Multi-level Intervention for Suicide Prevention in New Zealand

INTERVENTION: The Multi‐level Intervention for Suicide Prevention in New Zealand study (MISP‐NZ) involved five levels of intervention, training in suicide prevention, workshops on mental health issues, community interventions, media interventions and the distribution of print based resources. The whole study ran for 31 months with a six month baseline period (1 Dec 2009 to 31 May 2010) and a 25 month intervention period (01 June 2010 to 30 June 2012). Training in recognition of suicide risk factors involved using a local adaptation of the online Question, Persuade, Refer (QPR) training. This training intervention was distributed to individuals in the community. Workshops on various mental health issues such as depression, alcohol, anxiety, alcohol and drug issues, and self‐harm were delivered. The delivery of the workshops varied. In one DHB a MISP established suicide prevention network invited various influential speakers on suicide prevention and mental health‐related topics once a month with an attendance of up to 80 people over the study period. MISP intervention staff were sometimes invited to join mental health forums or similar organized by DHB staff and MISP intervention staff would present alongside DHB staff. Most other presentations were delivered solely by trained MISP intervention staff who had a backgrounds of nursing, social work and OT; and had received additional suicide prevention training. Group sizes varied with the sizes of organisations. MISP intervention staff aligned their workshops to organizational needs, hence the session times varied from between 20‐30 minutes to 3‐4 hour sessions. Presentations were delivered during weekly staff meeting, at yearly training days, at mental health forums, at workplaces and many workshops were specifically organized. Working hours to deliver those workshops ranged from 6 am to 10 pm, with some delivered at weekends. Organisations included businesses, health organisations and the public. MISP intervention staff provided between 0 and 5 workshops week. The average was estimated to be one workshop per week per DHB (approximately 4 workshops a week all DHBs), varying in length as per requirement of the organization, over the 25 months intervention period. Community based interventions included information days and information stalls at family days and festivals. Media based interventions focused on working with local media to support best practice in the reporting of suicide. Distribution of print and web‐based resources such as leaflets and poster from national campaigns, and the Mental Health Foundation and related mental health organisations. Print and web‐based resources were distributed throughout the 25 months intervention period. Distribution occurred concurrently with the delivery of workshop, preliminary engagement and follow up. To monitor the implementaiotn of the intervnetions, weekly teleconferences, regular clinical supervision of intervention staff and quarterly face to face meetings ensured that interventions in each DHB aligned between DHBs whilst adhering to the purpose of the study. Follow‐up QPR workshops were delivered monthly for six months in order to debrief participants on their training outcome and if and how they had used their QPR skills. Decreasing numbers of workshop participants led to the de‐establishment of these QPR sessions and an increased focus on the distribution and delivery of suicide prevention workshops. CONDITION: intentional self‐harm suicide SECONDARY OUTCOME: Suicidal behaviour by the following population subgroups: ; Males age 20‐60. ; Maori. ; Maori males 20‐60 INCLUSION CRITERIA: All residents in each intervention DHB area. PRIMARY OUTCOME: District Health Board level suicidal behaviour including: the annual rate per 100,000 persons of intentional self‐harm and self‐inflicted death. Intentional self‐harm is assessed using presentations to emergency departments identified from electronic databases and medical records. Self‐inflicted death is assessed using coroner's data from the Coronial Services of New Zealand. ; Suicidal behaviour will include all presentations for Intentional Self‐harm (ISH) to Emergency Departments in the 8 DHB regions for attempted suicide and self‐harm. ISH will be measured as the number of identified ISH events in the ED data (as the numerator) relative to DHB population sizes (as the person‐time denominator). The person‐time used in the denominator will be derived from census data for the DHBs in the study. Rates of self‐inflicted deaths, which will include all completed (and suspected) suicides (i.e. excluding self‐harm which does not result in death) will be requested from the Coronial Services of New Zealand. ISH will be used as the marker of effect on suicidal behaviours because the number of self‐inflicted deaths is too small to use as the main outcome measure alone, leading to insufficient power to be confident of detecting a difference.