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5 th Annual Forum Wednesday 28 th April 2010 Royal Hospital Kilmainham ‘Promoting Positive Mental Health and Reducing Stigma’

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Presentation on theme: "5 th Annual Forum Wednesday 28 th April 2010 Royal Hospital Kilmainham ‘Promoting Positive Mental Health and Reducing Stigma’"— Presentation transcript:

1 5 th Annual Forum Wednesday 28 th April 2010 Royal Hospital Kilmainham ‘Promoting Positive Mental Health and Reducing Stigma’

2 Optimising Suicide Prevention Programmes and their Implementation in Europe (OSPI-Europe) The role of Positive Mental Health Promotion and Social Marketing in a Multi-Level Suicide Prevention Programme Ms. Claire Coffey, Dr. Ella Arensman & EU Consortium Due to the large size of images and photos, these will be shown during the workshop presentation

3 OSPI-Europe An innovative suicide prevention project funded by the European Commission’s 7 th Framework Programme An innovative suicide prevention project funded by the European Commission’s 7 th Framework Programme Brings together a consortium of suicide researchers from 11 countries throughout Europe, all with an established track record of designing and implementing suicide prevention strategies Brings together a consortium of suicide researchers from 11 countries throughout Europe, all with an established track record of designing and implementing suicide prevention strategies OSPI-Limerick is conducted in collaboration with the Suicide Prevention Office and the Limerick Mental Health Management Team.

4 OSPI-Europe Aims: To test the effectiveness of an optimised, evidence-based, multilevel intervention to reduce suicide and deliberate self harm, which complements existing national and local guidelines and actions To test the effectiveness of an optimised, evidence-based, multilevel intervention to reduce suicide and deliberate self harm, which complements existing national and local guidelines and actions To provide the EU member states with realistic action-based recommendations that can be implemented on a regional basis to reduce suicidality and related mental health problems. To provide the EU member states with realistic action-based recommendations that can be implemented on a regional basis to reduce suicidality and related mental health problems.

5 Background Key aspect of OSPI-Europe is a multi-level intervention based on previous work by the Nuremburg Alliance Against Depression (NAD) and the European Alliance Against Depression (EAAD) Key aspect of OSPI-Europe is a multi-level intervention based on previous work by the Nuremburg Alliance Against Depression (NAD) and the European Alliance Against Depression (EAAD) This approach is in line with evidence from other fields of prevention which have showed that tackling a public health problem on multiple levels and with multiple strategies is more effective than using only a single strategy This approach is in line with evidence from other fields of prevention which have showed that tackling a public health problem on multiple levels and with multiple strategies is more effective than using only a single strategy In Ireland, EAAD was conducted throughout Cork and Kerry between In Ireland, EAAD was conducted throughout Cork and Kerry between

6 Effectiveness of original multi-level pilot study: Nuremburg Alliance Against Depression (NAD) % +12% NurembergWürzburg % +24% 2002 Fisher‘s exact test (two-tailed): 2000 versus 2001; p < versus 2002; p< 0,001 Suicidal acts

7 OSPI-Europe: An innovative multi-level intervention to be implemented in County Limerick OSPI-Europe 5-level intervention Level 1: Primary care workshops Level 2: General public awareness campaign Level 3: Community facilitator training Level 4: Offers for high risk groups Level 5: Restricting access to lethal means

8 2008/2009 Jan 2010 July 2011 Dec 2012 Evaluation (suicides, DSH, Attitudes) Limerick (Intervention region) Evidence based 5 level intervention Evaluation (suicides, DSH, Attitudes) Galway (Control Region) Baseline data collection Design Follow- up data collection

9 Baseline data for suicide rates in intervention and control regions 2005 & 2006

10 Baseline data for male deliberate self harm in intervention and control regions 2008

11 Baseline data for female deliberate self harm in intervention and control regions 2008

12 Suicide ca 500 p.a. Deliberate self harm medically treated ca. 11,000 p.a. “ “Hidden” cases of Deliberate self harm ca. 60,000 p.a. The role of positive mental health promotion in implementing the OSPI intervention programme Positive Mental Health Promotion

13 Examples of Positive Mental Health Promotion in OSPI  Increasing awareness of depression through Gatekeeper training among health care professionals (e.g. GPs, psychiatric nurses) and community facilitators (e.g. social workers, Gardai, youth workers, clergy)  Increased depression awareness will contribute to early identification of people with depression and self harm / suicide risk  Early identification of people at risk of depression and/or suicidal behaviour will contribute to early intervention

14 Examples of Positive Mental Health Promotion in OSPI ctd.  Reducing stigma associated with depression, suicidal behaviour and help seeking behaviour through an extensive public awareness campaign  Reduced stigma may positively affect:  quality of life for people with depression, impacting on employment status, educational options, and social opportunities  detection and treatment of depressive disorders  help-seeking behaviour  adherence to treatment

15 Learning from EAAD: Evidence for the effectiveness of positive mental health promotion Attitude change following Gatekeeper training P<.05

16 Learning from EAAD: Evidence for the effectiveness of positive mental health promotion Changes in confidence levels following Gatekeeper training P<.01

17 Social marketing The application of marketing concepts and tools to influence the behaviour of target audiences to achieve social goals The application of marketing concepts and tools to influence the behaviour of target audiences to achieve social goals Influencing behaviours of a target group so that the personal welfare within the group is enhanced Influencing behaviours of a target group so that the personal welfare within the group is enhanced 4 steps of social marketing 1. Problem identification 2. Defining target audience of marketing campaign 3. Development of technology for change 4. Evaluation

18 OSPI-Europe and Social Marketing 1. Problem identification Challenging inaccurate beliefs about depression and suicidal behaviour and replacing these stereotypes with factual information “Most people who harm themselves are not depressed” “Once a person has had suicidal thoughts, he/she will never let them go”

19 Core messages of OSPI-Europe “Depression can affect everybody” “Depression has many faces” “Depression can be treated”

20 OSPI-Europe and Social Marketing 2. Defining target audience of marketing campaign Target audienceTarget behaviour/outcome Level 1: GPs/ health workers in primary care Recognise signs of depression and suicidal behaviour. Treat and refer to psychological therapies as appropriate. Level 2: General publicIncreased literacy regarding depression and suicidal behaviour. Subsequent change in stigmatising attitudes towards depression and suicidal behaviour. Level 3: Community facilitatorsRecognise signs of depression and suicidal behaviour and promote help-seeking behaviours. Level 4: High risk groupsIncrease help-seeking behaviour. Availability of evidence based treatments. Level 5: Professionals in position to reduce access to lethal means Recognising signs of depression and suicidal behaviour and reducing access to lethal means (e.g. pharmacists, taxi drivers, undertakers)

21 1.Train-the-Trainer model 2.Advisory Panel 3.Strategic implementation of information/key messages 4.Widespread dissemination of materials to maximise saturation within target groups 5.Networking OSPI-Europe and Social Marketing 3. Development of technology for change

22 Efficacy of the intervention in reducing suicidal behaviour – changes in suicide and non-fatal suicidal acts Efficacy of the intervention in reducing suicidal behaviour – changes in suicide and non-fatal suicidal acts Evaluation of intermediate outcome criteria Evaluation of intermediate outcome criteria Changes in attitudes towards depression, suicidal behaviour and help-- seeking Changes in attitudes towards depression, suicidal behaviour and help-- seeking Questionnaires delivered before, immediately after, and 4 months following training programmes Questionnaires delivered before, immediately after, and 4 months following training programmes Telephone survey of general public at baseline and following the intervention period Telephone survey of general public at baseline and following the intervention period Process evaluation Process evaluation Context: the precise circumstances in which the intervention is introduced Context: the precise circumstances in which the intervention is introduced Mechanism: the precise way in which the intervention is carried out Mechanism: the precise way in which the intervention is carried out Standardisation? Standardisation? Sufficient funding? Sufficient funding? Political support? Political support? OSPI-Europe and Social Marketing 4. Evaluation

23 Contact details Claire Coffey, National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork. Tel

24 5 th Annual Forum Wednesday 28 th April 2010 Royal Hospital Kilmainham ‘Promoting Positive Mental Health and Reducing Stigma’

25 SAVING AND EMPOWERING YOUNG LIVES IN EUROPE – SEYLE-: The role of positive mental health promotion and social marketing in SEYLE Ms Jacklyn McCarthy

26 SEYLE A health promoting programme for adolescents in European Schools Austria Austria Estonia Estonia France France Germany Germany Hungary Hungary Ireland Ireland Israel Israel Italy Italy Romania Romania Slovenia Slovenia Spain Spain Sweden Sweden

27 SEYLE Project Objectives Gather info on health and well-being Gather info on health and well-being Interventions Interventions Evaluate Interventions Evaluate Interventions Recommend health-promoting models Recommend health-promoting models

28 Baseline Questionnaire Content Content –Healthy and Unhealthy Behaviours –Coping Styles –Self-Harm/ suicidality –Referrals to Health-care System All screened for emergency cases All screened for emergency cases Follow-ups: 3 months and 12 months Follow-ups: 3 months and 12 months All students completing questionnaire are given Contact Cards with contact numbers and s of services All students completing questionnaire are given Contact Cards with contact numbers and s of services Facilitator to advise where and how to seek help is available by telephone; text and 24/ 7 for the month of November and at reduced times thereafter to end of 2009 Facilitator to advise where and how to seek help is available by telephone; text and 24/ 7 for the month of November and at reduced times thereafter to end of 2009

29 Proposed Intervention Arms SEYLE study involves Second year students in mixed gender schools in Cork Kerry area SEYLE study involves Second year students in mixed gender schools in Cork Kerry area Three active interventions and one control arm implemented in 4 schools each (250 students per arm). Three active interventions and one control arm implemented in 4 schools each (250 students per arm). 1.QPR : Question, Persuade and Refer gatekeepers (teachers) to help them to recognise children with difficulties and assist them to access appropriate services 2.Professional screen: Baseline questionnaire screened those with problems are offered a brief clinical interview after parents/ guardians are notified 3.Awareness: Posters, Lectures and Role-plays of mental health topics 4.Minimal intervention: Posters only

30 Teacher Training QPR – Question, Persuade and Refer QPR – Question, Persuade and Refer –Question somebody displaying warning signs –Persuade them to seek help –Referral to appropriate health services

31 Professional Screening Screen Baseline Questionnaire Screen Baseline Questionnaire No problems – debriefing No problems – debriefing Problems – brief clinical interview Problems – brief clinical interview *Parent(s)/ Guardian(s) are notified Unless already attending services. Referral onwards to services if required

32 Awareness intervention “ Affect and Improve the way you feel ” 1. Lecture/Role-play topics Awareness about choices Awareness about choices Awareness about feelings and Awareness about feelings and how to manage stress and crises situations Awareness about depression and Awareness about depression and suicidal thoughts 2. Posters and Booklet –Awareness of mental health –Self-Help advice –Stress and crisis –Depression and suicidal thoughts –Helping a troubled friend –Getting Advice: Who to contact

33 Minimal intervention Complete questionnaires Complete questionnaires receive contact cards receive contact cards Posters Posters –Awareness of mental health –Self-Help advice –Stress and crisis –Depression and suicidal thoughts –Helping a troubled friend –Getting Advice: Who to contact

34 Self-Referral Self-recognise the need for help Self-recognise the need for help Contact an assigned facilitator Contact an assigned facilitator Further action taken, if necessary Further action taken, if necessary

35 Key Arm 1 QPR (4 schools): Arm 1 QPR (4 schools): Arm 2 Awareness (4 schools): Arm 2 Awareness (4 schools): Arm 3 Prof screen (4 schools) : Arm 3 Prof screen (4 schools) : Arm 4 Minimal Intervention Arm 4 Minimal Intervention (5 schools):

36

37 Preliminary results: baseline Total number of letters sent 1,602 Total number of letters sent 1,602 Total number of opt-outs 20 /1,124 Total number of opt-outs 20 /1,124 Total number of students filling questionnaires : 1,106 Total number of students filling questionnaires : 1,106 –Prof screen (Opt in including one TY Class) 191 –QPR (opt out in 3 schools/ opt in in one)237 –Awareness (opt out)340 –Minimal intervention (opt out/ 5 schools)338 Total number of “emergency” cases identified 78 Total number of “emergency” cases identified 78 Total number of “emergency” cases seen 26 Total number of “emergency” cases seen 26 –Total number of “real” emergencies 3 Total number of “prof screen” cases identified 48 Total number of “prof screen” cases identified 48 Total number of “prof screen” cases seen 20 Total number of “prof screen” cases seen 20

38 Social Marketing Application of marketing concepts and tools aimed at influencing the voluntary behaviour of target audiences to achieve social goals Application of marketing concepts and tools aimed at influencing the voluntary behaviour of target audiences to achieve social goals Aims to achieve behavioural change that will benefit the target audience and society Aims to achieve behavioural change that will benefit the target audience and society Social Marketing & SEYLE Audience – 2 nd year/ transition year students Audience – 2 nd year/ transition year students Specific Behaviour – Help seeking behaviour Specific Behaviour – Help seeking behaviour Research & evaluation core of SEYLE Research & evaluation core of SEYLE Learning what young people want & need Learning what young people want & need

39 Audience Target Behaviour Social marketing Parent/Guardian Awareness of mental health Opening the lines of communication between the parent & the young person Acceptance & recognition of services available to young people Information pack Information evening SEYLE website Telephone call/letter School Important role of mental health promotion in the school setting Awareness of mental health services available to young people Information pack Information evening SEYLE website Identification of young people through the questionnaire Teachers Empowering teachers to recognise a young person who is displaying signs of difficulty Assisting a young person in getting help Booklet Roleplays QPR Training Lectures Contact card Young People Greater awareness of mental health & related topics Enabling & encouraging young people to get help Booklet Roleplays Awareness Sessions Posters Contact card

40 Satisfaction with the Awareness programme: Self-rated knowledge & understanding

41 Overall satisfaction with elements of the Awareness programme

42 Satisfaction with the Awareness Booklet

43 Satisfaction and use of the contact card:-

44 Preliminary results: 3 month follow-up and data entry 3 month follow-up mostly completed in March ’10 3 month follow-up mostly completed in March ’10 All schools participated: Total numbers: 986 All schools participated: Total numbers: 986 –Awareness:262 –Prof screen:165 –QPR: 209 –Control:350 Total number of “emergency cases” identified 35 Total number of “emergency cases” identified 35 Feedback received regarding interventions. Feedback received regarding interventions. –Dissonance between apparent honesty of students in completing questionnaire and resistance regarding parents being informed. Still major difficulties arranging follow-up interviews. Still major difficulties arranging follow-up interviews. Late increase in interest in facilitator number! Late increase in interest in facilitator number! - Baseline – 2 contacts - Baseline – 2 contacts - 3 month follow-up – 6 contacts (3 people) - 3 month follow-up – 6 contacts (3 people)

45 Contact us National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork. National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork. Tel: Tel: Web: Web: Dr. Helen KeeleyDr. Paul Corcoran Dr. Helen KeeleyDr. Paul Corcoran Dr. Carmel McAuliffe Padraig Cotter Dr. Carmel McAuliffe Padraig Cotter Jacklyn McCarthy


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