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My name is Steven

 I am a full-time doctorate student at Middlesex University, London. I am also the creator of Suicide Intervention First Aid (SIFA), a recognisable platform from which promising suicide intervention initiatives are tried and tested by qualified researchers.  I am here hoping to raise funds that will facilitate this research in underdeveloped areas, with people considered very vulnerable to suicide. Please read through my condensed account of what SIFA is, why it is necessary, and why it needs your support!  Thank you.

Whilst 

we still have a way to go, we are currently witnessing a breakthrough in mental health care provision, many people experiencing issues relating to their mental health, who would have previously battled their problems alone, are now actively seeking support from family members, friends, and mental health professionals! This breakthrough is not an accident, its the result of numerous efforts to refine our attitudes towards mental health. Some of you may have heard of, or even enrolled in a Mental Health First Aid (MHFA) course?  MHFA is an educational course that was originally designed in Australia in the year 2000, by Betty Kitchener and Anthony Jorm, and is now used internationally. By challenging myths and increasing factual knowledge about mental health, MHFA training has demonstrated, time and time again, its ability to reduce stigmatising attitudes towards those experiencing a crisis, as well as increase attendees own help-seeking behaviours. I cannot express enough how important it is to challenge and amend debilitative attitudes, they are one of the leading barriers to people seeking support!!

Improvements

in attitudes toward suicide, and in turn supportive action, however, is trailing somewhat behind mental health, particularly due to a lack of awareness, meaning it is still considered a taboo subject. Also, when the topic of suicide is raised it is often used synonymously with mental health, though, the two are not always interchangeable and the belief that they are can be a barrier to peoples help-seeking behaviours.  Globally, suicide is recorded to be the 2nd leading cause of death for those aged 15 to 29 years old (World Health Organisation, WHO, 2014). It is estimated that approximately 800,000 people take their own lives annually, equating to one every 40 seconds (WHO, 2014). In light of the success seen in reducing mental health-related stigma, the WHO advises that a similar approach is taken to reduce the rates of death by suicide. The WHO advises researchers and policymakers to increase education and awareness about suicide, amongst the general public.

One particular approach

that has been employed to increase education and awareness of the general public, is gatekeeper training (GT), through teaching community members how to identify a person that may at risk of suicide, how to engage and risk-assess, and how and where to appropriately refer them to further care. The benefits of community-based initiatives such as GT are evident when taking into consideration that people experiencing a suicidal episode are unlikely to seek assistance from mental health professionals; rather, solace is sought from a friend or relative. The particular advantage to GT, however, runs parallel to the identification that those within the immediate environment of an at-risk person, despite their best intentions, are often limited in their ability to provide effective support. 

GT

is a collective term that encapsulates varying educational models. GT initiatives that have received extensive empirical support, include, though are not limited to, Signs of Suicide (SOS, Aseltine & DeMartino, 2004), Applied Suicide Intervention Skills Training (ASIST, LivingWorks Educational Inc., 2005), Question, Persuade, and Respond (QPR, Quinnet, 1995), and Mental Health First Aid (MHFA, Kitchener & Jorm, 2000). These programs are demonstrating the ability to increase factual knowledge about suicide; improve attitudes towards suicide intervention and help-seeking behaviours; Reluctance to intervene and stigma; as well as attendees self-efficacy to intervene in a crisis.  

Knowledge:

Tompkins et al. (2009) evaluated GT within a secondary school setting, in response to a high suicide rate amongst adolescents. The investigators measured the short-term effects of  QPR training, provided to 78 members of school personnel. The impact of QPR training was evaluated through the comparison between an experimental and a control group, wherein the experimental group received no formal GT training. In a three-month follow-up, those that received training demonstrated a significant improvement in suicide knowledge, as well as increased personal experience with suicidal individuals. Moreover, the effectiveness of the SOS training was measured by Aseltine and DeMartino (2004). The researchers employed SOS within a high school setting, where teenagers were randomly assigned to an SOS group or a control group. Three months later, students that participated in SOS training demonstrated a significant improvement in their understanding of depression and suicide compared to those in the control group.

Beliefs and attitudes:

In the United Kingdom, a GT program was delivered to railway police (n=168), a sample of the population which are considered to be likely to engage with suicidal individuals (Marzano, Smith, Long, Kisby & Hawton, 2016). By evaluating pre- and post-testing scores, Marzano and colleagues concluded that attitude towards intervention was significantly improved immediately following the training, and was maintained six months later. It is important to note, however, that very few of the original GT participants were able to partake in the six-months follow-up (n=21). Moreover, Aseltine and DeMartino (2004), found that heightened, adaptive attitudes towards suicide lead to fewer suicide attempts and ideations amongst adolescents, up to three months following SOS training. 

Reluctance and stigma:

Although MHFA is not exclusively designed to train individuals on how to intervene in a suicidal crisis, the ability of the model to reduce societal stigma, and in turn, enhance caregiving efforts, has received extensive testing. A review of MHFA evaluations identified the course as having statistically significant reduction societal distance from people experiencing a mental health crisis, enhancing the participants’ likelihood of corresponding with health care professionals about treatments, as well as enhancing supportive behaviours,  (Kitchener and Jorm, 2006).

Self-efficacy to intervene:

One way in particular in which GT attempts to facilitate attendees’ self-efficacy to intervene is through the enhancement of measurable suicide intervention skills (Shannonhouse, Lin, Shaw, Wanna, & Porter, 2017). A pre- and post-training review of QPR delivered to university employees in America, found significant improvements in the participants’ gatekeeper skills. Specifically, the capacity to demonstrate active listening, ask direct questions relating to a person’s suicidality, encourage help-seeking behaviours, and provide relevant referral options (Cross, Matthieu, & Lezine, 2010).