Suicide Prevention Strategic Plan 2016-2018: Journey to Zero Through Leadership, Support and Continuous Improvement

Executive Summary:
Suicide is a complex, biopsychosocial phenomenon with a significant human
toll, however it is preventable. Around 800 000 people die by suicide every year and
suicide is the second leading cause of death in young people aged 15-29 years globally,
while it is the leading cause of death in people aged 15-44 in Australia. Suicide is a
significant cause of mortality in Australia, with 2,866 deaths by suicide in 2016, almost 8
people per day, with a standardized death rate of 11.7 per 100,000 people nationally.
The experience of suicide and attempted suicide has a far-reaching impact on families,
friends and communities. It is estimated that for each adult who dies by suicide, more
than 20 others engage in an attempt.
In response to this global issue, many countries, including Australia, have
developed national and regional suicide prevention strategies and frameworks. This
document reviews these frameworks and provides a synthesis of the literature. Key
themes which emerge are 1) the need for a systems approach to suicide prevention
interventions, 2) an approach which embeds the concepts of just culture and staff care
into the core values of a suicide prevention framework, and 3) an approach at hospital
and health service level which integrates the themes of core values and work culture,
leadership, education, access to care, therapeutic alliance and collaborative care,
evidence based interventions, robust transition of care and follow-up, and 4) a suicide
prevention framework that improves through ongoing evaluation and research
After consultation and review of the literature, the Gold Coast Mental Health and
Specialist Services (GCMHSS) identified the Zero Suicide Framework (ZSF) as a
suitable scaffold within which the themes and principles presented above are
operationalised. This document describes in its early chapters the implementation
processes of the GCMHSS Suicide Prevention Strategy based on ZSF.
This document describes the suite of clinical interventions identified as the
GCMHSS Suicide Prevention Pathway (SPP). The latter chapters in this document
describe important preliminary outcomes of the SPP implementation and evaluation
process. For instance, training provided for suicide prevention was evaluated by
GCMHSS staff, and the results show self-reported improvements in knowledge,
confidence levels and application to practice in regards to the assessment and
management of clients presenting with suicidality. Furthermore, an evaluation of training
for the Prevention-Orientated Risk Assessment in the SPP, showed improvements in
both quality of risk formulation and increased clinician confidence with this assessment
framework, after a 3-hr training workshop. The report also provides descriptions of the
safety planning framework (a component of the SPP).
Evaluation and research have been identified as core elements of most suicide
prevention frameworks, including the ZSF, and this report concludes with the Evaluation
and Research Strategy (2016-2019), a component of the GCMHSS Suicide Prevention
Strategy, as well as a comparative cross sectional study, pre- and post-implementation,
of the SPP, which provides early evidence of improvements in service provision to
consumers presenting with suicidal behaviour when comparing data from 2015 to 2017.
This work also shows a reduction in representations with suicidal behaviour, in people
commenced on the SPP, compared to those who were not commenced on the SPP.