The Paradox of Suicide Prevention

Kathryn Turner, Anthony R. Pisani, Jerneja Sveticic, Nick O’Connor, Sabine Woerwag-Mehta, Kylie Burke and Nicolas J. C. Stapelberg
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Kathryn Turner: Metro North Mental Health, Metro North Health, Brisbane, QLD 4029, Australia
Anthony R. Pisani: Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY 14642, USA
Jerneja Sveticic: Gold Coast Primary Health Network, Robina, QLD 4226, Australia
Nick O’Connor: Clinical Excellence Commission, Sydney, NSW 2065, Australia
Sabine Woerwag-Mehta: Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
Kylie Burke: Metro North Mental Health, Metro North Health, Brisbane, QLD 4029, Australia
Nicolas J. C. Stapelberg: Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia

IJERPH, 2022, vol. 19, issue 22, 1-15

Abstract: The recognition that we cannot use risk stratification (high, medium, low) to predict suicide or to allocate resources has led to a paradigm shift in suicide prevention efforts. There are challenges in adapting to these new paradigms, including reluctance of clinicians and services to move away from traditional risk categorisations; and conversely, the risk of a pendulum swing in which the focus of care swings from one approach to determining service priority and focus (e.g., diagnosis, formulation, risk and clinical care) to a new focus (e.g., suicide specific and non-clinical care), potentially supplanting the previous approach. This paper argues that the Prevention Paradox provides a useful mental model to support a shift in paradigm, whilst maintaining a balanced approach that incorporates new paradigms within the effective aspects of existing ones. The Prevention Paradox highlights the seemingly paradoxical situation where the greatest burden of disease or death is caused by those at low to moderate risk due their larger numbers. Current planning frameworks and resources do not support successful or sustainable adoption of these new approaches, leading to missed opportunities to prevent suicidal behaviours in healthcare. Adopting systems approaches to suicide prevention, such as the Zero Suicide Framework, implemented in a large mental health service in Australia and presented in this paper as a case study, can support a balanced approach of population- and individual-based suicide prevention efforts. Results demonstrate significant reductions in re-presentations with suicide attempts for consumers receiving this model of care; however, the increasing numbers of placements compromise the capacity of clinical teams to complete all components of standardised pathway of care. This highlights the need for review of resource planning frameworks and ongoing evaluations of the critical aspects of the interventions.

Keywords: suicide prevention; mental health service; pathway of care (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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