5th Annual Forum
Wednesday
28th 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
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
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.
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.
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
Effectiveness of original multi-level pilot study: Nuremburg
Alliance Against Depression (NAD)
Suicidal acts
600
500
520
-18%
425
400
Fisher‘s exact test (two-tailed):
2000 versus 2001; p < 0.03
2000 versus 2002; p< 0,001
-24%
382
+24%
300
+12%
200
125 140
156
2000
2002
100
0
2000
2001
2002
Nuremberg
2001
Würzburg
OSPI-Europe:
An innovative multi-level intervention to be
implemented in County Limerick
Design
Evaluation (suicides, DSH, Attitudes) Limerick (Intervention
region)
Baseline
data
collection
Evidence based 5 level
intervention
Followup data
collection
Evaluation (suicides, DSH, Attitudes) Galway (Control Region)
2008/2009
Jan 2010
July 2011
Dec 2012
Baseline data for suicide rates in intervention
and control regions 2005 & 2006
25
Rate per 100,000
20
15
10
5
0
Limerick
2005
Galway
2005
Limerick
2006
Galway
2006
Men
Women
Baseline data for male deliberate self harm in intervention
and control regions 2008
Baseline data for female deliberate self harm in intervention
and control regions 2008
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.
“Hidden” cases of
Deliberate “self harm
ca. 60,000 p.a.
Positive
Mental
Health
Promotion
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
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
Learning from EAAD:
Evidence for the effectiveness of
positive mental health promotion
Attitude change following Gatekeeper training
Suicide can be prevented
Follow-up
It is always possible to help a
person with suicidal thoughts
Baseline
Suicide happens without warning
P<.05
0%
20%
40%
60%
80%
100%
Learning from EAAD:
Evidence for the effectiveness of
positive mental health promotion
Changes in confidence levels following Gatekeeper training
Confidence that I could recognise a person with
depression
Confidence that I could differentiate a mild depression
from a suicidal risk
Confidence that I could recognise potential suicidal
risk
Confidence to relate/instill help seeking behaviour to
someone suffering from depression/suicide
P<.01
0
1
2
3
4
5
Baseline
6
7
Follow-Up
8
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
1.
Problem identification
2.
Defining target audience of marketing campaign
3.
Development of technology for change
4.
Evaluation
OSPI-Europe and Social Marketing
1. Problem identification
Challenging inaccurate beliefs about depression and
suicidal behaviour and replacing these stereotypes with
factual information
“Most people
who harm
themselves
are not
depressed”
“Once a person
has had suicidal
thoughts,
he/she will
never let them
go”
Core messages of OSPI-Europe
“Depression can affect everybody”
“Depression has many faces”
“Depression can be treated”
OSPI-Europe and Social Marketing
2. Defining target audience of marketing campaign
Target audience
Target behaviour/outcome
Level 1: GPs/ health workers in
primary care
Recognise signs of depression and suicidal behaviour.
Treat and refer to psychological therapies as appropriate.
Level 2: General public
Increased literacy regarding depression and suicidal
behaviour. Subsequent change in stigmatising attitudes
towards depression and suicidal behaviour.
Level 3: Community facilitators
Recognise signs of depression and suicidal behaviour and
promote help-seeking behaviours.
Level 4: High risk groups
Increase help-seeking behaviour. Availability of evidence
based treatments.
Level 5: Professionals in position Recognising signs of depression and suicidal behaviour
to reduce access to lethal means and reducing access to lethal means (e.g. pharmacists,
taxi drivers, undertakers)
OSPI-Europe and Social Marketing
3. 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
OSPI-Europe and Social Marketing
4. 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?
Contact details
Claire Coffey,
National Suicide Research Foundation,
1 Perrott Avenue,
College Road,
Cork.
Tel. 021 4277499
E-mail: claire.nsrf@iol.ie
5th Annual Forum
Wednesday
28th April 2010
Royal Hospital Kilmainham
‘Promoting Positive Mental Health
and Reducing Stigma’
SAVING AND EMPOWERING YOUNG LIVES
IN EUROPE – SEYLE-:
The role of positive mental health promotion and social
marketing in SEYLE
Ms Jacklyn McCarthy
SEYLE
A health promoting programme for adolescents in European
Schools
• Austria
• Israel
• Estonia
• Italy
• France
• Romania
• Germany
• Slovenia
• Hungary
• Spain
• Ireland
• Sweden
SEYLE Project Objectives
• Gather info on health and well-being
• Interventions
• Evaluate Interventions
• Recommend health-promoting models
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
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).
1.
2.
3.
4.
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
Teacher Training
• QPR – Question, Persuade and Refer
– Question somebody displaying
warning signs
– Persuade them to seek help
– Referral to appropriate health
services
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
Awareness intervention
“Affect and Improve the way you feel ”
1.
Saving and Empowering Young Lives in
Europe
Contact Card
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
Awareness of
Mental Health
 YOUR mental health influences the way you think
about yourself and others
 No one is free from problems
 Talking about your feelings can help you
 Using alcohol or drugs, being aggressive, neglecting
your physical health, or bullying others may be
symptoms of distress, depression or psychological
problems
 Life can be challenging, but YOU are not alone
For advice on how to get help:
Call/Text:
Email:
085 2440661
contactseyle@iol.ie
Minimal intervention
Saving and Empowering Young Lives in
Europe
• 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
Contact Card
Awareness of
Mental Health
 YOUR mental health influences the way you think
about yourself and others
 No one is free from problems
 Talking about your feelings can help you
 Using alcohol or drugs, being aggressive, neglecting
your physical health, or bullying others may be
symptoms of distress, depression or psychological
problems
 Life can be challenging, but YOU are not alone
For advice on how to get help:
Call/Text:
Email:
085 2440661
contactseyle@iol.ie
Self-Referral
• Self-recognise the need for help
• Contact an assigned facilitator
• Further action taken, if necessary
Key
• Arm 1 QPR (4 schools):
• Arm 2 Awareness (4 schools):
• Arm 3 Prof screen (4 schools) :
• Arm 4 Minimal Intervention
(5 schools):
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)
QPR (opt out in 3 schools/ opt in in one)
Awareness (opt out)
Minimal intervention (opt out/ 5 schools)
191
237
340
338
• Total number of “emergency” cases identified 78
• Total number of “emergency” cases seen
– Total number of “real” emergencies
• Total number of “prof screen” cases identified
• Total number of “prof screen” cases seen
26
3
48
20
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
Audience
Target Behaviour
Social marketing
Parent/
Guardian
Awareness of mental health
Opening the lines of
communication between the
parent & the young person
Acceptance & recognition of
services available to young people
Information pack
Information evening
SEYLE website
Telephone call/letter
School
Important role of mental health
promotion in the school setting
Awareness of mental health
services available to young people
Information pack
Information evening
SEYLE website
Identification of young people
through the questionnaire
Teachers
Empowering teachers to recognise
a young person who is displaying
signs of difficulty
Assisting a young person in
getting help
Booklet
Roleplays
QPR Training
Lectures
Contact card
Young People
Greater awareness of mental
health & related topics
Enabling & encouraging young
people to get help
Booklet
Roleplays
Awareness Sessions
Posters
Contact card
Satisfaction with the Awareness
programme:
Self-rated knowledge & understanding
Low
Mental health
Medium
6
Depression and
suicidal thoughts
9
Persuading someone
to get help
8
How to get help for
someone
7
Local agencies that
help young people
46
48
43
49
41
51
37
16
0%
High
56
47
20%
40%
36
60%
80%
100%
Overall satisfaction with elements of the
Awareness programme
Yes
No
Rated Awareness
Programme as good
overall
96
5
Would recommend
Awareness Programme
to others
94
6
Rated the quality of the
sessions as good
95
5
Found the role play
sessions helpful
90
0%
20%
40%
10
60%
80%
100%
Satisfaction with the Awareness Booklet
Yes
Found the Awareness
Booklet helpful
Information was
missing from the
Booklet
No
67
33
6
0%
94
20%
40%
60%
80%
100%
Satisfaction and use of the contact card:Yes
No
Good idea to provide
young people with a
contact card
93
Did you use the contact
1
card
Are you likely to use the
contact card in the
future
99
12
0%
8
88
20%
40%
60%
80%
100%
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:
Prof screen:
QPR:
Control:
262
165
209
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)
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