Critical outcomes informed by lived experience and clinical practice

The research of the Mental Health and Suicide Prevention Research and Education Group at UniSA is focused on improving the lives of people with mental health issues across the lifespan. It encompasses clinical practice approaches and techniques, the experience of the individual and groups in settings including acute care and the community. Our researchers represent a multidisciplinary knowledge base with years of experience working with mental health consumers, clinicians and policymakers.

Our team welcomes interest in partnerships and collaborations from entities with aligned interests. Please contact us for more information.  

Our group has recently led or contributed to the following research projects:

  • Activating Lived Experience Leadership (ALEL), 2019-21 minus-thick plus-thick

    Development of Lived Experience workforce to examine and describe how Lived Experience advocacy and leadership embedded within the mental health system can be defined, recognised and utilised in South Australia.

    Key People: Ellie Hodges (Lived Experience Leadership and Advocacy Network), Professor Nicholas Procter, and research team members from the Mental Health and Suicide Prevention Research Group.

    Funding Body: Fay Fuller Foundation.

    The aim of this research is to influence and effect ongoing system change through answering key questions related to the impact of Lived Experience (LE) advocacy and representation on individual recovery from mental health issues, to understand the reasons why LE leadership and advocacy is under-recognised or acknowledged by the health system and how this can be changed, and to address need and achieve better design of training resources and networks to guide and support LE advocacy, representation and leadership. This is with a view to embedding LE advocacy and leadership resources and thinking into communities and the South Australian health system. 

  • Evaluation of the Mental Health Lived Experience Register, 2019 minus-thick plus-thick

    Key People: Dr Mark Loughhead, Professor Nicholas Procter, and the Lived Experience Engagement team of the Office of the Chief Psychiatrist, SA Health. This project is also supported by a steering group with lived experience advisors.

    Funding Body: This project is supported by the Office of the Chief Psychiatrist and in-kind contributions from the Mental Health and Suicide Prevention Research Group.

    The purpose of this project is to evaluate the effectiveness of the communication and recruitment practices of the Mental Health Lived Experience Register for engaging consumers and carers in policy development activities. The project will invite consumers and carers to participate in a survey or focus group discussion about the effectiveness of the Register and how it can be improved. Health workers interested in consumer engagement and communication strategies will also be invited to a focus group discussion.

  • Are young adults aware of the long-lasting consequences of methamphetamine ('Ice') use on all health, and would knowledge of a visible long-lasting consequence decrease use of the drug? 2017-19 minus-thick plus-thick

    Key People: Dr Gabrielle Todd, Dr Dominic Thewlis, Professor Nicholas Procter, Professor Adrian Esterman, Professor Jason White, Ms Deb Kadarusman (Drug Arm), Associate Professor Robert Wilcox (Neurologist, Flinders Medical Centre).

    Funding Body: Fay Fuller Foundation.

    The strategic purpose of this project grant is to examine how educational interventions may favourably shift the risk of young South Australians at risk of methamphetamine use. The project will obtain high level evidence of how young South Australians decide upon methamphetamine use or non-use.

  • Suicide prevention education for NGO caseworkers, 2017-2018 minus-thick plus-thick

    Key People: Professor Nicholas Procter, Dr Monika Ferguson, Associate Professor Mary Anne Kenny (Murdoch University), Mr Noel Clement (Director Migration, Emergencies and Movement, Australian Red Cross).

    Funding Bodies: Australian Red Cross, AMES Australia, MDA Ltd.

    Asylum seekers who are found to be refugees are granted a visa that entitles them to temporary residency. This may be a Temporary Protection Visa (TPV) or a Safe Haven Enterprise Visa (SHEV). There are approximately 30,000 asylum seekers currently living in the Australian community who are in this category. The impermanent nature of these temporary visas and the processes associated with their renewal mean that TPV and SHEV holders face considerable anxiety; specifically, mental distress and uncertainty about their continuing personal circumstances. This project delivers and evaluates training to address mental deterioration and related vulnerabilities for asylums seeker and refugee population who are on temporary visas.

  • Help-seeking for mental health concerns by emergency service first responders, 2017-2018 minus-thick plus-thick

    Key People: Dr Amy Baker, Professor Nicholas Procter.

    Funding Body: The Repat Foundation – The Road Home.

    The purpose of this work is twofold; to engage with emergency services first responders to: 1) better understand the barriers and enablers to seeking help for mental health concerns, and 2) develop strategies that can improve help-seeking amongst this population. Through greater understanding of what helps and hinders help-seeking for mental health concerns amongst first responders, this participatory action research project will lead to tangible, targeted resources that can benefit first responders and those who provide them with care and support.

  • Artists in Residence – Rural and Remote Inpatient Unit, 2017-18 minus-thick plus-thick

    Key People: Dr Amy Baker, Professor Nicholas Procter, Mr David Moseley (Country Health SA LHN, SA Health), four Artists in Residence across the two years.

    Funding Body: Country Health SA Local Health Network, SA Health and the Mental Health and Suicide Prevention Research Group, University of South Australia.

    In 2017 and 2018 the University of South Australia and SA Health jointly sponsored four artists in residence to work at the Rural and Remote Inpatient Unit at Glenside Health Service. The aim of this project was for artists to work with consumers to portray their stories of mental health and recovery in a visual sense. The artists created artwork by working alongside consumers who had been admitted to the Rural and Remote Inpatient Unit. Artworks were produced by the artists in residence based on consumer stories of recovery, or by consumers participating in the art-making process themselves alongside the artists in residence. The artists in residence created pieces of art to exhibit in the 2017 and 2018 SALA exhibitions based on the stories of the consumers’ recovery journeys.

  • Developing a research protocol for evaluation of a suicide prevention network, 2016-17 minus-thick plus-thick

    Key People: Dr Amy Baker, Professor Nicholas Procter, Dr Monika Ferguson, Ms Heather Eaton, Dr Rachel Earl (Local Government Association of SA), Ms Lynne James (Principal Project Officer Suicide Prevention, Office of the Chief Psychiatrist SA Health), Members of the Whyalla Suicide Prevention Network.

    Funding Body: Local Government Association of South Australia.

    This project includes development of a Suicide Prevention Network evaluation tool, drawing ‘real time’ evidence from the Whyalla Suicide Prevention Network. The strategic purpose of this activity is to review and analyse best practices in community level suicide awareness and prevention. As a result of this work, SA Health will have an evaluation tool available to all Suicide Prevention Networks across SA.

  • Design of a research methodology for suicide prevention research (Connecting with People), 2016-17 minus-thick plus-thick

    Key People: Dr Monika Ferguson, Professor Nicholas Procter, Dr Conrad Newman (Senior Consultant Psychiatrist, SA Health), Members of the SA Health Connecting with People Working Group.

    Funding Body: SA Health.

    This project involves developing an evidence base for Connecting with People (CwP) training in South Australia. Its purpose is to support SA Health’s CwP Suicide Prevention initiative, underpinned by the highest national and international standards of research, teaching and community engagement. This activity also contributes to multi-site and multidisciplinary development of educational interventions to prevent suicide, helping to empower the workforce to provide evidence based care for people at risk of suicide.

PhD projects

  • Acute interventions for Borderline Personality Disorder in emergency and community settings: A mixed-methods collaborative inquiry. minus-thick plus-thick

    Candidate: Kristy Acres
    Supervisors: Professor Nicholas Procter, Dr Mark Loughhead, Dr Monika Ferguson, Dr Paul Cammell (BPD Co)

    The objective of this study is to bring together the voices of consumers with borderline personality disorder (BPD), their carers and clinicians involved in acute care, regarding their experiences in accessing an assessment and intervention service in an acute crisis. Given the challenges experienced by consumers, carers and clinicians in this environment it is critical to understand the barriers and enablers experienced in a brief intervention setting and how this translates to a reduction in distress and harm for the consumer.

    This study will apply a mixed-methods experience-based co-design (EBCD) design to understand how the introduction of an Assessment and Brief Intervention Clinic (ABiC) for BPD in South Australia has impacted outcomes in an acute crisis. A three-staged approach to data collection and analysis in a sequential Quantitative → Qualitative design will be used to inform each stage of the study. This is both unique and novel to BPD interventions and evaluation and will be the first study of its kind.

    This project is funded by SA Health's Borderline Personality Disorder Collaborative (BPD Co)

  • The mental health consequences of the Fast Track Assessment of protection claims: The perspectives of legal professionals and asylum seekers. minus-thick plus-thick

    Candidate: Associate Professor Mary Anne Kenny 
    Supervisors: Professor Nicholas Procter, Professor Carol Grech

    In December 2014 the Australian government introduced a new 'Fast Track Assessment' procedure to manage protection claims made by a group of asylum seekers who arrived in Australia by boat between August 2012 and December 2013. This research will look at the nature, scope and mental health consequences of legal processing attendant upon asylum seekers applying for protection within the new legal framework. It will examine the impact of the process as perceived by people who are providing asylum seekers with legal support, examining the response to vulnerable people and how they negotiate mental health concerns. The research will also consider the intersection between human rights, mental health and law for those asylum seekers that are impacted upon by this process.

  • NDIS and the lived experience of people with mental health concerns presenting to the emergency department: A mixed methods study. minus-thick plus-thick

    Candidate: Heather McIntyre
    Supervisors: Professor Nicholas Procter, Dr Mark Loughhead, Laura Hayes (Mind Australia)

    This project is concerned with the lived experience interface between emergency department (ED) care and services for existing clients of the National Disability Insurance Scheme (NDIS). Situated in the context of a large ED, this research will explore the boundaries between health service provision at the ED and the design of NDIS care plans. The project brings together the voices of mental health consumers, their loved ones and clinicians involved at the time of emergency mental health care. Specifically, the project aims to describe and explain the consumer experience of ED mental health care and how continuity and care is manifest during an acute crisis and immediately thereafter whilst on an existing NDIS plan. The lived experience of consumers and carers with an NDIS plan has been described as complex and multifaceted and in some instances marked by confusion and discontinuity. This project aims to provide greater understanding around health care system experiences from the perspective of all concerned.

    This project is funded by Mind Australia.

  • Psychological autopsy and the public sector mental health response to men who die by suicide in South Australia. minus-thick plus-thick

    Candidate: Dr Conrad Newman 
    Supervisors: Professor Nicholas Procter, Associate Professor David Evans, Professor Carol Grech

    At least six people per day die of suicide in Australia; five of these are men. This research will examine a unique dataset of recorded dialogues from 15 men aged 18–65 years who contacted the South Australian Public Sector Mental Health Triage Service seeking help and subsequently ended their life by suicide. The chain of care for these men from the time of contact with MHT until their death by suicide will be examined to determine what protective action (or lack thereof) was provided to them by public sector mental health services. This research will introduce the 'voice' of the decedent and clinicians (through the use of MHT recordings) into the field of suicidology for the first time. This has the potential to inform clinical practice, service provision and policy.

  • Exploring the role of police in providing a mental health response to the community. minus-thick plus-thick

    Candidate: Kelly Pusey
    Supervisors: Professor Nicholas Procter, Dr Monika Ferguson, Associate Professor David Evans, Mr Colin Cunningham

    Given the nature of police interaction with people in mental distress, there is a need for better insight and understanding about how and why people interact with police and the sequence of events for the person attended to. The purpose of this PhD research is to undertake deeper examination of police activity and make recommendations on the drivers for interaction between police and people who use mental health services, specifically at the time of mental distress, suicide or self-harming states. This mixed-methods study will examine the numbers of people who interact with police, what drives such interaction and what issues people have requiring police attendance. The research will also examine the perspectives of mental health clinicians working in the emergency department with whom police engage at the time of transfer to hospital. 

  • Understanding the context, influence and sustainability of lived experience workforce in mental health service delivery – a mixed-methods collaborative inquiry. minus-thick plus-thick

    Candidate: Verity Reeves
    Supervisors: Professor Nicholas Procter, Dr Mark Loughhead

    Peer support workers (PSW) with a lived experience of mental illness are a fundamental component of recovery-orientated practice. Australia’s current mental healthcare system has been working toward the effective implementation and integration of consumers in both policy making and service delivery. Prior research has identified challenges in embedding lived experience expertise within mental health services, highlighting a lack of clear role definition, adequate training and supportive organisational culture. Despite growing evidence for peer support providing positive outcomes such as increased empowerment and hope for recovery, there remains a gap between non-peer mental health professionals and PSW. This gap is evidenced in challenges of effectively implementing peer support roles, often reflecting instances of othering and stigma. Successful implementation and ongoing sustainability of the peer support role is posited as likely highly dependent on its understanding, recognition and acceptance by non-peer colleagues. 

    This study seeks to examine this proposition in more detail alongside the co-design of an educational intervention to close this gap utilising two complimentary and interrelated processes. Firstly, to gain a deeper understanding of the influences of the PSW role, including implementation, acceptance and sustainability. Secondly, to assess effectiveness of educational intervention for improving organisational culture for recognition of peer work within mental health service environments.

    This project is funded by UnitingSA.

  • Aged care residents with secrets: staff experiences and management of private disclosures. minus-thick plus-thick

    Candidate: Kiriaki Stewart
    Supervisors: Associate Professor David Evans, Dr Andie Xu

    Transition to residential aged care (RAC) presents challenges in managing personal information, including secrets of a private nature. Given the intimate nature of healthcare in residential aged care, confidential disclosures of personal secrets to staff may occur. This PhD research aims to explore and develop a description of the nature of private disclosures made to RAC staff by persons residing in RAC, a description of staff management of these disclosures, and a description of the outcome of these disclosures. Knowledge generated from this study may inform healthcare practice, policy, education and further research relating to residential aged care. 

  • Nature and extent of suicide ideation among construction workers. minus-thick plus-thick

    Candidate: Simon Tyler
    Supervisors: Professor Nicholas Procter, Dr Kate Gunn, Mr Bob Clifford (MATES in Construction)

    Suicide death rates among construction industry workers are higher than age-standardised rates in the Australian community. However, little is known about the nature and extent of suicidal ideation (SI) among the workforce and how this compares to the wider Australian community, and within this, what are considered to be the drivers and contributors toward suicidal states. This project will examine the nature and extent of SI among construction workers across age groups and length of employment within the industry. Secondary analysis of differences in SI and attempts will also be explored to examine associations between job type, socioeconomic, socio-demographic and associated mental health factors. Differing patterns of association between mental health and SI and attempts across age and length of employment will also be investigated.

    This project is funded by MATES in Construction through the Allison Milner Memorial Fund scholarship. Simon is the inaugural recipient of this scholarship. 

    > Read Simon's article Building the therapeutic alliance with men published in the Australian Nursing and Midwifery Journal, Vol 27, No. 3, April-June 2021

PhD completions

  • The use of situation awareness by mental health nurses to inform the involuntary admission decision: An ethnographic study. minus-thick plus-thick

    Candidate: Dr Christopher Patterson
    Supervisors: Professor Nicholas Procter, Dr Monika Ferguson

    The function of admitting a person to a mental health facility as an involuntary patient is a central component of contemporary mental health legislation and practice in Australia. The admission is commonly based on the decision of a legally-recognised health professional, such as an accredited mental health nurse. The decision to admit an individual as an involuntary patient has a direct impact on the person’s health, autonomy and liberty and ultimately their human rights. Knowing the major determinants of the decision-making process is essential to being able to understand future decisions. By identifying how health practitioners identify, use and make meaning of the factors and elements relevant to making a decision, an understanding of the practice can be formed. Considering that such a complexity of factors is used to inform a decision of importance, a framework that enables the investigation of the decision-making process is important. This study posits that the concept of ‘situation awareness’ provides a suitable framework to understand how health practitioners make a decision.

  • The experience of attempted suicide by older people: Within and between the meaning of protection. minus-thick plus-thick

    Candidate: Dr Kate Deuter
    Supervisors: Professor Nicholas Procter, Associate Professor David Evans, Dr Katrina Jaworski

    The past decade has seen significant contributions to the literature on late life suicidal behaviour. Much of the research reported is devoted to understanding risk factors for suicide in the elderly population; relatively less attention has been paid to examining factors that might be protective against the decision of an elderly person to end their life. This qualitative PhD study aims to explore the meanings that older people attribute to protective factors in relation to their experience of attempted suicide. The central objective related to this aim is to understand the nature and scope of protective factors that give older suicide survivors reasons and experiences to live following a non-fatal suicide attempt.

Masters projects

  • Fathers providing kangaroo care (KC) in a neonatal unit: an exploratory study. minus-thick plus-thick

    Candidate: Sophia Dong
    Supervisors: Professor Mary Steen, Dr Dianne Wepa

    Background: KC is used as a standard practice in neonatal intensive care units (NICUs) worldwide and mostly mothers but some fathers also are supported to give KC to their newborn. This practice aims to provide optimal nurturing and health outcomes for premature and term infants. Over the last few decades fathers have played a greater role in their infants’ care and development. However, little is known about Father–infant KC (Father KC). To address this gap, an exploratory study aims to gain insights into the views and experiences of fathers providing KC to their babies in Neonatal Intensive Care Unit (NICU).
    Objectives: To explore and gain insights into the father’s views and experiences of providing KC to their baby in an NICU setting in South Australia (SA).
    Methods: A scoping review and a qualitative descriptive study will be undertaken. Phase 1 – A scoping review will provide supporting evidence for the direction and breadth to undertake Phase 2. This second phase will conduct a qualitative descriptive study. In Phase 2, one-to-one interviews will be conducted with approximately, 10 -12 fathers who provide KC to their babies in a neonatal unit. This proposal will apply a step-by-step guide to accomplish this research study.
    Results: The findings of the scoping review, plus the views and experiences of fathers’ providing KC to their babies will be submitted for publication in two peer reviewed journals. In addition to dissemination to the local lay and professional bodies and individuals.
    Conclusion: The scoping review will identify the gaps in the literature relating to Father KC in NICUs. The exploratory study will provide comprehensive, in depth verbatim of the views and experiences of fathers giving Father KC to their babies in an NICU setting in SA, and thus contributing to the current knowledge and literature.

Honours completions

  • A qualitative study of family carers of people diagnosed with borderline personality disorder: What are carer’s views and experiences of preferred nursing practices in the emergency department setting? minus-thick plus-thick

    Honours student: Kristy Acres
    Supervisors: Dr Mark Loughhead, Professor Nicholas Procter

    Borderline Personality Disorder (BPD) is a common mental illness which features challenges for ongoing psychosocial functioning. The experience of feelings and behaviours relating to self-harm and/or suicide often result in crisis situations for the consumer and family. Carers, partners and significant others are instrumental in the support and management of crisis with the consumer and often seek hospital care via emergency departments.

    This qualitative study aimed to better understand the carer experience of nursing practices and communication whilst in emergency departments. It explored the common and unique experiences of carers when they are supporting consumers with BPD to access ED based care; views and expectations of carers towards nursing practices and communication in emergency departments; the ED nursing practices carers see as effective and preferred; and carers’ views on overcoming barriers to effective nursing care for consumers with BPD and for themselves in the caring role.

    This project was sponsored by Sanctuary BPD Carer Support Group and UniSA’s Mental Health and Suicide Prevention Research and Education Group.

    Download the Report on Carer Perspectives on ED Nursing Practices for a Person with BPD [pdf, 814kb]

  • Barriers and enablers experienced by police officers when responding to individuals in suicidal crisis: An exploratory study based on Australian coronial findings. minus-thick plus-thick

    Honours student: Kelly Pusey
    Supervisors: Professor Nicholas Procter, Professor Carol Grech, Dr Amy Baker

    Since the shift from institutionalisation to community based treatment for people with mental illness, police have seen a steady increase in the amount of contact they are having with persons who are in suicide or self-harm crisis. Police can spend anything from ten to 30 per cent of their time responding to mental health incidents and in some instances, police may detain a person with a mental health related concern as often as every two hours.

    People in suicidal crisis have been found to have increased contact with police prior to death, therefore it is important to be able to examine the nature of these interactions and potentially analyse if anything could have been done differently to prevent the fatality. This study examined coronial inquest findings of confirmed or suspected suicides from all Australian states and territories, excluding South Australia, where the deceased had contact with police within the 48 hours preceding their death. These findings were analysed to identify if there are any recurrent recommendations that are made that could be used to develop policies for police officers that respond to individuals who exhibit suicidal or self-harming behaviours.