Presentation is loading. Please wait.

Presentation is loading. Please wait.

Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM.

Similar presentations


Presentation on theme: "Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM."— Presentation transcript:

1 Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM

2

3 Nearly 1 million people in 2007

4

5

6

7

8

9 SUICIDES AS A PROPORTION OF ALL DEATHS ABS,20073303.0

10 Revised suicide rates under both scenarios did not significantly differ from recorded suicide rates based on 95% confidence intervals.

11

12  Big changes have occurred over 12 years  The changes in youth suicide could be described as dramatic (55% reduction)  They appear to be real, despite any possible misclassifications  It is tempting to suggest that the National Strategy ± state strategies may have had some impact

13 “The recent sudden turnaround in Australian young male suicide trends and its extent appears to preclude explanations centering on slow-moving social indices traditionally associated with suicide, or on possible cohort effects. This sudden decrease has occurred mainly in non-impulsive means, and at the same time has broken a long-standing secular link between 20-24 yr male suicide and unemployment, lending plausibility to the case for the NYSPS having had an impact on young male suicide in Australia.”

14

15 There are 2 issues within the rates which need to be addressed: Rural and Remote Status, and Rural and Remote Status, and Socio-economic Status Socio-economic Status

16 Australian suicide rates by urban-rural residence, 1979-2003 (rate per 100,000) Page A, Morrell S, Taylor R, Dudley M, Carter G. Further increases in rural suicide in young Australian adults: Secular trends 1979-2003. Soc Sci Med. 65(3): 442-53.

17 Page A, Morrell S, Taylor R, Carter G, Dudley M. Divergent trends in suicide by socio-economic status in Australia. Soc Psychiatry Psychiatr Epidemiol 2006;41(11):911-7. Australian suicide rates by low, middle & high SES, 1979-2003 (rate per 100,000)

18

19 Harding et al., 2006. NATSEM

20

21 MaleFemaleTotalRank% All deathsOR Suicide (X60-X84) Indig Aust 74291035 4.2 2.8 Non-indig 1,5884442,03214 1.5 Accidental Poison. (X40-X49) Indig Aust 24133714 1.5 3.75 Non-indig 40815656439 0.4 Assault (X85-Y09) Indig Aust 22153714 1.5 15 Non-indig 1006216251 0.1

22  This brings us to the crucial issue of the origins of suicide.  On the one hand we know that suicide is a behaviour related to mental illness and occurring at the end point of despair  On the other hand, there are social and cultural conditions which contribute to the development of mental health problems and despair

23

24  Support high risk through Suicide Prevention Centre (I)  Post-discharge contact with psychiatric inpatients (I) (3%)  Education for GPs (II)  Drug treatments and ECT (II)  Improved Prescribing (eg SSRIs) (III) (4%)  Suicide Prevention Centres (III)  Group treatment for depressed and suicidal (III)  Media restrictions on reporting (III)  Legislation of Drugs (eg Barbiturates) (III)  Support high risk through Suicide Prevention Centre (I)  Post-discharge contact with psychiatric inpatients (I) (3%)  Education for GPs (II)  Drug treatments and ECT (II)  Improved Prescribing (eg SSRIs) (III) (4%)  Suicide Prevention Centres (III)  Group treatment for depressed and suicidal (III)  Media restrictions on reporting (III)  Legislation of Drugs (eg Barbiturates) (III)

25  “National suicide prevention strategies have been proposed despite knowledge deficits about the effectiveness of some common key components  the most promising interventions are physician education, means restriction, and gatekeeper education. Many universal or targeted educational interventions are multifaceted, and it is not known which components produce the desired outcome”

26 National Strategies are successful if they provide…  communication program to the whole population  education for relevant groups (‘gatekeepers’)  reduced access to means (bridges, firearms, etc)  a strategy on drugs and alcohol  a critical mass of clinical services with relevant and sufficient highly trained professionals  improved services managing suicidal people, as well as improved linkages with the community  proper evaluation with a formative approach  a strategy for Indigenous peoples

27 A large number of people at small risk may give rise to more cases of disease than a small number of cases at high risk A population strategy of prevention is necessary where risk is widely diffused through the whole population. Rose, Geoffrey, The strategy of preventive medicine. Oxford University Press, 1992

28 Low High Suicide risk Mortality threshold threshold Population Move population population risk risk

29 Mental Health Promotion

30  70+ Projects funded, covering:  Primary prevention and cultural change  Early Intervention  Crisis Intervention  Treatment, support and postvention  Access to Means/Injury prevention  $31m+ (over 4 years)  National Advisory Council Valuing Young Lives, Penny Mitchell, Australian Institute of Family Studies, 2000

31  Process Indicators are available for:  Professional training (eg in parenting programs)  Gatekeeper training (eg KYA & GPs - 7% or 3500)  Curricula for schools  Media Resource Kit  Training for Telephone Counsellors  Crisis/Hospital Emergency Departments  Community Development projects Valuing Young Lives, Penny Mitchell, Australian Institute of Family Studies, 2000

32  Impact Indicators  Clinical programs (“some evidence”)  Population level impacts (“no evidence exists”)  Outcome Indicators (only a few available)  Clinical programs  3 programs in mental health services  1 program in Accident & Emergency  Parenting programs  Telephone counselling services  Programs for marginalised youth Valuing Young Lives, Penny Mitchell, Australian Institute of Family Studies, 2000 The Evaluation Experience, Jonine Penrose-Wall et al., NYSPS Evaluation Working Group, 2000

33  Many, if not most, of the smaller programs simply completed their course, were not refunded, and their long term impact at a local level is unknown  A few programs acted as springboards for larger, better programs  Some of the larger programs have lasted to the present day and continue to have impact at a national level

34

35  Achieving the Balance (Suicide Prevention Australia, 1998) negotiated widely with Media to provide clear, relevant advice.  Then, a new National Media & Mental  Health Committee commissioned:  major literature review  1-year prospective research  revised guidelines  www.MindFrame-Media.info  Achieving the Balance (Suicide Prevention Australia, 1998) negotiated widely with Media to provide clear, relevant advice.  Then, a new National Media & Mental  Health Committee commissioned:  major literature review  1-year prospective research  revised guidelines  www.MindFrame-Media.info

36

37

38

39

40

41

42

43

44

45 In the 18 years before the 1996 gun law reforms, there were 13 mass shootings in Australia, and none in the 10.5 years afterwards. Declines in firearm-related deaths before the law reforms accelerated after the reforms for total firearm deaths (p 0.04), firearm suicides (p 0.007) and firearm homicides (p = 0.15), but not for unintentional firearm deaths, which increased. No evidence of substitution effect for suicides or homicides was observed. S Chapman, P Alpers, K Agho, M Jones, Injury Prevention 2006;12:365–372

46 MALEFEMALE 0-1415-240-1415-24 Amitryptiline1727 Dothiepin2198724 Doxepin19941178 Fluoxetine852632134 Other27,292408349402845 Total27,4917,13450447417 ABS, 1999 Total: 47,086

47 704,200 young people used psychotropics  41,548 (5.9%) Citalopram  25,351 (3.6%) Paroxetine  51,407 (7.3%) Sertraline  11,972 (1.7%) Other SSRI  20,422 (2.9%) Venlafaxine  12,676 (1.8%) Tricyclics  12,676 (1.8%) Other Antidepressant  10.1% Anxiolytics  83.5% other including 69.2% Vitamins and Minerals Table 15, page 36 Ausstats 2005 = 18.5% 130,277 Total SSRI prescriptions

48

49

50  No change in rates of depression between 1995 and 2005 (ABS: Mental & Behavioural Problems, 2005)  More children <17 years were homeless and sought help through Supported Accommodation Assistance Program (SAAP) (AIHW)  Reported cases of child abuse rose from 91,734 to 115,471 during the period 1995/6-2000/1  Number of children placed in out of home care rose from 14,078 to 18,241 during the period 1997 - 2001

51 129/12,0061.1%129/12,0061.1%

52 Of those who self-injured in the month prior to survey, 48.4% also experienced suicidal ideation in the month compared to only 7.7% of those who did not self-injure (OR 11.25, 95% CI 7.88-16.06). However, only 14 of 133 one-month self- injurers (10.5%) also reported a suicide attempt in the previous 12 months. Despite the small number, the rate is high compared to non-self injurers (33 of 11,873, 0.28%) (OR 41.60, 95% CI 21.32 – 81.18).

53 Meta-analysis of 331 Coronial Studies  65 studies met criteria;  Subject N = 19,347;  Alcohol discovered in 81.7% suicides;  22.7% intoxicated at time of death (Blood Alcohol Concentration ≥ 100mg/dL Smith, Branas and Miller, 1999 Meta-analysis of 331 Coronial Studies  65 studies met criteria;  Subject N = 19,347;  Alcohol discovered in 81.7% suicides;  22.7% intoxicated at time of death (Blood Alcohol Concentration ≥ 100mg/dL Smith, Branas and Miller, 1999

54  DENMARK (1916-17) prices up, suicide down Skog, 1993  RUSSIA (1984-88) restrictions on Vodka sales following Perestroika led to reduced suicide Wasserman et al., 1994  UNITED STATES (1970-89) states with lower spirit consumption have reduced suicide Gruenewald et al., 1995  ICELAND (1989) legalization of strong beer / reduced spirits / decrease in suicide rate Lester 1999  DENMARK (1916-17) prices up, suicide down Skog, 1993  RUSSIA (1984-88) restrictions on Vodka sales following Perestroika led to reduced suicide Wasserman et al., 1994  UNITED STATES (1970-89) states with lower spirit consumption have reduced suicide Gruenewald et al., 1995  ICELAND (1989) legalization of strong beer / reduced spirits / decrease in suicide rate Lester 1999

55  Strong association between drinking and attempts in 13 year olds (Time 1) (chi-square 220.5, p<0.0001)  15.9% of those drinking >1/week claimed an attempt, compared to 0.9% for those claiming never (Odds ratio 17.3).  Strong association between drinking and attempts in 13 year olds (Time 1) (chi-square 220.5, p<0.0001)  15.9% of those drinking >1/week claimed an attempt, compared to 0.9% for those claiming never (Odds ratio 17.3).

56  357 deaths attributed to opioids in 2004, ages 15 to 54 years.  Males comprised 78% of the deaths  Ten-year breakdown of deaths attributed to opioids in 2004 showed:  43% were among the 25-34 year age group,  28% in the 35-44 age group,  18% in the 45-54 age group,  10% 15-24 age group. Degenhardt et al.,2006. National Drug and Alcohol Research Centre.  357 deaths attributed to opioids in 2004, ages 15 to 54 years.  Males comprised 78% of the deaths  Ten-year breakdown of deaths attributed to opioids in 2004 showed:  43% were among the 25-34 year age group,  28% in the 35-44 age group,  18% in the 45-54 age group,  10% 15-24 age group. Degenhardt et al.,2006. National Drug and Alcohol Research Centre.

57  Non-suicidal patients can all defend notions of continuity of the self  80% of suicidal patients can mount no argument about continuity (self or other)  Failures in ‘self’ continuity ‘predict’ suicide risk (Ball & Chandler, 1989; Lalonde & Ferris, 2001)

58  Euro-American culture & Essentialism  Self & knowledge are individualistic  Aboriginal culture & Narrative  Self is relational  Knowledge is communal/cultural product  Identity is defined by Place (on the land), and is fashioned out of materials made available by culture Lalonde 2006

59 Courtesy: Michael Chandler University of British Columbia

60

61  In a very recent study (Patrao, Page, Martin - unpublished paper ex a masters thesis)  Postcodes with access to 6 NYSPS programs or more had a significantly lower young male suicide rate (34.5 per 100,000) compared to areas with little activity (38.8 per 100,000)  Relative risk of suicide in highest SES group with greatest level of preventive activity was 0.91 (0.81-1.02) compared to the lowest SES group with no activity.  We are currently reworking the analysis…

62  When designing programs we need a balance between increasing protective factors and reducing risks  Universal approaches to improve ‘resilience’ and ‘connectedness’  We need to raise awareness about issues, alert people to avenues for care, and provide tools to further their skills  We need clear and supported pathways to care  I offer you an example…

63 ‘Mates in Construction’ Constructing a Healthy Industry in Queensland

64 A suicide prevention and social capacity building program, with a vision for resilient & resourceful apprentices and workers, confidently facing life challenges. ‘Mates in Construction’

65 What does it do? General awareness training about mental health problems and the problem of suicide (ASIST etc) General awareness training about mental health problems and the problem of suicide (ASIST etc) Life Skills Toolbox raises awareness of health and wellness, provides strategies, encourages access to care Life Skills Toolbox raises awareness of health and wellness, provides strategies, encourages access to care ‘Connectors’ provide links to existing services ‘Connectors’ provide links to existing services Provides an access line for crisis management and referral Provides an access line for crisis management and referral Deals with serious problems immediately Deals with serious problems immediately

66 “I was providing General Awareness Training to a group of apprentices when I noticed one of them affected by the presentation. In the break he said – “John, I was ticking all the boxes! All that stuff about the signs of suicide fits one of my mates. I think we might stand at his grave one day and say – If only we had known!”. We contacted the young man’s parents. They confirmed he had been thinking about suicide, and decided on when and where to do it as well… See this young apprentice may just have saved a life; it just does not get much better than that!”

67

68

69 Client NumbersNumber% New182 Archived105 Active77 Age 15-241314 25-342425 35-443334 45-552122 56+55

70 OzHELP Problem LISTCases% Relationship6311 Financial559 Family549 Work related407 Alcohol356 Legal325 Personal Injury/Health325 Anger325 Drug315 Suicide Ideation305 Employment285 Mental Health Problem (diagnosed)234 Fatality/Grief203 Suicide Intervention132

71  A part of me still believes in the importance of reducing risk factors - unemployment, socio- economic exclusion, abuse, depression.  But the programs from the NYSPS which have endured, and have continued to have long term impact, are about resilience, connectedness, increased awareness, clear information for when crises occurs, and help-seeking.  We need to develop an attributable impact ratio (AIR) (cf. attributable risk or protective fraction) to get a clearer handle on just what works in the long term.


Download ppt "Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM Professor Graham Martin OAM MD, MBBS, FRANZCP, DPM."

Similar presentations


Ads by Google