Jan. K. Mokkenstorm M.D.,            psychiatrist            Director 113 Online            j.mokkenstorm@113online.nl    ...
113OnlineFirst two year results        • Background: why online help may benefit suicide          prevention        • Outl...
The problem     • Netherlands: 16 million inhabitants     • 1600 suicides per year     • 96.000 attempts registered     • ...
Help seeking barriers     (Pagura et al 2009, Bruffaerts et al 2011)        •      Low perceived need        •      Wish f...
Unmet needs and        expectations in regular care        (Pirkis et al 2001, Taylor et al 2009)                    – Spe...
Why online help may       benefit suicide prevention       • Reach: large scale dissemination       • Low treshold and eas...
Stage 1       Website +telephone hotline                              Education                    Hotline                ...
Pioneer online interactive       SAHAR                    Acute                   Peer                     chat           ...
Stage 2:       online interactive           Education                                         Advice              Acute   ...
Presentatie titel   10   01-09-12
Stage 3 Multi level    online platform                                       Education                       Direct       ...
Site stats       Site usage    5 / 10 / 09-20 / 03 /12         Average per day       Sitevisits                           ...
Selftests & Autoreplies      Selftest                Age< 23 SIQ J      Age 23+: BSI                                 (0-72...
Acute chat calls:      use and satisfaction  • DEMAND>> Supply  •    Av. duration: 61 min (sd 39 min).  •    48% female, 1...
Comparison Mishara silent monitoring study       1-800-SUICIDE Telephone vs 113Online Chat       Suicide and Life-Threaten...
Online Psychotherapy by       chat or e-mail  •    Anonymous, free  •    Solution Focused; CBT/DBT/ACT elements  •    Trea...
Routine Outcome Monitor       Effect studies (RCT)                                                              T2:       ...
Presentatie titel   18   01-09-12
Railway related        content acute chats        •      260 of 2443 unique acute chat callers (10,6%) refer to           ...
Adverse events    • We know of 3 suicides, in 2 cases the client was      in regular treatment as well.    • Suicide attem...
Conclusion        • 113Online reaches a large number of (very)          suicidal, concerned or bereaved individuals.      ...
Acknowledgments and thanks     •      Professionals and Volunteers of 113Online and Ex6     •      Management and voluntee...
References•   Bruffaerts,R., Demyttenaere, K., Hwang, I., Chiu, W.T. Sampson, N. ,Kessler, R.C.,    Alonso, J., Borges, G....
Thank You                   www.113online.nlwww.113online.nl                  24   01-09-12
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113 online suicide prevention: First two year results presented at the ESSSB14 Tel Aviv sept 2012

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The use of the internet is a promising approach in preventing suicide on the individual as well as the population level. However, this promise remains to be proven in trials and in practice.
The national Dutch suicide prevention platform113Online offers a 24/7 online anonymous mental health care programme. This includes crisis resolution, guided self help, and online psychotherapy. This programme is provided by professionals in close cooperation with volunteers staffing chat- and telephone helplines.

In this presentation philosophy, structure, methods, cost, and preliminary results of the first two years of 113Online are presented.

Published in: Health & Medicine, Spiritual
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113 online suicide prevention: First two year results presented at the ESSSB14 Tel Aviv sept 2012

  1. 1. Jan. K. Mokkenstorm M.D., psychiatrist Director 113 Online j.mokkenstorm@113online.nl mokkenstorm@gmail.com info@113online.nlwww.113online.nl 01-09-12
  2. 2. 113OnlineFirst two year results • Background: why online help may benefit suicide prevention • Outline of the online services • Preliminary results: help seeker characteristics, site use, service use, application of railway suicide prevention • ConclusionPresentatie titel 2 01-09-12
  3. 3. The problem • Netherlands: 16 million inhabitants • 1600 suicides per year • 96.000 attempts registered • > 500.000 individuals with death wish or suicidal ideation> 2 weeks • 40 % of attempters no treatment sought <1 year • 33% of attempters no treatment sought ever (Ten Have et al 2011 NEMESIS 2 Results of the Netherlands Mental Health Survey and Incidence Study)www.113online.nl 3 01-09-12
  4. 4. Help seeking barriers (Pagura et al 2009, Bruffaerts et al 2011) • Low perceived need • Wish for autonomy, control • Stigma • Structural & financial barriers • Negative experiences with regular care?Presentatie titel 4 01-09-12
  5. 5. Unmet needs and expectations in regular care (Pirkis et al 2001, Taylor et al 2009) – Specific competence & knowledge – Empathy and respect – Shared decision making – Open communicationPresentatie titel 5 01-09-12
  6. 6. Why online help may benefit suicide prevention • Reach: large scale dissemination • Low treshold and easy acces • Autonomy and control of the help seeker • Online disinhibition effects enhance therapeutic processes • Online interventions are effectivewww.113online.nl 6 01-09-12
  7. 7. Stage 1 Website +telephone hotline Education Hotline AdvicePresentatie titel 7 01-09-12
  8. 8. Pioneer online interactive SAHAR Acute Peer chat support HotlinePresentatie titel 8 01-09-12
  9. 9. Stage 2: online interactive Education Advice Acute chat Peer support HotlinePresentatie titel 9 01-09-12
  10. 10. Presentatie titel 10 01-09-12
  11. 11. Stage 3 Multi level online platform Education Direct Self Test Referral Advice Brief Online Therapy Acute Peer chat support Hotline Self Help CoursePresentatie titel 11 01-09-12
  12. 12. Site stats Site usage 5 / 10 / 09-20 / 03 /12 Average per day Sitevisits 730 Unique visitors 367 Pageviews 6,2 Visit Duration 00:03:053 Visitors Yough<18 yr Adult 18+ Total Suicidal 14,8% 53,8% 68,6% Concerned 5,8% 17,6% 23,4% Bereaved 1,4% 6,7% 8,0% Total 21,9% 78.1% 100%www.113online.n 12 01-09-12
  13. 13. Selftests & Autoreplies Selftest Age< 23 SIQ J Age 23+: BSI (0-72) (0-39) Average tests per day 6 10 Age 19,2 (sd 6,7) 36,6 (sd 11,8) % Female 72% 60% Average Score 40,7 (sd 20,7) 20,5 (sd 8,5) Autoreply Advice Age<23 Age 23+ Absent-Low 10% 5% Mild 5% 2% Suicidal 8% 38% Severely Suicidal 78% 55%www.113online.n 13 01-09-12
  14. 14. Acute chat calls: use and satisfaction • DEMAND>> Supply • Av. duration: 61 min (sd 39 min). • 48% female, 15 % male, 37% ?. Av. 25,6 • 46% of callers in a form of mental health treatment • Content: 41% psychiatric symptoms and treatment • 63 % of callers thanked the helper spontaneously • 15 % dissatisfiedwww.113online.n 14 01-09-12
  15. 15. Comparison Mishara silent monitoring study 1-800-SUICIDE Telephone vs 113Online Chat Suicide and Life-Threatening Behavior 37(3) June 2007 1-800: n=1431 tel.calls 113: n=396 chats Worse No change Better 1-800 113 1-800 113 1-800 113Apprehensive/ Confident 11% 7% 49% 52% 38% 43%Sad / Happy 9% 5% 67% 51% 22% 44%Helpless / Resourcefull 10% 15% 41% 44% 49% 41%Hopeless / Hopefull 11% 8% 47% 46% 40% 46%Confused/Decided 10% 8% 36% 54% 52% 39%Depressive mood 7% 8% 74% 56% 18% 36%Desperate 6% 7% 77% 55% 16% 38%Sustain thoughts 8% 56% 37%Suicide ambivalence 2% 8% 84% 69% 14% 23%(n=121)Presentatie titel 15 01-09-12
  16. 16. Online Psychotherapy by chat or e-mail • Anonymous, free • Solution Focused; CBT/DBT/ACT elements • Treatment manual • Trained & supervised psychologists • Brief: max 8 sessions/exchanges • Average number sessions = 5 • Av. number of completed therapies = 25/weekwww.113online.nl 16 01-09-12
  17. 17. Routine Outcome Monitor Effect studies (RCT) T2: BSS/SIQ CES-D T2 FOLLOW-UP T1: BSS/SIQ T1 END CES-D Gould& Therapy THERAPY PROCESS SRS ORS Session or Exchange T0: T0 START BSS/SIQ CES-Dwww.113online.nl 17 01-09-12
  18. 18. Presentatie titel 18 01-09-12
  19. 19. Railway related content acute chats • 260 of 2443 unique acute chat callers (10,6%) refer to the railways as a means of suicide. In 16 cases this related to someone else. There were 3 direct and positive references tot the “ I Listen” signs Situation Number % of 260 On the railway now 10 3,8% Today-yesterday 19 7,3% This week 10 3,8% Ever 27 10,3% Urge or a plan now 64 24,6% Decided against rail suicide 32 12,3% Ambivalent on rail suicide 23 8,8%Presentatie titel 19 01-09-12
  20. 20. Adverse events • We know of 3 suicides, in 2 cases the client was in regular treatment as well. • Suicide attempts occur during calls or sessions and have been dealt with by emergency services if caller/client revealed location. • Management received 3 formal complaints regarding unmet expectations.www.113online.nl 20 01-09-12
  21. 21. Conclusion • 113Online reaches a large number of (very) suicidal, concerned or bereaved individuals. • A substantial number did not seek help otherwise. • 113Online meets needs and expectations (partially) unmet in regular care. • Effectivity remains to be proven • Less than expected adverse events.Presentatie titel 21 01-09-12
  22. 22. Acknowledgments and thanks • Professionals and Volunteers of 113Online and Ex6 • Management and volunteers of Sensoor Helpline • Mady Samuels; Netherlands Ministry of Health Care (VWS) • ProRail • Prof. Ad Kerkhof • Prof. Brian Mishara • Prof. Jan Smit • Dr. Annemiek Huisman • Lucy Stut • Anouk Romers • Merijn Eikelenboom • Dr. Bregje van Spijker • Leo Wijnbelt • Ed Claasens • Age Nils HolsteinPresentatie titel 22 01-09-12
  23. 23. References• Bruffaerts,R., Demyttenaere, K., Hwang, I., Chiu, W.T. Sampson, N. ,Kessler, R.C., Alonso, J., Borges, G., Girolamo, G de , Graaf, R. de, Florescu, S, Gureye, O., Hu, C., Karam, E.G., Kawakami, N., Kostyuchenko, S., Kovess-Mastety, V., Lee, S., Levingson, D., Matschinger, H., Posada-Villa, J., Sagar, R., Scott, K.M., Stein, D.J., Tomov, T., Viana, M.C., Nock, M.K. Treatment of suicidal people around the world BJP 2011; 199(1): 64–70.• Krysinska, K.E. and D. De Leo, Telecommunication and suicide prevention: hopes and challenges for the new century. Omega - Journal of Death & Dying, 2007. (3): p. 237-53.• Mishara BL, Chagnon F, Daigle M, Balan B, Raymond S, Marcoux I, et al. Which helper behaviors and intervention styles are related to better short-term outcomes in telephone crisis intervention? Results from a silent monitoring study of calls to the U.S. 1-800- SUICIDE network. Suicide Life Threat Behav 2007a; 37: 291-307.• Pagura J, Fotti S, Katz LY, Sareen J. Help seeking and percieved need for mental health care among individuals in Canada with suicidal behaviors. Psychiatr Serv 2009; 60: 943-49.• Pirkis J, Burgess P, Meadows G, Dunt D. Self-reported needs for care among persons who have suicidal ideation or who have attempted suicide. Psychiatr Serv 2001; 52: 381-83.• Taylor, T.L., Hawton,K., Fortune, S., Kapur, N. Attitudes towards clinical services among people who self-harm: systematic review Br.J.Psych (2009) 194, 104–110.
  24. 24. Thank You www.113online.nlwww.113online.nl 24 01-09-12
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