Conference Agenda

Introduction

Healthcare professionals have increased risk of suicide with access to means and often operating within a culture of blame creating abnormal levels of distress.

Reforming the culture of healthcare makes an important contribution to reducing suicide among healthcare workers. Integral to this is building a culture of trust, learning & forward-looking accountability which fosters a psychologically safe work environment. (Dekker 2017)

In Australia, health systems are adopting the Zero Suicide Healthcare Framework. Restorative, just and learning culture (RJLC) is integral to the success of implementation. RJLC provides a framework to understand the complexities of work & support learning. It mitigates against old paradigms of risk prediction and hindsight bias. It helps to overcome pessimism & nihilism with respect to the ability to learn from, and prevent, suicides (Turner 2020).

Method

To support RJLC development a blended program, incorporating four online knowledge-based modules supported by face-to-face learning, was piloted in three health services.

Results

The evaluation showed the online modules delivered high levels of satisfaction (80%) and relevance to job roles (80%). Face-to-face workshop results were less positive with 50% of participants having expectations met. However, in qualitative interviews it was noted that workshops were regarded as the most impactful component of the program.

Based on the evaluation, the program has been restructured to better meet the needs of different three different audiences within health services:

• Executive leadership and Boards
• Operational leaders who will lead the culture development
• Health service staff

Learning outcomes

1. Understand the distinction between retributive and restorative, just and learning cultures
2. Describe the key drivers of psychological safety within healthcare
3. Apply the principles of restorative just and learning culture to adverse incident reviews within healthcare.

Conclusion:

Health service leaders have a responsibility to reform and reshape health system culture to reduce suicide among the healthcare workforce.

Background
A substantial proportion of individuals who die by suicide may be reached through workplace-based preventive efforts. Yet, evidence regarding suicide rates by occupational groups remains to be updated. The aim of this study was to calculate suicide rates by occupational group and examine trends over time, suicide methods, and proportion of prior psychiatric treatment.

Methods
A cohort design was applied to national data on all Danish residents aged ≥18 years during 1991–2023. Individual-level, yearly data on 72 different occupational group was linked to data on causes of death. We calculated incidence rates. Adjusted incidence rate ratios (aIRRs) were estimated using Poisson regression and primary school teachers as a reference. Use of suicide method and prior psychiatric treatment was examined.

Results

Among 6.88 million adults, the highest aIRRs were observed among craft and related trade workers (2.9, 95% CI 2.4-3.5), veterinarians (2.5, 95% CI 1.4-4.6), medical doctors (2.3, 95% CI 1.8-2.9), train drivers (2.2, 95% CI 1.3-3.6), and farmers crop and livestock farmers (1.9, 95% CI 1.5-2.3). Over calendar time, suicide rates declined for medical doctors and craft and related trade workers. Suicide by poisoning was over-represented among healthcare professionals, whereas use of firearms was common in suicides among police and military personnel. Among the 72 occupational groups, 16,344 died by suicide, among these suicides, 8,788 (53.8%) had a prior contact to psychiatric services.
Conclusion

Despite improvements over time, occupations with elevated suicide rates were identified. Specific occupational groups had low utilization of psychiatric treatment and high use of available, lethal means. Efforts, such as addressing mental health literacy initiatives and means-restrictions might be considered.

Background: Suicide prevention traditionally focuses on suicide deaths alone. However, suicide, chronic alcohol-related disease, and drug poisoning share structural determinants that operate at occupational levels, including economic precarity, workplace isolation, and lack of protections. Examining these pathways together reveals patterns obscured when analysing suicide alone, identifying the full burden of mortality from structural disadvantage.

Objective: To identify occupational groups experiencing elevated mortality from suicide, chronic alcohol-related disease, and drug poisoning.

Methods: We analysed National Coronial Information System data for employed Australian workers aged 18-64 years (2001-2022). Deaths were classified as suicide (X60-X84), chronic alcohol-related disease (K70, K73-K74, I42.6, K86.0), or drug poisoning (X40-X44, Y10-Y14, F11-F19). We calculated age-standardised mortality rates by occupation and sex. Age-standardized mortality rates were calculated by occupation and sex. Joinpoint regression assessed temporal trends.

Results: Construction workers highest age-standardised mortality rate for these deaths combined (91.8 per 100,000; Incidence rate ratio (IRR) 5.8 95%CI 5.0-6.7), followed by Labourers (44.8 per 100,000, IRR 2.4, 95%CI 2.1-2.7), Farm, Forestry and Garden Workers (41.1 per 100,000, IRR 2.1, 95%CI 1.8-2.5) and Machinery and Stationary Plant Operators (40.1 per 100,000, IRR 2.1, 95%CI 1.8-2.4). Temporal analysis from 2001-2022 revealed increasing mortality due to suicide, chronic alcohol-related disease and drug poisoning combined among Machine and Stationary Plant Operators (Annual Average Percentage Change (AAPC), 2.50, 1.24-3.92), Technicians and Tradesworkers (AAPC), 1.39, 95%CI 0.74-2.09), and Labourers (AAPC 2.13, 95%CI 1.11-3.31).

Conclusions: Mortality from suicide, chronic alcohol disease, and drug poisoning exhibits marked occupational patterning, with elevated burden concentrated in manual labour occupations experiencing structural disadvantage. These findings suggest occupational and employment conditions, not individual factors, drive population-level mortality patterns. This highlights the potential population gains in addressing structural determinants: employment security, workplace protections, and occupational health infrastructure.

Introduction: Globally, veterinarians face elevated suicide risk, and Australia experiences similar trends. The unique workplace stressors and moral injurious events expose veterinarians to psychosocial hazards contributing to suicidal thoughts and behaviours. This research aimed to qualitatively explore the complex phenomenon of suicidality among veterinarians.

Methods: As a part of a convergent parallel design of the AUSVETS study, participants were registered veterinarians recruited via purposive sampling aligned with the Australian Veterinary Associations Workforce Survey Report, and sample size determined by information power. Recruitment occurred through invitation following the cross-sectional survey and social media platforms. Guided by the Public Health Model and the Integrated Motivational-Volitional Model of Suicide, semi-structured interviews were conducted using an interview protocol informed by literature, a lived experience advisory group and team expertise. Interviews were transcribed verbatim and analysed using reflexive thematic analysis following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

Results: The subjective narrative of the veterinarians highlighted unique psychosocial hazards in the workplace and moral injurious events that can lead to suicidal thoughts, intents, plans and behaviours. Key themes included toxic workplace culture and bullying, moral injurious events, biological and psychological vulnerabilities, lack of support, and participants’ recommendations for priority preventative strategies.

Conclusions: Findings provide nuanced insights into workplace stressors and moral injurious events contributing to suicidality, offering theoretical and practical implications. These results can inform systemic and policies level changes needed to operationalise suicide prevention strategies within the veterinary profession.

Introduction: Patient death by suicide is a profoundly distressing occupational event for mental health professionals, with far-reaching implications for clinical practice and wellbeing. Mental health nurses experience particularly high rates of patient suicide exposure and evidence suggests their professional practice may be among the most severely affected in the aftermath. However, this experience remains under-investigated among mental health nurses internationally, with no known research in the Irish context. This study explores how patient suicide affects the personal and professional lives of mental health nurses in Ireland and identifies supports which mitigates the impact.

Methods: A survey informed by previous research was circulated to mental health nurses in Ireland. Nearly all respondents (n=138,96.5%) had worked with a patient who died by suicide/suspected suicide. Frequency and regression analyses were conducted on quantitative data, while qualitative data were analysed thematically.

Results: Respondents were predominantly female (74.6%), working in general adult psychiatry (60.8%), with extensive experience (84.1% working >10 years). Nearly 20% reported substantial detrimental effects on clinical practice, with 38.9% indicating impacts lasting >8 weeks. The most highly rated personal consequences included decreased self-confidence (18.1%), preoccupation with suicide (15.2%), and poor sleep (10.1%). Supports identified as helpful included shared care team support (31.8%), team meetings (25.6%), and formal line management (26.5%). Recommended supports included personal debriefing (63.8%), access to a senior suicide lead for advice (54.3%), and support navigating formal processes (50.0%). Multiple regression analysis controlling for gender, years working, and clinical level, revealed that feelings of responsibility (F=5.601,dfs=4,94,p<.001) and guilt (F=5.347,dfs=5,94,p<.001) significantly predicted emotional impact, with the model explaining 18.8% of variance.

Conclusions: Patient suicide profoundly affects mental health nurses' personal and professional lives. This study provides much-needed insight into the necessary systemic organisational changes to enhance support structures and improve professional resilience, which is crucial for professional practice and patient care.