country of origin, specific screening criteria met, and the depth with which it discussed RJ. Results From 599 articles screened, 39 articles, and books were included (published 2001-2021). Twenty-five (64%) articles discussed RJ theory with few describing application practices with substantial depth. Ten (26%) articles only referenced the term "restorative justice" and seven (18%) discussed legal applications in health care. Fifty-four percent were from outside the United States. Articles tended to describe RJ uses to address harm and often missed the opportunity to explore RJ's capacity to proactively build community and culture that helps prevent harm. Conclusions RJ in health care is a rapidly expanding field that offers a framework capable of building stronger communities, authentically preventing and responding to harm, inviting radical inclusion of diverse participants to build shared understanding and culture, and ameliorate some of the most toxic and unproductive hierarchical practices in academics and medicine. Most literature calls to RJ for help to respond to harm, although there are very few well-designed and evaluated implementations. Investment in RJ practices holds significant promise to steer our historically hierarchical, "othering" and imperfect systems to align with values of justice (vs. punishment), equity, diversity, and inclusion.
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Affiliation(s)
- Gregory Sawin
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Samantha Kaplan
- Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Larson Sawin
- Independent Researcher and Restorative Justice Consultant, Durham, North Carolina, USA
| | - Ann Brown
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sonoo Thadaney Israni
- Stanford University School of Medicine, Stanford, California, USA
- Rx for RJ Initiative, University of San Diego, San Diego, California, USA
| | - Jessica Schonberg
- Office for Faculty, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ada Gregory
- Kenan Institute for Ethics, Duke University, Durham, North Carolina, USA
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Pisani AR, Boudreaux ED. Systems Approach to Suicide Prevention: Strengthening Culture, Practice, and Education. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:152-159. [PMID: 37201147 PMCID: PMC10172554 DOI: 10.1176/appi.focus.20220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Contemporary approaches to suicide prevention extend beyond an individual's interactions with care providers to seek opportunities for improvement in the wider care system. A systems-based analysis can yield opportunities to improve prevention and recovery across the care continuum. This article uses an example of an individual seeking care in an emergency department to show how a traditional clinical case formulation can be framed in terms of the outer and inner contexts of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to illuminate the impact of systemic factors on outcomes and to identify opportunities for improvement. Three mutually reinforcing domains (a culture of safety and prevention; best practices, policies, and pathways; and workforce education and development) of a systems approach to suicide prevention are outlined, along with their defining characteristics. A culture of safety and prevention requires engaged, informed leaders who prioritize prevention; lived experience integrated into leadership teams; and adverse events review in a Restorative Just Culture focused on healing and improvement. Best practices, policies, and pathways that promote safety, recovery, and health require codesign of processes and services and evolve through continuous measurement and improvement. To support a culture of safety and prevention, and caring, competent application of policy, organizations benefit from a longitudinal approach to workforce education. This includes a common framework and language; models clinical and lived experience collaboration; and supports continuous learning, as well as onboarding of new staff, rather than following a "one-and-done" approach, so that suicide prevention training remains top of mind across the workforce.
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Affiliation(s)
- Anthony R Pisani
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
| | - Edwin D Boudreaux
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
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Kar Ray M, Theodoros T, Wyder M, Nghiem S, Chiu J, Morrison T, Steginga A, Sorrensen R, Kinsella K, Lombardo C. Proactive Detection (PROTECT) and Safety Planning to Shorten Emergency Department Stays for Psychiatric Patients. Psychiatr Serv 2023; 74:17-23. [PMID: 35795980 DOI: 10.1176/appi.ps.202100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE A literature gap exists for interventions to decrease average length of stay (ALOS) for patients with psychiatric presentations at the emergency department (ED). Long ALOSs are often related to sequential assessments of patients with high suicide risk or patients awaiting an inpatient bed. Safety planning may provide opportunities for diverting patients to the community and for reducing ED ALOS. This study reports on the impact of a safety-planning approach based on the PROTECT (proactive detection) framework for suicide prevention. METHODS A complex intervention (comprising leadership, governance, and innovation) was instrumental in embedding a new clinical culture of proactive detection and positive risk management through safety planning at Princess Alexandra Hospital in Brisbane, Queensland, Australia. Practice as usual continued at a comparator nonintervention site (NIS). In total, 24,515 psychiatric presentations over 24 months were grouped into monthly averages for key outcomes, providing a sample size of 24 at each site. A difference-in-differences analysis across sites, preintervention (January-November 2019) and postimplementation (December 2019-December 2020), was used to estimate the intervention's impact. RESULTS ED ALOS for psychiatric presentations, patients with an ALOS >12 hours, patients with an ALOS >24 hours, and inpatient psychiatric admissions decreased significantly compared with NIS (p<0.01) pre- and postimplementation of the safety-planning intervention. CONCLUSIONS Embedding a recovery-oriented culture of safety significantly reduced ED ALOS for psychiatric evaluations. Leadership, governance, and innovative practices that shift the focus of assessment and care from a mindset of risk prediction to one of prevention through collaborative safety planning as outlined in the PROTECT framework may have far-reaching benefits for patient care.
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Affiliation(s)
- Manaan Kar Ray
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Theo Theodoros
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Marianne Wyder
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Son Nghiem
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Jacqui Chiu
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Thomas Morrison
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Anne Steginga
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Rosemary Sorrensen
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Kieran Kinsella
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
| | - Chiara Lombardo
- Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Brisbane, Queensland, Australia (Kar Ray, Theodoros, Wyder, Morrison, Steginga, Sorrensen, Kinsella); Australian Institute for Suicide Research and Prevention (Kar Ray) and The Hopkins Centre (Wyder), Griffith University, Brisbane, Queensland, Australia; Princess Alexandra-Southside Clinical Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (Theodoros); Department of Health Services, Research and Policy, Australian National University, Canberra, New South Wales, Australia (Nghiem); Toowoomba Base Hospital, Toowoomba, Queensland, Australia (Chiu); Research and Development, Mental Health Foundation, London, and Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge, United Kingdom (Lombardo)
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10
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Richards JE, Yarborough BJH, Holden E, Shulman L, Stumbo SP, Coley Y, Simon GE. Implementation of Suicide Risk Estimation Analytics to Support Mental Health Care for Quality Improvement. JAMA Netw Open 2022; 5:e2247195. [PMID: 36525278 PMCID: PMC9856428 DOI: 10.1001/jamanetworkopen.2022.47195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This quality improvement study describes use of estimation analytics to augment existing suicide prevention practices during routine mental health specialty encounters at a large US health care system.
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Affiliation(s)
- Julie E. Richards
- Kaiser Permanente Washington Heath Research Institute, Seattle
- Department of Health Systems & Population Health, University of Washington, Seattle
| | | | - Erika Holden
- Kaiser Permanente Washington Heath Research Institute, Seattle
| | - Lisa Shulman
- Kaiser Permanente Washington Heath Research Institute, Seattle
| | - Scott P. Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Yates Coley
- Kaiser Permanente Washington Heath Research Institute, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Gregory E. Simon
- Kaiser Permanente Washington Heath Research Institute, Seattle
- Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Kaiser Permanente Washington Department of Mental Health & Wellness, Seattle, Washington
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11
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Turner K, Pisani AR, Sveticic J, O’Connor N, Woerway-Mehta S, Burke K, Stapelberg NJC. The Paradox of Suicide Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214983. [PMID: 36429717 PMCID: PMC9690149 DOI: 10.3390/ijerph192214983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 05/11/2023]
Abstract
The recognition that we cannot use risk stratification (high, medium, low) to predict suicide or to allocate resources has led to a paradigm shift in suicide prevention efforts. There are challenges in adapting to these new paradigms, including reluctance of clinicians and services to move away from traditional risk categorisations; and conversely, the risk of a pendulum swing in which the focus of care swings from one approach to determining service priority and focus (e.g., diagnosis, formulation, risk and clinical care) to a new focus (e.g., suicide specific and non-clinical care), potentially supplanting the previous approach. This paper argues that the Prevention Paradox provides a useful mental model to support a shift in paradigm, whilst maintaining a balanced approach that incorporates new paradigms within the effective aspects of existing ones. The Prevention Paradox highlights the seemingly paradoxical situation where the greatest burden of disease or death is caused by those at low to moderate risk due their larger numbers. Current planning frameworks and resources do not support successful or sustainable adoption of these new approaches, leading to missed opportunities to prevent suicidal behaviours in healthcare. Adopting systems approaches to suicide prevention, such as the Zero Suicide Framework, implemented in a large mental health service in Australia and presented in this paper as a case study, can support a balanced approach of population- and individual-based suicide prevention efforts. Results demonstrate significant reductions in re-presentations with suicide attempts for consumers receiving this model of care; however, the increasing numbers of placements compromise the capacity of clinical teams to complete all components of standardised pathway of care. This highlights the need for review of resource planning frameworks and ongoing evaluations of the critical aspects of the interventions.
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Affiliation(s)
- Kathryn Turner
- Metro North Mental Health, Metro North Health, Brisbane, QLD 4029, Australia
- Correspondence:
| | - Anthony R. Pisani
- Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY 14642, USA
| | | | - Nick O’Connor
- Clinical Excellence Commission, Sydney, NSW 2065, Australia
| | - Sabine Woerway-Mehta
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4215, Australia
| | - Kylie Burke
- Metro North Mental Health, Metro North Health, Brisbane, QLD 4029, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
- Australian Research Council’s Centre of Excellence for Children and Families over the Life Course, Brisbane, QLD 4068, Australia
| | - Nicolas J. C. Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4215, Australia
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12
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Tamworth M, Killaspy H, Billings J, Gibbons R. Psychiatrists' Experience of a Peer Support Group for Reflecting on Patient Suicide and Homicide: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114507. [PMID: 36361387 PMCID: PMC9654625 DOI: 10.3390/ijerph192114507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 05/13/2023]
Abstract
There is a lack of support for mental health professionals who experience a patient suicide or homicide. This is despite a high likelihood of such an occurrence and the heavy professional and personal toll the experience can take. We conducted 15 interviews with members of a facilitated peer support group run for consultant psychiatrists who have experienced a patient homicide or suicide. Our interviews explored the trauma of the experience as well as the effectiveness of the group in helping the clinician heal. Our results echoed previous research that the experience can be profoundly traumatic. A professionally facilitated, consultant-only peer group specifically dedicated to suicide and homicide were the key components helping participants to process their grief. Mental health trusts should consider setting up facilitated peer support groups for clinicians who experience patient suicide or homicide.
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Affiliation(s)
- Millie Tamworth
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Correspondence:
| | - Helen Killaspy
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Camden & Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London W1T 7NF, UK
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13
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Austin DM, Pauley G, Ferkins L. Establishing a Guide for Developing Organizational Support in Healthcare Following a Critical or Sentinel Event. QUALITATIVE HEALTH RESEARCH 2022; 32:1607-1619. [PMID: 35786094 DOI: 10.1177/10497323221111644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Health professionals require support and recognition to help manage the well-known impact of critical or sentinel events relating to patient care. The potential distress can be magnified or mitigated by the response of the organization and colleagues. However, strategies that are accessible, relevant, and effective in the aftermath of a poor outcome are not well established. Using an action research methodology, a support tool was collaboratively designed, developed, and evaluated in a maternity service of one organization and adapted to the mental health and addiction service in another. Four principles that are intrinsic to the establishment of support tools became apparent across the two settings. Through applying these criteria to the customization of the support tool, it became relevant within the new service setting, and an implementation guide for other organizations was created. Although undertaken pre-pandemic, insights derived from this study may benefit post-pandemic situations where the need for health professional support is even greater.
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Affiliation(s)
| | - Gerard Pauley
- 1410Auckland University of Technology, Wellington, New Zealand
| | - Lesley Ferkins
- 1410Auckland University of Technology, Wellington, New Zealand
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14
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Berg SH, Rørtveit K, Walby FA, Aase K. Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis. BMC Health Serv Res 2022; 22:967. [PMID: 35906685 PMCID: PMC9336074 DOI: 10.1186/s12913-022-08282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention. Methods A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review. Results Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring. Conclusion Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced. Trial registration https://doi.org/10.1136/bmjopen-2016-012874
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Affiliation(s)
- Siv Hilde Berg
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, N-4036, Stavanger, Norway. .,Clinics of Adult Mental Health Care, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
| | - Kristine Rørtveit
- Milieu Therapy and Mental Health Nursing Research Group, Clinics of Adult Mental Health Care, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.,Life Phenomena and Caring Research Group, Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, Building 12, N-0320, Oslo, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, N-4036, Stavanger, Norway
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15
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Olarte-Godoy J. Newtonian science, complexity science and suicide-critically analysing the philosophical basis for suicide research: A discussion paper. J Adv Nurs 2022; 78:e101-e110. [PMID: 35765763 DOI: 10.1111/jan.15346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/04/2022] [Accepted: 06/17/2022] [Indexed: 11/27/2022]
Abstract
AIM A critical discussion comparing Newtonian science and complexity science as the philosophical basis for suicide research and its impact on suicide knowledge development and clinical practice. DESIGN Discussion paper. DATA SOURCES A review of literature on suicide research and complexity science ranging from 2000 to 2022. IMPLICATIONS FOR NURSING Suicide research based on a Newtonian worldview can have negative consequences for suicide knowledge development and can permeate nursing practice in ways that take away from addressing the complex needs of patients, their families and healthcare teams. CONCLUSION A Newtonian worldview as a philosophical basis for research is insufficient for the study of a phenomenon as complex as suicide. A complexity science approach is better suited to the study of suicide given the multiple, interrelated, emerging factors that can contribute to a person's decision to end their own life. IMPACT Suggestions are provided as to how a complexity science approach to the research of suicide can inform useful knowledge development that better meets the needs of individuals facing suicidality and their families. Researchers, healthcare administrators and nurses providing care to those struggling with suicidality can benefit from adopting a complexity science worldview in addressing this multifaceted phenomenon.
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16
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Wand A, McKay R, Pond D. Towards Zero Suicide: need and opportunities to improve implementation of clinical elements for older adults. Australas Psychiatry 2022; 30:290-293. [PMID: 34839743 DOI: 10.1177/10398562211054034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Zero Suicide (ZS) framework is increasingly used in Australia, but without published adaptations for older people, and limited access by older people when implemented. The aim of this paper is to inform Towards Zero Suicide (TZS) implementations to benefit older adults by considering the key differences in older adults at risk of suicide according to each clinical component of the ZS framework. CONCLUSION TZS aspires to reduce deaths by suicide for people within healthcare by refocusing interventions on suicidality rather than diagnosis alone, emphasising evidence-based practices and cultural change. For TZS to be effective for older people, it is essential to ensure practices are based upon evidence relevant to older people and to ensure ageism is effectively counteracted. Older adults have distinct patterns of help seeking and service use, accompanied by differences in risk factors, presentations, and outcomes of suicidal behaviours. Ageism affects assessment, decision-making and actions to address self-harm and suicide for older people. Immediate and longer-term actions are essential to effectively implement TZS in this population.
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Affiliation(s)
- Anne Wand
- Faculty of Medicine and Health, University of Sydney, Australia; and Faculty of Medicine, University of New South Wales, Australia
| | - Roderick McKay
- NSW Health Education and Training Institute, North Parramatta, NSW, Australia
| | - Dimity Pond
- The University of Newcastle, Callaghan, NSW, Australia
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17
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Spottswood M, Lim CT, Davydow D, Huang H. Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review. Front Med (Lausanne) 2022; 9:892205. [PMID: 35712115 PMCID: PMC9196265 DOI: 10.3389/fmed.2022.892205] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review. Methods A narrative review was performed. Observations Many interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed. Conclusions and Relevance The findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.
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Affiliation(s)
- Margaret Spottswood
- Department of Psychiatry, University of Vermont Medical Center, University of Vermont, Burlington, VT, United States
- Department of Psychiatry, Community Health Centers of Burlington, Burlington, VT, United States
| | - Christopher T. Lim
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Dimitry Davydow
- Executive Leadership, Comprehensive Life Resources, Tacoma, WA, United States
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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18
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Wailling J, Kooijman A, Hughes J, O'Hara JK. Humanizing harm: Using a restorative approach to heal and learn from adverse events. Health Expect 2022; 25:1192-1199. [PMID: 35322513 PMCID: PMC9327844 DOI: 10.1111/hex.13478] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/06/2022] [Accepted: 03/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background Healthcare is not without risk. Despite two decades of policy focus and improvement efforts, the global incidence of harm remains stubbornly persistent, with estimates suggesting that 10% of hospital patients are affected by adverse events. Methods We explore how current investigative responses can compound the harm for all those affected—patients, families, health professionals and organizations—by neglecting to appreciate and respond to the human impacts. We suggest that the risk of compounded harm may be reduced when investigations respond to the need for healing alongside system learning, with the former having been consistently neglected. Discussion We argue that incident responses must be conceived within a relational as well as a regulatory framework, and that this—a restorative approach—has the potential to radically shift the focus, conduct and outcomes of investigative processes. Conclusion The identification of the preconditions and mechanisms that enable the success of restorative approaches in global health systems and legal contexts is required if their demonstrated potential is to be realized on a larger scale. The policy must be co‐created by all those who will be affected by reforms and be guided by restorative principles. Patient or Public Contribution This viewpoint represents an international collaboration between a clinician academic, safety scientist and harmed patient and family members. The paper incorporates key findings and definitions from New Zealand's restorative response to surgical mesh harm, which was co‐designed with patient advocates, academics and clinicians.
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Affiliation(s)
- Jo Wailling
- School of Government, Te Ngāpara Centre for Restorative Practice, Victoria University of Wellington, Wellington, New Zealand
| | - Allison Kooijman
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Jane K O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
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19
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Affiliation(s)
- Shuichi Suetani
- Institute for Urban Indigenous Health, Windsor, Australia.,Physical Health and Mental Health Stream, 90131Queensland Centre for Mental Health Research, Wacol, Australia.,1974The University of Queensland, Brisbane, Australia.,School of Medicine, Griffith University, Nathan, Australia
| | - Stephen Parker
- 1974The University of Queensland, Brisbane, Australia.,School of Medicine, Griffith University, Nathan, Australia.,Metro North Mental Health Service, Herston, QLD, Australia
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20
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Morris D, Sveticic J, Grice D, Turner K, Graham N. Collaborative Approach to Supporting Staff in a Mental Healthcare Setting: "Always There" Peer Support Program. Issues Ment Health Nurs 2022; 43:42-50. [PMID: 34403302 DOI: 10.1080/01612840.2021.1953651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper describes the development and implementation of a peer-support program Always There in a large public mental health service in Queensland, Australia. The program is modelled on Scott's three tier model of peer support, with trained responders providing emotional support to staff following a traumatic adverse event, or when experiencing acute or cumulative stress. Support is provided in complete confidentiality. Main lessons learned in the 2 years since the launch of the program are shared in this paper, outlining successes such as improvements in staff's perception of organisational culture, and challenges related to embedding the program to "business as usual".
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Affiliation(s)
- Debby Morris
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Diana Grice
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Nicole Graham
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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21
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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; 18:10634. [PMID: 34682380 PMCID: PMC8535550 DOI: 10.3390/ijerph182010634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
This study explored the experiences of healthcare consumers who had recently attempted suicide, and their carers, following placement on a Suicide Prevention Pathway based on the Zero Suicide framework. Qualitative interviews were conducted with 10 consumers and 5 carers using a semi-structured interview schedule. Interviews were transcribed and thematic analysis was applied to identify prominent themes and sub-themes. Three interrelated themes were identified. The first theme was 'Feeling safe and valued' with the associated sub-theme pertaining to perceived stigmatizing treatment and self-stigma. The second was 'Intersection of consumer and staff/organizational needs' with a related sub-theme of time pressure and reduced self-disclosure. The final theme was 'Importance of the 'whole picture', highlighting the relevance of assessing and addressing psychosocial factors when planning for consumer recovery. Overall, consumers and their carers reported a favorable experience of the Suicide Prevention Pathway; however, there were several areas identified for improvement. These included reconciling the time-pressures of a busy health service system, ensuring consumers and carers feel their psychosocial concerns are addressed, and ensuring that adequate rapport is developed. Key to this is ensuring consumers feel cared for and reducing perceptions of stigma.
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Affiliation(s)
- Victoria Ross
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Nicolas J. C. Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Angela Davies
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Sarah Walker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
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22
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Stapelberg NJC, Sveticic J, Hughes I, Almeida-Crasto A, Gaee-Atefi T, Gill N, Grice D, Krishnaiah R, Lindsay L, Patist C, Engelen HV, Walker S, Welch M, Woerwag-Mehta S, Turner K. Efficacy of the Zero Suicide framework in reducing recurrent suicide attempts: cross-sectional and time-to-recurrent-event analyses. Br J Psychiatry 2021; 219:427-436. [PMID: 33176895 DOI: 10.1192/bjp.2020.190] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The Zero Suicide framework is a system-wide approach to prevent suicides in health services. It has been implemented worldwide but has a poor evidence-base of effectiveness. AIMS To evaluate the effectiveness of the Zero Suicide framework, implemented in a clinical suicide prevention pathway (SPP) by a large public mental health service in Australia, in reducing repeated suicide attempts after an index attempt. METHOD A total of 604 persons with 737 suicide attempt presentations were identified between 1 July and 31 December 2017. Relative risk for a subsequent suicide attempt within various time periods was calculated using cross-sectional analysis. Subsequently, a 10-year suicide attempt history (2009-2018) for the cohort was used in time-to-recurrent-event analyses. RESULTS Placement on the SPP reduced risk for a repeated suicide attempt within 7 days (RR = 0.29; 95% CI 0.11-0.75), 14 days (RR = 0.38; 95% CI 0.18-0.78), 30 days (RR = 0.55; 95% CI 0.33-0.94) and 90 days (RR = 0.62; 95% CI 0.41-0.95). Time-to-recurrent event analysis showed that SPP placement extended time to re-presentation (HR = 0.65; 95% CI 0.57-0.67). A diagnosis of personality disorder (HR = 2.70; 95% CI 2.03-3.58), previous suicide attempt (HR = 1.78; 95% CI 1.46-2.17) and Indigenous status (HR = 1.46; 95% CI 0.98-2.25) increased the hazard for re-presentation, whereas older age decreased it (HR = 0.92; 95% CI 0.86-0.98). The effect of the SPP was similar across all groups, reducing the risk of re-presentation to about 65% of that seen in those not placed on the SPP. CONCLUSIONS This paper demonstrates a reduction in repeated suicide attempts after an index attempt and a longer time to a subsequent attempt for those receiving multilevel care based on the Zero Suicide framework.
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Affiliation(s)
- Nicolas J C Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland; and Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Alice Almeida-Crasto
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Taralina Gaee-Atefi
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Neeraj Gill
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland; and School of Medicine, Griffith University, Gold Coast, Queensland,Australia
| | - Diana Grice
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ravikumar Krishnaiah
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Luke Lindsay
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Carla Patist
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Heidy Van Engelen
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Sarah Walker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Sabine Woerwag-Mehta
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland; and Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland,Australia
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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Mackenhauer J, Winsløv JH, Holmskov J, Brødsgaard I, Larsen TG, Mainz J. Analysis of Suicides Reported as Adverse Events in Psychiatry Resulted in Nine Quality Improvement Initiatives. CRISIS 2021; 43:307-314. [PMID: 34003020 DOI: 10.1027/0227-5910/a000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The majority of persons who die by suicide have a mental disorder. Preventive strategies should include addressing social and psychological factors and the treatment of the mental disorder. Aim: We aimed to identify breaches in clinical care and identify areas for quality improvement initiatives. Method: An aggregate analysis of suicides reported as adverse events during 2012-2016 to Psychiatry, North Denmark Region was carried out. We developed an audit chart and identified items through (a) medical chart review and (b) consensus meetings in an expert panel. Results: A total of 35 cases were analyzed. Suicide risk assessments were adequately documented in the medial chart in six of 35 cases. Risk assessments emphasized suicidal ideation rather than well-known risk factors such as previous suicide attempts, substance abuse, physical illness, or job loss. Relatives were involved in four of 35 of the risk assessments. The panel suggested nine areas for quality improvement. Limitations: Most people who die by suicide are not seen in mental health facilities prior to suicide, and hence conclusions can only be generalized to these patients. Information on the gap between "Work-as-Done" and "Work-As-Imagined" was not recognized. Conclusion: Most of the risk assessments among suicides reported as adverse events to our mental health facilities were insufficient. Quality improvement initiatives focusing on training, documentation, involving relatives, communication, and data sharing must be planned to improve clinical care.
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Affiliation(s)
- Julie Mackenhauer
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University, Denmark.,Psychiatry Management, Aalborg University Hospital Psychiatry, Aalborg, Denmark
| | - Jan-Henrik Winsløv
- Unit for Suicide Prevention, Aalborg University Hospital Psychiatry, Aalborg, Denmark
| | - Jens Holmskov
- Klinik Psykiatri Nord, Aalborg University Hospital Psychiatry, Brønderslev, Denmark
| | - Inger Brødsgaard
- Klinik Psykiatri Syd, Aalborg University Hospital Psychiatry, Aalborg, Denmark
| | - Tina Gram Larsen
- Psychiatry Management, Aalborg University Hospital Psychiatry, Aalborg, Denmark
| | - Jan Mainz
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University, Denmark.,Psychiatry Management, Aalborg University Hospital Psychiatry, Aalborg, Denmark.,Department of Community Mental Health, University of Haifa, Israel.,Department for Health Economics, University of Southern Denmark, Odense, Denmark
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Turner K, Sveticic J, Almeida-Crasto A, Gaee-Atefi T, Green V, Grice D, Kelly P, Krishnaiah R, Lindsay L, Mayahle B, Patist C, Van Engelen H, Walker S, Welch M, Woerwag-Mehta S, Stapelberg NJ. Implementing a systems approach to suicide prevention in a mental health service using the Zero Suicide Framework. Aust N Z J Psychiatry 2021; 55:241-253. [PMID: 33198477 DOI: 10.1177/0004867420971698] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Alice Almeida-Crasto
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Taralina Gaee-Atefi
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Vicki Green
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Diana Grice
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Petra Kelly
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Ravikumar Krishnaiah
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Luke Lindsay
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Brian Mayahle
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Carla Patist
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Heidy Van Engelen
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Sarah Walker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Sabine Woerwag-Mehta
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Nicolas Jc Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
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25
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Roche GC, Fung P, Ransing R, Noor IM, Shalbafan M, El Hayek S, Koh EBY, Gupta AK, Kudva KG. The state of psychiatric research in the Asia Pacific region. Asia Pac Psychiatry 2021; 13:e12432. [PMID: 33145988 DOI: 10.1111/appy.12432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study aims to review recent scientific publications and research output in the field of psychiatry, from a series of countries in the Asia-Pacific region (Australia, India, Indonesia, Iran, Lebanon, Malaysia, and Nepal), with a view to identify themes and similarities across regions, as well as to examine the barriers and challenges in mental health research faced by countries in the region. METHODS Seven psychiatrists from seven countries reviewed recent published and ongoing research in psychiatry in their respective nations, with respect to themes, as well as any barriers or challenges faced by mental health researchers. RESULTS While the seven nations included in this review vary in terms of research capabilities and economic development level, they share many similarities both in terms of research direction, and with regards to challenges faced. Limitations in the form of sociocultural differences from the West, and a lack of funding were some of the barriers identified. DISCUSSION Mental health research in the region has been progressing well. However, more varied research in the form of qualitative or economic studies are lacking, as are multi-center studies. The similar issues that nations face with regards to research could perhaps benefit from collaborative efforts and initiatives for the furtherance of research in the region.
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Affiliation(s)
- Glen Cedric Roche
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Paul Fung
- Paramatta Mission, Parramatta, New South Wales, Australia.,Health Education and Training Institute Higher Education, North Paramatta, New South Wales, Australia
| | - Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Isa Multazam Noor
- Department of Psychiatry, Dr. Soeharto Heerdjan Mental Hospital, Jakarta, Indonesia
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samer El Hayek
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Eugene Boon Yau Koh
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Kundadak Ganesh Kudva
- Early Psychosis Intervention Programme and East Region, Institute of Mental Health, Singapore
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26
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Sardinha S, Suetani S, Parker S. From evidence-based medicine to evidence-informed practice: Comments on Turner et al. 2020. Aust N Z J Psychiatry 2021; 55:223. [PMID: 32623900 DOI: 10.1177/0004867420939661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Savio Sardinha
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Nathan, QLD, Australia
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Nathan, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Stephen Parker
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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