ATAPS Suicide Prevention Service for 2011/12 Financial Year
CSGPN was one of nineteen GP Networks that received funding for the trial of ATAPS Self Harm and Early Intervention Project from 2008. This project has been a resounding success across the nineteen GP networks as judged by the reduction in the outcome scores of the individuals who underwent counseling for self harm or suicidal ideation. The Modified Scale for Suicidal Ideation fell from pre-treatment mean of 11.22 which is mild-to-moderate suicidal ideation to a post treatment mean of 2.4 which indicates a low suicidal ideation. In view of the success of this trial, the Department of Health and Ageing has decided to roll out this program across Australia and from now on it is called the ATAPS Suicide Prevention Service.

Deliberate Self Harm
Deliberate self harm (DSH) refers to acts of intentional self poisoning or injury but excludes body piercing, tattooing, high risk behaviour and self harm due to rare inborn errors of metabolism.

KEY FACTS
Self harm is the strongest risk factor for suicide
15-33% who self harm will re-present within an year
Almost half of all repeat events took place within 3 months and almost two-thirds within the first 6 months of an index DSH event
About 17% females and 4% males self harm each year
“Hidden” cases of self harm is estimated to be about 23%

Recommendations for the management of DSH
Ensure prompt assessment and maintenance of safety
Ensure prompt access to medical / surgical assessment
Ensure prompt access to mental health assessment
Ensure intensive intervention for patients with risk of repetition

Manchester Self Harm Rule
Based on data collected over a 3.5 year period on 9086 episodes of DSH involving 6,730 patients, the Centre for Suicide Prevention, University of Manchester devised a Manchester Self Harm Rule or MASH rule. A ‘yes’ to the following puts a patient in a high risk category:

History of self harm?
Previous psychiatric treatment?
Current psychiatric treatment?
Benzodiazepine taken as overdose?

If the answers to the above four questions are yes – the patient is at high risk of suicide. The MASH rule correctly predicted 94% of all repeaters including twenty two cases of suicide and global assessment by clinicians predicted 85% of all repeaters. The study claims that the MASH rule missed no suicides occurring within 6 months and concluded that “the accuracy of predicting short-term repetition of self-harm by clinicians could be improved by incorporating this simple rule into their assessment.”

Eligibility for the ATAPS Suicide Prevention Service
This service is primarily deigned for three groups of people:
People who, after a suicide attempt or self harm incident, have been discharged into care of a GP from a hospital
People who have presented to GP after an incident of self harm
People who expressed strong suicidal ideation to their GP

Making a referral
People can be referred for services by the following:
their GP
the Emergency Department
a hospital ward
NSW state acute mental health support team

The GP does NOT need to complete a GP Mental Health Treatment plan prior to referral, unlike the other ATAPS streams.

Intervention Period
The ATAPS Suicide Prevention Service is designed to provide immediate and short term (1-2 months) support for people during the period of high suicide risk. It is not intended to provide support over a longer period. Most importantly, the allied health professional (AHP) is to contact the person within 24 hours of referral and the first session must occur within 72 hours of referral. 

There is no limit on the number of sessions the client can access unlike other ATAPS streams.

Arrangements should also be in place for Crisis Support Services ATAPS after hours support:  Mon-Fri 5pm-9am, all day Saturday & Sunday support (1800-859-585) to contact the patient.

Interventions and training requirements for AHPs
Interventions are similar to other ATAPS streams and are expected to be a mixture of face-to-face consultations and follow-up telephone calls for continuity of care.  The AHP may undertake care coordination role and facilitate access to psychiatrists. GPs who participate in case conferences should be aware of the Medicare item numbers.

The AHPs engaged to provide services under the ATAPS Suicide Prevention Service must have specific training in suicide prevention in addition to being accepted as an ATAPS provider. It is mandatory for all AHPs to complete the training and assessment developed by the Australian Psychological Society for the ATAPS Suicide Prevention Service Trial Project. This training is designed to ensure that all AHPs across Australia have the at least a minimum level of understanding as to how to work with this high risk group. It is mandatory for all AHPs to have successfully completed the module before providing services under ATAPS Suicide Prevention service.