Suicide prevention and management of deliberate self-harm: Randomized control trial of an assertive engagement, brief psychotherapy and community linkage model

SPED is an innovative service development and research project operating in Melbourne’s metropolitan western region. SPED is focused on the contribution of psychosocial factors to deliberate self-harm and the prevention of suicide in an identified at-risk and vulnerable population of people who present to a Hospital emergency department (ED) having experienced self-harm, suicidal ideation or a suicide attempt. A randomised control trial design was utilised to compare the efficacy of this brief psychosocial telephonic intervention as an enhancement to usual care following discharge from ED. 202 participants were interviewed; 171 remained engaged at six-weeks. At six-weeks, as compared with those that did not received SPED’s intervention, those that received SPED’s intervention demonstrated improvements in all aspects of general health status (as measured by the General Health Questionnaire – GHQ-28), psychological well-being, illness, social relationships and overall health-related quality of life (as measured by the Assessment of Quality of Life – AQoL).  Overall, those that received SPED’s intervention placed a higher importance on wanting to stay alive than those that did not receive the intervention, and had half the number of re-presentations to ED in the following six-months. This project is integral to further development of services for people presenting with deliberate self-harm and suicidal ideation to hospital EDs, supporting the efficacy of this type of brief psychosocial intervention.

Building Family Skills Together (BFST) Mind

Building Family Skills Together (BFST) Mind provides an in-home evidence-based service to families who live in Northern Melbourne that have an adult family member who has a serious mental illness, such as schizophrenia, bipolar affective disorder and major depression. The service provides Behavioural Family Therapy, offering assistance to families by sharing information about the illness, finding easier ways to talk to each other and ways to manage difficulties when they arise. The aim is to improve family relationships, reduce stress, support recovery and deal with day-to-day challenges. The evaluation of BFST Mind showed that half the consumers receiving the service were born overseas along with one third of the carers, suggesting the program was successful in reaching hidden culturally and linguistically diverse (CALD) families. The evaluation, which compared assessments conducted before and after receipt of the service, showed improved mental health and quality of life and family functioning amongst consumers and decreased burden for their families, confirming the effectiveness of this family psycho-education approach. The evaluation also detected a higher percentage of consumers who reported satisfaction with their lives following the program, while the percentage of carers reporting a need for more assistance decreased

Survey of High Impact Psychosis (SHIP)

The second Australian national survey of psychosis (also known as the Survey of High Impact Psychosis (SHIP)) was a prevalence study of psychotic mental illness across Australia conducted in 2010, plus an in-depth analysis of factors influencing the daily lives of people living with psychosis, with a focus on those amenable to change. It was a follow up of the “Low Prevalence Study” in 1998. The NWAMHS national survey dataset has comprehensive data on consumer characteristics and service usage, including evidence-based psychosocial interventions (their availability from both consumer and case manager perspectives along with case manager views on barriers to their availability and whether similar interventions are being delivered). These NWAMHS data have been benchmarked against the other national survey sites and provided a gap analysis that informed the local community services re-design and its accompanying evaluation. Analysis of data from the second national survey of psychosis is continuing: eight articles (published or in press/submission) have already been generated by PRC staff and their collaborators.

A Survey of Caregivers of People with Psychosis in the Australian Survey of High Impact Psychosis (SHIP): The relationship between caregiver experience and consumer characteristics

This recently submitted PhD research project aimed to explore and better understand the grief, health and well-being, quality of life, social connectedness and caregiving consequences of carers of people with psychosis within a prevalence framework. This research took place in the context of the Australian National Survey of High Impact Psychosis (SHIP) in Victoria, with results which are likely to be representative of carers of people with psychosis. Ninety eight carers participated in this study; these carers experienced moderate grief and poorer social connectedness and higher psychological distress than people in the general population, according to population norms.  CALD carers have even poorer mental health and quality of life than Australian-born carers. There were few changes for carers over the course of 1 year other than a worsened perception of their quality of life related to their physical health, suggesting a pressing need to assess and improve carers’ physical health. The carers’ perceptions of higher functioning of their relatives with psychosis at baseline led to better social connection, less grief and higher satisfaction in psychological health for carers at follow-up, suggesting increased efforts to improve consumer functioning through rehabilitation and recovery-informed approaches could impact positively on carer health and wellbeing.

Supported employment and vocational service options for people with psychiatric disabilities

Employment-related research has continued to be conducted in programs which provide employment support, including social firms. Much of this work has been conducted in partnership with Social Firms Australia (SoFA) and Professor Marc Corbiere (University of Sherbrooke, Canada). Social firms are not-for-profit business enterprises whose purpose is to create accessible employment for people with a psychiatric disability. Research led by Professor Susan Rossell (Swinburne University) has been conducted to test whether employees in social firms can improve their work productivity through participation in a cognitive remediation program that aims to improve their thinking skills. In addition, we have conducted comparative research to better understand the workplace adjustments and supports that are effective in improving job retention for employees with a mental illness in social firms in various countries (Australia, Italy and Canada). This research will also give general workplaces evidence on how to effectively support their employees with a mental illness. Finally, we have performed an integrative literature review to identify factors that impact job tenure, with a focus on community jobs obtained and sustained through supported employment and social firms.

Adverse life events and their relationship with mental health

This Master’s thesis focussed on secondary analysis of the quantitative and qualitative data that was collected in Victoria via the Second Australian (National) Survey of Psychosis in 2010.  It explored this data in relation to adverse life events and their relationship with mental health and the implications for public mental health service delivery.  The mixed methods approach revealed the high prevalence, multiplicity and extremities of adverse events. In total, 84% of Victorian participants reported having experienced at least one adverse event type in childhood, with 52% of the sample reporting exposure to two or more. Qualitatively the most frequently recorded childhood events included abuse of a sexual, physical or emotional nature (39% of females from the qualitative sample disclosed that they had been sexually abused as a child). Patterns and associations between adverse life events and emotional and behavioural responses over the life course were highlighted and included themes of interrelationship issues, re-victimisation, anger, criminality and connections between adverse childhood events and delusion and hallucination content. The findings have significant implications for public policy and public mental health service delivery including the need for the provision of safe housing and secure therapeutic relationships and for staff to prioritise being trauma-informed.