Lessons learned by listening: the imperative for improvement and Zero Suicide . Isbd isad amsterdam...

Lessons learned by listening to anonymous, suicidal online help seekers

17-07-16www.113online.nl 1

Jan K. Mokkenstorm1,3,4 Renske Gilissen 3

Ad J.F.M. Kerkhof2,3

Johan H. Smit1,4

1 Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. j.mokkenstorm@113online.nl 2 Department of Clinical Psychology and the EMGO Institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands3 113Online Foundation Amsterdam, the Netherlands4 Department of Research & Innovation, GGZInGeest, Amsterdam, The Netherlands

Faculty Disclosurex No, nothing to disclose

Yes, please specify:

March 30 - April 2, 2014Sheraton Sonoma CountyPetaluma, California

Off-Label Product Use

Will you be presenting or referencing off-label or investigational use of a therapeutic product?

x No

Yes, please specify:

• @JanMokkenstorm

• j.mokkenstorm@113online.nl

113 National Dutch Suicide Prevention Platform

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ONLINE HELP

SUPRANET

COMMUNITY, CARE

RESEARCHSURE-NL

MEDIA

SP RESOURCE CENTRE

• Privacy, anonymity, convenience

• Online interventions (cost) effective • Reach: large scale dissemination feasible• Overcoming help seeking barriers (Pagura et al 2009, Bruffaerts et al 2011)

• LIMITS: diagnosis, physical intervention• CAVE: dependence, “toxic” dis-inhibition /acting out,

“cyber Münchhausen”, triangulation/splitting.

Online suicide prevention

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• Online reach: – Demand >>> Supply– Chat >> Telephone– Female>>Male– Young>Old

• 60-75% severe mental health problems– Affective, Trauma, Addiction, Personality– Acute/ crisis & chronic/recurrent self harm

REACH * EFFECT

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• 20-60 min Crisis Chat: mixed effects on emotional state– Improvement 38-49% ( best: hopeful, confident)– No change 43-62% (most often: depressive mood)– Deterioration: 1-14% (worst: confused, helpless)– Suicidality often not re-assessed at end of conversation!!!

• 2-6 session online therapy – High attrition– Solution Focused Therapy approach insufficient– Practice variance– One size fits all, versus totally personalized treatment

REACH * EFFECT

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• WE HAVE TO FOCUS AT SUICIDALITY• Balance between directive/non directive listening• Need to develop& uphold quality standards,

improve assessment & training of helpers• Given demand: triage is unavoidable• Better Motivate volatile (young) help seekers • Better engagement of older help seekers (men)

• RCT’s with manual based modular treatment in preparation

Lessons for 113Online

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– Therapist avoidance: “Not allowed to talk about suicide and my despair”

– Indirect & group approach“Feel not understood”

– Dys-regulation:“Procedures, procedures, procedures”

– Ineffective : “It just doesn’t work”

35% of online help seekers are in health care or wait for it

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• Suicide in the Netherlands: 38% increase in 8 years, 40% while in specialist mental health care

• Suicidality needs a distinct, direct diagnostic and therapeutic approach, irrespective of setting or “underlying illness”

• IMPERATIVE TO IMPROVE– Get our care-act together:– Access, process, acceptability, effectiveness, safety– Read the F*ck*ng Manual: follow guidelines

Lesson to be learned by specialist mental health care:

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PERFECT DEPRESSION CARE PROGRAMHenry Ford Medical Group

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OUR PATIENTS NEED US TO BE BOLD:ZERO SUICIDES IN HEALTH CARE

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THANK YOU

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j.mokkenstorm@113online.nlinfo@113online.nl@JanMokkenstorm