Tackling depression, suicide and other psychiatric emergencies

Suicide and depression have the power to decimate lives, break apart families and have a negative ripple effect on wider communities. Every year, more than one million people across the globe take their own life – and depression is by far the most common risk factor.

Our research here at the University of Stirling seeks to explore new ways in which free prevention services can create positive outcomes and new care pathways for patients in Scotland, Europe and beyond.

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Our research

People who die by suicide do often contact healthcare services in the year before their death. That's why training programmes for improving the capacity of healthcare professionals and those working in community settings to detect, signpost to services, or treat depression and manage suicide risk, are some of the leading evidence-based strategies in the field of suicide prevention.

Unfortunately, a lack of capacity for referral or signposting to services or other forms of help for individuals – especially in lower income countries – makes the need for other (free) treatment or self- help options imperative.

The University has been a key European partner in a study, entitled “Preventing Depression and Improving Awareness through Networking in the EU (PREDI-NU)” which was designed to develop and implement free evidence-based resources for both professionals as well as the public – supplemented by online therapy for people experiencing depression. This online therapy is delivered via the website “ifightdepression.com”.

Our research was used to create online therapy resources for the "iFightDepression" website, which has attracted over 6 million users since it launched.

infographic: Our research

Our research

helped create an EU-wide website for professionals and the public designed to combat depression

infographic: 6 million+

6 million+

people have visited the iFightDepression website, with 4.7 million using it to initiate self-management

infographic: Stirling experts

Stirling experts

co-developed the Scottish Government’s award-winning new Distress Brief Intervention programme

Helping millions find support

Through the iFightDepression website, researchers were able to raise awareness of depression and suicidal behaviour and provide a self-help psychological intervention for people with depression  founded on research.

Analytics show the website attracted more than 6.3 million unique visitors across all languages. More than 4.7 million of those visitors used the site’s ‘self-test’ questionnaire that allows them to start a programme of self-management.

What’s more, a surge in visitors during the COVID-19 pandemic suggests that the website may have been a valuable resource when in-person treatments were more difficult to access.

GPs were able to use the website to directly help patients, and psychotherapists reported that the tool enabled a reduction in the number of therapeutic sessions needed for patients. The ease of accessibility and the fact that the website is free were also highlighted as major advantages for patients unable to afford counselling and for those who had inhibitions about accessing help through traditional treatment pathways.

General Practitioners, psychotherapists and members of the public all use the "iFightDepression" website, with a surge of visitors accessing the resource during the COVID-19 pandemic.

Developing new care pathways across Scotland

To improve care for people who present to healthcare as psychiatric emergencies in Scotland, our researchers have used record linkage techniques through multiple studies to better understand these psychiatric emergencies (including those at risk of suicide) and improve their care pathways.

One study linked data relating to Scottish Ambulance Service (SAS) psychiatric emergencies and self-harm with Emergency Department (ED) data, and Acute & Mental Health episode and deaths data, following individuals for at least 12 months.

It found more than half of the people (62%) attended by the SAS were either left at home (11%) or discharged from ED with no known follow-up (51%). Within 12 months of their emergency call, 279 of the 6,802 callers had died – with 35% recorded as suicide.

Our research included a stakeholder workshop which revealed that 93% perceived the study findings to be ‘very useful’ or ‘quite useful’ in understanding the patient population – and nine out of ten found the data to useful in developing evidence-informed alternative care pathways.

Building on this, our team were invited by the Scottish Government to join a working group to further apply this data to the ‘Enhanced Mental Health Pathways’ project. Further analysis went on to reveal that mental health related journeys in the out-of-hours period represented four times as many journeys through NHS 24 than indicated by standard analyses and were responsible for 27% of all ambulance journeys. These journeys also resulted in longer waiting times in A&E – and according to our research, could have ultimately been resolved by telephone contact in around 60% of cases.

This analysis led to Government investment of £2 million for the ‘Enhanced Mental Health Pathways’ project to support dedicated mental health nurses being recruited to staff NHS24’s 111 service to provide front line patient care. Calls to the 111 service made by people in distress are now diverted to these dedicated staff, where calls are triaged, care provided or escalated as necessary.

This mental health service is therefore dealing with an estimated approximate 100,000 calls per year benefitting many thousands of people across Scotland.

Our research with NHS24 led to Government investment of £2 million for the ‘Enhanced Mental Health Pathways’ project to support dedicated mental health nurses being recruited to staff NHS24’s 111 service to provide front line patient care.

Responding to the mental health crisis in Scotland

Based on these ‘best practice’ models of community-based training to support awareness raising, detection and onward referral or signposting for people experiencing depression, mental distress or suicide risk, Professor Margaret Maxwell was then a partner in the co-development of the Distress Brief Intervention (DBI) on behalf of NHS Scotland and Scottish Government to provide a rapid response to those experiencing distress.

The DBI service (delivered by Third sector organisations) offers next day contact with a distress worker to anyone presenting in distress to A&E, police, ambulance services or primary care.

The programme has since been awarded £3.4 million in funding from the Scottish Government – and since going live in 2017, four pilot sites across Scotland have helped more than 13,000 people. The impact of DBI was recognised by its receipt of a Scottish Health Award in 2019.

Professor Margaret Maxwell was responsible for the co-development of the Distress Brief Intervention on behalf of NHS Scotland and the Scottish Government to provide a rapid response to those experiencing distress.

Explore more

Other members of staff involved in the research outlined above include Dr Fiona Harris; Dr Edward Duncan; Dr Catherine Best; Dr Josie Evans; and Dr David Fitzpatrick.

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Related publications

iFightDepression website, https://ifightdepression.com

Arensman et al. (2015) Depression awareness and self-management through the internet: An internationally standardised approach. JMIR Res Protoc 4(3):e99. DOI: 10.2196/resprot.4358.

Duncan EAS, Best C, Dougall N, Skar S, Evans J, Corfield AR, Fitzpatrick D, Goldie I, Maxwell M, Snooks H, Stark C, White C and Wojcik W. Epidemiology of emergency ambulance service calls related to mental health problems and self-harm: a national record linkage study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2019) 27:34 https://doi.org/10.1186/s13049-019-0611-9

DBI Programme Manager’s Six Monthly Report October 19 – March 20 Issue 7 (July 2020), p.5. https://www.dbi.scot/resources/progress-reports/