7.7 Selective approaches

Drawing on the peer-reviewed literature, a summary of the current evidence/best practice related to selective approaches is provided below.

Summary of current evidence/best practice ^65,66,67,68

There is good evidence that selective strategies that aim to improve the ability of medical practitioners in primary care to recognise and treat depression can result in lower suicide rates.

Gatekeeper training programs that focus on enhancing the skills of community, organisational and institutional gatekeepers (such as people who work in schools, prisons, workplaces, etc.) have been shown to be effective selective approaches in improving the identification and referral of people at risk of suicidal behaviour.

A range of community capacity-building approaches have also been identified as being promising selective approaches. These include screening for depression or suicide risk (for example, in schools, universities or primary care settings), crisis centres and crisis helplines, and support for people who have been bereaved by suicide.

Findings in relation to NSPP-funded activities

A number of projects reported including gatekeeper training (either of professionals or other community members) as one component of their activities. Only one NSPP-funded project (local) specifically supported medical practitioners to better recognise and treat depression and suicide risk.

More than half of the funded projects reported undertaking some form of community capacity building. These activities included provision of crisis lines/crisis centres, services for those bereaved by suicide and screening/identification of people who may be at risk. Considerable variation existed in how these activities were delivered between target group and settings (eg, workplaces, schools, drop-in centres).

Key findings

While gatekeeper training and community capacity-building activities were among the selective approaches reported by the 49 projects, considerable variations exist in how these activities were delivered between target groups and settings. Services for people bereaved by suicide featured prominently. While only one project targeted knowledge and awareness of medical practitioners, there are a number of other initiatives that support GPs to better identify and refer suicidal patients to appropriate care. These include initiatives such as the ATAPS Suicide Prevention service initiative (Section 11.3) and the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) Program.

⁶⁵ Beautrais et al, 'Effective Strategies for Suicide Prevention in New Zealand'.
⁶⁶ Mann et al, 'Suicide Prevention Strategies'.
⁶⁷ Nordentoft, 'Crucial Elements in Suicide Prevention Strategies'.
⁶⁸ van der Feltz-Cornelis et al, 'Best Practice Elements of Multilevel Suicide Prevention Strategies'.