The Ripple Effect: Help us beat rural suicide

The Ripple Effect involves the development of a sustained, flexible and planned digital intervention, implemented at a local population level, to prompt change across the knowledge, attitudinal and behavioural components of self-stigma and perceived-stigma experienced by males aged 30-64 years from the community of farming with a personal experience of suicide. In recognising that suicide affects a broad range of the population, no adult will be excluded from participating in the Ripple Effect, However, the male target group will be the primary focus. THE RIPPLE EFFECT DEVELOPMENT TEAM The Ripple Effect has been developed by the National Centre for Farmer Health, Deakin University, the Victorian Farmers Federation, AgChatOZ, the Mental Illness Fellowship of North Queensland, Sandpit and Western District Health Service. The development of the Ripple Effect has been guided by a Steering Group comprising 15 health professionals (psychologists, social workers, nurses), researchers (specialising in farmer health and behavioural science), farming industry professionals, digital designers, stigma experts and farming community members with an experience of suicide. All content has been reviewed by a psychologist. The Chief Investigator of the Ripple Effect is Associate Professor Dr Susan Brumby, Director of the National Centre for Farmer Health (Ph D, RN. RM., Dip Farm. M’Ment, Grad Dip Women’s Studies, Master Health Management, Certificate IV (Workplace training and assessment) MRCNA, ACHSE, ARLF). Dr Brumby has 0ver 30 years experience in rural health and wellbeing. The Ripple Effect Research Fellow and Senior Investigator, Alison Kennedy (PhD, BBSc(Honours), PostGradDip(Criminology)) has six years of experience in rural mental health. THE RIPPLE EFFECT INTERVENTION The Ripple Effect intervention will run over a period of 8 months, preceded by a 6 week pilot program. Participants will access the Ripple Effect website where they will be required to read a Participant Information Form and complete a Consent Form before being able to register to participate in the Ripple Effect. It will be emphasised that the website is not designed for crisis response and information on seeking crisis support will be provided (information about crisis services continues to be provided on every page). Upon registration, participants will complete the Stigma of Suicide Scale (SOSS) and the Literacy of Suicide Scale (LOSS)(pre-test). The Ripple Effect goal of reducing suicide stigma will be achieved in 3 ways: 1. Shared stories and experiences - participants will have the opportunity to share aspects of the own story as well as read other people's messages (collected via hard copy and digital Ripple Effect postcards). Postcard messages will be screened, before being digitised and included on the website, to ensure they meet the Mindframe media guidelines for talking about suicide. A series of digital stories—created by members of the farming community with an experience of suicide during a professionally facilitated workshop—will also be presented to participants. These stories highlight experiences of suicide stigma and how this can be overcome. 2. Information/education - participants will answer a series of questions about their experience of suicide as they progress through the website (for example, have you spoken to anyone about your experience?), allowing for both staged and curated information to be presented to them. This information covers five topics: a) Knowledge about suicide: Including information about risk/protective factors, warning signs, precipitating events, understanding suicide attempts/suicide thoughts and suicide stigma. b) Everyone's experience is different: Emphasising the variability of suicide experience and including information on Culturally and Linguistically Diverse (CALD) people, Aboriginal and Torres Strait Islander people, sexuality and gender diversity, and disability/illness/ageing and how these differences can affect suicide risk and how we respond to this. c) Talking about suicide: Emphasising the importance of talking safely about suicide to reduce risk and how this will vary depending on a person's experience of suicide (either bereaved by suicide, attempted suicide, had thoughts of suicide, cared for someone who has attempted suicide or been touched by suicide in some other way). Includes information on starting and managing conversations with people in distress, crisis response, avoiding judgement, preparation and knowledge of resources and self care. Includes guidance on becoming involved in suicide prevention activities and talking about suicide with the broader community. d) Recognising and maximising resources to help you and others: Encourages people to be positive and proactive in seeking support, knowing what is available and identifying and overcoming barriers to support. Provides information on caring and supporting others. e) Knowing what's needed for keeping well: Providing information on maintaining physical, emotional, intellectual and spiritual health and setting personal goals to achieve these. Participants will be asked to set personal goals and will have the opportunity to self-evaluate their achievements. For each of the five topics, all participants will be presented with core content. This core content will take approximately 3 hours in total (across the combined topic areas) to complete. Additional tailored information will be presented depending on the nature of their experience of suicide. 3. Resources/support services - participants will be provided with an extensive list of resources and support services with national, state and local availability. Participant involvement in the Ripple Effect is self-paced to a maximum of 12-weeks. Participants are able to move in and out of the intervention as it suits them. The nature of the registration system allows for people to pick up where they left off. A personal profile page allows participants to identify their progress through the intervention. Participants will receive an email/SMS reminder if they have not logged in to the Ripple Effect after a certain period of time (determined by the participant). On completion of all of the core content, participants will again complete the Stigma of Suicide Scale (SOSS) and the Literacy of Suicide Scale (LOSS)(post-test). Participants will be asked to identify their willingness to participate in a semi-structured follow-up interview about their experience participating in the Ripple Effect. 10 qualitative interviews will be conducted by a researcher with doctoral-level experience in interviewing farmers with an experience of suicide.