| 4. In which ways is the initiative creative and innovative?
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The suicide prevention system has been developed for 13 years (1999 – 2012). Stages of development can be summarized as follows
Phase 1 " Sakon Nakhon Model" (1999-2001): JVKK studied suicide problems in Sakon Nakhon by interviewing attempt suicide cases, their relatives, community leaders, and health personnel and found important obstacles of access to care and un-continuing of services. The result was used to develop a course syllabus and training handbook for nurses and health personnel. Workshop to exchanged best practices came out the report forms, data management care report and guidelines for health personnel and used as a pilot implementation in Sakon Nakhon province.
Phase 2 “Expanding the project (2001-2003)” In 2001, Department Mental Health assigned JVKK as project manager expand this model to 33 provinces that had high rate of suicide from 4 regions of the country. JVKK collaborated with Khon Kean University to monitor and evaluate the project. The results showed needs for screening tools on suicide attempt. In 2003, JVKK developed surveillance report system on depression and suicide (DS 506).
Phase 3 "Nationwide accessibility" (2004-2006) the Sakon Nakhon Model was used nationwide through provincial strategic plan. Every hospital reported surveillance in DS 506 form to provincial health office. Data from all provincial offices were sent to JVKK on line to analyze to be national suicide database. Severity of suicide problem showed to be problem and was defined as one of the Ministry of Public Health’s indicators since 2005.
Phase 4 "Toward Sustainability (2007-2010)”: JVKK provided Geographical Information System (GIS) to support all Public Health Units by combining surveillance data and death certificate data in GIS. JVKK adjusted its’role on supporting and monitoring health service system. Suggestion from the field led to development of new depression and risk of suicide (DS 8), simplified version to use in community.
Phase 5 “Turning point to national and international level”. (2010 - 2012) The main strategies were extending cooperation to the public sector and international organizations. The suicide problem was announced as one of the national agenda of 4th National Health Assembly's in 2011. International Learning Center was developed aiming to be leader of knowledge management, training in specific issue and exchange technical issues. The international co-operations with neighboring countries (China, Singapore, Hong Kong and Cambodia) were initiated in 2012.
Phase 6 “ Excellence center Suicide” (2012 - present). Results from operating continuously. It is apparent to the feasibility and usefulness.The adoption Moreover, the country has formed a new work. To be integrated in And the Academic Unit. Serve academic support and development personnel to be ready to cope with the problem by themselves. Therefore,JVKK change the role of the executive management of the care system across the country. The agency has the expertise to develop a defense minister who tried to harm themselves . As a consulting and system design to ensure that the system remains. It also acts as the data analysis and in-depth research even more. Provide information to other agencies are ready and confident with the ability to cope with problems that may come back again.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The stakeholders involved in the implementation were:
1. The Department of Mental Health drove the policy and supported budget. JVKK was funded and assigned as a national project manager for analyzing problems, supervision, monitoring, evaluation and support the academic development. Mental Health Centers (MHCs) and Mental Health hospitals, service units of the Department of Mental Health in the region provided technical support, training, monitor and supervise community hospitals and health promoting hospitals. Community hospitals and health promoting hospitals provide services according to the standard. Khon Kaen Universities and Chaing Mai Universities were collaborated to develop standard service system which applicable for each area.
2. The provincial and district public health offices and local organizations involved in the process leading to the actual practice in the community by being trained to provide consultancy services, do home visit, report, collect data, analyze data and transfer the data. Hence the national database was established and reliable.
3. The evaluation for change was an important process. Community leaders, family
and relatives provided feedback to improve the implementation in accordance with the actual situation through the provincial health network assembly coordinator. The Mental Health Centers were responsible for regional assessment, analysis and evaluation information. The JVKK was responsible for national evaluation and recommendation on prevention policy.
4. The Health Assembly, in the northern part of Thailand, is a process in which the relevant public and State agencies exchange their knowledge and cordially learn from each other through a participatory and systematically organized in 2011. So that the solution is comprehensive and meets the real needs of the people.
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| 6. How was the strategy implemented and what resources were mobilized?
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Budget
1999-2000: model development stage. This was financially supported by JVKK internal revenue to promote education in Sakon Nakhon province.
2000-2012: expansion stage. This stage was financially supported by the bureau of the budget at the amount of 9.5-10 million baht annually. This budget was allocated according to annual strategy as followed: 1) campaign on knowledge dissemination to the public through various channels (10%); 2) human resource development for people in and out of the ministry of public health network including organizing trainings, seminars, and publishing training manuals (42%); 3) producing handbook, technology for public health personnel and community leaders (10%); 4) database and website (suicidethai.com) development (16%); 5) research and innovation (22%). JVKK was responsible for financial management of the project.
2007: eight Northern provinces began the project using money from the local administration offices, provincial senior slubs, national health security fund and fund from mental health centers.
2008-2010: another twenty-five provinces followed suit, budget spending ranged from 169,000 to 248,370 for data survey, community leader training, and social support developments in the community. The activities were integrated to routine work of each province later on.
Under the conditions of limited budget and change in social factors, it was necessary to analyze and search for the stakeholders and build up participation with diverse groups in the government sector, the private sector and the mass media sector.
Technical
Information technology has been fully implemented. Report was sent on line. Suicidal rate was classified according to its violence and was tallied based on Geographical Information System (GIS). Website has been developed to promote communication, support coordination and monitoring. The website also disseminates knowledge and technology among workers in the networks. JVKK took care of the IT system, updated knowledge, developed and produced tools and technology appropriated to target groups.
Human resources
1) Development of health personnel: at least three health personnel (doctors, nurses, psychologists, and public health workers) from regional/provincial hospitals and community hospitals were selected for training on mental therapy, monitoring and supervision skill, data analysis, epidemiology research, curriculum writing, manual development, IT, and CPG process,. 2) Development of network outside the ministry of public health, five to ten people (community leaders, Tambon chiefs, village chiefs and local administration officers) were selected from each community for training on mental health and assessment of suicidal risk. In addition, we are in cooperation with Faculty of Medicine, Khon Kaen and Chaing Mai University for research development and contribution to the body of knowledge.
Resource management
Data and results were analyzed quantitatively and qualitatively. Public hearing was operated; annual operating plan was prepared accordingly. Expenses for each activity were calculated and human resource is managed following predetermined objectives and strategies. Operational and strategic meeting was organized so everyone involved understood objectives, goals, duties and ways to work together. Personnel at all levels got operation manual for implementation. Auditing is organized once a year to alleviate problems for province that found difficulty to follow details in the manual.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The achievement took place and was the main factor that can be used to predict success in the social problems of Thailand including by:
1. The development of human resources both in and out of the ministry of public health. 86.38% of health personnel were trained. In addition, on average 809 health volunteers and community leaders, 166 teachers and 100 nurses were trained. These personnel could handle the services from institution through community level.
2. Suicidal database of Thailand has established since 2007 covered 77 provinces. Public Health posts screened the case, identify and brought the case to health service system. Data was sent on line to JVKK every 6 months. JVKK analyzed data and compile to warning system and summarized annually to provincial mental network.
3. Development of integrated health system and access to community linkages. Clinical Practice Guideline (CPG) for medical personnel were used to provide standard and sustainable services. In 2012, all health service units all over the country set up solving of suicide problem as a provincial policy. 85% of attempt suicide cases were turned to home visit system, 82.5 % were in follow-up system. Campaign at national level was hold on 10th September each year.
4. Ongoing Development of knowledge and technology, divided into 4 groups: 1) instruments used to assess risk of suicide, 2) training course/program for physicians, nurses and community leaders to prevent a suicide, 3) Clinical Practice Guideline (CPG)for tertiary hospital, general hospital and community hospital, 4) suicidal prevention guideline for people. 5) Epidemiological researches about self-harm behavior of Thai population, during 2005 -2009 (2 studies per year). Moreover, 16 researches were published during 2007 – 2012, and 4 sets of E-Learning for health personnel were produced.
The impact of implementation has been extended to all provinces in Thailand. The problem of the difference in geographical, cultural and living conditions requires that the driving mechanisms must be based on principles derived from the continued studies in each area. An extremely important point is having the database of each area that serves as a "warning system" that leads to re-processing capable of coping with the problems.
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| 8. What were the most successful outputs and why was the initiative effective?
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1. The cooperation of individuals involved with the operation.
The public health personnel take care of all self-harm persons with case management. Health personnel used surveillance report (DS 8) to follow up and refer the case. The report was record and sent on line. Every case will be protected by coding system. At provincial level, the report was compiled and sent to JVKK every 6 and 12 months.
2. Database of Suicide Thailand.
Data sources from a death certificate by Ministry of Interior were coordinated with the Bureau of Policy and Strategy every 6 months. Since 2012, personnel from Khon Kaen Rajanagarindra Psychiatric hospital and Planning Division, Department of Mental Health are assigned to analyze and prove the accuracy of information together.
3. Integrated Service Systems Development and Community.
Supervision and monitoring system. The supervisors composed of personnel from the Department of Mental Health and the Office of Inspector General, Ministry of Health. Every 6 months, these supervisors will supervise and monitor the results of help care system for attempt suicide at regional level and submit to JVKK every 6 and 12 months. At provincial level, representatives from mental health hospital and provincial health office were supervisors and supervised at 6th and 9th month of fiscal year.
4. Continuous Development and Technology.
Every year around December, Khon Kaen Rajanagarindra Psychiatric hospital will survey about the demand for new knowledge, media and technology from the public health personnel. In addition, user who received e-documents or was supported by expert will be evaluated on the implementation of knowledge and technology used, either in paper form or via the website.
5. Human Potential Development, both inside and outside the Ministry of Public Health.
Early in the fiscal year, questionnaires were distributed to network both in and outside the ministry to review potential development needs related to care of self-harm persons, knowledge transferring, potential development for training/seminars.
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| 9. What were the main obstacles encountered and how were they overcome?
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Three problems in implementing the model are :
1. Health personnel, lack of knowledge Correct understanding,due to lack of knowledge and skills to treat persons who were at risk of suicide. Continuous meetings have been organized for personnel on searching method, screening and treatment of self-harm cases. Knowledge also can be accessed through E-Leaning. Seminars, sharing experience during supervision, and presentation of research/study in national meeting were means to increase knowledge and skills to personnel in the network.
2. Public attitudes that ignore the need to engage in problem solving . So, we readjusted the content and methods of campaign appropriate to target groups, production of interesting, but simple guideline for the public, bringing celebrities to be presenters of the campaign, and developing simple assessment tools to use in community.
3. Planning to prevent problems appropriate to each area. Because of the large area of operations, Language and cultural differences are factors involved. It is difficult to perform a task to accomplish in a short time, so we used the epidemiological studies. Reviews of knowledge and academic performance of multiple sources and evaluation of performance regularly can ensure completion of the works. The Khon Kaen Rajanagarindra Psychiatric hospital pushed the issue of suicide as public policy that all sectors, especially civil society should take the major role in dealing with the problem. The technical units of the Department of Mental Health provided technical support and promote the participation of the people involved in managing the problem
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