Using technology to prevent suicide
Published: 9 April, 2017
Australia has seen a 20% increase in the number of suicides in the last decade and in response to this growing health crisis, the Black Dog Institute has made suicide prevention a priority research area.
As a translational research institute, Black Dog is a world leader in putting research to practice. Black Dog’s suicide prevention research team are working on a range of innovative projects to overcome the obstacles inherent to help seeking. Accessible and anonymous, technology has been found to play a key role in help seeking.
Internationally, the Black Dog Institute has made a commitment to the ImpleMentAll project – a collaboration moving towards faster and more effective e-health interventions. But what does this look like on the ground level and what will it mean for Australians?
Improving aftercare and early intervention are part of Black Dog’s areas of focus. RAFT (Reconnecting AFTer a Suicide Attempt) and iBobbly, the first suicide prevention app designed for Indigenous Australian youth, are two examples of the pioneering work being done at Black Dog.
Research has shown that the first few days following release from hospital, for someone who has attempted suicide or deliberate self-harm, are critical. Despite this, one-third of people discharged after such an attempt will receive no mental health follow-up. RAFT hopes to change this.
“RAFT is looking at a way of providing some follow-up care through text messaging, with links to online support, in the period after discharge,” says Dr Mark Larsen, Early Career Fellow from the Society for Mental Health Research. “People have done some previous work in using things like postcards and follow-up letters, but we’re using text messaging as a more technology-based solution,” he explains.
Brief contact with recently discharged patients, such as postcards, letters and phone calls, has been found to reduce suicide re-attempts by up to 50%. This is the first time research is being done into the effectiveness of digital technology though.
Using technology to break the barriers and to help seeking
“We feel technology has the potential to be more accepted and accessible, particularly to a younger population,” says Dr Larsen. Text messaging has the added benefit of providing easy access to further resources. “We’ve also got links in the text messages to additional online support and resources, so we’re expanding the scope of what can be delivered in just postcards.”
RAFT is currently being assessed at the Royal Prince Alfred Hospital in Sydney, where people coming into the emergency department following a self-harm or suicide attempt are being offered the follow-up text messaging service. There will soon also be pilot sites in Toowoomba and Brisbane.
The iBobbly team’s work also holds a critical space in suicide prevention. Currently, the suicide risk of Indigenous Australian youth (aged 15 to 34) is almost four times that of their non-Indigenous counterparts.
While the trial is still ongoing, after using iBobbly for six weeks, the 61 participants from Western Australia’s Kimberly region experienced a 42% reduction in depression symptoms. They also reported a 28% reduction in psychological distress and a 30% reduction in thoughts of suicide.
“The suicide ideation result was not statistically significant, but it is promising that suicide ideation was reduced,” says Joe Tighe, Black Dog researcher. Tighe explains that the main goal of the initial trial was to gauge if the app would be relevant. “We didn’t know if Indigenous youth would engage with or like it. With version 2.0, the goal is to reduce suicidal thinking. Now we need to know with this larger trial that will include hundreds of people.” Detailed research findings are available at BMJ Open.
Studies have shown geographic isolation is a barrier to Indigenous help seeking. iBobbly tries to combat this and, once downloaded, does not require internet connectivity so that users can access the resources at all times.
It's similar to a video game
After incorporating community feedback and requests for more in-depth information, a wider trial of iBobbly version 2.0 is being undertaken across Australia. “Some people that really engaged with it wanted it to contain more, many more activities and many more exercises,” says Tighe, comparing the new version to a video game with multiple levels. “So pretty much like gaming, we provided layers and layers of content, for people to go as deep as they wanted to go.”
Collaboration with Indigenous partners informed the development of the app and the available resources, including the decision to include gender-specific audio resources. “Local community partnership was crucial to us successfully running the trial,” says Tighe.
With wide community support for the pilot, and a drop-out rate of only 3%, the next version of iBobbly could have an even greater reach.