Coordinated assertive aftercare: Measuring the experience and impact of a hybrid clinical/non-clinical post-suicidal assertive outreach team

Abstract

• Brief, assertive follow-up after a suicide attempt can reduce future risk. • Combined multidisciplinary clinical and non-clinical practical and emotional support. • Showed substantial improvements to suicidality, distress, coping and wellbeing. • Emergency healthcare use was also significantly reduced. • Experience of care through this model was found to be highly positive. The most significant risk factor for suicide is a previous suicide attempt. For individuals who present to hospital, accessing aftercare is essential to ameliorate this risk, but frequently discharge occurs without adequate follow-up. To improve post-suicidal aftercare, a hybrid team (Alfred Hope) was developed offering three-months of psychosocial and clinical assertive outreach support. This study aimed to measure change in distress, suicidal ideation and coping beliefs and experience of care. For 92 consumers, initial and end-of-contact measures were collected: Suicidal Ideation Attributes Scale (suicidal ideation), Patient Health Questionnaire-4 (distress), Outcome Rating Scale (wellbeing), State Hope Scale (current hopeful thinking) and Coping Self-Efficacy Scale (coping ability beliefs). Qualitative responses regarding experience of care were also collected. At initial contact, 79% of consumers reported at least moderate distress, 78% suicidal ideation suggesting high risk of suicidal behaviour and 83% impaired wellbeing. Large effects were observed for reduced suicidal ideation and distress and improved wellbeing, coping self-efficacy and hopeful thinking (all p <.001) and emergency department presentations reduced significantly ( p <.001). Qualities of staff, what was received, and outcome of engagement were themes summarising what consumers reported was helpful. Uncontrolled longitudinal study and not all consumers completed end-of-contact measures. Operation of a clinical/non-clinical assertive post-suicidal outreach team is feasible, highly valued and supported improvement for most consumers. With some participants displaying persistent high suicide risk, clinical and psychosocial expertise is needed alongside being collaborative and respectfully persistent to address stressors and build coping ability to better overcome future adversity.