Mission & Practice Statement
Our mission is to provide the highest quality service possible to work with and train practitioners likely to encounter clients experiencing suicidal ideation, suicidal behaviour or bereavement of suicide. We also strive to equip workplaces to effectively respond to the critical needs of their workforce, while fostering an environment that delivers meaning, connection and hope.
We seek to develop and maintain strong collaborative relationships and approaches with caring professionals across the country. These professionals work across a broad range of disciplines and situational contexts. In everything we do, our goal is to ensure that our training, supervision and support is tailored to, and responsive to, the identified needs of individuals, their organisations, and the community or population they serve.
We aim to integrate lived experience into our service delivery, though also note that we respect all experiences, of many forms. We seek to create the greatest possible synergy between evidence-based theory and real-life experience, for our clients, clinicians, workplaces and communities.
We strive to remain current in regards to information, research and advances in the field of suicidology.
We will disseminate information offering explanation and research on efficacy, appropriateness and evidence. Strategies for dissemination may include, newsletters, discussion forums, supervision, consultation services and the delivery of high quality workshops.
Recognising that other organisations demonstrate a similar commitment to the provision of best practice services, we seek to work with them wherever possible. Our mutual goal of reducing suicide impacting our loved ones, facilitates our collaboration.
We desire to challenge stigma, bias and maladaptive approaches and attitudes in the most professional and effective manner possible.
We promote hope, meaning and purpose in lives affected by suicide via proactive practice strategies.
We will not normalise suicide, but recognise that suicidality has become prevalent in the narrative of psychological pain and in the context of complex psychosocial pressures, warranting greater systemic and cultural investments.
We will challenge systems and attitudes that fail to recognise the complexity of behaviour, including suicidality, with professionalism and appropriate respect for all concerned.
Committed to Best Practice and Evidence-Based Practice
Evidence-based practice in psychology (EBPP), as defined by the American Psychological Association (APA) in August, 2005, is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences.
It is applied through clinical engagement including case studies with clients, the manner in which research and experimental design is conducted as well meta-analysis of research. Randomised control trials (RCTs) evaluating interventions head to head for efficacy are the gold standard in research offering evidence based practice. In researching suicidality, there is significant ethical difficulty whereby the Delphi method (consensus on expert opinion rather than experimental design) has suggested best practice.
In Australia, the Australian Psychological Society (APS) recently published the fourth edition review of Evidence-based Psychological Interventions in the Treatment of Mental Disorders: A review of the literature (APS 2018). Despite this comprehensive review, the focus is on mental disorder, with no statement or evaluation considered suicidality or self injury independently of the mental disorder or intervention. This reflects an ‘old-school’ framework for understanding suicidality. It reflects the limitations of approaching interventions for suicidality from a medical model rather than the complex interplay of social, cultural etc we know it to be. Of course, when suicidality emerges in the context of mental illness, these interventions are appropriate, as long as suicidality is a focus concurrently with symptomatology. It should be noted, however, that the efficacy of psychological interventions are often not evaluated on reductions of suicidality alone, but the psychological symptoms whereby it has been known for client’s symptoms to remit while suicidality continues.
The desire to identify and implement best practice interventions is a noble one, but not ‘one size fits all’. Returning to the APA weighting of the issue, they state:
“…the purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention.”
We must move away from approaching suicidality as purely a function of mental disorder and embrace strategies that may be effective from a population level through to supporting individual recovery and well being.
EBBP Implications for SRAA
SRAA endorse foundation principles of effective and relevant needs assessment, that is culturally aligned to the individual, but which may include:
- The evaluation of psychological symptoms, behaviours and/or expressed and implied suicidal intent
- Concurrent evaluation of the individuals psycho-social, cultural, community, educational, physical/health and existential pressures (not exhaustive) and lived experience/history
Such assessment includes, but is not limited to, psychological and/or psychiatric clinical assessment. Validated suicide risk assessment protocols, psychometric screening tools and interviews with trusted others where possible. Similarly, we can argue to exclude or avoided, the same assessment measures as culturally and contextually indicated. Interviews with third parties (such as general practitioners, other treating professionals, family, friends, teachers or colleagues) provide a wealth of information to an assessor, where consent and transparency with the client and family are essential.
In line with the above comments, assessment approaches need to take into account community and cultural factors, such as those of Aboriginal and Torres Strait Islander peoples, people identifying as LGBTIQ, work environments or other contextually relevant factors. In circumstances where community or context is fundamental, a broader acknowledgement of family and/or community pressures may be sought, while Euro-centric clinical measures may be anywhere from irrelevant to totally inappropriate. Broader consultation and consideration may be required in order to best understand how and why the risk has emerged and presented in the manner it has.
Tools, measures, protocols and clinical approaches should:
- Demonstrate evidence based efficacy for the population they serve
- Comply with quality research principles, and
- Implement respect for the client’s psycho-social-cultural orientation
- Be subject to regular review of the psychometric properties of clinical measures
Furthermore, this process is only of value when each factor is considered and weighed within the context of the whole of client position. This way, the formulation is a holistic assessment of risk, is entirely personalised and unique to that individual.
Nothing less is acceptable. We will highlight (sometimes controversially) when we feel that practice or research lacks rigour or evidence, or when negligent claims and inappropriate conduct have been highlighted. We feel that our clients and the community deserve the best care we can afford and transparency in the limits of what is possible in terms of suicide prevention.
Suicide risk assessment and management is not a clinically driven formula, a tick-the-box framework or a formulation in response to gut reaction and we certainly want professionals and services to know what is achieveable.
Evidence – We Stand at the Forefront
As indicated at the outset, “best practice” in suicidology is an industry catch cry, despite a lack of clearly and authoritatively defined meaning. In light of this, we have detailed some of the implications and practical strategies for the operations conducted by Suicide Risk Assessment Australia.
The following explicitly details our benchmark in delivering best practice services in suicide prevention and postvention.
Led by director and psychologist Carmen Betterridge, the team is made up of professionals who are both well qualified but also clinically experienced. While it is essential to have theory and research based knowledge, the practical application of such knowledge is enhanced by real world clinicians who appreciate the challenges of health systems, culture and professional practice. We have spoken at length about the quality of our team, but this is the foundation for ensuring we meet the benchmark.
We utilise, promote and critically evaluate a number of assessment tools and methodologies in our assessment and representation of expert opinions, in addition to recommendations for training, consultation and supervision with professionals. These include but are not limited to:
- Screening Tool for Assessing Risk of Suicide Protocol (Hawgood & De Leo 2018)*.
- Columbia – Suicide Severity Rating Scale (C-SSRS) (Posner, Bren, Stanley, Brown, Fisher, Zelazny, Burke, Oquenddo & Mann, 2008), given it’s many versions and evidence base**.
- Collaborative Assessment and Management of Suicidality (CAMS), as developed by David Jobes (2006) and supported by international research in relation to practice principles***.
Please be aware, firstly that some of these tools and methodologies may be subject to copyright and licencing, and secondly, that our interactions, discussions and evaluations of these tools or techniques do not qualify as meeting the formal training requirements intended by their developers. Should you desire endorsement or licences for use of these tools, please refer directly to those authors.
*Hawgood, J. & De Leo, D. (2018). Screening Tool for Assessing Risk of Suicide. Griffith University: Australian Institute for Suicide Research and Prevention.
**Posner, K., Brent, D., Lucas, C., Gould, M., Stanley, B., Brown, G., Fisher, P., Zelazny, J., Burke, A., Oquendo, M., Mann, J. (2008). Columbia Suicide Severity Rating Scale (C-SSRS) Baseline/ Screening Version. The Research Foundation for Mental Hygiene http://cssrs.columbia.edu/wp-content/uploads/C-SSRS1-14-09-BaselineScreening.pdf
***Jobes, D. (2006) Managing Suicidal Risk: A collaborative approach, New York: Guilford press.
We utilise Australian data and research wherever possible, referencing and acknowledging variations between different Australian regions, populations and cultures. This is appropriate due to the complexity of suicidality, differences in reporting, analysis and communication systems. Standardised reporting within Australia and indeed internationally is yet to be achieved.
Data is sourced from sound epidemiological research bases and organisations. These include the ABS, Queensland Suicide Registry (AISRAP), Mindframe media and other government monitored and independent agencies. We acknowledge that data presented by us and other sources may be an under representation of the prevalence and impact, forget the person and story behind the loss as well as oversimplify the potential causes of death.
We also acknowledge that the provision of real time data is difficult.
Our Training Resources
We fully reference our training manuals, and we ensure their content are grounded in evidence obtained in peer-reviewed sources at every opportunity. These articles, books, research and evidence sources adhere to quality research principles pertaining to research design, methodology, validity, replication and more.
We seek to disseminate only the latest and most efficacious practice principles. To this end, though there can be contradictory information available regarding suicidology, we are careful to not provide opinion outside of the parameters set by existing research.
A number of our workshops have been endorsed by professional bodies, including the Australian Association of Social Work and the Australian College of Mental Health Nurses.
These further support our assertion that our training and services meet professional benchmarks for education and suicide prevention/postvention practice, beyond psychology.
Compliance with Guidelines and Codes
Suicide Risk Assessment Australia adheres to relevant ethical guidelines and codes. These include the Australian Psychological Society’s:
- Code of Ethics, (2018) and
- Ethical Guidelines Relating to Clients at Risk of Suicide (2014)
It is noted that there are Guidelines and Codes that are currently in development or draft form, which although not yet ratified or finalised, remain valuable resources. These include New Zealand’s Best Practice Guideline: Coping with a Client Suicide (2017) (NB: legislation and ethical practice varies from country to country, and state and territories). We have developed our own Terms and Conditions with respect to engagement with our services, in addition to position statements related to privacy and confidentiality for those participating in surveys or research.
Carmen is currently a member of an APS working group developing clinical guidelines for working with clients experiencing suicidality in addition to an international working group examining the impact of working with suicidality on the clinician. Outcomes of these working groups will be shared once finalised.
We support and endorse eminent leaders in suicide prevention
We endorse and promote the position statements, reports and discussion papers written by eminent leaders and researchers, including the Australian Institute for Suicide Prevention (AISRAP), Suicide Prevention Australia, Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) and SANE Australia, to name a few. Resources are prepared by leading professionals through research and/or consultative processes, with recommendations acknowledged in the delivery of our own services.
Appropriate Incorporation of Lived Experience
The stories and lives of those who have experienced suicidality, has perhaps immeasurable value. We support and engage the expertise of lived experience and assert that without such stories, much of our clinical advances would never have been realised. See our Resources section for contact information on a number of Lived Experience organisations.
We are clear in noting that while some may be comfortable in their position as an identified representative with lived experience of suicidality, we do no insist or require disclosure of lived experience to value all people (as volunteers, workers, professionals or otherwise) in order to engaging, interface or otherwise work with you in the prevention of suicide and psychache. We believe that everyone should be valued with respect to their unique stories of strength, power and growth in addition to harnessing their knowledge, skills and resources.
Research into the impact of suicide on individuals, families and the community has strengthened our resolve to work together, and support the suicide prevention community. The Ripple Effect: Understanding the exposure and impact of suicide in Australia (Maple et al; 2016) is one such report that values the stories of lives lost and those left to grieve.
Lived experience is an essential but not sufficient driver in suicide prevention in Australia. WE ALL must play a role.
Your Responsibilities Made Clear
Whilst providing the best information available, the latest data, and the most validated and effective strategies, we cannot remove the responsibility that rests with the individual engaging with our service, whether that is as a practitioner, workplace representative or supervisee. Indeed, responsibility for growth and learning is two-way and we seek your feedback to ensure we are meeting your needs. Equally, we seek to not merely present information, but to make clear your responsibilities, as well as empower you as you plan and implement your learning into your professional situation.
OF NOTE: Your responsibilities also include respecting the copyright of the materials presented and seeking training or licencing in skills, tools or psychometrics that SRAA are not authorised to deliver.
Interactive and “Best Practice” Training
Specific information and skills are valuable, however it is changes in attitudes and practice that most significantly predict the efficacy of suicide risk assessment training. This is best achieved through the use of interactive learning strategies, and techniques that enable participants to fully engage with the information being presented.
Our workshops include pre-and post assessment, so that participants can have their learning needs identified, and their potential for behavioural change evaluated.
In summary, SRAA are committed to delivering best practice training and services in suicide prevention and postvention through:
- Our team
- Tools and measures that are current
- Data sourcing
- Training resources
- Pursuit and attainment of professional standards and endorsement
- Guideline and code compliance
- Supporting and endorsing existing expertise and leadership
- Appropriate incorporation of lived experience
- Clear communication regarding responsibilities, and
- Interactive and “Best Practice” Training
There are some of the evidences that we are, and will continue to, effectively and professionally meet our mission and practice objectives.