Suicide prevention and first aid


A resource for GPs

Normalising patients’ feelings

☰ Table of contents


A useful analogy …


‘I have nothing to wear.’

‘But you have a closet full of clothes.’

To the outsider, what may seem like an irrational feeling is very real and rational for the person experiencing it. It is the same for those suffering from anxiety. To the outsider, it might seem like the person has everything (ie a great job, family and social life). However, a crippling fear of one thing renders all others as inconsequential. While anxiety might be seen as an irrational feeling by an outsider, it might be completely rational to the person.19

Part of the problem with the way services and the community respond to mental health issues is the stigma that is associated with mental illness.

You can help to reduce the problems caused by stigma by normalising mental health issues and by talking about mental illness/conditions/disorders the same way you would about physical illness/conditions/disorders.

The information below includes mental health analogies and strategies that might assist you to normalise mental health issues and reduce stigma for your patients.

  1. Mental Health First Aid Australia. What we do at Mental Health First Aid. Melbourne: MHFA, 2015.  [Accessed 4 March 2016].
  2. Ferrari AJ, Norman RE, Freedman G, et al. The burden attributable to mental and substance use disorders as risk factors for suicide: Findings from the global burden of disease study 2010. PLoS One 2014;9(4):e91936.
  3. Hawton K, van Heeringen K. Suicide. Lancet 2009;373(9672):1372–81.
  4. Australian Bureau of Statistics. Causes of death, Australia, 2014. Cat. no. 3303.0. Canberra: ABS, 2016.  [Accessed 1 February 2016].
  5. Australian Bureau of Statistics. Australian social trends, March, 2011. Cat. no. 4102.0. Canberra: ABS, 2011.  [Accessed 13 January 2016].
  6. Carey M, Jones K, Meadows G, et al. Accuracy of general practitioner unassisted detection of depression. Aust N Z J Psychiatry 2014;48(6):571–78.
  7. beyondblue. Common warning signs. Hawthorn West, Vic: beyondblue, 2016.  [Accessed 14 December 2015].
  8. Mitchell AJ, Rao S, Vaze A. International comparison of clinicians’ ability to identify depression in primary care: Meta-analysis and meta-regression of predictors. Br J Gen Pract 2011;61(583):e72–80. doi:10.3399/bjgp11X556227.
  9. Lampe L, Fritz K, Boyce P, et al. Psychiatrists and GPs: Diagnostic decision making, personality profiles and attitudes toward depression and anxiety. Australas Psychiatry 2013;21(3):231–37.
  10. Wilhelm KA, Finch AW, Davenport TA, Hickie IB. What can alert the general practitioner to people whose common mental health problems are unrecognised? Med J Aust 2008;188(12 Suppl):S114–18.
  11. Kyrios M, Mouding R, Nedeljkovic M. Anxiety disorders – Assessment and management in general practice. Aust Fam Physician 2011;40(6):370–74.
  12. Nepon J, Belik SL, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety 2010;27(9):791–98.
  13. beyondblue. What causes anxiety? Hawthorn West, Vic: beyondblue, 2016.  [Accessed 16 February 2016].
  14. Stensland MD, Zhu B, Ascher-Svanum H, Ball DE. Costs associated with attempted suicide among individuals with bipolar disorder. J Ment Health Policy Econ 2010;13(2):87–92.
  15. Cerimele JM, Chwastiak LA, Chan YF, Harrison DA, Unutzer J. The presentation, recognition and management of bipolar depression in primary care. J Gen Intern Med 2013;28(12):1648–56.
  16. Black Dog Institute. Bipolar disorder: Symptoms. Randwick, NSW: Black Dog Institute, 2012. [Accessed 4 February 2016].
  17. Benazzi F. Bipolar disorder – Focus on bipolar II disorder and mixed depression. Lancet 2007;369(9565):935–45.
  18. Almeida OP, Pirkis J, Kerse N, et al. A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Ann Fam Med 2012;10(4):347–56.
  19. Women’s Web. Analogies to help one understand depression and other mental health conditions. Women’s Web, 2014.  [Accessed 3 March 2016].
  20. Parker J. Recovery in mental health. S Afr Med J 2014;104(1):77.
  21. Lloyd C, Waghorn G, Williams PL. Conceptualising recovery in mental health rehabilitation. Br J Occup Ther 2008;71(8):321–28.
  22. Department of Health. Principles of recovery oriented mental health practice. Canberra: DoH, 2010. [Accessed 3 March 2016].
  23. Sivasankaran B. Mental health risk assessment: A guide for GPs. Aust Fam Physician 2011;40(6):366–69.  [Accessed 30 May 2016].
  24. Hawgood J, De Leo D. Screening tool for assessing risk of suicide (STARS). Nathan, Qld: Australian Institute for Suicide Research and Prevention, Griffith University, 2015. [Accessed 3 March 2016].
  25. Melvin GA, Gresham D, Beaton S. Safety first – not last! Suicide Safety Planning Intervention (SPI). InPsych 2016; 38(1):14–15. 
    [Accessed 30 May 16].
  26. Zantinge EM, Verhaak PF, de Bakker DH, van der Meer K, Bensing JM. Does burnout among doctors affect their involvement in patients’ mental health problems? A study of videotaped consultations. BMC Fam Pract 2009;10:60.
  27. Wade D, Howard A, Fletcher S, Cooper J, Forbes D. Early response to psychological trauma – What GPs can do. Aust Fam Physician 2013;42(9):610–14.
  28. Brondt A, Sokolowski I, Olesen F, Vedsted P. Continuing medical education and burnout among Danish GPs. Br J Gen Pract 2008;58(546):15–19.

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