Safe spaces

Safe spaces are becoming an important alternative to suicide prevention in clinical settings.

Many people present to Emergency Departments experiencing suicidal thinking, unsure of where else to go. However, Emergency Departments are complex clinical environments that are not always the most appropriate point of care for people experiencing mental distress.1-2

Safe spaces is an umbrella term referring to non-clinical, peer-led supports for people in suicidal crisis. These spaces aim to provide an alternative to conventional mental health and hospital services, and are usually operated by peer workers with a lived experience of suicide.
 
Safe spaces (also known as safe havens or safe haven ‘cafés’) do not replace clinical mental health interventions, but rather help people navigate the mental health system, connect them to local services and encourage people to develop self-management skills to maintain their mental health.4

The model was first used by the NHS in Aldershot, UK in 2014 and provided a foundation for future Safe Havens, based on a reduction of mental health hospital admissions.5

This model was first trialled in Australia in 2018, with a service co-located at St Vincent’s Hospital in Melbourne, Victoria.

The Melbourne service has since inspired the introduction of hybrid models in Queensland, New South Wales, Tasmania and Western Australia.6

Safe spaces in communities

The Safe Haven concept was initially based on the UK mental health charity Mind’s 2011 independent inquiry into acute and crisis mental health services.7 This research found that people wanted a safe place to go in times of crisis, to be treated in a caring and respectful way, with a reduction in the medical emphasis of usual acute care. The report also acknowledged the benefits of peer support. 

Safe Haven Café - Aldershot, UK

The first Safe Haven Café opened in 2014 in Aldershot, UK, providing an evening drop in service. The café is staffed by trained psychiatric nurses and other mental health professionals as well as peer supporters. Anyone experiencing a mental health problem, diagnosed or not, can drop in for a cup of tea and a chat and can request more formal help if needed. A study carried out for Surrey and Borders Partnership NHS Foundation Trust (SABP) by Mental Health Strategies showed that from April to October 2014 there was a 33% reduction in the number of admissions to acute in-patient psychiatric beds within the Safe Haven’s catchment area.5,8

Safe Haven Café - St Vincent’s Hospital, Melbourne, Victoria

One in nine patients who presented to the St Vincent’s Hospital Emergency Department (ED) from 2015 to 2017 cited mental health as their primary reason for attending.
 
Modelled on the Aldershot Safe Haven Café, the Safe Haven Café at St Vincent’s Hospital was established in 2018 as a non-clinical, therapeutic alternative for those needing assistance but not emergency care. It offers respite and peer support to help build resilience and capacity for people to self-manage their mental health in the community.

A review of the service conducted by PwC9 reported: 

  • Improved consumer experience of care and sense of social connectedness in the local community
  • Reduced mental health presentations to the hospital’s ED, freeing up capacity and potentially reducing treatment delays for other ED patients
  • Estimated savings of more than $30,000 per annum by diverting consumers from the ED to a more appropriate model of care.9

Café visitors said they felt ‘welcome’, ‘safe’, ‘comfortable’ and ‘relaxed’. They also reported gaining a sense of hope, feeling valued, heard and seen, and that the café helped them connect with people. This improved their confidence in settings outside of the café, enabling them to make other positive changes in their lives.5

NSW Safe Havens

The NSW Government has allocated more than $25 million for 20 new services over three years, under the Towards Zero Suicides initiatives.

Known as Safe Havens, the centres are usually based close by to hospital grounds, with suicide prevention staff, peer workers and/or mental health clinicians on hand to offer emotional support and information on available services.

Objectives include:

  • Reducing deaths by suicide, suicide attempts and self-harm
  • Providing immediate, personalised, compassionate care
  • Connecting people to support services to address the underlying factors of their distress
  • Reducing pressure on Emergency Departments

So far, seven sites are active across NSW, with the additional sites due to open during the second half of 2021.2

Queensland

The 2019 Queensland budget announced $10.8 million to establish eight safe spaces based on the Safe Haven Café model and staffed by mental health clinicians and peer support staff. The initiative will offer a safe, caring and respectful environment along with peer support to empower people looking for assistance, but not needing acute care.4

WA

Two Safe Haven Cafés opened in WA in early 2021, and are now providing an alternative to emergency departments for people with mental health issues experiencing distress. They are at Royal Perth Hospital and Kununurra District Hospital.10

Tasmania

A mobile Safe Place Café is one of a number of community initiatives being trialled on Tasmania’s east coast under the National Suicide Prevention Trial, supported by Primary Health Tasmania.The coffee van travels to a different part of the Break O’Day region for two days each fortnight. The van is staffed by a project officer and one or two volunteers who provide coffee, resources and a listening ear for locals. The mobile café isn’t a counselling service, but it is a regular, visible point of contact for locals who may be struggling, or know someone who is.11

Safe spaces in research

While evaluation reports indicate the positive impact of existing safe spaces in suicide prevention and community mental health, peer reviewed research is scarce.

A team led by Australian National University’s Associate Professor Michelle Banfield recently won a $1.35 million federal government grant to examine the effectiveness of Safe Space Cafés in the ACT and NSW. The three-year study seeks to understand whether the concept is feasible and acceptable for people in emotional distress and suicidal crisis as an alternative to presenting to a hospital emergency department. In the project, titled Co-creating safe space, people with lived experience will co-create the cafés, so that the co-design process can also be evaluated.12

Safe spaces and lived experience

Advocates for safe spaces recognise that lived experience is a unique form of expertise and that the practical insights of people who have ‘walked the walk’ should guide the design and delivery of these supports. There is an emerging evidence base for their therapeutic value in promoting hope, healing and recovery.3

Lead organisation for the crucial role of lived experience, Roses in the Ocean, say that once enabled with training and support, those with lived experience can drive positive change suicide prevention. Their experience can help in reducing stigmatising attitudes and culture in care and contribute to health and sustainable communities.

Notes

1

Mok K, Riley J, Rosebrock H, Gale N, Nicolopoulos A, Larsen M, Armstrong S, Heffernan C, Laggis G, Torok M, Shand F. (2020) The lived experience of suicide: A rapid review. Black Dog Institute, Sydney. Available from: https://www.suicidepreventionaust.org/wp-content/uploads/2020/11/The-lived-experience-perspective-of-suicide-A-rapid-review.pdfhttps://www.suicidepreventionaust.org/wp-content/uploads/2020/11/The-lived-experience-perspective-of-suicide-A-rapid-review.pdf

2

NSW Ministry of Health Mental Health Branch. (2020) Alternatives to Emergency Department Presentations. Available from: https://www.health.nsw.gov.au/mentalhealth/Pages/services-towards-zero-suicides-redirection-from-emergency-departments.aspx

3

Hains, A., Paterson, E. & Lumby, C. (2O19). Report Card. Illawarra Shoalhaven Suicide Prevention Collaborative. Available from: https://www.suicidepreventioncollaborative.org.au/assets/bea0f0472b/SPC_reportcard-2019_FINAL_single.pdf

4

Queensland Mental Health Commission. (2019) Budget 2019-20 Suicide prevention initiatives. Available from: https://www.qmhc.qld.gov.au/sites/default/files/fact_sheet_80.1_million_suicide_prevention_budget_initiatives.pdf

5

National Health Service UK. (2016) Case study: Safe Haven Café in Aldershot. Available from: https://www.england.nhs.uk/mental-health/case-studies/aldershot/

6

Better Safe Victoria. (2020) Safe Haven Café. Available from: https://www.bettersafercare.vic.gov.au/improvement/projects/mh/safe-haven-cafe

7

Mind (2011) Listening to Experience. Available from: https://www.mind.org.uk/media-a/4377/listening_to_experience_web.pdf

8

NHS North East Hampshire and Farnham Clinical Commissioning Group. (2014) ‘The Safe Haven’ Aldershot Evaluation Report July 2014. Available from: https://acem.org.au/getmedia/d...

9

PricewaterhouseCoopers Consulting Australia. (2018) Economic impact of the Safe Haven Café Melbourne. Available from: https://www.thecentrehki.com.a...

10

Government of Western Australia Mental Health Commission. (2021) Safe Haven Cafes. Available from: https://www.mhc.wa.gov.au/about-us/major-projects/safe-haven-cafes/

11

Primary Health Tasmania. (2019) Taking a Safe Place on the road in Break O’Day. Available from: https://www.primaryhealthtas.com.au/2019/05/taking-a-safe-place-on-the-road-in-break-oday/

12

Kathryn Lewis. Canberra Times news item 24 June 2021 ANU study into ‘safe haven cafes’ in ACT and NSW. Available from: https://www.canberratimes.com.au/story/7310849/study-examines-safe-haven-cafes-as-ed-alternative-for-suicidal-crises/