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5 th Annual Forum Wednesday 28 th April 2010 Royal Hospital Kilmainham

5 th Annual Forum Wednesday 28 th April 2010 Royal Hospital Kilmainham ‘Promoting Positive Mental Health and Reducing Stigma ’. Due to the large size of images and photos, these will be shown during the workshop presentation.

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5 th Annual Forum Wednesday 28 th April 2010 Royal Hospital Kilmainham

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  1. 5th Annual Forum Wednesday 28th April 2010 Royal Hospital Kilmainham ‘Promoting Positive Mental Health and Reducing Stigma’

  2. Due to the large size of images and photos, these will be shown during the workshop presentation Optimising Suicide Prevention Programmes and their Implementation in Europe (OSPI-Europe) The role of Positive Mental Health Promotion and Social Marketing in a Multi-Level Suicide Prevention Programme Ms. Claire Coffey, Dr. Ella Arensman & EU Consortium

  3. OSPI-Europe • An innovative suicide prevention project funded by the European Commission’s 7th Framework Programme • Brings together a consortium of suicide researchers from 11 countries throughout Europe, all with an established track record of designing and implementing suicide prevention strategies OSPI-Limerick is conducted in collaboration with the Suicide Prevention Office and the Limerick Mental Health Management Team.

  4. OSPI-Europe Aims: • To test the effectiveness of an optimised, evidence-based, multilevel intervention to reduce suicide and deliberate self harm, which complements existing national and local guidelines and actions • To provide the EU member states with realistic action-based recommendations that can be implemented on a regional basis to reduce suicidality and related mental health problems.

  5. Background • Key aspect of OSPI-Europe is a multi-level intervention based on previous work by the Nuremburg Alliance Against Depression (NAD) and the European Alliance Against Depression (EAAD) • This approach is in line with evidence from other fields of prevention which have showed that tackling a public health problem on multiple levels and with multiple strategies is more effective than using only a single strategy • In Ireland, EAAD was conducted throughout Cork and Kerry between 2005-2006

  6. Fisher‘s exact test (two-tailed): 2000 versus 2001; p < 0.03 2000 versus 2002; p< 0,001 -18% -24% 425 382 +24% +12% 156 140 2001 2002 2001 2002 Effectiveness of original multi-level pilot study: Nuremburg Alliance Against Depression (NAD) 600 520 500 400 Suicidal acts 300 200 125 100 0 2000 2000 Nuremberg Würzburg

  7. OSPI-Europe:An innovative multi-level intervention to be implemented in County Limerick

  8. Design Evaluation (suicides, DSH, Attitudes) Limerick (Intervention region) Evidence based 5 level intervention Baseline data collection Follow-up data collection Evaluation (suicides, DSH, Attitudes) Galway (Control Region) 2008/2009 Jan 2010 July 2011 Dec 2012

  9. Baseline data for suicide rates in intervention and control regions 2005 & 2006

  10. Baseline data for male deliberate self harm in intervention and control regions 2008

  11. Baseline data for female deliberate self harm in intervention and control regions 2008

  12. The role of positive mental health promotion in implementing the OSPI intervention programme Suicide ca 500 p.a. Deliberate self harm medically treated ca. 11,000 p.a. Positive Mental Health Promotion “ “Hidden” cases of Deliberate self harm ca. 60,000 p.a.

  13. Examples of Positive Mental Health Promotion in OSPI • Increasing awareness of depression through Gatekeeper training among health care professionals (e.g. GPs, psychiatric nurses) and community facilitators (e.g. social workers, Gardai, youth workers, clergy) • Increased depression awareness will contribute to early identification of people with depression and self harm / suicide risk • Early identification of people at risk of depression and/or suicidal behaviour will contribute to early intervention

  14. Examples of Positive Mental Health Promotion in OSPI ctd. • Reducing stigma associated with depression, suicidal behaviour and help seeking behaviour through an extensive public awareness campaign • Reduced stigma may positively affect: • quality of life for people with depression, impacting on employment status, educational options, and social opportunities • detection and treatment of depressive disorders • help-seeking behaviour • adherence to treatment

  15. Learning from EAAD:Evidence for the effectiveness of positive mental health promotion Attitude change following Gatekeeper training P<.05

  16. Learning from EAAD: Evidence for the effectiveness of positive mental health promotion Changes in confidence levels following Gatekeeper training P<.01

  17. Social marketing • The application of marketing concepts and tools to influence the behaviour of target audiences to achieve social goals • Influencing behaviours of a target group so that the personal welfare within the group is enhanced 4 steps of social marketing • Problem identification • Defining target audience of marketing campaign • Development of technology for change • Evaluation

  18. OSPI-Europe and Social Marketing1. Problem identification Challenging inaccurate beliefs about depression and suicidal behaviour and replacing these stereotypes with factual information “Once a person has had suicidal thoughts, he/she will never let them go” “Most people who harm themselves are not depressed”

  19. Core messages of OSPI-Europe “Depression can affect everybody” “Depression has many faces” “Depression can be treated”

  20. OSPI-Europe and Social Marketing2. Defining target audience of marketing campaign

  21. OSPI-Europe and Social Marketing3. Development of technology for change 1. Train-the-Trainer model 2. Advisory Panel 3. Strategic implementation of information/key messages 4. Widespread dissemination of materials to maximise saturation within target groups 5. Networking

  22. OSPI-Europe and Social Marketing4. Evaluation • Efficacy of the intervention in reducing suicidal behaviour – changes in suicide and non-fatal suicidal acts • Evaluation of intermediate outcome criteria • Changes in attitudes towards depression, suicidal behaviour and help--seeking • Questionnaires delivered before, immediately after, and 4 months following training programmes • Telephone survey of general public at baseline and following the intervention period • Process evaluation • Context: the precise circumstances in which the intervention is introduced • Mechanism: the precise way in which the intervention is carried out • Standardisation? • Sufficient funding? • Political support?

  23. Contact details Claire Coffey, National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork. Tel. 021 4277499 E-mail: claire.nsrf@iol.ie

  24. 5th Annual Forum Wednesday 28th April 2010 Royal Hospital Kilmainham ‘Promoting Positive Mental Health and Reducing Stigma’

  25. SAVING AND EMPOWERING YOUNG LIVES IN EUROPE – SEYLE-:The role of positive mental health promotion and social marketing in SEYLE Ms Jacklyn McCarthy

  26. Austria Estonia France Germany Hungary Ireland Israel Italy Romania Slovenia Spain Sweden SEYLEA health promoting programme for adolescents in European Schools

  27. SEYLE Project Objectives • Gather info on health and well-being • Interventions • Evaluate Interventions • Recommend health-promoting models

  28. Baseline Questionnaire • Content • Healthy and Unhealthy Behaviours • Coping Styles • Self-Harm/ suicidality • Referrals to Health-care System • All screened for emergency cases • Follow-ups: 3 months and 12 months • All students completing questionnaire are given Contact Cards with contact numbers and e-mails of services • Facilitator to advise where and how to seek help is available by telephone; text and e-mail 24/ 7 for the month of November and at reduced times thereafter to end of 2009

  29. Proposed Intervention Arms • SEYLE study involves Second year students in mixed gender schools in Cork Kerry area • Three active interventions and one control arm implemented in 4 schools each (250 students per arm). • QPR : Question, Persuade and Refer gatekeepers (teachers) to help them to recognise children with difficulties and assist them to access appropriate services • Professional screen: Baseline questionnaire screened those with problems are offered a brief clinical interview after parents/ guardians are notified • Awareness: Posters, Lectures and Role-plays of mental health topics • Minimal intervention: Posters only

  30. Teacher Training • QPR – Question, Persuade and Refer • Question somebody displaying warning signs • Persuade them to seek help • Referral to appropriate health services

  31. Professional Screening Screen Baseline Questionnaire No problems – debriefing Problems – brief clinical interview *Parent(s)/ Guardian(s) are notified Unless already attending services. Referral onwards to services if required

  32. Awareness intervention“Affect and Improve the way you feel ” 1. Lecture/Role-play topics Awareness about choices Awareness about feelings and how to manage stress and crises situations Awareness about depression and suicidal thoughts 2. Posters and Booklet Awareness of mental health Self-Help advice Stress and crisis Depression and suicidal thoughts Helping a troubled friend Getting Advice: Who to contact

  33. Minimal intervention Complete questionnaires receive contact cards Posters Awareness of mental health Self-Help advice Stress and crisis Depression and suicidal thoughts Helping a troubled friend Getting Advice: Who to contact

  34. Self-Referral Self-recognise the need for help Contact an assigned facilitator Further action taken, if necessary

  35. Key • Arm 1 QPR (4 schools): • Arm 2 Awareness (4 schools): • Arm 3 Prof screen (4 schools) : • Arm 4 Minimal Intervention (5 schools):

  36. Preliminary results: baseline • Total number of letters sent 1,602 • Total number of opt-outs 20 /1,124 • Total number of students filling questionnaires : 1,106 • Prof screen (Opt in including one TY Class) 191 • QPR (opt out in 3 schools/ opt in in one) 237 • Awareness (opt out) 340 • Minimal intervention (opt out/ 5 schools) 338 • Total number of “emergency” cases identified 78 • Total number of “emergency” cases seen 26 • Total number of “real” emergencies 3 • Total number of “prof screen” cases identified 48 • Total number of “prof screen” cases seen 20

  37. Social Marketing • Application of marketing concepts and tools aimed at influencing the voluntary behaviour of target audiences to achieve social goals • Aims to achieve behavioural change that will benefit the target audience and society Social Marketing & SEYLE • Audience – 2nd year/ transition year students • Specific Behaviour – Help seeking behaviour • Research & evaluation core of SEYLE • Learning what young people want & need

  38. Satisfaction with the Awareness programme: Self-rated knowledge & understanding

  39. Overall satisfaction with elements of the Awareness programme

  40. Satisfaction with the Awareness Booklet

  41. Satisfaction and use of the contact card:-

  42. Preliminary results:3 month follow-up and data entry • 3 month follow-up mostly completed in March ’10 • All schools participated: Total numbers: 986 • Awareness: 262 • Prof screen: 165 • QPR: 209 • Control: 350 • Total number of “emergency cases” identified 35 • Feedback received regarding interventions. • Dissonance between apparent honesty of students in completing questionnaire and resistance regarding parents being informed. • Still major difficulties arranging follow-up interviews. • Late increase in interest in facilitator number! - Baseline – 2 contacts - 3 month follow-up – 6 contacts (3 people)

  43. Contact us • National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork. • Tel: 021 4277 499 • Email: seyle.nsrf@iol.ie • Web: www.seyle.org Dr. Helen Keeley Dr. Paul Corcoran Dr. Carmel McAuliffe Padraig Cotter Jacklyn McCarthy

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