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Purpose This discursive paper presents a lived experience leadership model as developed as part of the Activating Lived Experience Leadership (ALEL) project to increase the recognition and understanding of lived experience leadership in mental health and social sectors. The model of lived experience leadership was formulated through a collaboration between the South Australian Lived Experience Leadership & Advocacy Network and the Mental Health and Suicide Prevention Research and Education Group. Design/methodology/approach As one of the outcomes of the ALEL research project, this model incorporates findings from a two-year research project in South Australia using participatory action research methodology and cocreation methodology. Focus groups with lived experience leaders, interviews with sector leaders and a national survey of lived experience leaders provided the basis of qualitative data, which was interpreted via an iterative and shared analysis. This work identified intersecting lived experience values, actions, qualities and skills as characteristics of effective lived experience leadership and was visioned and led by lived experience leaders. Findings The resulting model frames lived experience leadership as a social movement for recognition, inclusion and justice and is composed of six leadership actions: centres lived experience; stands up and speaks out; champions justice; nurtures connected and collective spaces; mobilises strategically; and leads change. Leadership is also guided by the values of integrity, authenticity, mutuality and intersectionality, and the key positionings of staying peer and sharing power. Originality/value This model is based on innovative primary research, which has been developed to encourage understanding across mental health and social sectors on the work of lived experience leaders in seeking change and the value that they offer for systems transformation. It also offers unique insights to guide reflective learning for the lived experience and consumer movement, workers, clinicians, policymakers and communities.

Abstract. Background: Safety planning involves the co-development of a personalized list of coping strategies to prevent a suicide crisis. Aims: We explored the perspectives of workers regarding safety planning as a suicide prevention strategy for people of refugee background and those seeking asylum in Australia. Method: Participants attended suicide prevention training, specific to refugees and asylum seekers, at which safety planning was a key component. Semistructured, posttraining interviews ( n = 12) were analyzed thematically. Results: Four key themes were identified: safety planning as a co-created, personalized activity for the client; therapeutic benefits of developing a safety plan; barriers to engaging in safety planning; strategies to enhance safety planning engagement. Limitations: First-hand refugee and asylum-seeker experiences were not included. Conclusion: As a relatively low-cost, flexible intervention, safety planning may be valuable and effective for these groups.

Abstract. Background: There are concerning rates of suicidality among asylum seekers and refugees in Australia, and tailored suicide prevention initiatives are needed. Aims: We aimed to evaluate the impact of a tailored suicide prevention education program for people working with asylum seekers and refugees. Method: Attendees of the education program completed self-report questionnaires at pretraining, posttraining, and 4–6 months follow-up. Results: Over 400 workers, volunteers, and students across Australia took part in the education program. A series of linear mixed-effects models revealed significant improvements in outcome measures from pretraining ( n = 247) to posttraining ( n = 231). Improvements were maintained at follow-up ( n = 75). Limitations: Limitations of this research were the lack of a control group and a low follow-up response rate. Conclusion: Findings suggest that a 2 days tailored suicide prevention education program contributes to significant improvements in workers’ attitudes toward suicide prevention, and their confidence and competence in assessing and responding to suicidal distress.

Carers of loved ones with Borderline Personality Disorder (BPD) often present to Emergency Departments (ED) during acute crisis situations. The initial contact for the carer and consumer in distress is often an emergency nurse. By gaining a greater understanding of carers (18+) perspectives on ED nursing practices when consumers with BPD are requiring crisis support, knowledge about preferred and best practice can be gained. To obtain this knowledge, four semi-structured focus group interviews were undertaken with a purposive sample of 13 carers through existing carer networks. Transcripts were analysed thematically to identify shared experiences and perspectives across interviews. Four key themes emerged: challenges in accessing crisis support, the need for communication, stigmatising practices, and different levels of care. Findings highlight the ED is viewed as a frontline service which has the capacity to link with another specialist supports when in crisis. Despite this; Communication, confidentiality issues and stigmatising practices continue. The results of this study have implications for nursing practice in the ED, providing important insights that can potentially benefit the carer, consumer and the ED to improve the quality of care offered for people in crisis. Refereed/Peer-reviewed

This research explored participants’ experience and perceptions of a two-day suicide prevention education programme, and any impact that it has had on them and their work with refugees and asylum seekers since. At approximately six months post-training (May to September 2018), semi-structured telephone interviews were conducted with 15 participants. The interviews were audio-recorded, transcribed, and thematically analysed. Thematic analysis of the data identified two overarching themes and five subthemes. The two overarching themes were: (1) Changes to the individual and their practice; and (2) The culture and context of the work. Participants described a range of impacts that the training had on them and their workplace, in both personal and professional domains. The study findings suggest that equipping workers with skills and knowledge in culturally tailored and evidence-based suicide prevention can lead to an increased sense of hope, optimism, confidence, and agency and reportedly enabled workers to more readily intervene when presented with clients directly or indirectly communicating suicidal ideation. Findings support existing literature regarding gatekeeper training effectiveness. However, given the unique context of asylum seeker and refugee suicide, they also extend our understanding of the impact of bespoke or tailored approaches to gatekeeper training. Refereed/Peer-reviewed

Refereed/Peer-reviewed In Australia, mental illness has been recognised as a National Health Priority area, with the coronavirus pandemic adding a layer of urgency to the need to address the multiple health problems faced by clients with mental illnesses. Whilst much has been done in efforts to support these clients, little is known about their medication knowledge and experience with health professionals. The aim of the study was to explore the knowledge and beliefs of clients on the use of psychotropic medications and study their experiences with healthcare providers. Adult participants at a not-for-profit community-managed specialist mental health service provider in Adelaide, South Australia were recruited. Four focus group sessions were conducted between February 2020 and March 2021. All sessions were co-facilitated by a peer practitioner with lived experience. Sessions were audio recorded and transcribed verbatim. Participants (n = 27) reported that provision of medication education was inadequate and, in some cases, non-existent. There was an apparent lack of support for monitoring and managing common side effects, such as weight gain. Participants described not being involved in any decision-making processes and that establishing and maintaining a therapeutic relationship with their healthcare providers was challenging. Perceived stigma remains a barrier in accessing healthcare. Despite participants regularly interacting with a range of healthcare providers, findings highlight key gaps in care, particularly medication education and establishing a therapeutic relationship with their healthcare providers. Future mental health reforms should consider the provision of additional medication education in community settings, such as at not-for-profit organisations. Moreover, healthcare providers should take a proactive approach in establishing therapeutic relationships.

This systematic review synthesizes existing peer reviewed evidence reporting on evaluated strategies used for enhancing communication pathways for continuity of care between the emergency department and mental health community supports. Following the PRISMA guidelines and the PICO framework, this review was conducted between January and July 2021. Included articles needed to evaluate communication pathway interventions for continuity of care between the emergency department and mental health community services which support service users with mental health and/or suicidal crisis. The seven included studies identified three support coordination interventions, two motivational interviewing interventions, an electronic record enhanced strategy and results from a phone follow-up study. This review demonstrates that support coordination, motivational interviewing, education, or an enhanced electronic record strategy can improve continuity of care, and in some cases, reduce the need for people to re-present to ED when they are experiencing mental health concerns or suicidal crisis. Results of this review reveal that a multipronged approach of communication pathways for continuity of care would enable more effective connections with mental health community supports and enable better outcomes for people requiring services. Refereed/Peer-reviewed

UNSTRUCTURED In ‘National Disability Insurance Scheme and the Lived Experience of Psychosocial Disability for People Presenting to the Emergency Department: Protocol for a Mixed Methods Study’ some errors were noted after publication. One author has requested a revision of the text; although the article was signed off the author’s contribution was not contained in the article.

BACKGROUND Currently, within Australia, 3.6% of all emergency department (ED) presentations are mental health–related. Information about the context of the person presenting to the ED (beyond immediate needs), including their psychosocial disability (PSD) National Disability Insurance Scheme (NDIS) plan, is reported as incomplete and fragmented. There are missed opportunities for early intervention and care continuity that could potentially inform ED practitioners to revise current practices. OBJECTIVE The aims of this study are: (1) to obtain original data from the lived experience voice of those with the PSD NDIS plan and their experience when presenting to an ED, (2) to gather information from NDIS service providers to reveal communication pathways between the ED and NDIS services, and (3) to gain knowledge from ED clinicians around processes for continuity of care with this population group. METHODS This inductive, mixed methods phenomenological study will involve data collection analyzed sequentially, with each stage informing future stages of the research. Interviews will focus on the lived experience voice exploring potential indicators that have led to an ED presentation, alongside an analysis of associated clinical and administrative documentation and communications. Focus groups with NDIS support workers and support coordinators will provide phenomenological data around the experience from their perspective. National quantitative surveys among those with a PSD NDIS plan and emergency services clinicians will provide insight into current practices within community care and ED presentations. The research project design includes a lived experience advisory group who are assisting with the design of the interview and focus group schedules and national surveys, as well as in shaping the interpretation of qualitative information. All transcripts will be subject to thematic analysis to understand individuals’ meaning-making of these complex and particular phenomena. The research team includes a lived experience researcher and a lived experience carer (PhD candidate). RESULTS This study is funded by MIND Australia as a PhD industry scholarship, which commenced in April 2020. A systematic review as a preresearch activity has been completed and is currently under review. The Human Research Ethics Committee of the University of South Australia has approved this project. An advisory group has been selected, and interview, focus group, and survey schedules are currently being codesigned. Recruitment will commence in November 2021. It is envisaged that data collection will be completed by June 2022. CONCLUSIONS Understanding the lived experience of the precare, during care, and postcare stages of ED presentations from the perspective of those with a PSD NDIS plan will inform the research team around current practices and provide information about improvement for pathways of care for this vulnerable group of people, while also informing health policy. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/33268

Background: Caring for a person with borderline personality disorder remains largely stigmatised and misunderstood. When a crisis arises, carers often seek help with the person they care for in emergency care settings such as the emergency department. The aim of this review was to explore, locate and compile the literature regarding the perspectives of family carers for a person with borderline personality disorder in an emergency care setting with a focus on nursing practices. This review advances understandings of carer perspectives in emergency care settings. Methods: The Joanna Briggs Institute (2015) [1], methodology for scoping reviews guided this review. A search of Emcare, Medline and Ovid Nursing was performed during April 2018, to identify literature where carer views and perspectives on engaging with emergency care services were reported. A grey literature search was also conducted. A total of ten articles and reports were included in this review. Consultation with a carer support group precipitated this review, which assisted in the formulation of the research questions. Results: Papers found via the study focused on health professional responses, rather than on nursing practice. Findings indicate that carers often perceive emergency departments as the only option for emergency care in a crisis. Carers require information about how to effectively manage a crisis with their loved one more effectively. Conclusion: This scoping review identified that carers are often not consulted or engaged with by health professionals. Carers often perceive that nurses and health professionals have a lack understanding about the consumer's conceptualisation of distress and the nature of BPD, which becomes a barrier to effective crisis support and management. The literature often reported that a trusting and collaborative relationship between carers, nurses and health professionals demonstrated improved outcomes for the carer and consumer. Refereed/Peer-reviewed

The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI. Refereed/Peer-reviewed

The purpose of this systematic review was to locate and synthesize peer‐reviewed evidence regarding the effectiveness of providing suicide prevention education to nursing students. Systematic searches were conducted in seven databases (EMBASE, EmCare, Joanna Briggs, MEDLINE, PsycINFO, Scopus, and Web of Science). Results were screened in duplicate at two stages: title and abstract, and full text. Critical appraisal and data extraction were also completed in duplicate. Initial database searching yielded 303 results. Following the addition of seven records from relevant reference lists, and the removal of duplicates, a total of 118 results were included for screening. Eight articles were deemed eligible for inclusion in this review; most (n = 5) were quantitative. While all were conducted within university settings, half were stand‐alone education sessions, while the remaining were integrated with existing programmes/courses. The types of education programmes varied considerably across studies, with only three being established, evidence‐based programmes. The studies explore a range of outcomes, which have been narratively categorized as enhanced skills, abilities, and self‐confidence; development of positive attitudes and beliefs; acquisition of knowledge; and programme experience and evaluation. While there is a small body of evidence indicating that suicide prevention education programmes contribute to improvements in skills, abilities, self‐confidence, and attitudes among nursing students, the variability in educational interventions and outcomes, coupled with short‐term evaluation time frames, makes it difficult to fully understand the impact of this important suicide prevention strategy. Refereed/Peer-reviewed

Background Currently, within Australia, 3.6% of all emergency department (ED) presentations are mental health–related. Information about the context of the person presenting to the ED (beyond immediate needs), including their psychosocial disability (PSD) National Disability Insurance Scheme (NDIS) plan, is reported as incomplete and fragmented. There are missed opportunities for early support and care continuity that could potentially inform ED practitioners to revise current practices. Objective The aims of this study are: (1) to obtain original data from the lived experience voice of those with the PSD NDIS plan and their experience when presenting to an ED, (2) to gather information from NDIS service providers to reveal communication pathways between the ED and NDIS services, and (3) to gain knowledge from ED clinicians around processes for improving continuity of care and consumer experience. Methods This inductive, mixed methods phenomenological study will involve data collection analyzed sequentially, with each stage informing future stages of the research. Interviews will focus on the lived experience voice exploring concerns that have led to an ED presentation, alongside an analysis of associated clinical and administrative documentation and communications. Focus groups with NDIS support workers and support coordinators will provide phenomenological data around the experience from their perspective. National quantitative surveys among those with a PSD NDIS plan and emergency services clinicians will provide insight into current practices within community care and ED presentations. The research project design includes a lived experience advisory group who are assisting with the design of the interview and focus group schedules and national surveys, as well as in shaping the interpretation of qualitative information. All transcripts will be subject to thematic analysis to understand individuals’ meaning-making of these complex and particular phenomena. The research team includes a lived experience researcher and a lived experience carer (PhD candidate). Results This study is funded by MIND Australia as a PhD industry scholarship, which commenced in April 2020. A systematic review as a preresearch activity has been completed and is currently under review. The Human Research Ethics Committee of the University of South Australia has approved this project. An advisory group has been selected, and interview, focus group, and survey schedules are currently being codesigned. Recruitment will commence in November 2021. It is envisaged that data collection will be completed by June 2022. Conclusions Understanding the lived experience of the precare, during care, and postcare stages of ED presentations from the perspective of those with a PSD NDIS plan will inform the research team around current practices and provide information about improvement for pathways of care for consumers and carers, while also informing health policy. International Registered Report Identifier (IRRID) PRR1-10.2196/33268

Objective: This study sought to understand the perspectives of young people (12-25 years) with experience of mental health services on what makes for youth-friendly mental health services.Method: A purposive strategy was used to recruit 32 young people aged 12-25 years with diverse backgrounds, through mental health and youth services. Six semi-structured group interviews were undertaken and one individual interview. We were especially interested in aspects that facilitated or obstructed young people from seeking help, and key experiences across their consumer journey. Transcripts were analysed thematically to identify shared experiences and perspectives across the interviews.Results: Five key themes emerged: the central role that teachers, school counsellors, parents, and friends play in help seeking and responding to crisis; the impact of fear, uncertainty, and stigma in decision-making and engaging with services; finding the right therapist and effective help; ways to improve flexibility and ease of access; the need for better quality consumer information for accessing a mental health service.Discussion: The results of the study have implications for the design of mental health services, providing important insights that can increase young people's engagement with services, and ultimately, improve the mental health and well-being of young people in Australia. Refereed/Peer-reviewed

Introduction This chapter provides an overview of the common medicines prescribed within mental health care and explores the ways in which personal narratives and social expectations can influence the experience of taking medicines. The chapter also looks at concepts and practices that influence the management of medicines and encourage safe and high-quality use of medicines. These concepts include compliance, adherence and concordance, shared decision-making, quality use of medicines, monitoring and review. The associated practices draw attention to the context of mental health care in the current era, in which health practitioners, including nurses, operate as a team. Facilitating a positive experience of medicinal use requires quality communication and team work, whereby nurses, psychologists, occupational therapists, dietitians, medical practitioners and pharmacists work in partnerships with the consumer and carer. The roles of the mental health practitioner are discussed in terms of supporting the experience of consumers and families with the use of medication, providing information and guidance, advocating for the expressed wishes of consumers and assisting in solving problems, monitoring safety and health promoting activities. Reflective exercises help readers to consider the engagement and communication skills required for the promotion of a positive experience for consumers, and encourage them to be involved in their medicine-related care. Why do I need to know about the use of medicines? Psychotropic medicines are at the centre of treatment for many forms of mental illness. Most health practitioners come into contact, on a daily basis, with people taking psychotropic medicines. Providing safe and high-quality health care requires you to understand the concepts and themes expressed within the learning objectives. This learning will help you to understand why the prescription of psychotropic medicines is linked to community attitudes and stigma towards mental illness and why many consumers may be hesitant to take these medicines or may wish to discuss their experience of them. From a safety perspective, in this chapter you will also learn about the side effects of psychotropic medicines and how you can assist in identifying adverse events and health risks for consumers. The chapter also introduces the concept of shared decision-making, which is a framework that includes consumers and carers in treatment planning and helps them to understand and express their wishes and preferences regarding treatment.