Action against Depression and Suicide Suicide Prevention Programmes: Integrating Implementation and Evaluation

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1 Action against Depression and Suicide Suicide Prevention Programmes: Integrating Implementation and Evaluation Professor Ella Arensman National Suicide Research Foundation Department of Epidemiology and Public Health, University College Cork, Ireland WHO Collaborating Centre for Surveillance and Research in Suicide Prevention President, International Association for Suicide Prevention

2 WHO Global Mental Health Action Plan, Commitment by Health Ministers in all 194 WHO member states to formally recognise the importance of mental health. Commitment by all member states to take actions to improve mental health and to contribute to the attainment of a set of agreed global targets. Key targets: - 20% increase in service coverage for severe mental disorders - 10% reduction of the suicide rate in countries by 2020

3 Evidence informed core components of national suicide prevention strategies 1) Surveillance 7) Crisis Intervention 2) Means Restriction 8) Postvention 3) Media 9) Awareness 4) Access to Services 10) Stigma Reduction 5) Training and Education 11) Oversight and Coordination 6) Treatment

4 National Suicide Prevention Strategies in EU countries Has the strategy been fully or partially implemented? IASP-WHO Survey Has the national strategy been financed? 7 7 Fully Partially No response Yes, in full Yes, in part No No response 13 1 Has the national strategy been evaluated? Yes No No response

5 An Evidence Based Multi-Level Suicide Prevention Programme

6 60-70% 30-35% 6-9% 2-5% Attended GP Depression diagnosed Treated sufficiently Still compliant after 3 months of treatment Hegerl et al, 2006; 2010

7 Nuremberg Alliance Against Depression: Multi-level suicide prevention programme Interventions for approx. 150 persons with increased suicide risk 4 Interventions for patients and family members (self-help, high risk groups) Approx. 150,000 leaflets; 25,000 brochures; tv, radio campaigns 1 Training for GPs Aim: Improving the treatment for people with depression and prevention of suicide 3 Awareness campaign for the general public 20% (n=77) of all GPs 2 Training for Community Facilitators More than 2000 community facilitators

8 Suicidal Acts Suicidal behaviour in Nuremberg and Wuerzburg % -24.0% -32.2% Chi² (one-tailed): 2000 versus 2001; p< 0, versus 2002; p< 0, versus 2003; p< 0, % +7.7% -5.5% Nuremberg Wurzburg Hegerl et al. 2006; 2010

9 From the Nuremberg Alliance to the European Alliance Against Depression ( EU-funded project To promote the implementation of regional alliances against depression Adaptation to different cultures and languages Implementation in more than 100 regions in 19 countries incl. Countries outside Europe, e.g. Chili, Suriname, French Polynesia Hegerl et al, 2013; 2008

10 Szolnok Alliance Against Depression: Impact on suicide rates compared to the national suicide rates (p=.017) and a control region (p=.0015) (Szekely et al 2014, PLoS ONE)

11 Optimising Suicide Prevention Programmes and their Implementation in Europe: Partners and intervention regions Four implementation regions Intervention region (population) Control region (population) Germany Hungary Ireland Portugal Leipzig (507,000) Miskolc (171,000) Limerick (83,863) Amadora (200,000) Magdeburg (230,000) Szeged (167,000) Galway (183,863) Almada (150,000) OSPI-Europe: Optimizing Suicide Prevention Programs and their Implementation in Europe

12 Outcomes evaluation Gatekeeper training police officers Confidence in recognizing suicide risk and communicating with a suicidal person Confidence Communication Time 1 Time Pre-training Post-training

13 Outcomes of the evaluation of the multi-level programme on suicidal behaviour (suicide + self-harm) Germany Hungary Number of suicidal acts Intervention Region Control Region Baseline Average for the two years after onset of the intervention χ 2 = 1.12; p = 0.14 (one-tailed) Number of suicidal acts Intervention Region Control Region Baseline Average for the two years after onset of the intervention χ 2 = 0.33; p = 0.28 (one-tailed) Portugal Ireland Number of suicidal acts Intervention Region Control Region Baseline Average for the two years after onset of the intervention χ 2 = 4.82; p = 0.01 (one-tailed) Number of suicidal acts Intervention Region Control Region Baseline Average for the two years after onset of the intervention χ 2 = 2.55; p = 0.06 (one-tailed)

14 Possible explanations Relatively short time frame for implementation of the entire multi-level program: Implementation of the multi-level interventions in the 4 OSPI regions was 18 months vs. 30 months in Nuremberg Impact of external factors, such as the economic recession, political election campaign, flooding Increased awareness (via training), may facilitate referral of persons with suicidal behaviour 14

15 Key recommendations Simultaneously addressing interventions for depression and suicidal behaviour is an effective strategy Multi-level suicide prevention strategies have strong synergistic effects and implementation is feasible in different health systems and cultural contexts Therefore, it is important to combine process and outcome evaluation Implementation = Evaluation Effective implementation via the development of networks of regional alliances based on local alliances

16 Impact of the Multi-level suicide prevention programme

17 Thank you! Prof Ella Arensman National Suicide Research Foundation & Department of Epidemiology and Public Health University College Cork President, International Association for Suicide Prevention