This presentation discusses the Lowdown services, including an overview of support pathways for young people indicating suicide, an ethnic breakdown of the service users and the results of the evaluation from the perspective of the service provider and service users. It is clear that these services can play an increasingly important role over the next few years in filling well-documented service gaps, as well as complementing and moderating demand on existing primary care and mental health services.
Presentation by Dylan Norton, Lifeline Aotearoa, Candace Bagnall, Ministry of Health at the 2009 SPINZ National Symposium: Culture and Suicide Prevention in Aotearoa: http://www.spinz.org.nz/page/108-events-archive+spinz-national-symposium-2009+symposium-coverage
2. Defining the problem – the context
• National Depression Initiative
- Very successful television campaign – 93%
prompted recall of advertisements for
total population, 96% for Maori and 91%
amongst young people aged 16-24 years
- Strong recall of the help seeking message
(60%)
- 58% had discussed the ads
- BUT less than 10% of helpline calls were
from young people, who tend not to visit
GPs either
3. Defining the problem – the context
• Extent of the problem amongst
youth (15-24 years)
- 1 in 11 young New Zealanders will
experience a major depressive disorder
over a 12 month period
- Youth have the highest hospitalisation rate
for intentional self-harm – twice as high as
those aged 25-34 years
- 100 young people die each year by suicide
- Depression is a factor in most suicide
attempts
4. What did we do about it?
• Young people wanted
- Easy navigation and good information
- Clean, low-key look – not too bright and
busy
- A trustworthy voice – of authority
- Stories from real people
- Interactive stuff
- Professional, personalised, back-up
support – they wanted to know who they
were talking to
5. What did we do about it?
• What young people got - website
- Designers produced leading edge website
- Excellent buy-in from young people,
including ‘talent’ who told their stories
- NZ music was profiled and made available
for download
- Fact sheets were written and checked with
expert advisory group
- Launch and events featuring celebrities
and musicians attracted lots of media
6. How well did the Lowdown work?
• Website evaluation results (online
survey)
- 90% very positive response from online
survey respondents on all aspects of web
function and layout
- Key message was about help – you can get
help, you can help others
- 95% would recommend the site to
someone in need
BUT
- Fewer than 14% of 15-24 year olds
recognised the Lowdown name
11. Lifeline Aotearoa support services
• SMS Text 5626
• Email team@thelowdown.co.nz
• Moderated message board
• Webcam service (latest communication channel)
12. Service Uptake: Jan 08 – June 09
• 119,464 total website visits.
• 148,802 text messages received and sent.
• 5265 emails received and sent.
• 1530 posts on the message board.
16. Text and Email users
• 47% of text contacts were classified by thelowdown
team as relating to depression
• 49% of email contacts were classified by thelowdown
team as relating to depression
• 31% of text contacts reported suicidal thoughts
• 28% of email contacts reported suicidal thoughts
18. Text and Email users
• Text and email users were both predominately female
(77% and 67% respectively)
• The main age grouping for text users was 15 – 21 years
(63% of users)
• Age profile for email users was much older than for text users
47% were aged 22 yrs & over compared with 16% of text users
• 77% of text users were students
• 40% of email users were students
19. Txt & e-mail brief intervention services
• Explore presenting issues and support
problem solving
• Non judgemental support
• Information
• Signposting other services
20. Txt & e-mail brief intervention services
• Support significant others
• Strengthen social support networks
• Support hope, self esteem and self efficacy
• Self help strategies
• Manage risk, respond to suicide
21. Message board
• Total threads since launch: 770
• Total reply posts since launch: 1067
• Every message moderated.
• Safe place to give and receive peer support.
• Suicide or self harm posts rejected.
• Rejected suicide posts followed up.
24. Evaluation
• Phoenix Research- Evaluation of Youth
Initiative
• January – December 2008
• Text, Email and Website
• On-line Panel and Service Users (18.5% Maori)
25. How well the service met needs
• 80% of Service Users indicated that the text
service met their needs extremely to quite
well
• 70-75% of Service Users indicated that the
email support services met their needs
extremely to quite well
26. Evaluation Quotes
• ‘Because with me, I was at high risk of suicide
– they called the police and that got the ball
rolling on getting me help’
• ‘I love this site because it is genuinely good, the
fact sheets, the self-test, just everything – I
have severe depression and finding this place is
like gold – I'm serious’
27. Quotes
• ‘Helped me see that I needed to get myself
help’
• ‘That what I was experiencing wasn't weird or
strange and that I wasn't alone in the way I
was feeling - also that there were so many
different ways for me to get help, i.e. I have
trouble using the telephone, so the message
board was great’
Notas del editor
Facts and knowlwdge: FAQ, downloadable PDF info sheets, self test (Becks Depression inventory), help services, urgent help.
Busiest month July 09 14,500 messages sent and received. The Average Text Session Length during this period was 1 hr 24 mins24 secs. Txt - Average session numbers between 13 and 16 messages, Email 2. The Average Email Session Length during this period was 1 hr 25 mins6 secs During this period there were 13244 text messages received and 14308 text messages sent and of these 1067 were automated information responses. In addition we received 1259 emails and sent out 1152 emails. site heralded by health professionals as a world class leader in its field – and we’ve only just begun! Musicians, celebs, everyday people are asking to contribute to the site and share their story top site clicks are: NZGirl, MSN Messenger , NZDating.co.nz 2.6 per cent found the site by searching for ‘suicide’ in a search engine
This graph shows the number of separate email addresses and cell phone numbers in the last two six month periods (a measure of unique individuals using the service). While the levels were somewhat similar in the first six months, the rate has increased dramatically for cell phones in the last 6 months, rising to 950 unique individuals.
Taken from 2900 service user profiles Compared to 14.7 percent of the population
Taken from 220 profiles Maori compared to 14.7 percent of the population
Approx 48% of contacts related to depression Approx 30% of contacts reported suicidal thoughts.
Note: Small sample size
70% female (approx) Average age for text approx 16 Average age for e-mail approx 20
Explore presenting issues and support problem solving (e.g. Bullying, relationship issues e.g. Partner/parents) Information – on depression and related issues (e.g. Bullying) Signposting: GP, mental health, school counsellors, specialist services e.g. LGBTTF, Non judgemental support (service applies client centred counselling principles) in empathy, genuine – ness. Self help strategies (specific activities that can improve their mood). Support hope, self esteem and self efficacy. Use of affirmation, highlighting things they have done previously to support themselves etc, things they are good at etc.
Significant others: info (website) and the and the importance of looking after yourself. Where appropriate encourage young people to talk about things with family) Identifying positive things that are going on.
Delayed moderation, i.e. not a “real time chat function”. Safe place: no discrimination, inappropriate language, place to share contact details etc. Suicide: service user is emailed directly or is guided back to the txt/e-mails support service depending on type and level of risk (this has been done on 5 occasions). If no peer support received, directed to contact the Lowdown txt and email support services. Moderation guidelines document
On 51 occasions team members were able to put in place safety plans or the risk was reassessed as low with the support of the on call crisis support team. Risk process – Risk raised - team member uses training skills to manage risk and develops a safety plan – unable to do so to safe level : Crisis support accessed – emergency service contacted.
On 91% of occasions the police were able to locate the service user with the information provided (which often be just a mob phone number). No further info 22% Identified as hoax 5% This is a relatively small amount from the feedback we received. Linked to family support 26% - This was not something service users often felt they could do themselves without being ‘minimised’. Established safety 26% (no further info) Taken to friends 4% Taken to police station 4% Voluntary respite care 4% Taken to hospital for overdose 9%
Phoenix Research Service Users and On-line Panel 50 service users – gathered by being invited via the service to take part Online panel - 14 – 25 year olds invited online nationwide – N=583 surveys completed – asked to visit the site and then complete questionnaire. Un-weighted sample sizes: - Maori N – 108 - Pacific N – 26 - Asian N – 41 - Other N - 408