Intuition, Imagination and Innovation riple i in Suicidology T Conference Virtual Conference 16th–19th June 2020 11th Programme and Abstract Book 2020 June |16th–19the encer onf Intuition, Imagination and Innovation in Suicidology Conference C 11th Triple i | Virtual Conference | 16th–19th June 2020 Programme and Abstract Book tual E-ISSN 2712-5467 ir Edited by · Diego de Leo and Vita Poštuvan Cover Photo, Design and Layout · Alen Ježovnik i|V Published by · University of Primorska press Titov trg 4, 6000 Koper www.hippocampus.si Triple Editor in Chief · Jonatan Vinkler Managing Editor · Alen Ježovnik Koper · 2020 11th © 2020 University of Primorska Electronic Edition http://www.hippocampus.si/ISBN/978-961-7055-67-2.pdf http://www.hippocampus.si/ISBN/978-961-293-000-4/index.html https://doi.org/10.26493/978-961-7055-67-2 Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID=20910851 ISBN 978-961-7055-67-2 (pdf ) ISBN 978-961-293-000-4 (html) Table of Contents 2020 June Welcome Address · 4 Organizers · 5 Programme Outline · 7 Listening to the Suicidal in the Wake of Covid-19 Vanda Scott · 8 |16th–19the Are There Some Premature Deaths We Should Not Prevent? Suicide Prevention When Assistance in Dying is Available enc Brian L. Mishara · 9 er Suicide Prevention at Scale: nf The Twin Challenges of Implementation and Evaluation oC Navneet Kapur · 10 Self-Harm in Children and Adolescents: An Update on Key Issues tual Keith Hawton · 11 ir Community Interventions Lakshmi Vijayakumar · 13 i|V Impacts of Covid-19 on Mental Health and Suicide Risk in Occupational Settings: Implications for Suicide Prevention and Research Ella Arensman · 14 Triple Covid-19 and Suicide Prevention Diego De Leo · 16 11th Zero Suicide: A Big Hairy Audacious Goal Joe Rafferty · 17 3 Welcome Address 2020 Dear intuitive, imaginative and innovative guest, June We are happy to welcome you at the Triple i Virtual Conference, event this year brought to you by Slovene Centre for Suicide Research, De Leo Fund Onlus and International Association for Suicide Prevention! The conference is an international annual event organized by the Slovene Centre for Suicide Research (Andrej Marušič Institute, University of Primorska) in collaboration with FAMNIT (University of Primorska). Our aim is to in- |16th–19th crease awareness and knowledge about suicide and thus contribute to the e development of suicide prevention and postvention activities. enc In recent years, the conference has developed into a platform for fruitful er discussions among distinguished experts in suicide research and preventi-nf on, interacting with young and perspective suicidologists and other mental o health professionals. C Regrettably, due to the epidemiological situation regarding the spread of the SARS-CoV-2 virus, we had to cancel this year’s Triple i conference. None-tual theless, employees from different organizations connected and prepared a ir virtual version of the traditional conference, as we want to enable eager participants to listen to and interact with world-renowned suicidologists. The i|V exchange of knowledge and experience regarding suicidal behaviour is all the more important in these new and challenging circumstances. And at-tendance at the virtual conference thus enables just that: the opportunity Triple to listen to new and innovative findings in the field of suicidology while al-so connecting and exchanging knowledge with participants from countries 11th around the world. The Triple i 2020 programme includes topics of suicide research and clinical work with suicidal patients and thus addresses theory, research, prevention and interventions in suicidology. Each lecture will be followed by a discussion in which the participants will be invited to share their views. Existing difficulties in both research and clinical work will be specifically addressed. Let the Triple i Conference be an opportunity for you to express and practice your intuition, imagination and innovative ideas. Prof. Diego De Leo and Dr. Vita Poštuvan, Chairs Wendy Orchard, Wendy Cliff, Vanja Gomboc, and Katherine Thomson, Organising Committee 4 Organizers 2020 Slovene Centre for Suicide Research (UP IAM SCSR) June Slovene Centre for Suicide Research was founded in 2011 within UP Andrej Marušič Institute, University of Primorska. The initiative for establishment of an independent unit within the institute was put forward by Prof. Diego De Leo and a group of former co-workers of late Prof. Andrej Marušič in the me-mory of his work and with the purpose of continuing it. Research and prevention of suicide are addressed as crucial activities of |16th–19th clinical-research work. The Centre is involved in international and national e projects and is the initiator of numerous innovative approaches in suicidology. The Centre’s vision is to provide high-quality research for better under-enc standing of suicidal behaviour, thus contributing to suicide prevention, in-er tervention and postvention. nf You are welcome to read more about us at zivziv.si! oC De Leo Fund Onlus tual De Leo Fund Onlus was established with the desire to offer a source of su-ir pport for parents, children, relatives and friends who are suddenly forced to face the death of a loved one, emerging from road accidents, work-related i|V accidents, suicide, natural disasters, crimes. At such times, human and professional support can play a role of enormous significance in mitigating pain and isolation of which invariably suffer the survivors to these deaths. Triple In parallel with care activities, De Leo Fund organizes training courses, me-etings and seminars. In the context of scientific projects, De Leo Fund col-11th laborates with universities and other institutions to carry out research programs and educational activities in the field of suicide and traumatic berea-vement issues in children, adolescents and adults. You are welcome to read more about us at https://www.deleofund.org! The International Association for Suicide Prevention (IASP) The International Association for Suicide Prevention (IASP) is a Non-Governmental Organization and the largest international organization dedicated to suicide prevention. It was founded by the late Professor Erwin Ringel and Dr. Norman Farberow in 1960 and now includes professionals and volunteers from 77 countries. 5 The International Association for Suicide Prevention (IASP) is dedicated to preventing suicidal behaviour, alleviating its effects, and providing a forum 2020 for academics, mental health professionals, crisis workers, volunteers and suicide survivors. June You are welcome to read more about us at https://www.iasp.info! |16th–19the encernfoC tualir i|V Triple 11th 6 Programme Outline 2020 Tuesday, 16th June 2020 10.00–11.00 Ms. Vanda Scott, ‘Listening to the Suicidal in Wake of Covid-19.’ June 16.00–17.00 Prof. Brian L. Mishara, ‘Are There Some Premature Deaths We Should Not Prevent? Suicide Prevention When Assistance in Dying is Available.’ Wednesday 17th June 2020 10.00–11.00 Prof. Navneet Kapur, ‘Suicide Prevention at Scale: The Twin |16th–19the Challenges of Implementation and Evaluation.’ 16.00–17.00 Prof. Keith Hawton, ‘Self-Harm in Children and Adolescents: enc Key Issues.’ er Thursday 18th June 2020 nfo 10.00–11.00 Dr. Lakshmi Vijayakumar, ‘Community Interventions.’ C 16.00–17.00 Prof. Ella Arensman, ‘Impacts of Covid-19 on Mental Health and Suicide Risk in Occupational Settings: Implications for Suicide tual Prevention and Research.’ ir Friday 19th June 2020 i|V 10.00–11.00 Prof. Diego De Leo, ‘Covid-19 and Suicide Prevention.’ 16.00–17.00 Mr. Joe Rafferty, ‘Zero Suicide: A Big Hairy Audacious Goal.’ Triple 11th 7 Listening to the Suicidal 2020 in the Wake of Covid-19 Vanda Scott June Ms. Vanda Scott is currently the international advisor to the International Association for Suicide Prevention and holds several advisory positions with NGOs including the De Leo Fund. She participated in the development of a worldwide network of agencies for suicide prevention, which enhances cooperation betwe- |16th–19th en mental health professionals and volunteers. Her speech will be about coope-e rative approaches to prevention of suicide with examples on three levels – local, national and international. encer Abstract. Unknown, unexpected, medical emergency – Covid-19 a global cri-nf sis. In December 2019 coronavirus was identified in China and by early March o extended exponentially across many nations, East and West, and the World C Health Organisation declared Covid-19, a global pandemic. Globally, gover-nments immediately enforced a range of actions from the research of the vi-tual rus through to extensive medical treatment, social isolation, workplace and ir countrywide closures. The impact is unmeasurable and will affect economic and social stability as well as the general and mental health of the popula-i|V tion in all countries. Almost 80 of all suicides occur in the low and middle income countries; these very same countries that will experience even grea-ter inequities during this pandemic due to weak public health systems, lack Triple of mental health professionals and facilities, the negative economic effect of lockdowns and the evident increase in poverty. Along with mental health 11th professionals worldwide, Suicide Prevention Crisis Centres have been in the front line of responding to the public and, unquestionably, will continue to have a significant role in being accessible for those suffering suicidal ideation and behaviour. The purpose of this presentation is to take a small sample of the work from crisis centres in both the developed and developing countries and review the changes in their services that is currently being experienced and also reflect on what could be expected. It is too early to predict the changes in suicidal behaviour. However, this sector is only too aware that there is a need to prepare for an undetermined change in trends in suicidal behaviour along with unknown knowledge on how such changes may be resourced. A few challenging options will be explored. 8 https://doi.org/10.26493/978-961-7055-67-2.8 Are There Some Premature Deaths We Should Not Prevent? Suicide Prevention 2020 When Assistance in Dying is Available Brian L. Mishara June Brian Mishara is Professor of Psychology and Director of the Centre for Research and Intervention on Suicide and Euthanasia (CRISE) at the Université du Québec à Montréal, Canada. He is a founder of Suicide Action Montreal, the Montreal |16th–19th suicide prevention centre, a Vice-chairperson of the Trustees of Befrienders Worl-e dwide, an international organization of helplines, a past president of the International Association for Suicide Prevention and Canadian Association for Suicide enc Prevention. He consults and conducts suicide prevention training internationally er and has helped establish helplines using telephone, chat and text services. As he nf likes challenges, he is an active researcher in several fields, among which we sho-o uld mention the effectiveness of suicide prevention programmes, understanding C suicide in children, theories of suicidality, euthanasia etc. His recent research also focuses on best practices and ethical issues in using new technologies in suicide tual prevention. ir Abstract. Suicide prevention services are generally supposed to do their ut-i|V most to prevent suicides with all persons, regardless of the suicidal individual’s characteristics and reasons given for wanting to die. Their assumptions are that doing otherwise constitutes discrimination and that they would Triple venture into an ethical morass if they attempt to determine whether some lives are more worthy of saving than others. However, where MAiD (assisted suicide and euthanasia) has been legalized, should we continue to strive to 11th prevent all suicides? Or are there some circumstances where we should ab-stain from preventing a death by suicide or even encourage people to seek to end their lives by MAiD? This presentation explores if there are justified distinctions between how to respond to people requesting or considering requesting MAiD, and how to respond to suicidal individuals. We examine whether suicide is sometimes rational and without ambivalence, as well as how respect for autonomy may be balanced against obligations to protect vulnerable populations. https://doi.org/10.26493/978-961-7055-67-2.9 9 Suicide Prevention at Scale: 2020 The Twin Challenges of Implementation and Evaluation June Navneet Kapur Prof. Navneet Kapur Professor of Psychiatry and Population Health at the University of Manchester, UK and an Honorary Consultant Psychiatrist at Greater Man- |16th–19th chester Mental Health NHS Foundation Trust. His research mostly targets epide-e miological methods, the aetiology and treatment of suicide behaviour, as well as patient safety. His main contributions have been focussed in the area of health enc service responses to suicide. Prof. Kapur is particularly enthusiastic about the re-er search work, because, even though clinical work can be very rewarding, research nf offers the possibility to impact on the lives of many people not just the person in o front of you. C Abstract. Despite decades of research examining the epidemiology and ae-tual tiology of suicide we are light on research which tells what works for who. ir On top of that there is an implementation gap where the things we know might help fail to be adopted into routine practice. In this talk, I will discuss i|V a number of strategies that could improve implementation of our research findings: carrying out the highest quality research to inform practice; mes-saging it simply; engaging with policy makers and the media; disseminating Triple widely using different methods; supporting staff by developing training and implementation tools; implementing at both national and local levels; and of 11th course persistence. I will then go on to discuss examples of large scale evalu-ations of suicide prevention strategies and policies before describing a major national initiative from the UK. This is ongoing and takes a phased approach to prevention led by local health areas themselves. The audience will be invited to consider potential challenges and solutions. 10 https://doi.org/10.26493/978-961-7055-67-2.10 Self-Harm in Children and Adolescents: An Update on Key Issues 2020 Keith Hawton June Prof. Keith Hawton is a Director of the Centre for Suicide Research at the University of Oxford. For more than 40 years he and his research group have been conducting investigations concerning the causes, treatment, prevention and outcome of suicidal behaviour. Prof. Hawton has received research awards from all the major international suicide prevention organisations. His interests include |16th–19th epidemiology and clinical management of self-harm, suicide and self-harm in e adolescents, media influences on self-harm and evaluation of suicide prevention initiatives. Key factors that motivate him to continue working in the field of enc suicidology are the emergence of new challenges and phenomena, such as the er role of the internet in suicidal behaviour, new types of suicidal behaviour; the nfo satisfaction of making contributions to prevention of suicide; rewarding colla-C borations with a wide range of people, both nationally and internationally; and the fact that the field attracts many people who share the same values. tual Abstract. Evidence from several countries highlights increasing rates of bo-ir th self-harm and suicide in young people. In England for example, rates of i|V self-harm have recently increased very substantially in female adolescents, especially those aged under 17 years of age. Also rates of suicide have increased in under-20 year-olds of both genders over the past decade. As in adults, self-harm is an important risk factor for future suicide. There is a pressing ne-Triple ed therefore to identify contributory factors that may assist in the design of prevention and treatment initiatives to try to reduce this phenomenon and 11th to help ameliorate its consequences for young people. This has become all the more pressing with the many difficulties presented by the Covid-19 pandemic. In this presentation the epidemiology of self-harm and suicide will be discussed in the context of the iceberg model. Some key factors that contribute to self-harm will then be considered. These include evidence about the important role of puberty in the onset of self-harm, and the contribution of psychiatric disorders, mood instability and sleep disorders. Self-harm and suicide in children and adolescents often appears to spread between individuals, with clusters of the behaviour being far more common than in adults. While media influences on self-harm and suicide continue to be important in young people, the internet and social networking are making an increasing https://doi.org/10.26493/978-961-7055-67-2.11 11 contribution, with some positive aspects, as well as negative ones. Recent findings on the association between self-harm and subsequent suicide will 2020 be presented, highlighting the long-term risk of suicide in children and adolescents and the fact that there is often a change of method between acts of June self-harm and eventual suicide. The impact of self-harm on families will be considered. The presentation will conclude with a summary of key challenges for prevention, including a discussion of the issue posed by the Covid-19 pandemic. |16th–19the encernfoC tualir i|V Triple 11th 12 Community Interventions Lakshmi Vijayakumar 2020 June Dr. Lakshmi Vijayakumar is the Head of SNEHA Suicide prevention Centre in Chennai. She is particularly interested in the combination of clinical and public health interventions and suicide prevention possibilities within them. She has been conferred ‘Honorary Fellowship’ of the Royal College of Psychiatrists (FR-CPsych), UK for her work on suicide prevention locally, nationally and globally. She is the first woman psychiatrist from South East Asia to receive this honour. |16th–19th Dr. Vijayakumar was a guest of the Triple i conference for the first time in 2014 e when she spoke about the relevance of formulating locally relevant, culturally appropriate, costeffective and sustainable interventions. enc Abstract. Suicide rates vary widely across countries and within regions in er each country. Developing a ‘one size fits all’ suicide prevention program-nfo mes are unlikely to bring down the suicide rates. A bottoms up reach is also C needed. It is crucial to develop cost effective and culturally appropriate interventions involving the community. The major challenges in developing such tual interventions are identifying and understanding the sociocultural context of ir the community, engaging with different sections of the community without compromising evidence base or effectiveness of suicide interventions, task i|V shifting and ensuring sustainability. Examples of community suicide prevention interventions from high, middle and low-income countries and for vulnerable sections of the community will be discussed. Triple 11th https://doi.org/10.26493/978-961-7055-67-2.13 13 Impacts of Covid-19 on Mental Health 2020 and Suicide Risk in Occupational Settings: Implications for Suicide Prevention June and Research Ella Arensman Prof. Ella Arensman is Research Professor with the School of Public Health, Uni- |16th–19th versity College Cork and Chief Scientist with the National Suicide Research Fo-e undation (NSRF), Ireland. She is Vice President of the European Alliance Against Depression, and past President of the International Association for Suicide Pre-enc vention. She is also Visiting Professor with the Australian Institute for Suicide Re-er search and Prevention, Griffith University, Brisbane. She has been involved in re-nfo search and prevention of suicide, self-harm and related issues for more than 30 C years, with emphasis on risk and protective factors associated with suicide and self-harm, and effectiveness of preventive programmes. In Ireland, she played a tual key role in developing the first and second National Suicide Prevention Program-ir me: Reach Out, 2005–2014, and Connecting for Life, 2015–2020. i|V Abstract. The impacts of the Covid-19 pandemic are far reaching and long lasting for people in many work settings, and especially for those in Small and Medium Enterprises (SMEs) in terms of people’s wellbeing and mental health and the social and economic impacts. A review of the impacts of Covid-19 Triple and associated movement restriction measures on people with psychiatric disorders and non-clinical mental health difficulties in occupational settings 11th has been conducted by the MINDUP (Mental Health Promotion and Intervention in Occupational Settings) consortium. Considering the short-term and long-term impacts of Covid-19, including staff stress and anxiety, reduced quality and perhaps intensity of prevention of and care for those with mental disorders, or other impacts associated with the Covid-19-crisis, the MINDUP project is timely while it offers to SMEs support and intervention tools with a specific focus on alleviating depression and anxiety among staff. The reaction to the Covid-19 pandemic led to several changes in occupational settings such as increased and changed emotional work demands for some professionals, e.g. health care workers; exposure to infected patients and remote working. While many large organizations usually support their staff with Employee Assistance Programmes or workplace health promotion 14 https://doi.org/10.26493/978-961-7055-67-2.14 to support their employees in times of crisis, this is commonly not the case in SMEs and therefore the impact of Covid-19 may be exacerbated in these settings. In addition, loss of employment and financial stressors are well-2020 recognised risk factors for suicide. Governments should therefore provide financial safety nets, and consideration must be given not only to individuals’ June current situations but also their futures. For example, many young people have had their education interrupted and are anxious about their prospects. Educational institutions must seek alternative ways. The MINDUP project be-gan in January 2020 and aims to improve mental health and wellbeing in the workplace by developing, implementing and evaluating a multilevel intervention targeting both prevalent psychiatric disorders (depression, anxiety |16th–19th disorders) and non-clinical aspects of mental health (stress, burnout, wellbe-e ing, depressive symptoms). In addition, evidence-based tools and interventions will presented that can be included in response plans, implemented in enc SMEs and other occupational settings. ernfoC tualir i|V Triple 11th 15 Covid-19 and Suicide Prevention 2020 Diego De Leo June Prof. Diego De Leo (the head of Slovene Centre for Suicide Research and profes-sor of Psychiatry at the Griffith University in Brisbane, Australia), is considered as one of top five world leading experts in suicidology by international professional and scientific public. His research expertise includes definitional issues in suicidology, culture and suicide, international trends and national suicide prevention |16th–19th programs. He received numerous world renowned awards for his scientific work. e His bibliography includes over 420 peer-reviewed articles and 180 book chapters. Abstract. The SARS-CoV-2 pandemic – which causes Covid-19 – is feared to enc cause a confluence of risk factors capable of increasing suicidal behaviours. er Policies to combat infection, such as social distancing, social isolation and nfo quarantine, can have negative effects on vulnerable people such as the el-C derly and those with mental illness. The increased sense of disconnection from society, physical estrangement and the loss of the usual social and work tual opportunities can provoke feelings of loneliness and social isolation, which ir are well-known risk factors for suicide, especially in late life. Quarantine it-self has been associated with psychological distress, especially when prolon-i|V ged, as demonstrated by the previous SARS outbreak. Rationing of resources, frustration and boredom, fear of infection, insufficient or contradictory information are all stressful factors associated with poor mental health outcomes. Triple Anxiety, depression and stress-related disorders are common consequences of emergency situations, especially if long-lasting. In addition, during the pandemic, people with mental conditions may find obstacles to accessing 11th continuous treatment, including regular access to drugs and medical checks. As happened in Italy, people residing in nursing homes can be particularly at risk of abandonment with inadequate resources, overwhelmed staff and lack of contact with family members. People who report to emergency depart-ments with suicidal behaviours may also be disadvantaged due to lengthy cues with priority given to suspected Covid-19 cases, resulting in suboptimal levels of care, which can potentially affect suicide numbers. As happened wi-th the economic crisis between 2008–2010, it is particularly feared that the Covid-19 pandemic will provoke a global recession, capable of causing a significant number of ‘economic suicides’ through mechanisms such as loss of employment and indebtedness, and housing insecurity. 16 https://doi.org/10.26493/978-961-7055-67-2.16 Zero Suicide: A Big Hairy Audacious Goal Joe Rafferty 2020 June Mr. Joe Rafferty is one of the co-founders of the Zero Suicide Alliance, a national suicide prevention collaboration of over 1500 members across the UK and the globe. Before coming to Mersey Care, which hosts the ZSA, Joe held the post of Director of Commissioning Support at the NHS Commissioning Board, having national responsibility for the design and delivery of a significant component of the commissioning side reforms outlined in the White Paper: Liberating the NHS. |16th–19th Prior to this, he was seconded from the Chief Executive role at NHS Central Lan-e cashire, to become the Director of Commissioning Development for NHS North West, with a remit to lead the development of commissioning reforms across the enc North West of England. From 2007 to 2010 he was the Chief Executive of NHS er Central Lancashire and the Regional Director of Commissioning and Strategy for nf NHS North West from 2006–2008. Other Board-level roles have included Director o of Performance in Cumbria and Lancashire SHA and Director of System Reform C at Bolton Hospital NHS Trust. Prior to these roles, he was part of the team that set up Greater Manchester SHA. tualir Abstract. This presentation explores the benefits of using audacious, zero-based thinking to stimulate change in healthcare provider and wider societal i|V thinking in relation to suicide prevention. The Zero Suicide Alliance (ZSA) was born out of one mental health trust’s thrust to begin to radically re-engineer it’s thinking and delivery in relation to suicides of patients in their care. This Triple approach of zero suicide created a focus and release of clinical creativity that has fundamentally alter the organisation’s position on suicide prevention, it’s 11th approach to service redesign and its overall philosophy on learning – giving rise to a comprehensive and successful Just Culture programme. These benefits have become the centre point for establishing the Zero Suicide Alliance, a bottom up movement in the UK with a philosophy of knowledge into action. The presentation explores the benefits of the zero suicide approach and describes the work of the ZSA. https://doi.org/10.26493/978-961-7055-67-2.17 17 I follow my intuition, I imagine more than ever, I love to innovate … University of Primorska Press www.hippocampus.si Document Outline 11th Triple i Table of Contents Welcome Address Organizers Programme Outline Listening to the Suicidal in the Wake of Covid-19 Are There Some Premature Deaths We Should Not Prevent? Suicide Prevention at Scale Self-Harm in Children and Adolescents Community Interventions Impacts of Covid-19 on Mental Health and Suicide Risk in Occupational Settings Covid-19 and Suicide Prevention Zero Suicide: A Big Hairy Audacious Goal