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?

Suicide prevention strategies generally consist of two approaches: selective interventions or indicated interventions.

Selective interventions are directed towards individuals at greater risk of suicidal behaviour. These often include gatekeeper training and training frontline health workers.

Indicated interventions are targeted towards individuals who are already displaying signs of suicidal behaviour. These interventions require more time and resources to manage suicide risk through active follow-up. Aftercare is classified as an indicated intervention and is the care someone receives following a suicide attempt which includes case management to support the person’s individual needs.

A systems approach to suicide prevention that includes both intervention styles has been recognised as the most effective to prevent suicide. 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 for 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: (i) post-suicide attempt aftercare support, (ii) gatekeeper training, (iii) peer-led drop-in facilities, (iv) expansion of clinical counselling workforce in rural communities, (v) community-based suicide-prevention outreach teams, and (vi) broader enhancements in peer support and peer-led initiatives.

All interventions were simulated for the period of calendar year 2019 to 2023 (inclusive).

What was found?

Researchers ran the dynamic modelling system to determine which intervention approach is predicted to be most effective in preventing suicide 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-year period and the projected number of people who died by suicide to increase by 11%.

When early and indicated interventions 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 had the potential to contribute almost half of the NSW target of 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 aid in identifying which interventions provide the most effective reductions in suicide and which interventions are best placed to operate in conjunction to achieve the highest reduction of suicides in NSW.

Modelling in an informed way can support the development of NSW suicide prevention policy and strategy to ensure that resources are placed to achieve the highest reduction in suicide deaths and suicide attempts.