The Esperance primary prevention of suicide project

Background: Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia. Aims: To evaluate the effect of three evidence-based initiatives for the primary prevention of suicide: (i) providing suicide awareness sessions for staff members in health, education and social services; (ii) limiting the sale of over the counter analgesics (aspirin and paracetamol) to packets containing less than the minimum lethal dose; and (iii) implementing Commonwealth media guidelines in the reporting of suicides by media. Methods: Changes in knowledge, awareness, attitudes, comfort and use, before and after each intervention were assessed using standardized instruments and pro forma derived from previous work, such as the Youth Suicide Prevention Training Manual and Suicide Intervention Beliefs Scale. Percentage changes in the number of retail outlets selling over the counter analgesics to less than potentially lethal quantities (less than 8 g of paracetamol or aspirin) were also measured. Media representatives were interviewed to gain their perceptions of Commonwealth Guidelines for the reporting of suicide, and encouraged to consult the project team before reporting suicide related issues. Results: The baseline survey illustrated that mental health staff and general practitioners were more aware of suicide issues, risk factors for suicide and awareness of professional and ethical responses than staff from other services, and were more willing to raise the issue with a person at risk. Thirty-three subjects participated in suicide awareness training of whom 21 (66%) returned questionnaires. There were significant increases in awareness of suicide-related issues and risk factors, as well as reported levels of knowledge of professional and ethical responses and comfort, competence and confidence levels when assisting a person at risk. Only three media representatives were aware of the Commonwealth Health Department Guidelines for reporting suicide and only one believed that the guidelines influenced their reporting. The local newspapers subsequently contacted the researchers to check that their reporting met the guidelines. As regards access to analgesics, one out of seven retailers agreed to implement the strategy (pending agreement from other retailers), another claimed increased awareness of the danger of analgesics, and three maintained that they would attempt to monitor excessive amounts sold to one individual. Conclusions: Local initiatives can improve the awareness and knowledge of staff in the assessment of suicide risk, as well as of local media. These need to be complemented by initiatives at State or Commonwealth level to produce change in statewide media, or sales of over the counter analgesics