|Year : 2015 | Volume
| Issue : 3 | Page : 201-204
A suicide awareness and intervention program for health professional students
Eve De Silva, Lisa Bowerman, Craig Zimitat
School of Medicine, University of Tasmania, Tasmania, Australia
|Date of Web Publication||11-Mar-2016|
School of Medicine, University of Tasmania, Private Bag 74, Hobart, Tasmania
Source of Support: None, Conflict of Interest: None
Background: Many emergency service professionals and health professionals play important roles in the assessment and management of suicide risk but often receive inadequate mental health training in this area. A 'Suicide Awareness and Intervention Program' (SAIP) was developed for first year medical, paramedical and pharmacy students at the University of Tasmania, Australia. The program aimed to increase students' knowledge and awareness about suicide-related issues, develop interpersonal skills around suicide screening and increase awareness of available support services. Methods: A 5-hour experiential SAIP was embedded within the curriculum. A pre and post evaluation of knowledge, skills and attitudes was conducted, with an open-ended follow-up survey regarding use of what was learned in the program. Results: Pre and post SAIP surveys showed significant improvement inknowledge and practical skills. Feedback from students and the counselling service indicated enduring impact of the program. Discussion: Participation in the SAIP increased knowledge, skills and attitudes related to the assessment and management of individuals at risk for suicide, and the application of this ability to students' personal and professional lives.
Keywords: Health professional education, medical students, mental health, paramedical students, pharmacy students, suicide prevention, undergraduate
|How to cite this article:|
De Silva E, Bowerman L, Zimitat C. A suicide awareness and intervention program for health professional students. Educ Health 2015;28:201-4
| Background|| |
Suicide is a global public health problem affecting all parts of society. Healthcare professionals play an important role in assessing and managing people at risk for suicide in the general population. General Practitioners (GPs), paramedics and pharmacists regularly interact with individuals at risk of suicide and facilitate referral to medical and support services. Health professionals themselves also have a relatively high risk of suicide because of the nature of their professions and due to occupational exposure to suicide and other critical incidents.,, The higher risk of suicide also extends to undergraduate health professional students, due both to the stress of their work and training and being in an age group at high risk of mental illness.
Suicide awareness training programs for those who first encounter individuals at risk for suicide–teachers, athletic coaches, first responders, primary health care practitioners—provide knowledge and skills to identify and support individuals at risk and refer them to relevant services. Typically, these personnel would undertake suicide recognition and response training. Training programs for professionals who may first encounter an individual considering suicide have been demonstrated to provide positive outcomes in structured work environments, health care and community settings. It is estimated  that training community-based health professionals to recognize and respond to individuals at risk for suicide could decrease suicide risk of suicide completion by 20-70%. Educating health professional students (e.g. medical, paramedical and pharmacy students) with knowledge, skills and attitude for suicide intervention would be a complementary strategy.
Despite the important role of General Practitioners in suicide prevention, Australian General Practitioners and undergraduate medical students rate their own interpersonal suicide prevention skills as poor. Medical and pharmacy students have limited exposure in the curriculum and on placements, while paramedical students frequently encounter clients with acute mental health disturbances including attempted and completed suicides on emergency care placements. Few Australian medical schools have curricula that include developing knowledge, skills and attitudes for suicide intervention, which appears to be international gap in medical and health professional education., The broad goal of this 'Suicide Awareness & Intervention Program' (SAIP) was to increase health professional students' knowledge and awareness of suicide related issues, encourage students to better access help for their own mental health issues and develop skills to support and respond to others who may show signs of distress.
| Design of the Suicide Awareness and Intervention Program|| |
A community-based SAIP  for first-contact health professionals was adapted for use in the School of Medicine, Faculty of Health, University of Tasmania, Australia. The medical, paramedical, and pharmacy programs enrol high school leavers, are each of 3 to 5 years duration and produce graduates that enter a year of supervised internship. The program was delivered by trained staff to groups of 10 to15 students. This training involved an intensive five day program including: One day of being a participant, a one day workshop learning about suicide, one day of skill development to deliver the program and two further days delivering the program under direct supervision. The goals of the program were modified [Table 1] for health professions students  to include a more detailed and health professional-focused evidence-base with introduction of new contextual material, experiences and case studies. More specifically, this program uniquely introduced a model of behaviours as an aid to understanding and explaining suicide to others, as well as communication role play. In brief, the five-hour SAIP was comprised of three main sessions: (i) An introductory interactive lecture and video that provides an overview of myths, misconceptions and statistical information related to suicide in the general population and for various health professions, (ii) exploration of a suicide journey illustrated through use of a tributaries/dam/river analogy and a tunnel vision exercise to illustrate and allow students to experience the decreasing options and feelings of no escape that can lead to thoughts of suicide; (iii) scenario discussions and role play which involves communication and questioning skills. In small groups, participants learn how to A – Ask the person at risk if they are considering suicide; B – assess for past Behaviours or experience, thereby better estimating the level of risk; C – asking if the person has a Current plan, and D – Discovering what is “keeping them alive” and how they managed to cope with their stresses and struggles before. In the final session, participants demonstrate through role play how to recognise, assess and respond to a person who appears to be at risk for suicide.
|Table 1: Key learning outcomes and activities of the suicide awareness and intervention program 1-day program|
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| Methods|| |
The SAIP was added to the curriculum for all first year medical, paramedical and pharmacy students in the School of Medicine. All participants in the SAIP were invited to complete a pre and post-SAIP survey, with follow-up questionnaires exploring how they have applied the knowledge, skills and attitudes developed through the SAIP. The survey contained questions relating to satisfaction with the program, students' previous knowledge and training in regard to suicide awareness and intervention, their level of comfort in talking about suicide to various people who appear to be at risk for suicide, and confidence in their ability to provide appropriate assistance to a family member, friend, colleague and stranger. Follow-up emails to staff and students sought feedback on the SAIP and their use of the knowledge skills and attitudes developed through the SAIP in personal, clinical and professional settings. There were no incentives for participation. This research was approved by the local Human Research Ethics Committee.
| Results|| |
The SAIP was offered to 542 health professional students over the period 2010-2014. We report here comparative data for all three professional groups (N = 266; response rate 97%) that participated in 2012 [Table 2]. The student evaluation of SAIP was very positive. More than 91% of students, including 96% of medical students, 94% of paramedical students, and 91% of pharmacy students agreed or strongly agreed that completing the workshop enhanced their preparation for clinical practice around suicide prevention, and 75% of students, including88% of medical students, 79% of paramedical students, and 74% of pharmacy students, agreed or strongly agreed that they would like further training related to mental health awareness and management. After the SAIP, there was a significant increase in students' knowledge of key facts about suicide that were part of the program's 'myth busting' section [Table 2]. Students reported significantly higher levels of comfort and confidence in discussing suicide witha family member, friends, colleagues and strangers after the SAIP training [Table 3]. Students reported greater awareness of support services available in the community and at the university. After the introduction of this program, case note data from Student Counselling Services showed a steady increase in the number of medical students who attended the service (from 8 to 30/year) over the next three years.
|Table 2: Participant pre- and post-workshop test scores regarding awareness about suicide issues (% correct score)|
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|Table 3: Participants' reported levels of comfort and confidence discussing suicide with an individual who may be “at risk“ before and after suicide awareness and intervention program training (mean, standard deviation) and changes in knowledge about suicide (% score)|
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Six months after completing the program, the SAIP team sought information by email from students about how they have applied the skills they learned in the program. Twenty-five of 266 students reported that they had used their skills to help themselves, provide peer support or provide support to clients and colleagues on clinical placements. The following comments relate to the variety of contexts for the application of their skills.
“Before this training I would not have had the confidence to help my friend and thanks to this training I was able to assist and make sure that he was safe”.
“Directly after my training I had [two conversations] both over the telephone. Without the skills learnt, I would not have felt comfortable in talking to anyone about suicide”.
“When I used my training on placement, the staff at the receiving end of the patient were happy to have all of the history I was able to learn from the patient”.
“This training helped me to understand what was going on in my life and I was able to then talk to my GP about it”.
Students reported contexts and situations in which they used their training, including professional development with practitioners on placement, talking with an agitated individual on a roof during a placement, increased self-awareness, active listening to friends, and seeking personal medical care.
| Discussion|| |
Suicide awareness is often not part of the education of health professionals. Implementing the SAIP led to greater knowledge and skills and improved attitudes relating to suicide prevention for students' personal and professional lives, for all three participating health professions student groups. Participation in the SAIP yielded significantly greater levels of comfort and confidence in talking to family members, friends, colleagues and strangers about suicide. Paramedical students scored higher pre-test scores on skills, perhaps reflecting the group's overall more mature age with its richer life experiences compared to the other student groups. Anecdotal evidence from student reports suggests that the SAIP had positive impacts on self-awareness, which is evident in student comments and reports from counselling staff. While not directly comparable to other SAIPs that are much shorter , this program demonstrated short term effects on knowledge and skills; some of the longer term impacts of the program (e.g. application) may be related to the nature and timing of follow-up and/or significant experiential components. Students found the river analogy and funnel experiences to be very powerful. Students in all years of their courses, academic staff and professional staff have requested access to SAIP, and some have sought advanced training to provide SAIP for community groups and professional groups (e.g. paramedical). The SAIP has been adapted for delivery to community health workers in other cultural contexts (e.g. Fiji) with early positive effect.
We recommend the importance of optimising the program length  to suit the logistics of SAIP delivery in dense curricula, and situating the program within the school structures and curriculum with active support from those interested in student welfare and teaching mental health. Future directions include evaluating the intensive 5-hour SAIP against an equivalent program delivered in several parts set longitudinally within the formal curriculum; assessing a wider range of outcome measures; examining the longer term retention of students' knowledge, skills and attitudes; and adapting the program for community youth groups and to enhancing health and well-being in healthcare workplaces.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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