Games tech to help health professionals identify suicidal ideation

Curtin University is utilising games technology to create web-based video simulations aimed at helping mental health experts identify and better communicate with people contemplating suicide.

As the World Health Organization points out, suicide is the second leading cause of death in people aged 15-29 worldwide, and one person dies of suicide in the world every 40 seconds.

Research also concludes that almost all of those individuals who take their life everyday have been in contact with a health professional in the year leading up to their suicide, some making contact just months before taking their lives. However, roughly only a third of individuals who commit suicide consult a specialist mental health professional beforehand.

Such statistics are concerning, considering the high rates of mental health issues in Australia and other western countries and the introduction of a wide range of mental health services and initiatives that are seemingly being underutilised.

In light of this, Dr Anna Fagence from Curtin University’s School of Nursing, Midwifery and Paramedicine developed a project to help make identification and treatment of people with suicidal ideation more effective. The project was recently awarded a grant by the WA Department of Health, and Fagence spoke to Nursing Review about some of the issues surrounding suicide and the benefits of the web-based video simulations in identification and prevention.

NR: Are suicide rates increasing, and if so, why?

AF: In general, as a trend, yes. The Australian Bureau of Statistics’ rates have fluctuated over the last 20 years, with a low in 2006 (10.2 per 100,000 people) and a peak in 2015 (12.9 per 100,000). Currently, the rate is 12.1 per 100,000. It’s the 14th leading cause of death for all Australians and the leading cause of death for Australians aged between 15-44.

The reasons are multifactorial but often it’s when we become overwhelmed by things that are happening in our lives. This can occur in the context of a mental illness such as depression or when we’re under considerable life stress such as significant financial trouble, a relationship breakdown/loss, loneliness and social isolation, or chronic illness.

The person begins to see death as a way to end pain. Most of us experience low-level fleeting suicidal thoughts at least once in our lives (eg wishing we would not wake up tomorrow) – these are very common in the population. What is much less common is acting upon those thoughts.

What are some of the challenges faced by health professionals in identifying and helping suicidal people?

Health professionals often assess suicide risk by counting how many risk factors someone has for suicide, but research shows that these risk factors aren’t very good in practice at accurately identifying who is at risk. Health professionals currently aren’t able to reliably predict who will move from thought to action. What does seem to help identify people who are at risk is a solid empathetic relationship between the health professional and the person. Health professionals who have better relationships with people and communicate respectfully and with compassion provide a safe environment where people can discuss their suicidal thoughts without fear of judgement from the health professional.

However, health professionals often don’t do this and so people may not feel comfortable enough to share their thoughts with them. For example, some health professionals ask questions like: “So, you’re not thinking of doing something silly are you?” which clearly signals to the person that it isn’t safe to discuss their suicidal thoughts with them because the health professional is going to stigmatise and judge them. Other people who do share their suicidal thoughts may not be properly supported through this discussion by the health professional for similar reasons. So, the emphasis in our project is to train health professionals to have more compassionate conversations with people experiencing suicidal thoughts.

How will games technology be used to develop these video simulations?

Based on gamification principles, serious games simulations incorporate engaging game design elements into health care simulation, where players have objectives, make decisions during the game, and get to see how those decisions and choices influence outcomes. Our project uses live-action serious video game simulations to train health professionals to be better communicators with people experiencing suicidal thoughts (eg to not use stigmatising or judgmental language).

How will the simulation help health care professionals practice and improve their communication skills when talking with people experiencing suicidal thoughts?

Upon entering the game, point-of-view videos will play where a person will advise the health professional player that they have been experiencing some distressing thoughts but will not disclose the nature or extent of those thoughts. Health professional players will then be asked to make a series of decisions about how to proceed with the conversation.

Some choices will lead to the health professional player developing a good relationship with the person who will then share more of their suicidal thoughts. Some choices will lead to the person not sharing their suicidal thoughts because the health professional player has chosen to poorly communicate with the person. Health professionals will receive a score based on how well they communicated with the person and will be able to play multiple times in order to better their score each time.

We’re heavily involving people with lived experience of suicidal thoughts to help us construct these serious game simulations to ensure we capture the right sort of communication. Once completed, initially these serious game simulations will be made available to health professional students and practising health professionals around Western Australia (including rural and remote health professionals) but being web-based there’s considerable scope to make them available both nationally and internationally with additional research funding.