Dr Katrina Witt, Senior Research Fellow in Suicide Prevention – Orygen
Translational research is a relatively new phrase for a relatively old idea: how can we best move research from the clinic to the community? Done well, translational research has the power to accelerate the flow of insights from researchers and clinicians to the community and vice versa. Too often, new insights from suicide research are not translated into saving people’s lives. Translation of research and clinical evidence therefore remains one of the key challenges in suicide prevention.
Thankfully, the situation is changing in Australia. The release of the full report from the Royal Commission into Mental Health Services in Victoria in early March, for example, emphasised the importance of facilitating translational research through the establishment of a dedicated Collaborative Centre for Mental Health and Wellbeing. This Centre will have a specific remit to facilitate interdisciplinary research into new models of care that can inform service delivery, policy-making, and law making within the broader mental health care sector.
Understanding what good quality mental health service provision means to patients, their families and carers, and clinicians is vital if we are to destigmatise and demystify help-seeking, improve access to care, and ensure that those who may be at risk of suicide receive the right care first time. Central to this will be research, practice, and policies that can embrace the complexity of factors involved in suicide.
The advent of dynamic systems simulation modelling (as used to plan the government’s response to the COVID-19 pandemic), and other similar computational models, may provide the field with just such an opportunity. These models bring together diverse sources of information to simulate what might happen to projected suicide rates at the population-level if certain policies and interventions are introduced (or, for that matter, wound back). Using these models, researchers from the Sydney University’s Brain and Mind Centre, for example, have found that five interventions are likely to have the greatest impact on Australia’s suicide rate: GP suicide prevention training, coordinated aftercare for those who have attempted suicide, school-based mental health and suicide prevention literacy programs, brief psychosocial interventions in the hospital, and improving access to evidence-based psychosocial treatments for suicide.
Findings from such models have informed the development and expansion of just such initiatives. In Victoria, for example, a number of Primary Health Networks (PHNs) are trialling either place-based or Hospital Outreach Post-suicidal Engagement (HOPE) services to provide coordinated care for those who present to hospital in suicidal crisis and/or following a suicide attempt. An evaluation of these programs, organised by the Metal Health Reform Victoria, is currently underway. However, there still remains a significant implementation gap between guidelines for self-harm and suicide prevention and professional clinical practice outside of these specific initiatives. In part, this reflects difficulties in striking a balance between ensuring such services are tailored to be locally relevant but also able to be compared between settings.
For the field of suicide prevention to move forward, resistance to evidence-based recommendations for suicide prevention must be addressed by ensuring that models of care are appropriately co-designed, co-implemented, and co-evaluated by all of us who have a stake in suicide prevention.