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Online interventions for suicidal behaviours in the Emergency Department

image - Online interventions for suicidal behaviours in the Emergency Department

Name: Julia Lappin

Position/s: A/Prof, School of Psychiatry and NDARC and Clinical Director, NSW Tertiary Referral Service for Psychosis

Can you please tell us about the project and why it is needed?

The ‘ED Study’ is a project funded by the Mindgardens Neuroscience Network. It is a clinical study examining the feasibility of referring individuals who present to the emergency department (ED) with suicidal behaviours to online interventions provided by the MindSpot digital mental health service.

The study is important because there are online clinician-assisted treatments that are available free in Australia through MindSpot. These interventions have been shown to be effective in the management of anxiety, depression and chronic pain in the general population. Such interventions are underutilized in ED as there is no routine referral of individuals presenting with suicidal behaviours to them. This project offers the opportunity to understand whether offering information about MindSpot in ED may enable people presenting with suicidal behaviours to engage in an online treatment. This is important as MindSpot interventions may prove for some an alternative to ED, and may result in reduced future ED presentations.  It also examines how many people presenting to ED with suicidal behaviours suffer chronic pain, which is increasingly realised to be an important predictor of suicidal behaviours.

What you are hoping to achieve in this project?

The team had three key overarching aims: First, to assess prevalence of chronic pain among individuals who present to ED with suicidal behaviours. Second, to determine the proportion of individuals presenting to ED with suicidal behaviours who go on to enrol in a MindSpot online intervention for depression, anxiety and/or chronic pain. Third, in both those who do and do not enrol, to examine feedback on the acceptability of the MindSpot intervention and reasons for engagement or non-engagement.

Who are the project team?

This is a great example of a collaborative clinical translational research project with a team comprising clinicians and researchers across a number of institutions. The study was led by Julia Lappin who works as a Clinical Academic Psychiatrist at Prince of Wales Hospital (POWH), following co-design with colleagues with research and lived expertise in suicidal behaviours and chronic pain. These include Dr Gabrielle Campbell and Prof Shane Darke from NDARC, A/Prof Fiona Shand from the Black Dog Institute, A/Prof James McCauley from NeuRA, and Lesley Brydon, our specialist advocate for chronic pain. The project research officer is Emma Zahra, also based at NDARC. On the ground at POWH Emergency Department, the study was conducted by the mental health clinical nurse consultants (CNCs) under the leadership of Prof Matthew Large, Chief Psychiatrist and Mr Mike Gatsi, the Mental Health Services Director for Eastern Suburbs Mental Health Services. Drs Swapnil Sharma, Brian Draper and Michael Connors are psychiatrists at POWH also on the team. The project wouldn’t have been possible without our collaborators from the MindSpot Clinic at Macquarie University: Profs Nick Titov, Blake Dear and Olav Nielsen. 

What impact do you imagine the project will have?

We hope that the study will increase awareness of the importance of asking about chronic pain when conducting an assessment of someone presenting in crisis with suicidal behaviours. Further, the project will help us understand what proportion of people presenting to ED with suicidal behaviours are interested in MindSpot, and how many follow through with self-enrolling. What’s really important for us to learn is how the people who did go on to enrol found MindSpot, for example: was it helpful? did they complete the intervention? did they feel better? Equally important, though, is to learn from those people who not enrol, what their reasons for non-engagement were, and whether more could be done to assist them enrol either in ED or in the days that follow. This will help us better understand how and when best to deliver information about MindSpot to the people most likely to benefit from it. This study is also a first step to offering alternatives to ED for people experiencing suicidal behaviours and contributes to a developing knowledge base around useful alternative pathways help reduce repeat presentations to ED in people who are distressed.

Is there any call to action or collaboration needs you would like to highlight?

We hope that this study will increase awareness about the opportunity for people with depression, anxiety and/or chronic pain to self-enrol in MindSpot interventions, which are evidence-based and free throughout Australia. Please check out the website for further information about the service: https://mindspot.org.au/