Guidelines for best practice psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts

The Menzies School of Health Research (Menzies), commissioned by the Centre for Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) have developed evidenced-based Guidelines for best practice psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts (Guidelines) to improve the quality of care and outcomes for people presenting with suicidal thoughts and behaviours.

The Guidelines were developed using the Delphi method to ensure recommendations reflect the latest available evidence and the perspectives of experts and those with lived experience.

The Guidelines contain recommendations designed to:

  • Develop the cultural competency of hospital staff as a foundation for providing more culturally responsive hospital mental health services.
  • Recommend practices and strategies that encourage patient and cultural safety.
  • Improve the quality of assessments that informs clinical decision-making.
  • Promote a person-centred approach to clinical decision-making that is focused on supporting recovery in the community.
  • Increase patient satisfaction with hospital services.
  • Encourage future help-seeking behaviours.

The recommendations cover essential areas of practice specific to assessing suicidal thoughts and self-harm by Aboriginal and Torres Strait Islander people, including:

  • Underlying principles of best practice that support increased cultural responsiveness.
  • Ways to effectively and appropriately engage and interact with Aboriginal and Torres Strait Islander people.
  • The risks, needs and strengths to assess that are clinically relevant and reflect the underlying social and emotional wellbeing of Aboriginal and Torres Strait Islander people.
  • How to ensure formulation of the psychosocial assessment informs culturally appropriate recommendations for care and treatment.
  • Additional recommendations tailored specifically for young Aboriginal and Torres Strait Islander people.

The Guideline document has been designed as a reference for clinical practitioners, supervisors and educators to use as part of pre-service training and ongoing professional development.

Home, Education/Employment, Activities, Drugs and alcohol, Sexuality, Suicide and depression assessment tool (HEADSS)

The HEADSS approach to obtaining a psychosocial assessment with young people has proven highly valuable and is used in primary care and hospital settings throughout Australia. The focus is on normalising the assessment process and assuring young people that don’t have to answer questions they are not comfortable with. The process allows an opportunity for health practitioners to establish trust, confidence and rapport with young people although it is important to discuss the limits of confidentiality if someone is at risk of self-harm or suicidal ideation. The assessment covers, Home, Education and employment, Activities, Drugs and alcohol, Sexuality Suicide Risk/depression. Although there are some variations with Eating and Safety also included in the assessment questions. (HEEADSSS)

The headspace psychosocial assessment

The headspace psychosocial assessment is an adaptation of the HEADSS to suit the Australian context, with an extension to 10 domains as well as a subsection on strengths, difficulties, and goals. It involves screening and probing questions as required.  However, it has not yet been adapted or validated for use specifically with Aboriginal and Torres Strait Islander young people. Special care needs to be taken by practitioners if applying this tool with Aboriginal and Torres Strait Islander young people.

However, in 2012–13, the ‘Y Health – Staying Deadly’ research project, funded by the Australian Primary Health Care Research Institute, developed a culturally valid and culturally specific version of the HEADSS assessment – the Youth Social Emotional Wellbeing (SEW) assessment.  It takes a strengths-based approach which focuses on the strengths and capabilities of individual young people and their community; advocates for a positive sense of cultural identity; and acknowledges that there is potential for change, growth, and success.  The Aboriginal and Torres Strait Islander Youth SEW assessment is a modified HEADSS version with a question guide to support the latter.

The Youth SEW assessment is recommended to be conducted as part of an annual health check under Item 715 of the Medicare health assessment for Aboriginal and Torres Strait Islander peoples. The ‘Y Health – Staying Deadly’ project also developed a template for an Aboriginal and Torres Strait Islander Youth Health Check, which can be adapted for use by individual services. The Adolescent Health GP Resource Kit produced by the NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre also provides templates for a health check for young people.

Further reading 

Nori A, Piovesan R, O’Connor J, Graham A, Shah S, Rigney D, McMillan M, BrownN. ‘Y Health – Staying Deadly’: an Aboriginal youth focussed translational action research project. ANU (Canberra) 2013

Parker, A Hetrick, S., & Purcell, R, 2010, Psychosocial assessment of young people: Refining and evaluating a youth friendly assessment interview. Australian Family Physcian , Vol 39, No 8