Safe spaces provide an alternative support to conventional mental health and hospital services for those in suicidal crisis. They are usually operated by peer workers with a lived experience of suicide who are well-placed to provide an atmosphere of safety and understanding, as well practical advice.
A team of researchers at the Australian National University have recently won a $1.35 million federal government grant to examine the effectiveness of Safe Spaces in the ACT and NSW over three years.
This research follows significant investment and successful and ongoing implementation of safe spaces (also called safe havens, safe places, or safe haven cafes) in Victoria, NSW, Queensland, WA and Tasmania by various other organisations and community groups. These have been very well received by the community, with positive consumer feedback and outcomes such as decreasing emergency department presentations and reducing emergency department waiting times. However, the body of peer-reviewed literature on safe spaces is lacking.
The Life in Mind team spoke to Associate Professor Michelle Banfield, who leads the team at the Australian National University, about her research into safe spaces.
Can you tell us about your current project to evaluate safe spaces and the outcomes you are intending to look at?
The 'Co-creating safe spaces' project is a lived experience-led, co-created project to evaluate various safe space and safe haven models across Australia. It’s important to say upfront that we will launch the project with a co-design workshop, including all the project partners and further people with lived experience. This is to ensure the evaluation approach and outcomes are practical and relevant to the people who access the safe spaces, those running them and the systems they are part of. All this means that our approach may change.
The project is developed on a framework called RE-AIM, which stands for Reach, Effectiveness, Adoption, Implementation and Maintenance. This is a comprehensive way of evaluating programs, as it focusses on processes and outcomes for individuals and for systems.
Our central focus is on the people accessing (or who could potentially access) the safe spaces. We will explore who does and doesn’t access the safe spaces to understand if they are meeting needs. We will also look at whether they effectively reduce emotional distress and suicidal crisis, and improve wellbeing, including for the staff running the spaces, who are primarily peer workers. Alongside those factors, we will also look at how the safe spaces fit within local systems, the processes of setting them up focussing on co-design, and what will be required to make them permanent, including cost-effectiveness.
What role do you see safe spaces having in the suicide prevention landscape in Australia?
Although there are various safe space models, what they have in common is that they are non-clinical approaches. Acute healthcare such as an emergency department, is rarely a good space for someone experiencing severe emotional distress or a suicidal crisis. Safe spaces are designed to offer somewhere people can go to reduce distress through activities such as a conversation with a peer worker or engaging in a sensory room.
They are co-designed with local communities, including people with lived experience, so they feature tried and true methods for reducing distress without making it all about illness.
Evaluations of early models even suggest that they can play an early intervention role, creating somewhere people can go as they start to experience distress but before they reach crisis.
In what ways do you think lived experience can contribute most significantly to suicide prevention?
Lived experience is central to suicide prevention. The expertise that comes with personally navigating both a crisis and a confusing system, or being a family member or friend trying to support someone to do so, cannot be found elsewhere. There is space for multiple forms of expertise in suicide prevention, and the multi-approaches are the most likely to succeed with such a complex area. Professional expertise is a part of the picture, but we need to ensure that best intentions don’t get in the way of what it is like to experience the system.
What do you believe is the most pressing issue in suicide prevention in Australia?
That’s a tough one, I believe there are many areas that are equally as important. As a wise member of our Advisory Group once said to me, people with lived experience don’t want to prioritise research topics because everything is important and anywhere you start is therefore tackling something important. I have an interest in where the gaps are in our system that people can so easily slip through, which is why safe spaces interest me, but that’s just one of the things I see as pressing.
Can you share with us one of your top tips for self-care?
Be kind to yourself. It sounds cliched, but it is central to most other things we can do. If I find that anxiety is building, I ask myself if this will matter in a week, a month, a year. Most of the time, the answer is no, and the feeling of being overwhelmed will start to subside. I then try to think about what I would say to someone else going through the same thing and give myself the same care. I would definitely use a safe space as part of my self-care plan, as this brings in other people and ways of taming the strong thoughts and feelings.
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