The Mind Yourself Project Overview & Preliminary Findings

1. The Mind Yourself ProjectOverview & Preliminary Findings Dr. Paul Gaffney Senior Clinical Psychologist & Mind Yourself Project Leader 11th June 2007

2. Mind Yourself Team Project Team Members: Paul Gaffney, Kiera Cosgrove, Francis Agnew, Katrina Collins, Shauna Carragher, Fiona Flynn, Peadar Mallon & Sinead McElduff Steering Group Members: Dr. Vincent Russell, Dr. Ella Arensman, Dr. Paddy Halligan, Dr. Declan Bedford, Eileen Williamson, Tom Cahill, John Kearney, Finian Murray & Dr. Maeve Doyle

3. Acknowledgements & Thanks • Grateful thanks to our colleagues in the HSE throughout Cavan, Monaghan, Meath and Louth, and the National Suicide Research Foundation. • Our project assistants, our Regional Steering and Local Advisory groups, Monaghan Lions Club and “The Wedding March”, ESB-Electric Aid & Rath na nOg Regional High Support Service • To all who have participated in and facilitated the project

4. A Thought to begin with… “If you always do what you’ve always done, you’ll always get what you’ve always got” Anon

5. What is the Background here? • Mind Yourself was established in Cavan/Monaghan during the summer of 2004 following successful application for funding from the then North Eastern Health Board “Health Inequalities Fund”, in partnership with the National Suicide Research Foundation. • A core group of professionals from various backgrounds had been trying to address issues related to suicide in Cavan since 2000, with the help of the Health Promotion Department, Local Management & the National Suicide Review Group.

6. How did Mind Yourself come about? • Following publication of the East Cavan Project report (Russell et al, 2002), The Impact of Suicide on Front line staff (Gaffney et al, 2002), and a presentation – “Banging Your Head Against the Wall? Problems encountered in research suicide” (Gaffney et al, 2003), we decided on a more pro-active approach, and the original “Mind Yourself” leaflet was developed with the Gaelic Players Association in September 2003. • This helped formed the basis to the current project alongside 2004 findings from the NSRF.

7. Why bother with this project? • Irish Suicide rates are still (too) high, especially for younger males, and DSH seems to be increasing • Intervention efforts are frustrated as young Irish people may be aware of our services, there is a question of how credible professionals are to them (Russell et al, 2002), and accessing services, availability and configuration of resources, and moving beyond “fire-fighting” have been problematic • Suicide remains notoriously difficult to predict and prevent (Eagles et al, 2001), so we need to look for fresh ideas, especially in pre- and post-vention

8. Looking for Inspiration:Young People’s Views • UN Convention on the Rights of the Child (1989) • Young people must be given a voice on matters that affect them. • The Lifestyle and Coping Survey (Sullivan et al., 2004) • Make services “youth friendly” & consult young people when developing services • Make information readily available to the friends and families of young people • The East Cavan Project (Russell et al., 2002) • While it may be perceived as quite easy to access help, young people are unlikely to go seeking it. Services need to come to them.

9. Looking For Inspiration: Youth Suicide Prevention Strategies • ‘Individual Factors’ Vs ‘Suicide Awareness’ style of programme (Gould et al, 2003; Hardon et al, 2001; Patton & Burns, 1998) • More effective to tackle the factors that influence suicidality • Skills Training Programmes (Gould et al, 2003) • Problem Solving • Coping Skills • Cognitive Skills

10. Looking For Inspiration: Youth Suicide Prevention Strategies • The Youth Suicide Prevention: Evidence Briefing (2004) • support the multisystemic approach to suicide prevention • O’Connor & Sheehy’s (2000) five general education and prevention strategies • Promote communication • Educate in coping strategies • Destigmatise difficulties with coping • Destigmatise affective disorders • Promote services

11. “Reach Out”National Strategy for Action on Suicide Prevention (2005) • 4 Level approach recommended: • General Population Approach • Targeted Approach • Responding to Suicide • Information and Research • General Population Approach Goal: “To promote positive mental health and well-being and bring about positive attitude change towards mental health, problem solving and coping in the general population” • www.dohc.ie/publications/reach_out.html

12. Focus of Project 1:Positive Psychology & Emotional Intelligence • “Positive Psychology” (Seligman 1999) endeavours to enhance well-being and happiness rather than remediate deficits (Carr, 2002), and complements traditional mental health work. • Positive psychology is in vogue now but is much older, with lineage back to Rogers, Maslow & even James in the early 1900’s. • Emotional Intelligence is viewed both as the ability to understand, process and regulate emotional data (Mayer, Caruso & Salovey, 2000) and as a set of personality traits (Bar-on, 2000)

13. Focus of Project 2: Personal Strengths: Resilience and Optimism • Resilience can be described as the capacity to survive, to progress through difficulty, to bounce back, to move on positively again and again • Benard (1992) identified four attributes characteristic of resilient Young people 1. Social competence 2. Problem solving skills 3. Autonomy 4. A sense of purpose • The Importance of nurturing hope and optimism (Carr, 2002)

14. Focus of Project 3: Cognitive Behavioural Approaches • Effective development of coping skills, especially problem-solving skills through Cognitive Behavioural Therapy (CBT) (Elliott and Frude, 2001) • When CBT is aimed at addressing problem-solving abilities in adolescents (Reinecke & Didie, 2005) • Suicidality decreased • Hopelessness decreased • Social problem solving ability enhanced • Perceived ability to cope enhanced

15. Focus of Project 4: Validated Evidence Overview • The SuggestedApproach: • Holistic life skills • Strength based • General population • Community based • CBT strategies that enhance problem solving skills and emphasise Optimism • Provision of information and services • Empirical evaluation of intervention programmes

16. Focus of Project 5: Community Focus • Previous research we have undertaken has highlighted the potential for community involvement, consultancy and direction in the area of suicide prevention, as well as significant amounts of local knowledge and insight within local communities (Russell et al, 2002) • Congruent with the notion that a death by suicide is not just a health phenomenon, but also related to prevailing cultural, social and political factors (as reflected by differing suicide rates and methods across countries and ethnic groups)

17. Outline of Intervention • Generally group based, approx 5,500 young people have received the intervention so far, throughout Cavan, Monaghan, Louth and Meath (including the pilot phase) across two 80 minute group sessions • Groups predominantly in secondary schools, and a range of other venues, with two facilitators. • Group maximum size is 15, average participant age is 16 years

18. Programme Outline • Session 1 • Young People’s problems and how they deal with them • Separating Thoughts and Feelings • Optimism and Pessimism • Catching Thoughts and Questioning negative beliefs (Group Exercise) • Crisis Situations and how to handle them • Session 2 • Identifying problems • Methods of Problem Solving: COPE (Group Exercise) One topic as chosen by the group e.g. Anger, Body Image, Gossip, Stress etc. • Community Focus • Second topic as chosen by the group

19. Evaluation of Intervention-Pilot Stage • HSE Dublin North East ethics committee approval, evaluation based in Cavan/Monaghan • Measured pre and post intervention by measures of depression (Birleson), emotional intelligence (Bar-On EQ: YV) and open ended questionnaire • Use of randomised experimental group (n = 720) and control group ( n = 420) • Initial evaluation completed – to be repeated at 12 & 24 monthly intervals

20. Evaluation: Selected Preliminary Results 1 • A decrease in Depression scores between pre and post intervention was observed for the control female group, the experimental male and female group, with the greatest shift being found for the experimental female group. • Analysis of variance between pre and post intervention scores for the experimental group showed significant effects for the Birleson, and certain Bar-On EQ scales.

21. Evaluation: Selected Preliminary Results 2 • Analysis of variance for school code and Birleson score found a statistically significant effect for the experimental and control groups, indicating differences between schools, which need to be investigated further. • General increase in pre and post intervention Bar-On EQ total scores in the experimental and to a lesser extent, control group

22. Evaluation: Selected Preliminary Results 3 • 91 % of female participants and 94 % of male participants agreed or strongly agreed that they enjoyed the programme • 83 % of female participants and 86% of Male participants agreed or strongly agreed that the programme was useful (8% of males/6 % of females disagreed) • 51 % of female participants and 55 % of Male participants agreed or strongly agreed that they coped better following the programme (13 % of males/11% of females disagreed)

23. So What ? • Preliminary results appear to suggest that the model can contribute to adolescent suicide prevention by helping lower depressive symptoms and enhancing emotional intelligence and strengths • This needs to be monitored over , 12 and 24 monthly intervals, and other factors considered. • Intervention can only be of use if it is of benefit, and not as an end in itself

24. What have we learned? • The flexible approach we have adopted seems as important as the actual intervention, and is best utilised as part of an overall plan (ie, “Reach Out”). • We are trying to learn from earlier mistakes in relation to the intervention and take on a broader range of opinions and outlooks • We have come across tragedy and the development of a post-vention programme has been important in a range of situations/events

25. Where from here? • Manuals & Materials available from April 2007, and distributed to interested parties in Ireland, UK & Europe, please ask for more information • Follow up evaluation, further analysis of initial findings and further dissemination • Possible shift to more training and consulting • “Training for Trainers” & “Postvention Programme” • “Take the First Step” Programme • Extended Mind Yourself – Clinical Setting • Physical Wellbeing/Mind Yourself programme

26. A thought to finish with….. “…The problem can no longer be seen as an individual and family tragedy, to be borne in secrecy and stigma. Suicide is everybody’s business”. Psychological Society of Ireland (1992)