1. The Development and Implementation of a suicide prevention initiative: The Traffic Light Safety Plan
Presented by Dr Elizabeth Preston and Edward Zeballos
Older People’s Mental Health Service (OPMH), NSW Health

2. The Development and Implementation of a suicide prevention initiative: The Traffic Light Safety Plan
Project Leaders:
Dr Elizabeth Preston – Clinical Psychologist, OPMH community
Edward Zeballos - Clinical Nurse Consultant, OPMH Acute Inpatient Unit
Dr Dev Lakshmanan – Psychiatrist, OPMH Acting Director
Jeni Martin – Clinical Psychologist, OPMH; Acute Inpatient Unit
James Bradbury - Clinical Nurse Consultant, OPMH Community
EDDIE

3. Suicide prevention
In Australia, 3128 people died from intentional self-harm in Research indicates these rates continue to rise.
The Australian death rate for 2017 was 12.6 deaths per 100,000 persons. Approx. 46th in the world
On 26/09/2018 the government allocated $36m to suicide prevention projects
Lifeline received close to 1 million calls in 2018 and on average helped 115 people make a safety plan each day
EDDIE
The health minister, Greg Hunt, announced (on 26th September 2018) the government had allocated $36m to suicide prevention projects.

4. LIZ
-suicide rates for the past 10 years, upwards trend, males being more likely to engage in intentional self harm. Actual figures are likely in fact higher as some deaths from suicide go unrecognised.
-Clearly suicide prevention interventions are needed

5. Rationale / Background
Consumers discharged from mental health inpatient units have a markedly increased risk for suicide compared to other consumers with mental health issues
An Australian meta-analysis of over 100 studies concluded:
Suicide prevention should commence during the inpatient admission
Suicide prevention strategies ought to continue once the person is discharged
LIZ
-as per slide

6. LIZ
-In response to this research, the Director of Mental Health in our local health district send out a memo recommending all consumers being discharged from a mental health unit receive a safety plan as part of discharge planning

7. Aim of current research project
To develop a formalised procedure and format for the design and implementation of consumer safety plans as part of suicide prevention strategies
To give consumers and family opportunity to ‘raise their voice’ about suicide and the design of their safety plans
The project is initially targeting all consumers discharged from the OPMH Acute Inpatient Unit, Wollongong Hospital
View to expand to other mental health inpatient units following evaluation
EDDIE
-raise you voice theme needs to be touched on

8. The Traffic Light Approach
The ‘traffic light’ approach is an easy to understand colour coded system to:
identify levels of suicidality
communicate levels of distress
choose appropriate strategies/responses
LIZ
The ‘traffic light’ format offers an easy to understand colour coded system to identify levels of suicidality, communicate levels of distress, and choose appropriate strategies/responses
A brief literature review was conducted to explore the use of the ‘traffic light’ format in mental health:
Various studies have applied the red-amber-green colour codes to communicate consumer’s level of risk/care planning amongst mental health staff [3-5]. The colour coded approach has also been used to help consumers identify and communicate levels of distress [6-8]. No other similar suicide safety plans using the traffic light analogy and format were identified.

9. Format
The ‘red’ category relates to high levels of suicide tendencies, recommending:
contacting mental health helpline
immediately telling a family member or friend
presenting to the emergency department
calling emergency services (if required)
The ‘amber’ category relates to moderate levels suicide tendencies, recommending:
contacting the community mental health team for support
individualised distress tolerance and distraction strategies
The ‘green’ category relates to low levels of suicide tendencies, recommending:
individualised strategies aimed at maintaining wellbeing
Eddie

10. TRAFFIC LIGHT SAFETY PLAN WHEN TO USE THIS PLAN
OLDER PEOPLE'S MENTAL HEALTH SERVICE
Name, Date
TRAFFIC
LIGHT
SAFETY
PLAN 
WHEN TO USE THIS PLAN
This plan should be used if you are feeling very upset
(i.e., thoughts of suicide or self harm, or feeling overwhelmed, panicky, anxious, or hopeless).
It provides ideas for helping with these feelings, because sometimes it is hard to think clearly when you are feeling very upset.
You may wish to talk about this plan with your family so that they can encourage you to use this plan if needed.
SAFETY WARNING
It is strongly recommended that you dispose of old/unused medications to your pharmacy. For your safety, please remove items at home that could be used to cause harm (e.g., weapons).
Liz
-The next few slides show a same safety plan. This is the cover of the plan which outlines when to use the plan and encourages consumers to talk about the plan with their family.
-It includes a safety warning recommended consumers dispose of unused medications or other means to suicide as we know that availability to a means is a significant risk factor in suicidal consumers.

11. MY TRAFFIC LIGHT SAFETY PLAN
WHAT’S HAPPENING?
WHAT TO DO?
Strong thoughts about Suicide
Strong thoughts about Self Harm
Conflict with Family
Feeling very depressed
Making a Plan to take my Life
Making Plan to hurt myself
Can’t sit still
Crying
Feeling very bad
Cannot cope
Tell one of the Staff (if in facility)
Tell Support Person _____
Call the Mental Health Helpline
Call 000 if you need Emergency Help
VERY
UPSET
QUITE
UPSET
WHAT’S HAPPENING?
WHAT TO DO?
Thoughts about Suicide
Thoughts about Self Harm
Thinking that ______
Worry about _____
Feeling guilty about _____
Lying down a lot
No energy
No enjoyment in anything
Don’t want to do anything
Practice the Amber Ideas for how to cope
Call your Case Manager _____
Ph: during office hours Mon-Fri 8.30am-5pm
Talk to Support Person _____
LIZ
The second page outlines what the consumer may be experiencing in each of the red, amber, and green zones. Each of these symptoms is individualised to each consumer. On the right we see a brief ‘what to do’ section as a quick reference. In the following pages the ‘what to do’ section is expanded for the amber and green zones.
A LITTLE UPSET
WHAT’S HAPPENING?
WHAT TO DO?
Short-lived thoughts about Suicide
Short-lived thoughts about Self Harm
A few worried thoughts
Not doing much activity
Not feeling like going out
Feeling a little nervous
Feeling a little down
Use the Green ideas for How to cope
Talk to Support Person ______

12. HOW TO COPE IF I AM QUITE UPSET
Comfort Yourself
Make a coffee & sit outside in the sun
Read
Read A good book
Relaxation
Do your Breathing – 3 counts in… hold 3 counts… breathe out 3 counts
Talk to Support Person/Care Staff
Be open about your thoughts and feelings
Have a lie down on your bed/lounge
Relax your body and get some comfort
Distraction
Focus on something else
Plan a holiday 
Think of happy times
Watch some TV
Make a cuppa
QUITE
UPSET
Liz
Here we see an example of strategies to engage in when ‘quite upset’ or the ‘amber zone’. Again these are individualised to the person but some typical examples include distraction strategies, self soothing, engaging with family, relaxation strategies.

13. HOW TO COPE IF I AM A LITTLE UPSET
Still keep your plans for the day (e.g., coffee with sister, walking the dog)
Do a small chore (e.g., brush the dog, put dishes away)
Remember to think positively 
Keep yourself occupied with activities (e.g., find-a-word, knitting, paint nails, baking)
Remember your Strengths and that you are a strong person with a strong mind.
Liz
And here we have an example of strategies in the green zone or if the person is ‘a little upset’
A LITTLE
UPSET

14. PARTICIPATING SITES
This project will be implemented across OPMH settings:
OPMH Acute Inpatient Unit
OPMH Community Team, Illawarra
OPMH Community Team, Shoalhaven
EDDIE

15. STUDY DESIGN AND OUTLINE
This project based on an Action Research approach
This project has 4 phases:
Planning
Action
Observation
Reflection
LIZ
The process consists of continual self-reflective cycles involving, planning in order to initiate change; Implementing the change and observing the responses; and reflecting on processes of change. More specifically for this project planning the design and implementation of the safety plans, implementing the safety plans and gathering feedback from consumers and their families, reflecting and making an needed adjustments.

16. Phase 1: PLANNING
Regular meetings with project leaders since December 2018, initially focusing on developing draft safety plans
Subsequently the development and implementation of safety plans with appropriate consumers
The planning stage will also involve collaboration and feedback from the Consumer Peer Workforce and Official Visitors
Development of a family focused safety plan
Eddie
Consumers will have a family focused safety plan developed as part of clinical intervention

17. PROCEDURE
LIZ
This slide outlines the procedure for developing a safety plan in the research project.
New admission who is involved in a MH assessment
Staff develop a safety plan with the person and following this we get feedback from them about the process
Support to use the safety plan during the admission if needed. This includes updating the safety plan as staff learn about the consumer’s warning signs and strategies. At this point the research project will get feedback from staff who have been involved in developing safety plans.
During discharge planning, the safety plan with be discussed with the consumer’s family and the community mental health team
Following discharge, the community team will follow-up consumer’s use of plan, make any edits. As part of the research project, the consumer will be invited to complete a short survey 3 months post discharge about their use of the plan.

18. Preliminary feedback
“Helps me know when to go to the hospital and when to manage my feelings myself”
“I love this plan, I’ve had mental health issues for decades but I’ve never seen something like this”
Helps family members feel more confident in ways to support their loved one
Helps transfer of care from inpatient unit to community team
Facilitates care planning by ED and Mental Health Helpline staff
liz

19. If successful How can this project be introduced area wide?
AIM Plan
Define the Change
Build Agent Capacity
Assess the Climate
Generate Sponsorship
Change Approach
Target Readiness
Build communicating plan
Develop reinforcement strategy
Create cultural fit
Implementation Risk Forecast
Monitoring and Evaluation
EDDIE

20. REFERENCES