A holistic aftercare model to prevent suicide

A review and ongoing research by La Trobe Rural Health School are turning the tide in Victoria’s rural suicide blackspot.

In 2019, 699 Victorians died by suicide. The Mildura local government area had regional Victoria’s highest suicide rate at 35.5 deaths per 100,000 residents.

In response, Mildura Base Public Hospital partnered with the La Trobe Rural Health School and Monash University to review current services for those in suicidal crisis.

Reviewers, led by La Trobe’s Dr Sean MacDermott, looked at 11 years of data relating to emergency department presentations and found that 2,327 people presented 4,326 times, including 1,999 re-presentations. The primary risk factors were age (being older), gender (male) and Indigenous status.

The study also mapped the current system of emergency care and follow-up, making several findings and recommendations:

• The emergency department was overused, overburdened and under-resourced.
• Few services were available to patients (who had attempted suicide) after discharge from hospital and there was no clear pathway to follow-up care.
• Services were focused on immediate health needs and not the social determinants driving people into crisis.
• Attracting and retaining a skilled workforce was an ongoing challenge, impacting service access.
• There was need to improve community awareness about mental illness to reduce stigma.
• There was need for a model of care to address both the clinical and social needs of patients.

It was clear a different approach was needed. With state and federal funding, the hospital established the Mildura Suicide Prevention Program in 2020; a new service model of holistic, client-centred aftercare for a period of up to 12 weeks.

Staffed by mental health professionals, including social workers, the model includes two evidence-based interventions: the Hospital Outreach Post-suicidal Engagement (HOPE) program and the Way Back Support Service.

Where HOPE provides proven clinical assessment and therapeutic care that actively involves the consumer in their own treatment plan, Way Back provides practical non-clinical support to help manage life situations and challenges. The idea behind this hybrid approach is to not just treat patients’ acute needs but also take steps to resolve underlying mental health concerns.

In 2021, 138 patients were referred to the program and the hospital is seeing early signs of success in reducing readmissions for suicide attempts.

The program is now an exemplar in suicide prevention, with the Victorian Government approving the merging of the HOPE and Way Back interventions into one service model to be rolled out statewide.

Chris Harvey, a researcher at La Trobe’s Mildura campus, recently commenced a Professional Doctorate of Social Work to evaluate and guide further improvements to Mildura’s aftercare model, supervised by Dr MacDermott.

‘I wanted to formalise the model of care and have a manual written … and also monitor the efficacy of the program to make sure it aligned with recommendations from Victoria’s mental health Royal Commission,’ said Chris.

Chris’s research has expanded to cover Albury–Wodonga’s delivery of the model, which provides an opportunity to evaluate the program in new settings and provide an evidence base for broader implementation.

Jon Evans was one of the first consumers of the service and is now a peer-support worker for the program. Jon acts as a ‘buddy’, offering hope and friendship to people referred to the program and through outreach work in the community.

Jon sees the transition from hospital back into the community as a critical time: ‘From my own lived experience, and from my observations, that transition can create issues. I try to mitigate the quick exit by staying with them pre- and post-discharge, … picking up on anything that might be going on.’

Jon attends the weekly multidisciplinary review meetings to discuss patient needs and treatment pathways, to ensure each patient is receiving the best possible patient-centred care.

Jon credits the program with saving his life. This drives him to continue his work in this area: ‘After my experience of the program, I can’t imagine working anywhere else.’