Formative Evaluation of Suicide Prevention Gatekeeper Training for Aged Care Workers

In Australia, and many other countries, older people have the highest rate of suicide of any age group. By 2050, 22.5% of the Australian population will be 65 years or older – a trend similarly noted in many other countries. Sadly, the number of suicides by older adults is therefore likely to rise. Interventions are critically needed to address suicide among older adults. The number of people using aged care services is also steadily rising and, as such, these services are increasingly caring for people who are amongst our most vulnerable to suicide. Very little is known about how to prevent suicides in older adults and less is known about how to prevent suicide in aged care. Research is urgently needed to support effective suicide prevention for older adults. Gatekeeper training shows promise as a suicide prevention strategy. In Australia, LivingWorks provides gatekeeper training to community members to support them to detect and respond to suicide risk in others. They will provide training to approximately 1500 aged care workers in 2023. Research is needed to tailor this training to the needs of older adults and to evaluate the training to ensure successful implementation for positive, sustainable impacts. Our project will undertake a consultation process with LivingWorks, aged care workers, and older adults to tailor gatekeeper training to aged care. We will then pilot the training and evaluate the impact of to inform refinement of the training and recommendations for effective implementation. Two hundred and fifty workers will be invited to take part in three online questionnaires (before, immediately after, and two months after training) designed to assess their perceptions of the training, gatekeeper competencies, suicide prevention intervention behaviors, and benefits to self and older adults. We will also undertake interviews or focus groups with up to 30 workers who have completed training. We hypothesize that following participation in the tailored gatekeeper training, aged care workers will have increased gatekeeper competencies as measured by our primary outcome, the Gatekeeper Behavior Scale (Albright et al. 2016). They will also report decreased beliefs in suicide myths (Nicholas et al, 2019), increased wellbeing measured by the Mental Health Continuum (Keyes et al. 2008), increased help-seeking intentions measured by the General Help Seeking Questionnaire (Wilson et al. 2005), and increased number of suicide interventions conducted with older adults. We are informed by frameworks in suicide prevention gatekeeper competency and behavior change. Our research addresses a key issue in aged care that has been highlighted in previous research, government policy, and by our research partner LivingWorks. Impactful gatekeeper training for aged care workers could result in decreased suicide risk for older adults and increased worker wellbeing. Our research will have impacts for suicide prevention in aged care beyond gatekeeper training as we examine the broader factors influencing suicide prevention in this sector. Our findings can also be used to determine other suicide prevention activities needed to bring about meaningful impacts for older adults using aged care services in Australia and internationally.