Modelling of suicide prevention systems and intervention supports community-based outreach approaches and alternatives to emergency department care in New South Wales

Strategies to Prevent Suicide and Attempted Suicide in New South Wales (Australia): Community-Based Outreach, Alternatives to Emergency Department Care, and Early Intervention

by Eileen Goldberg, Cindy Peng, Andrew Page, Piumee Bandara, and Danielle Currie

Published 31 May 2023

What's the issue?

Researchers of this study suggest that suicide prevention strategies for priority populations often consist of two approaches: selective interventions or indicated interventions.

Selective interventions are targeted at groups at greater risk of suicidal behaviour, such as rural communities or people who have previously self-harmed. Examples include gatekeeper training for community members and training frontline health workers.

Indicated interventions are aimed at individuals already displaying signs of suicidal behaviour. Aftercare is an example of an indicated intervention, focussed on providing someone proactive care and support following a suicide attempt.

A systems approach to suicide prevention that includes both intervention types has been recognised as the most effective to prevent suicide for priority populations. However, it is difficult to determine the exact effectiveness of each intervention type at the population level when multiple interventions are conducted as part of the systems approach.

What was done?

The researchers developed a system dynamics model to project the impact of different interventions undertaken in New South Wales to identify the following:

• What suicide prevention activities are likely to deliver the greatest reductions in self-harm hospitalisations and suicide deaths in NSW
• What system-level factors driving population-level changes in suicide and self-harm outcomes occur following the implementation of suicide prevention interventions.

The research team developed a dynamic modelling system to answer the above research questions. The modelling system was informed by published research, administrative data, two participatory online workshops, out-of-session stakeholder consultations, and two demonstration forums held between October 2020 and June 2021.

The dynamic modelling system included six interventions:

• Post-suicide attempt aftercare support
• Gatekeeper training
• Peer-led drop-in facilities
• Expansion of clinical counselling workforce in rural communities
• Community-based suicide-prevention outreach teams
• Broader enhancements in peer support and peer-led initiatives.

All interventions were simulated for 2019 to 2023 (inclusive).

What was found?

Researchers ran the dynamic modelling system to determine which suicide prevention intervention approaches were predicted to be most effective in preventing suicide attempts and deaths.

Between 2019 and 2023, under a “business-as-usual” baseline scenario, the model projected that the number of people in NSW who attempted suicide was expected to increase by 13% over the five years and the projected number of people who died by suicide to increase by 11%.

When suicide prevention intervention approaches were examined using the dynamic modelling system, it was found that 6.3% of cases of attempted suicide and 6.8% of cases of suicide could be averted.

Researchers examined the effectiveness of selective and indicated interventions to achieve a 20% reduction in suicide-related deaths in NSW and found that selective and indicated interventions could contribute almost half of the NSW target of a 20% reduction in suicide deaths. It was also found that these interventions could divert 8.7% of individuals away from hospital encounters.

Model findings also suggest that while short-term reductions in suicide can be achieved by focusing on individuals at high risk of experiencing a suicide re-attempt, the resources required to undertake these indicated interventions may be at the expense of longer-term reductions in suicide through the prevention of suicide attempts in individuals who have yet to experience a suicide attempt.

Why are findings important?

Systems dynamic modelling can help identify which interventions are most likely to reduce suicide and which interventions work best together to achieve the greatest reduction of suicides.

Modelling is an informed way to support the development of effective suicide prevention policies and strategies and effective targeting of resources.