Effectiveness of the Hunter Way Back Support Service: An historical controlled trial of a brief non‐clinical after‐care program for hospital‐treated deliberate self‐poisoning

McGill, Katie; Whyte, Ian M.; Sawyer, Lisa; Adams, Danielle R.; Delamothe, Katrina; Lewin, Terry J.; Robinson, Jo; Kay‐Lambkin, Frances

doi:10.1111/sltb.12840

Cited by 2 publications

(6 citation statements)

References 70 publications

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“…A historical controlled study found that no significant differences were observed between the Way Back intervention and the control group in terms of the proportion of individuals with any readmissions for suicide re-attempts or the number of readmissions during the follow-up period. 18 Further research on the implementation, acceptability, feasibility and sustainability of brief aftercare interventions is therefore needed so that local, more specific estimates of their short-term and long-term effectiveness can be generated. Furthermore, research to explore which of various different aftercare models are the most effective and cost-effective for suicide prevention should be carried out to support the best funding allocation.…”

Section: Discussionmentioning

confidence: 99%

“…17 The effectiveness of a theoretical brief aftercare intervention was based on an effect size derived from a recent meta-analysis by Doupnik et al, 13 whereas the direct intervention cost was based on estimates from the Australian brief aftercare programme for prevention of repeated self-harm. 18 In this study, a partial societal perspective was used to assess both the costs and health benefits. That meant that healthcare costs related to hospital admissions due to self-harm and the healthcare cost offsets and cost of productivity loss related to suicides were included in the base case analysis.…”

Section: Methodsmentioning

confidence: 99%

“…This specific site was chosen because it is the only site where a costing of the Way Back in practice has been conducted. 18 In this costing analysis, costs of the Way Back were calculated by summing the costs for (a) staff who delivered the intervention, (b) staff training and professional development, and (c) staff travel. The total cost of the Way Back was estimated at AUD$615 per person.…”

Section: Methodsmentioning

confidence: 99%

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Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm

Flego

Krysińska

et al. 2023

BJPsych open

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Background Prior self-harm represents the most significant risk factor for future self-harm or suicide. Aim To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. Method We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost–utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. Results The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: −56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: −0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. Conclusions A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm

Flego

Krysińska

et al. 2023

BJPsych open

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“…SPP includes a number of suicide specific interventions, such as safety planning, counselling on access to lethal means, consumer and carer psycho-education, and face-to-face contact with a mental health clinician within 48 h of discharge [ 8 ]. One aim was rapid connection of those who do not require ongoing public mental health support to other community support services, including primary care, private sector and non-clinical aftercare services, such as The Way Back Support Service (a not-for-profit organization providing non-clinical psychosocial support and transition services for individuals who have attempted or are at risk of suicide) [ 9 ]. High quality clinical handover in this transition phase was emphasised.…”

Section: A Case Study: the Gold Coast Suicide Prevention Pathwaymentioning

confidence: 99%

“…Responding to the risk and impact of suicide across the healthcare system requires a careful balance, incorporating diagnosis, risk and clinical care with suicide-specific and non-clinical care interventions. A recent evaluation of The Way Back Support Service (providing non-clinical aftercare after hospital treated suicide attempts) illustrates this by showing that non-clinical aftercare by itself had limited impact on those presenting with deliberate self-poisoning, indicating the need for evidence-based clinical interventions alongside the non-clinical care [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Paradox of Suicide Prevention

Turner

Pisani

Sveticic

et al. 2022

IJERPH

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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.

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Effectiveness of the Hunter Way Back Support Service: An historical controlled trial of a brief non‐clinical after‐care program for hospital‐treated deliberate self‐poisoning

Cited by 2 publications

References 70 publications

Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm

Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm

The Paradox of Suicide Prevention

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