Kar Ray Manaan, Groth Annabelle, Geffen Nicola, Gregory Melanie, Farley Eliza, Lane Abigail, Anand Muthur, Lombardo Chiara, Wyder Marianne
Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia.
Addiction and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.
Int J Ment Health Nurs. 2025 Jun;34(3):e70080. doi: 10.1111/inm.70080.
The global rise in presentations to emergency departments (EDs) for suicidal crises has created significant challenges for healthcare systems. Traditional approaches often emphasise containment and risk aversion, leading to prolonged ED stays and resource-intensive inpatient admissions. A large Australian metropolitan mental health service introduced a Wellbeing Team (WBT), and trialled the recovery-oriented AIMS (assessment, intervention, monitoring, step up/down) pathway. Grounded in the PROTECT framework, its focus is on person-centred care, integrating positive risk-taking and collaborative safety planning to stabilise individuals and reduce reliance on public mental health services. This study analysed 552 people referred to the WBT over 32 months, primarily from EDs (47.1%) and acute care teams (47.5%). The population predominantly consisted of women (63.2%), with a mean age of 27.9 years. The most common diagnoses were adjustment disorders (30.4%), depressive episodes (22.3%) and emotionally unstable personality disorder (14.7%). The WBT provided tailored interventions, including motivational interviewing, safety planning, distress tolerance techniques and psychopharmacological optimisation, guided by tools like the DESPAIR safety formulation. Outcomes revealed significant system efficiencies, with only 3.8% of participants requiring ongoing public mental health support. Most participants were successfully transitioned to primary care. Six-month post-intervention data showed 76.3% of individuals with no prior public mental health involvement did not re-present, and 60.7% with prior involvement did not require further input from secondary mental health services. These findings demonstrate the efficiency of recovery-oriented care in reducing systemic pressures while fostering sustainable outcomes, underscoring the potential of short-term, intensive, structured interventions like AIMS to transform suicide prevention pathways.
全球范围内,因自杀危机前往急诊科就诊的人数不断增加,这给医疗系统带来了巨大挑战。传统方法通常强调控制和规避风险,导致患者在急诊科停留时间延长,住院治疗资源消耗巨大。澳大利亚一个大型都市心理健康服务机构引入了福祉团队(WBT),并试行以康复为导向的AIMS(评估、干预、监测、升级/降级)路径。该路径以PROTECT框架为基础,注重以人为本的护理,将积极冒险和协作安全规划相结合,以稳定个体状况并减少对公共心理健康服务的依赖。本研究分析了在32个月内被转介至WBT的552人,主要来自急诊科(47.1%)和急性护理团队(47.5%)。人群主要为女性(63.2%),平均年龄27.9岁。最常见的诊断为适应障碍(30.4%)、抑郁发作(22.3%)和情绪不稳定人格障碍(14.7%)。WBT提供了量身定制的干预措施,包括动机访谈、安全规划、痛苦耐受技巧和心理药理学优化,并以DESPAIR安全配方等工具为指导。结果显示出显著的系统效率提升,只有3.8%的参与者需要持续的公共心理健康支持。大多数参与者成功过渡到初级保健。干预后六个月的数据显示,76.3%之前未参与过公共心理健康服务的个体未再次就诊,60.7%之前参与过的个体不需要二级心理健康服务的进一步干预。这些发现表明,以康复为导向的护理在减轻系统压力的同时促进可持续成果方面具有效率,凸显了AIMS等短期、密集、结构化干预措施在改变自杀预防路径方面的潜力。