On the 2nd of February, 2022, we organised an event to discuss a topic that is too often avoided. Given stats such as, over 2.1 Million Australian adults have considered dying by suicide at some point in their lifetime and each year around 65,000 people act on these thoughts - it’s an important discussion to have. Further, did you know that in 2020, 3,139 Australians ended their lives by suicide?
With those statistics, clearly, suicide prevention is everybody’s business.
This suicide prevention awareness webinar is intended to provoke thought and discussion about a challenging and sometimes stigmatised topic. All participants joined by donation, raising $1,175 for the Kai Fella Foundation, a foundation preventing youth suicide. If you were unable to join on the night and would still like to donate, please click the link below. Thank you to everyone who was so altruistic, we feel privileged to be a part of such a caring community.
And for the questions, we did not have a chance to get to, here, Ryan McGrath answers…
Are there stats for Residential Aged Care?
· "Available evidence suggests that entering residential care can itself contribute to mental illness and suicide risk. For example, a study of suicide deaths among people in residential aged care identified that maladjustments to life in RACFs was a factor in almost 30% of these deaths" (National Mental Health Commission, 2020, p. 3).
· "Older men have been identified as a group that faces a high risk of suicide. The most recent figures from the Australian Bureau of Statistics on Causes of Death in Australia show that men aged 85 years and over have the highest age-specific suicide rate of any group, at 32.9 deaths per 100,000 people" (National Mental Health Commission, 2020, p. 3).
· "The majority (86%) of all aged care residents on 30 June 2018 had at least one diagnosed mental health or behavioural disorder, about half (49%) had depression and half (52%) had dementia" (National Mental Health Commission, 2020, p. 3).
· "Australian research… estimates less than 1% of aged care residents received psychosocial treatment for mental ill health, 12 despite a strong evidence-base for the effectiveness of these interventions (National Mental Health Commission, 2020, p. 6).
How much detail would you discuss suicide with a patient? What would be helpful for the client?
· As briefly mentioned on the night by Karen, the depth/level of detail depends on your role, training and skill set and would be outside most allied health professional skillset. For example, probing about childhood trauma in an adult experiencing suicidal distress could potentially be re-traumatising. Mooney (2021) talks about this in the context of adults' experiences of disclosure to child protection social work services
o "Disclosing sexual abuse can be re-traumatising, reinforcing perceptions of powerlessness, loss of control, and loss of trust in others and those in authority… [Mooney's] findings show[ed] that participants were impacted by how they had lost control once their story had been handed over" (pp. 204-205).
· However, if a client shares that their suicidal distress is related to childhood sexual abuse, it is important to validate and support them.
o "It is human nature to want to be accepted and validated by others… For [survivors of childhood sexual abuse], the shame underlying their experiences is often so deep and the fear of not being affirmed so strong that allowing themselves to become known is often a terrifying prospect (Farber et al., 2009, p. 57).
· In terms of information needed to support a person who discloses suicidal distress, the attached guideline from NSW Health & an article written by Dr Helen Stallman on the "coping planning approach" may provide you with some guidance. Having been trained with Lifeline, I often structure my support for people experiencing suicidal distress using the CFRED model. Unfortunately, I believe the model is proprietary, and I can't find detailed information online. I have attached a proforma that I developed for personal use based on the CFRED model.
Advocating for clients disclosing suicidal distress within the context of inpatient rehabilitation. In my experience, it has been challenging to advocate for the mental health of these patients as the team are focused on optimising their physical function for their discharge
o Unfortunately, this is a challenge I have personally come across as well. There is no simple solution to this issue; however, to reiterate what was discussed on the night
o Continually raise this issue to the team in any way you can until you believe that appropriate care has been implemented.
o Social workers are your friend. "Social workers are unique in being oriented to and knowledgeable about advocacy… The goals of case advocacy are often to meet individuals; absolute needs, or the basic goods and services that support human survival in the short term" (Cox et al., 2018, p. 58). Consider having a one-on-one conversation with the relevant social worker about your concerns.
Would you have a template "safety plan" to suggest which could be used with the clients when needed?
Previous publications that discuss experiences of physiotherapists with clients experiencing suicidal distress
McGrath, R. L., MacDonald, J. B., Verdon, S., Parnell, T., & Smith, M. (2021). Encounters between physiotherapists and clients with suicidal thoughts and behaviours: A narrative literature review. New Zealand Journal of Physiotherapy, 49(2), 70–81. https://tinyurl.com/yujjh7mx
McGrath, R. L., Parnell, T., Verdon, S., MacDonald, J. B., & Smith, M. (2020). Trust, conversations and the ‘middle space’: A qualitative exploration of the experiences of physiotherapists with clients with suicidal thoughts and behaviours. PLOS ONE, 15(9), 1-20. https://doi.org/10.1371/journal.pone.0238884
Cox, L. E., Tice, C. J., & Long, D. D. (2018). Advocacy in social work. In Introduction to social work an advocacy-based profession (pp. 57-76). https://us.sagepub.com/sites/default/files/upm-assets/90577_book_item_90577.pdf
Farber, B. A., Khurgin-Bott, R., & Feldman, S. (2009). The benefits and risks of patient self-disclosure in the psychotherapy of women with a history of childhood sexual abuse. Psychotherapy: Theory, Research, Practice, Training, 46(1), 52-67. https://doi.org/10.1037/a0015136
Mooney, J. (2021). How adults tell: A study of adults' experiences of disclosure to child protection social work services [https://doi.org/10.1002/car.2677]. Child Abuse Review, 30(3), 193-209. https://doi.org/https://doi.org/10.1002/car.2677