Safe spaces

Safe spaces are becoming an important part of suicide prevention initiatives across Australia.

Many people present to emergency departments experiencing suicidal thoughts or behaviours, 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 suicidal distress.1,2

Safe spaces is an umbrella term referring to non-clinical, peer-led supports for people in suicidal distress. These spaces aim to provide an alternative to conventional mental health and hospital services, and are usually operated by peer workers with a lived and living experience of mental health concerns and suicidal distress.3

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 skills that enhance their mental health and wellbeing.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 support workers. 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 seeking assistance but not emergency care. It offers respite and peer support to help people build resilience and capacity to enhance their mental health and wellbeing.

A review of the service conducted by PwC9 reported:

  • Enhanced experiences of care and a strengthened sense of social connectedness within 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 people experiencing suicidal distress 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

New South Wales

The NSW Government has allocated more than $143.4 million over four 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.

There are currently 21 Safe Havens across New South Wales.10

Australian Capital Territory

Belconnen Safe Haven in the Australian Capital Territory is a non-clinical, supportive space for people experiencing mental health concerns or suicidal distress. The free service opened in 2021 and provides a welcoming and safe environment that utilises a Peer Workforce.11

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 offers a safe, caring and respectful environment along with peer support to empower people looking for assistance, but not needing acute care.

There are currently four Safe Spaces operating in Bardon, Strathpine, Caboolture and Redcliffe.12

Western Australia

Two Safe Haven Cafés opened in Western Australia in early 2021 and are now providing an alternative to emergency departments for people experiencing mental health concerns or suicidal distress. They are at Royal Perth Hospital and Kununurra District Hospital.13

Tasmania

Tasmania has one Safe Haven located at the Peacock Centre in North Hobart. The service offers compassionate support for people 15 years or older who are experiencing suicidal or situational distress. Staffed by peer workers with lived experience of mental health concerns and senior mental health clinicians, the team values accessibility, compassionate relationships, family support, and creating a respectful, inclusive environment.14

South Australia

A Safe Haven was opened 10 July, 2023, in Salisbury, South Australia. Delivered by Sonder, the pilot project is a collaborative initiative guided by the Lived Experience Leadership and Advocacy Network, with funding from the Adelaide Primary Health Network and the Northern Adelaide Local Health Network. Among those using the service, 14% indicated that they would have gone to an emergency department if the Safe Haven had not been available.15

Community-led safe spaces

Roses in the Ocean's National Community-led Safe Spaces project has established 15 community-led, volunteer-run, non-clinical safe spaces where people experiencing suicidal distress can find compassionate and empathetic support. The project was created in response to government investment in non-clinical support for people impacted by suicide in Australia. The Community-led Safe Space model is versatile and can operate differently depending on a community’s evolving needs. Roses in the Ocean supports local working groups by:

  • Providing a grant of $20,000 per year
  • Facilitating local co-design of the Community-led Safe Space
  • Facilitating training for volunteers
  • Providing fortnightly working group mentoring for the first 6 months of establishment
  • Providing a monthly online community of practice that connects the Community-led Safe Spaces nationally to discuss their progress and solutions to any challenges.

Advocates for safe havens recognise that lived and living 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

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 received a $1.35 million Federal Government grant to examine the effectiveness of Safe Space Cafés in the Australian Capital Territory and New South Wales. 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.16

Notes

1

Mok K, Riley J, Rosebrock H, Gale N, Nicolopoulos A, Larsen M, Armstrong S, Heffernan C, Laggis G, Torok M, Shand F. The lived experience of suicide: A rapid review. Black Dog Institute, Sydney. 2020. Available from: https://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. Alternatives to Emergency Department Presentations, https://www.health.nsw.gov.au:443/mentalhealth/resources/Pages/alternatives-ed-presentations.aspx
(2020).

3

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

4

Queensland Mental Health Commission. Budget 2019-20 suicide prevention initiatives. 2019. 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. Case study: Safe Haven Café in Aldershot, https://www.england.nhs.uk/mental-health/case-studies/crisis-mental-health-case-studies/aldershot/ (2016)

6

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

7

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

8

NHS North East Hampshire and Farnham Clinical Commissioning Group. ‘The Safe Haven’ Aldershot evaluation report July 2014. 2014. Available from: https://acem.org.au/getmedia/d955dbb0-86c6-4ca2-b25c-ac367b949bb8/Hampshire-Crisis-Cafe-Evaluation-ReportUK

9

PricewaterhouseCoopers Consulting Australia. Economic impact of the Safe Haven Café Melbourne. 2018. Available from: https://acem.org.au/getmedia/d955dbb0-86c6-4ca2-b25c-ac367b949bb8/Hampshire-Crisis-Cafe-Evaluation-ReportUK

10

NSW Ministry of Health Mental Health Branch. About Towards Zero Suicides, https://www.health.nsw.gov.au/towardszerosuicides/Pages/about.aspx (2024).

11

Stride. Safe Haven Belconnen, https://stride.com.au/mental-health-services/?type=Individual%20and%20Group%20Supports&id=0012w00000sbchuAAA (2024).

12

Brisbane North PHN. Safe Spaces open across North Brisbane and Moreton Bay, https://brisbanenorthphn.org.au/news/safe-spaces-open-across-north-brisbane-and-moreton-bay (2022).

13

Government of Western Australia Mental Health Commission. Safe Haven Cafes, https://www.mhc.wa.gov.au/getting-help/hospital-mental-health-alcohol-and-other-drug-services/safe-haven-cafes/ (2024).

14

Tasmanian Department of Health. Safe Haven, https://www.health.tas.gov.au/health-topics/mental-health/tasmanias-mental-health-system/adult-mental-health-service/peacock-centre/safe-haven (2023).

15

Government of South Australia Health Northern Adelaide Local Health Network. Safe Haven Launched Through Northern Partnerships, https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/About+us/Our+Local+Health+Networks/Northern+Adelaide+Local+Health+Network/About+us/Latest+news+from+NALHN/Safe+haven+launched+through+northern+partnerships (2023).

16

Australian National University. The safe space that could save a life, https://www.anu.edu.au/news/all-news/the-safe-space-that-could-save-a-life (2021).