Developing service models that address the drivers of situational distress
Our team recently undertook a review of a PHN-funded service that aims to support people in the community experiencing situational distress with non-clinical support. The program forms part of a coordinated, community-based approach to suicide prevention.
In the post below, we share some insights drawn from the project to help both commissioning agencies and service provider organisations consider how to design more compassionate service models that focus on situational distress.
Life events as a driver of emotional distress and suicidality
Data, stories and experiences consistently tell us that suicide is a complex issue and not well explained as a ‘mental health issue’. The most recent suicide data for Queensland indicates that:
almost half of people who died by suicide did not have a diagnosed mental health condition
more than 40% of people expressed an intent to die by suicide in the 12 months prior to their death
while ~80% of people were in contact with primary health care services in the 12 months prior to their death, but only one quarter of those who died by suicide saw their GP for a mental health condition in their lifetime
about than 1 in 6 people (17%) who died by suicide had attempted suicide in the previous 12 months
the most common adverse life events associated with deaths by suicide were relationship separation, financial problems, bereavement, family conflict, legal matters, or problems at work or school.
Traditional mental health services solely focused on a mental health diagnosis or waiting until someone has attempted suicide are therefore not likely to be able to respond to the suicide prevention needs of all within communities.
A Need for Compassionate Service Models That Address the Drivers of Situational Distress
The National Suicide Prevention Advisor’s Final Report titled Compassion First, informed by a national study of people's lived experience of suicidal distress and suicidal behaviours, highlights the need for more comprehensive and compassionate support for people experiencing suicidal distress.
The report emphasises the importance of designing service models that prioritise empathy and understanding, rather than simply focusing on clinical interventions. It identifies opportunities for change in the design of suicide prevention services, including the need for greater collaboration between health services and community-based organisations and networks.
Better responding to the needs of people in the community specifically around reducing suicidal distress will require:
identifying people who are experiencing distress to ensure they get the right supports in a timely way — recognising these people may not connect with health services
developing and scaling community-based and compassionate services and supports to ensure that people who do seek help in suicidal distress get the support that they need.
Additionally, more engagement is needed with other sectors and with individuals who have influence within their communities given the complexity of suicide prevention with many interconnected responsibilities.
Example of a Situational Distress Service Model
In late 2020, Gold Coast PHN funded Wesley Mission Queensland to undertake a two-year trial of a Community Suicide Prevention Service that aimed to identify and connect with people in the community experience situational distress, and connect them with non-clinical support to build resilience and connections. Key components included:
community development to build a network of community touchpoints
identifying, sensitively inquiring about and offering brief intervention at the point of someone experiencing distress
connecting individuals who require additional support to a dedicated service to address the drivers of situational distress in a time-limited program
providing compassionate support around a person’s goals, practical assistance and linkage with other supports in their community
A recent review of the service’s first two years of implementation found it was appropriate and effective — with positive experiences reported by service users and positive changes in distress outcomes.
The Role of PHNs in Commissioning More Responsive Suicide Prevention Services
Primary Health Networks (PHNs) play an important role in regionally integrated planning and commissioning of suicide prevention services that respond to the needs of their communities.
In the context of suicide prevention, PHNs play a critical role in ensuring that effective support informed by policy priorities, leading evidence and local experience is available to those who need that support.
The (previous) Commonwealth Government’s National Mental Health and Suicide Prevention Plan provided additional funding for a response focused on situational distress, with funding flowing through PHNs in partnership with State Governments including:
trialling broader referral pathways for after care services for people who have attempted suicide or experience suicidal distress that have not gone to a hospital
trialling a National Distress Intervention program that will reach people in crisis and provide immediate support.
All PHNs have also recently received additional funding from the Department of Health for a regional suicide prevention coordination role. Some PHNs have previously undertaken similar work as part of their involvement as a National Suicide Prevention Trial site, while other PHNs such as Northern Queensland PHN have taken a community-led approach across their regions over several years.
So what should PHNs do?
The policy environment and emerging evidence base continues to highlight the need for community-based suicide prevention responses that are compassionate, accessible and effective. PHNs can seek to address situational distress and contribute to positive suicide prevention outcomes through:
Engaging with other sectors such as local government, community organisations and government agencies — particularly those ‘touchpoints’ in community where people may be identified when experiencing distress
Investing in non-clinical, community-based services that use compassion, connection, skills and resilience as the intervention, ensuring a point of difference with existing services (particularly those with a clinical or therapeutic focus)
Building on what’s there in terms of community facilities, groups and events — engage these resources as part of a broader movement of change through suicide prevention training, networks and moderated peer support groups
Building capacity within the workforce by providing training and knowledge around compassion first approaches, trauma-informed care, cultural safety and working with the full diversity of local communities (including culture, age, gender, circumstances and experiences)
Evaluate, reflect and share to continually strive to meet the emerging needs of communities, ensure those who are and aren’t accessing support are providing feedback and reporting the outcomes that matter to them, and making knowledge and learning ‘open source’.
Need more information?
If you’re searching for some more information about our work with Primary Health Networks, you can check out our PHN-related work and insights here. Or want to chat? Please get in contact with our friendly team.