Aftercare

Aftercare is designed to increase access to, and engagement with, supports to prevent future suicidal behaviour during the critical period immediately following a suicide attempt. These services have traditionally been designed to be implemented directly after a presentation to hospital following a suicide attempt.

The term ‘universal aftercare’ refers to proactive and coordinated services and supports provided to people following a suicidal crisis or suicide attempt, with broad referral pathways within and outside of the health and hospital system, and integrated support for families and friends.

Providing supportive and effective care to people after a suicide attempt is a high priority and has been shown to reduce further suicide attempts and suicide deaths. The group at highest risk of further suicidal behaviour are those who have previously attempted suicide, with this risk being particularly heightened in the days and weeks following the attempt.

Types of aftercare services

There are various types of interventions used as part of an aftercare approach. In Australia, the types of services being implemented can be broadly grouped into:1

What does the evidence tell us?

The most recent evidence reviews were completed in 20191 and in 20232. Most studies of suicide aftercare services who used brief intervention programs and comprehensive aftercare programs were effective, however, the evidence for the effectiveness of brief contact interventions was somewhat lower.

Both brief interventions and comprehensive aftercare models were effective in reducing repeated suicide attempts, with some studies showing evidence for reductions in suicide deaths and increased service use. Brief contact interventions may be most useful as a follow-up to other programs once the person is no longer experiencing suicidal distress and has established a connection with a clinician or other service provider.1,2 It is therefore recommended that brief contact interventions should not be delivered as a standalone aftercare intervention.

Key components of effective aftercare services

A recent review of the literature highlighted key components of aftercare services. Effective interventions overall have some common elements, including the following:

Eligibility and referral pathways

  • Eligibility criteria to include people who have attempted suicide as well as those experiencing suicidal distress
  • Broader referral pathways beyond hospitals.

Service components

  • Integration of multiple service components to ensure broader coverage and effectiveness, catering to diverse population needs
  • Holistic and individually responsive (person-centred) support
  • Proactive follow-up
  • Case management
  • Collaborative safety planning
  • Linkages with other services, including referral partners to help bridge hospital care and community care
  • Flexible access and delivery – accessible locations and flexible methods of delivery.

Frequency and duration

  • Rapid initiation of support with frequent contact early
  • Duration of support is to be as-needed rather than time-limited
  • Options to ‘step back in’ to support at a later date.

Support for particular population groups

  • Provide safe, culturally-sensitive and inclusive support for all people
  • Tailored support for particular population groups
  • Support for family and friends.

Workforce considerations

  • Developing appropriate workforce skills is critical
  • Peer workers (non-clinical) to be integrated into aftercare service provision.

Other enabling elements

  • Lived experience involvement included at all stages of service design and delivery
  • Appropriate commissioning and funding of services
  • Improved monitoring and evaluation.

What else is needed?

  • Further research and implementation of aftercare programs that include support to family and friends of the person experiencing suicidal distress.
  • Further planning and implementation of aftercare support with broader eligibility criteria and referral pathways for universal aftercare.

Notes

1

Shand F, Woodward A, McGill K, et al. Suicide Aftercare Services Report. The Sax Institute. Epub ahead of print 1 October 2019. DOI: 10.57022/qpxf6172.

2

Martin A, Chakouch C, Josifovski N, et al. Suicide aftercare services: an Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute) for the Commonwealth Department of Health and Aged Care.