annex to the eaad interim report: country reports of the ......newspapers (de standaard, het...

Annex to the EAAD Interim Report:

Country Reports of the

EAAD Network

March 2005

European Alliance Against Depression

This document has been prepared in the context of the “European Alliance Against Depression”, an international project funded by the European Commis-sion. January 2005 Contact: EAAD Project Office Prof. Dr. Ulrich Hegerl Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität München Nussbaumstrasse 7, D-80336 München Tel.: +49 89 5160 5540 Fax: +49 89 5160 5542

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Content

CONTENT

COUNTRY REPORTS OF THE EAAD NETWORK..............................................5

Gesellschaft für Psychische Gesundheit-Psychohygiene Tirol ............................... 6

Mental Health Europe ............................................................................................. 8

Dartford, Gravesham & Swanley Primary Care Trust............................................ 14

Estonian-Swedish Institute of Suicidology............................................................. 18

STAKES Health and Social Services .................................................................... 23

Accueil psychiatrique Hôpital René Dubos ........................................................... 26

Bayerische Julius-Maximilians-Universität Würzburg............................................ 29

Semmelweis University Budapest, Institute of Behavioural Sciences ................... 32

Directorate of Health ............................................................................................. 35

National Suicide Research Foundation................................................................. 38

Gesundheitsassessorat der Autonomen Provinz Bozen ....................................... 45

Direcção-Geral da Saúde, Direcção de Serviços de Psiquiatria e Saúde Mental . 49

University of Edinburgh, Department of Community Health Sciences, General Practice Section .................................................................................................... 51

Institut za varovanje zdravja RS............................................................................ 54

Hospital de la Santa Crue i Santa Pau.................................................................. 58

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Country Reports of the EAAD Network

ANNEX TO THE EAAD INTERIM REPORT

COUNTRY REPORTS OF THE EAAD NETWORK

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AUSTRIA

GESELLSCHAFT FÜR PSYCHISCHE GESUNDHEIT-PSYCHOHYGIENE TIROL WP 2: Management of local campaign / Establishment of local network A regional co-ordinator and manager (legal representative) has been appointed, the local project team works approximately 20 hours / week. A project action plan includ-ing time schedule and budget plan has been defined. A regional patron has been involved: Gesundheitslandesrätin Dr. Elisabeth Zanon (State Councilor for Health in Tyrol). The local network has been established with 30 various institutions as part-ners like: wards of clinics, Tilak (Tiroler Landeskrankenanstalten, the organisation responsible for most of the hospitals in the Tyrol), social insurance organisations, NPOs (non / social profit organisations), Caritas of the Diocese of the Catholic Church in Innsbruck, psychiatrists and psychotherapists, self-help organisations, city vice-mayor, Chamber of Pharmacists, professional association of psychologists (Berufsverband der PsychologInnen), organisations specialised in the rehabilitation of patients with mental disorders and depression, .… The project was presented at different wards of clinics. We have been invited to present the project at the conven-tion Day of Psychiatry in East Tyrol (26th of February). WP 5: Intervention level ‘General Public’ The opening event and press conference will take place on the 24th of February. A telecast is planned for the 24th of February. Press and media relations have been established. Leaflets have been adapted and printed in a small number (550), they were distributed to our regional partners. We have begun to adapt the posters, video & CD covers. For the cinema spot, an advertising agency has been found to organise the distribution. We have started planning the campaign days with workshops and lectures on different subjects concerning depression, first lecturers have expressed interest and have been recruited. A school campaign has already been established and has to be specialised on the subject depression. The Austrian domain and web-site www.buendnis-tirol.at (with information on the project, depression, our partners, ...) will go online on 24 February. WP 6: Intervention level ‘Cooperation with GPs’ The main goal at the moment is to evaluate the needs of the GPs; we want to ensure that we create more of a supervisory atmosphere than a training situation. The GPs should receive help with meeting the challenges they face in their daily work concern-ing depressed people. WP 7: Intervention level ‘Community facilitators’ We haven't implemented any activities in this field yet. WP 8: Intervention level ‘High risk groups, self-help’ We co-operate closely with the self-help groups; they are partners in our regional network. We are working on setting up a “publicly available” crises hotline; a crisis hotline for persons after suicide attempt already exists.

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Country Reports of the EAAD network: Austria

WP 9: Evaluation of EAAD The rates of suicide deaths in Tyrol have been available by the provincial govern-ment since 1999.

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BELGIUM

MENTAL HEALTH EUROPE WP 2: Management of local campaign / Establishment of local network In Flanders, the coordinator of the project is Prof. dr. C. Van Audenhove, director of LUCAS – K.U.Leuven, in collaboration with Mrs. Van Dievel, director of Mental Health Europe. Gert Scheerder and Iris De Coster assist in managing and executing the general EAAD project in Flanders. A core group of 2 general practitioners (dr. M. Goetinck and dr. J. Vulsteke) and 2 psychiatrists (dr. H. van den Ameele and dr. W. Lecot) in the region of Brugge – Ieper, with whom regular meetings are held, takes the local responsibility for the project, in terms of the actions and public relation ac-tivities. In addition, an academic advisory board has been established of scientists in the field of general medicine, psychiatry and preventive medicine. This board advises on the scientific base of the EAAD project in Flanders (see attachment for list of members). In close collaboration with the core group we intensively mapped local actors in the health and wellness sector that could play a role in the prevention and treatment of depression and suicide. All were invited to the Invitational Conference on October 29th 2004 (cf infra), where a regional network of active partners was established (see attachment for inventory). This network now consists of 45 organizations, including general and psychiatric hospitals, general practitioners, community mental health centers, health promotion departments, pharmacists, social departments at schools and the police, self-help organizations, help-lines and outpatient health services. Close collaboration with these key actors is maintained in setting up actions at the 4 levels of EAAD, which to a large degree are carried out locally by these actors. Other announcements of the EAAD project in Flanders have been made in presenta-tions at scientific congresses:

- International Conference on Communication in Health Care (EACH), Sept 17th 2004, Brugge

- The 2nd Flemish Conference of Mental Health Care (2e Vlaams Congres Geestelijke Gezondheidszorg), Sept 24th 2004, Leuven

Furthermore, a website with basic information about the project is available in English and Dutch at: http://www.kuleuven.ac.be/lucas/InternationaleProjecten/index.htm#EAAD . Finally, regarding extra financial resources, the Belgian Federal government, the Flemish government and the Province of West-Flanders (the intervention region) and different foundations have been approached for financial support for the campaign. WP 5: Intervention level ‘General Public’ At the 29th of October the Flemish EAAD project was officially launched in Brugge at an Invitational Conference for all local partners in our regional network. Local politi-cians opened the event and pointed out the importance of the problems of depres-sion and suicide in the region. The framework, goals and action plans of EAAD were highlighted by the organizers. Key actors that already developed good practices on the 4 EAAD action levels were contacted and invited to inform about their activities

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http://www.kuleuven.ac.be/lucas/InternationaleProjecten/index.htm

Country Reports of the EAAD network: Belgium

on this Invitational Conference. The Conference was a success since it managed to bring together most relevant local actors: more than 80 people from about 40 differ-ent organizations were present. The general remarks of participants were very posi-tive and welcoming towards an initiative that is integrative and scientifically sound, and stimulates cooperation. This enthousiasm is promising in regard to the future involvement of these local actors. A first press release about the EAAD project plans and a press conference have been held on occasion of this Conference. This has resulted in satisfactory media coverage of the event: an interview was broadcasted by the local television (Focus TV) and 5 articles appeared in local newspapers or the regional edition of national newspapers (De Standaard, Het Nieuwsblad, De Zondag, De Krant van West-Vlaanderen, Campuskrant). Other press releases will be submitted as new features and results of the campaign emerge. Other public information events that have been held:

- Symposium on depression in children and adolescents (Sept 30th 2004, Brugge)

- Symposium on depression in the elderly (Nov 18th 2004, Brugge) Further public information events are planned for 2005. The preparation of a public information campaign in 2005 and the production of in-formation material (1.000 posters, 1.000 leaflets, 50 videos) are in progress, as nego-tiations are being held with local actors. WP 6: Intervention level ‘Cooperation with GPs’ Local GP organisations were present on the Invitational Conference of the Flemish EAAD project (Oct 29th 2004) and informed about our plans. In an ongoing project in the region of Brugge called “Between the Lines”, LUCAS and the core group of GP’s and psychiatrists already gained a lot of expertise concerning the needs of GP’s about depression and suicide and concerning the development, implementation and evaluation of training programs for GP’s on this topics. We can also rely on excellent trainers and lecturers. In both subregions Brugge and Ieper education programmes were planned in coop-eration with the core group and local GP organisations. Information material such as the structured patient files is used as training material in this education sessions. In the Brugge region, 3 GP education sessions were held about counseling therapy by the GP: introduction in cognitive behavioural therapy (May 6th 2004, June 10th 2004, June 17th 2004). In the Ieper region, a new education programme for GP’s was conceived: intervision sessions, in which personal experiences of GP’s are be revised, complement the training courses on selected depression themes, according to the specific needs of the GP’s. Topics on the agenda are e.g.: communication about suicide, the role or participation of the patient in the referral process between GP and psychiatrist. This education programme has started on Oct 7th 2004. A total of 8 sessions (intervision + training) are scheduled in this programme, with approximately 20 participants each.

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Further GP training courses, extending to the subject of suicide, and the use or dis-tribution of information video’s to GP’s are planned for 2005 in collaboration with our local partners, in order to obtain the number of 20 training courses in 2005. The experiences, instruments, tools and the organizers’ view on the topic, which were developed and used during the education programme “Between the lines”, will be published in a book aimed at supporting future education programmes. The pub-lishing is foreseen for early 2005. WP 7: Intervention level ‘Community facilitators’ In close collaboration with key actors in our local network current actions are re-viewed and further opportunities examined concerning educational sessions for community facilitators. Training courses on depression and suicide for school teachers, for hospital staff, for the police, for prison personnel, for helpdesk personnel and for ambulant caregivers (such as nurses) are already being undertaken in 2004 by experienced local part-ners. Training materials exist and courses are offered on demand, corresponding to the specific needs of the target group. These training courses will be further developed and carried out at larger scale to obtain the following number of training courses in 2005:

- 10 Training courses for school teachers - 10 Training courses for geriatric nurses / caregivers - 10 Training courses for the police

Specific target groups for which training is not yet offered but for which it is advisory to do so, are identified. These target groups include priests or pastoral workers and pharmacists, as well as experienced mental health workers, that should be offered train-the-trainer courses. Training courses and materials for these target groups are being developed in close collaboration with key actors in our local network in order to obtain the following number of training courses in 2005:

- 5 Training courses for pharmacists - 5 Training courses for priests or pastoral workers - 4 Train-the-trainer courses

WP 8: Intervention level ‘High risk groups, self-help’ In close collaboration with key actors in our local network current actions for high-risk groups and self-help organizations are reviewed and further opportunities examined. Concerning psycho-education sessions for high-risk groups, patients and family members, different courses were organized in 2004 by local partners such as psy-chiatric hospitals and mental health centers, and are also planned for 2005. Opportu-nities for the extension of these sessions will be supported. A crisis hotline service is organized by 2 local partners. One is specific for people dealing with suicidal problems; the other one is oriented towards more general psy-chosocial problems, but receives a significant proportion of calls related to suicidal problems.

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In 2005 3 pilot projects will start in the intervention region to follow up people that have committed a suicide attempt. They will be offered information on local help of-fers and an emergency card containing telephone numbers of important caregivers such as their GP. These projects will be further supported and evaluated. The aim is to distribute 100 emergency cards. There are 3 self-help groups dealing with depression and suicide (Nabij Zijn, Vlaamse Vereniging voor Manisch Depressieven, Similes) in the region. The partici-pated at the Invitational Conference (Oct 29th 2004) and are part of our local network. Further needs and opportunities for the extension of these self-help groups will be investigated. WP 9: Evaluation of EAAD An evaluation concept has been elaborated by the LUCAS research group and along the recommendations of the EAAD Working Group on Evaluation. Information has been gathered from local partners about the availability of indicators and feasibility of their measurement. The following evaluation indicators will be assessed: 1. Completed suicides The time frame for the baseline data collection will be 1992-2004, as these are the available data from the Ministry of Health of the Flemish Community. A request for baseline data on the number of completed suicides specifically for our intervention region (districts of Brugge, Ieper, Diksmuide and Veurne; 483.000 inhabitants), has been directed to this institution and is agreed upon. The data are expected early 2005. The time frame for the intervention data collection will be Jan 1st 2005 – Dec 31st 2005. Intervention data will be requested from the Ministry of Health of the Flemish Community at the end of the intervention period. There is an agreement on the use of these data. 2. Suicide attempts The time frame for the baseline data collection will be 1998-2004, as these are the available data from EPSI, a psychiatric emergency department in Brugge, that has a tradition of gathering these data. Baseline data on the number of suicide attempts in this hospital (that receives suicidal patients from the wider Brugge region) are re-quested and will be received early 2005 from EPSI. The time frame for the intervention data collection will be Jan 1st 2005 – Dec 31st 2005. Intervention data will also be gathered from EPSI at the end of the intervention period. 3. Assessment of knowledge and attitudes among GP’s, community facilitators and the general public Knowledge, attitudes and current practices concerning depression and suicide will be assessed from GP’s, community facilitators as well as the general public, using the instruments recommended by the EAAD Working Group on Evaluation. Baseline data collection is being prepared to take place in early 2005. Intervention data will be collected one year later, in order to assess training effects among GPs and community facilitators, and effects of the public information cam-paign on (high risk groups in) the general public.

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Annex 1: Summary of local partners in the prevention of depression and suicide type of intervention Organisation Short description

1) general practitioners

Training sessions LUCAS, University of Louvain

Training capacities to detect and handle depression for GP’s in the region of Brugge

LUCAS, University of Louvain

Training and intervision on the topic of de-pression for GP’s and psychiatrists in the region of Ieper

Flemish League of GP’s Web-based learning on suicide prevention for GP’s

Flemish League of GP’s training for local GP groups on depression and suicide

Mental health centers Educational package on suicide prevention for GP’s

Health insurance, Dpt. of prevention

Sensibilisation of GP’s in youth depression

2) other (care) professio-nals

Training sessions Mental health centers Educational package on suicide prevention for teachers, policemen and hospital staff

Centre for the Prevention of Suicide

Trainings sessions on suicide for home care services, teachers, help-lines, prison offi-cers, …

Health insurance, Dpt. of prevention

Information sessions on youth depression for teachers, parents and other educators

Family Help services Training in psychosocial support at home for home care personel

Psychiatric services at home

Training and support of other caregivers in psychiatric care at home

Cooperation among professionals

Taskforce on suicide prevention Brugge

Cooperation between hospitals and GP’s in follow-up of suicide attempters

Taskforce on suicide prevention Ieper

Cooperation between hospitals and GP’s in follow-up of suicide attempters

Flemish League of GP’s Consensus building on cooperation between GP’s and mental health centers in depres-sion and suicide

3) broad public / media Guidelines for media Flemish Federation of

Mental Health Guidelines for reporting on mental illnesses

Taskforce on suicide and the media

Guidelines for reporting on suicide

4) patients and their relatives

Psycho-education Psychiatric hospital Ieper Psycho-education on depression for patients and their relatives

mental health center Ieper

Psycho-education on depression for people with ‘mild’ depression

Psychiatric hospital Brugge

Psycho-education on depression for patients and their relatives

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Crisis support Tele-Onthaal Help-line (24h/24h) Centre for the Prevention

of Suicide Help-line (24h/24h) specifically concerning suicide

Taskforce on suicide prevention Brugge

Emergency cards for suicide attempters

Taskforce on suicide prevention Ieper

Emergency cards for suicide attempters

General hospital Veurne Emergency cards for suicide attempters self-help groups Nabij-Zijn Self-help group for people that lost a family

member league for manic

depression Self-help group for manic depressed people

Federation of self-help groups

Support for self-help groups

Other direct care Psychiatric services at

home psychiatric care at home

Family Help services psychosocial support at home Psychiatric hospital Ieper Residential care and day care Psychiatric hospital

Brugge Residential and ambulant care; day care

Psychiatric hospital Brugge

Residential and ambulant care

EPSI psychiatric emergency admissions Annex 2: Academic advisory group

Prof.dr. Van Royen Paul Academic Center for General Practitioners University of AntwerpProf.dr. Heyrman Jan Academic Center for General Practitioners University of LouvainProf.dr. D'Haenen Hugo University of BrusselsDr. Vandenbossche Bart Dpt. of Psychiatry University of AntwerpDr. Dierick Michel Dpt. of Psychiatry and Medical Psychology University of GhentDr. Pieters Guido psychiatrist Louvain

Cools Bob Ministry of HealthDr. Hamelinck Luc Dpt. of Psychodiagnostics and Psychopathology University of LouvainProf.dr. Van den Broucke Stephan Dpt. Of Health Psychology University of LouvainProf.dr. Van Heeringen Cees Dpt. of Psychiatry University of GhentDr. Lecot Wim psychiatrist IeperDr. Vulsteke Jef general practitioner IeperDr. Goetinck Michel general practitioner BruggeDr. van den Ameele Hans psychiatrist BruggeDr. Hooft Peter Ministry of HealthDr. Van Hecke Martine Ministry of HealthDr. Defruyt Jürgen psychiatrist Brugge

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ENGLAND

DARTFORD, GRAVESHAM & SWANLEY PRIMARY CARE TRUST WP 2: Management of local campaign / Establishment of local network A Steering Group has been set up comprising members from the Primary Care Trust, Mental Health Trust, University and a service user. A project plan and budget plan have been defined and a coordinator was appointed. The coordinator left after 2 months, so we are currently re-advertising, we are re-visiting the budget plan as part of this exercise to enable us to spend more on publicity materials. We have a local project team with clear tasks, set out in our ‘First Six Months’ docu-ment; this document is now being further developed; our plan is to extend the pro-ject across the whole of Kent as the next phase. We have not yet engaged a Regional Patron; our plan is to discuss this with the Di-rector of Public Health for Kent and Medway. We have been in contact with national leaders from the ‘Defeat Depression’ Campaign. We have not yet applied for further funding and sponsorship other than the next phase of the European funding through the project hosts in Munich; we are consider-ing national mental health organisations as a possibility. Local Medical Health Care allies are closely involved with the project; members from the Dartford, Gravesham and Swanley Primary Care Trust, the West Kent Health and Social Care (Mental Health) Trust and the University of Kent are engaged and ac-tively working on the project. 2 General Practitioners are involved on a ‘virtual’ basis. We are building a network which includes Local Authorities of Dartford, Gravesham and Sevenoaks, local Voluntary Organisations and Darent Valley (Acute) Hospital. We have also started to disseminate our work on a Regional basis and a presenta-tion was made at the South East Public Health Conference in February. We have disseminated information about the programme through the Joint Commis-sioning Board for Mental Health – a Dartford, Gravesham and Swanley based mental health interest group where services are planned and developed. Plans to inform other groups about the programme are at an early stage; some discussion has taken place. WP 5: Intervention level ‘General Public’ We are still at an early stage in developing our public awareness campaign; we see planning this as an important next step, but we wanted to have our programme in place before going out to the public. We shall be developing a communications strategy as part of our next six months programme. We would expect this to include a media strategy as well as develop-ment of materials and how we might use the EAAD materials.

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Country Reports of the EAAD network: England

WP 6: Intervention level ‘Cooperation with GPs’ Dartford, Gravesham and Swanley is well ahead with training GPs and other mem-bers of practice teams (in England a General Practitioner works with a team of peo-ple who include a Practice Nurse, District Nurses, Receptionists, counsellors etc.). Jan Prior is leading on this aspect. Our plan is to develop a much closer working relationship between GP practices and the Community Mental Health Teams from the Health and Social Care Trust. Train-ing needs assessments have been carried out and a programme is being devised to develop mental health awareness, carry out training regards ‘risk’ and to include spe-cifically as part of the EAAD programme training in Depression. Training will be provided through the University of Greenwich. Practitioners form the Primary Care Trust will also be included in the training programme. Details are not currently available; number of people involved and number of trainers can be pro-vided at a later date. Materials are still in the process of development; we have not as yet used any of the EAAD materials. We are interested in the system of ‘psychiatric first-aider’ being implemented in Scot-land. WP 7: Intervention level ‘Community facilitators’ We see Mental Health Promotion as an important element of our campaign. Bose Johnson is leading on this aspect. There is a regular meeting of community and voluntary organisations such as MIND, Health Action Teams, other local mental health organisations. The project has been discussed, and a training needs assessment has been carried out covering as many such organisations as are known to us. The next phase is to develop a training pro-gramme for these people who are seen as key to disseminating the programme lo-cally. The Primary Care Trust Health Promotion department also is engaged with pro-grammes which include ‘Healthy Schools’, Ethnic Health and Social Forum and Drugs Awareness. These programmes all provide us with the possibility of raising awareness and training people in mental health related areas. There are three Health Action Teams each with a ‘Healthy Living Centre’ (2 of which are nationally funded through the New Opportunities Fund) and again provide good opportunities for developing mental health awareness amongst the general public. Community youth workers are interested in acting as multipliers of the project outside of the school setting and will be included in the training. The Faith communities are engaging with this initiative & are keen to be involved. WP 8: Intervention level ‘High risk groups, self-help’ There has been national guidance on management of Deliberate Self Harm, and a group is involved with developing a programme between Darent Valley Hospital (our local Acute Hospital) and our Mental Health Trust. This work is led by Peter Hasler.

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Currently two psychiatric liaison workers are sited in the Accident and Emergency Centre and their role is to liaise with people who have harmed themselves / at-tempted suicide to ensure they are followed up in appropriate services. We are interested in assessment of how well the service is running. Our initial work has been an audit of cases using Accident and Emergency Centre records – we au-dited all records of Self Harm and a sample of overdose cases. A report is available. The next phase would be to develop a programme of further information collection prospectively. In addition we have collected statistics for admissions to hospital for depression and for deliberate self harm, currently we are teasing out the overlap between cases. Of interest is our finding that 38% of admissions were to the acute hospital. We have not explored setting up a hotline or giving emergency cards, but we do want to know if the system of having professionals in the emergency centre is effective. What sort of follow up are people receiving. We expect to see a decrease in Deliberate Self Harm cases as a result of our pro-gramme of work. WP 9: Evaluation of EAAD Our control region is difficult to define as the Mental Health /trust covers the whole of West Kent and our work is likely to have some effect in the rest of this region. We have considered East Kent as a control region, also Bexley and Greenwich; we now know that both these regions could be involved with the next phase of our work. Evaluation indicators include - Admissions for depression and deliberate self harm - Suicides - GP prescribing - Accident and Emergency visits - Prevalence of risk of depression and mental health indicator from SF36 from sur-

vey data (2001 baseline and 2005 repeat) - GP and patient satisfaction data We have begun to collect local baseline data and will be developing qualitative indi-cators for which we will need to seek further funding. Results currently include - 23 deaths per year from suicide and undetermined cause (3 year average) - Age standardised rate for suicide + undetermined cause 9.9/100,000 3rd highest

in Kent (after East Kent Coastal and Shepway) - 137 male and 206 female non-elective admissions April 2003- March 2004

38% to Darent Valley Hospital, 53% to West Kent Health and Social Care Trust, 9% elsewhere mostly south London and other Kent

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Country Reports of the EAAD network: England

Annex 1: Non-elective admissions for Depression (2001-2004)

Non-elective admissions for Depression 2001-4 annual rate / 1000 DGS residents by age and sex

0

0.5

1

1.5

2

2.5

3

3.5

4

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

malesfemales

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ESTONIA

ESTONIAN-SWEDISH INSTITUTE OF SUICIDOLOGY WP 2: Management of local campaign / Establishment of local network Project plan: Clear 4-level project action plan and timetable is defined. Draft of budget: The draft of budget is defined. Financing applications: Applications for financing in 2004: Social Ministry (not satis-fied, postponed for 2005), Minister of Population Affairs (not satisfied, postponed for 2005), Gambling Tax Council (150 000 EEK), Tallinn Social Welfare and Health Care Department (59 093 EEK), Tartu University (45 000 EEK). Total local contribution 254 093 EEK (38% of total funds needed for local contribution). Applications for fi-nancing in 2005: negotiations have been held with Social Ministry (positive decision for 2005 is made) and the Minister of Population Affairs. Organisation, regional coordinator & team: Local project organisation is defined and project team recruited: Airi Värnik is regional coordinator (overall management, nego-tiations with key persons, evaluation, trainings), Merike Sisask is regional co-worker (executive management, PR, production of information and campaign materials, self-help activities, trainings) Kairi Kõlves (evaluation, trainings) and Ene Palo are in-volved (evaluation, organizing work). Regional patron: Regional patron is the Minister of Population Affairs Mr Paul-Erik Rummo. Network of local partners: Most of potential local partners are defined (governmental institutions on national and local governmental level, non-governmental institutions, specialists on mental health, representatives of main target groups, media), negotia-tions and meetings have been held and are going on regularly. Negotiations are in process with church, voluntary organisations, pharmacy companies. Information about project background and actions is delivered continuously. Consultations from specialists on health care (especially mental health) are asked continuously. Lecturers: Most of potential lecturers are defined, except for priests and police. Re-cruitment process is continuous. WP 5: Intervention level ‘General Public’ Logo, symbolics, presentation material: EAAD logo and other symbolics are adapted to local conditions. A folder with presentation materials for stakeholders about the EAAD projects and about background situation (mortality, suicidality, mental health) is prepared. Translation and production of campaign and information materials: Material is trans-lated: films (3 German films from for GPs or patients, 1 Canadian film for school staff, 1 Swedish film for school staff, friends and parents), flyer, SOS emergency card, press kit. Preparations for production of information materials (posters, flyers, films, brochures) are made. Production of information materials: 60 VHS for GPs (and pa-

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Country Reports of the EAAD network: Estonia

tients) about depression, 540 CD for GPs (and patients) about depression, 500 bro-chures about suicide prevention for teachers and other school personnel, 500 bro-chures about suicide prevention for friends and family members, 20 000 flyers about depression, 20 000 SOS information cards, 2 educational films for schools. Dissemination strategies: Definition of regional strategies for dissemination of infor-mation materials and campaign materials. Planning is in process, final strategy not completely clear either formulated yet. Negotiations with GPs, pharmacy central stores etc are going on. PR & general press information strategy: PR strategy is defined and general press information strategy is prepared. Continuous collaborative contacts with different me-dia channels are created. Since Sept 2004 EAAD project is continuously visible in media. Public information events: Delivery of 5 public information events is planned. Prelimi-nary PR event – International Day for Suicide Prevention (Sept 10, 2004) – with press notice, interviews and media coverage. Mental health round table at the Chan-cellor of Justice of Estonia (Oct 8, 2004). Presentations by project team: about EAAD project, mortality, suicidality and mental health. Participants - high officials, societal and cultural prominents. Media invited. Festive opening event is planned to be held in Apr 2005 with participation of Lars Mehlum (president of the IASP, International As-sociation for Suicide Prevention). Press releases: Continuous delivery of press releases since Sept 10, 2004: articles in different daily and weekly newspapers, magazines, interviews in radio and TV broad-casts (6 times in Sept 2004, 15 times in Oct 2004, 4 times in Nov 2004, 5 times in Dec 2004, 8 times in Jan 2005). Regional EAAD website: Regional EAAD website www.eaad.ee containing different kind of information related to the project is ready. WP 6: Intervention level ‘Cooperation with GPs’ Information meetings with GPs: 5 information meetings for GPs to inform about the EAAD project and trainings are planned. One meeting is held in July 2004 to discuss the topic of first 3-day training program. GP training courses. Started with 3-days pilot training program in Dec 2004: Prof Wolfgang Rutz (Uppsala University) and Ms Ellenor Mittendorfer Rutz (Karolinska Institute) participated as visiting lecturers. Information material (VHS, CD, screening tools) were disseminated to 17 participants. E-training program for GPs and nurses: Training programme for GPs on the local EAAD website www.eaad.ee is under preparation. WP 7: Intervention level ‘Community facilitators’ Preparation of training programmes: Planning and preparing the modules of training programs for different target groups: GPs, social workers, teachers and other school personnel, military forces, police, priests, voluntary organisations. Plans are made

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http://www.eaad.ee/

http://www.eaad.ee/


and modules are ready for GPs, social workers, teachers and other school person-nel, military forces. Preparation of plans for police, priests and voluntary organisa-tions is in work. Translation of training programmes: Translation of available training programme for suicide prevention in schools into the English language and delivery to Project Office Translation is delayed due to financial reasons. Train-the-trainer course: Will be held in Feb 2005. In the training group 1 key person from each community facilitators’ group. Training for teachers and other school personnel: Start in Nov 2004. One seminar for headmasters (10 participants) and 3 X 1-day pilot training courses (67 participants) have been held in Nov-Dec 2004. Training for social workers: Will start in Feb 2005. Training for the military forces: Started Oct 2005, 2 X 1 day training courses have been held. Training for the police: Will start in Feb 2005. Training for priests: Will start in Feb 2005. Training for volunteers: 4 potential voluntary organisations as partners are defined. Will start in Jan 2005. WP 8: Intervention level ‘High risk groups, self-help’ SOS emergency cards for suicide attempters: Distribution of 1000 SOS emergency cards for suicide attempters. SOS cards are produced in Estonian and Russian lan-guage. Cards are available in emergency care departments of biggest hospital in Tal-linn and introduced during the courses for medical personnel. Translation of SOS card: Translation of SOS card for suicide attempters into English language is sent to project office. SOS information cards for people with psychic problems: Information is collected. Will be produced in Feb 2005. Initiation of self-help groups: 2 self-help groups will be initiated in March 2005. Telephone hotline: A telephone hotline "GP answers" will be established in May 2005. WP 9: Evaluation of EAAD Evaluation methodology and instruments: Methodology to assess evaluation indica-tors (incl. Instruments) is defined. Instruments are under preparation, attitude and knowledge questionnaire is pilot tested in Nov/Dec 2005.

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Country Reports of the EAAD network: Estonia

Measurement of completed suicides (baseline and after intervention, intervention re-gion and control region): Baseline data time frame: 1991-2003. Intervention data time frame: 2005-2008. Data collection in cooperation with Estonian Statistical Office. Sui-cide data until 2002 is collected. Suicide data for 2003 is not available yet due to offi-cial restriction (very strict new data protection law). Negotiations with control region Riga (capital city of Latvia) has been held. Assessment of suicide attempts / DSH (baseline and after intervention, intervention region and control region): Baseline data time frame: 2000-2003. Intervention data time frame: 2005-2008. Data collection in cooperation with Estonian Health Insur-ance Foundation and biggest hospitals in Tallinn (North-Estonian Regional Hospital, East-Tallinn Central Hospital). Data about suicide attempts until 2003 is collected. Negotiations with control region Riga have been held (capital city of Latvia). Assessment of prescription profiles (baseline and after intervention): Baseline data time frame: Jan 2004 - Dec 2004. Intervention data time frame: Jan 2005 - Dec 2006. Specification of the indicators: (1) different groups of antidepressants, anxiolytics, neuroleptics, sedatives/hypnotics, (2) volumes of sales and sales of packages, (3) DDD. Data collection in cooperation with Estonian Health Insurance Foundation and State Agency of Medicines. Collection has started start in Jan 2005. Data available by now for years 2000-2003. Assessment of diagnoses and treatment: Baseline data time frame: Jan 2004 - Dec 2004. Intervention data time frame: Jan 2005 - Dec 2006. Specification of the indica-tors: (1) number of treated persons, incidence and prevalence rate of depression, (2) duration of sick-leave days, (3) duration of hospital treatment, (4) complexity of ther-apy, usage of screening tools. Data collection in cooperation with Estonian Health Insurance Foundation. Collection has started start in Jan 2005. Data available by now for years 2000-2003. Data about complexity of treatment and usage of screen-ing tools in cooperation with GPs (survey). Health economic costs: Baseline data time frame: Jan 2004 - Dec 2004. Intervention data time frame: Jan 2005 - Dec 2006. Specification of the indicators: (1) direct costs of treatment of suicide attempters, (2) direct costs of treatment of depressive pa-tients. Data collection in cooperation with Estonian Health Insurance Foundation. Collection has started start in Jan 2005. Data available by now for years 2000-2003. Assessment of training effects among GPs (baseline and after intervention): Baseline data collection before every training workshop. Intervention data collection after every training workshop. Pilot tests among GPs in Dec 2005 (18 persons). Assessment of training effects among community facilitators (baseline and after in-tervention). Baseline data collection before every training workshop. Intervention data collection after every training workshop. Pilot test among school health care person-nel (67 persons) in Nov/Dec 2004. Media coverage of suicidality (baseline and after intervention): A master student (a journalist) assesses media coverage of suicidality for her master thesis using qualita-tive research methods.

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Changes in public attitudes (baseline and after intervention): Baseline assessment was not completed due to low priority and lack of financial resources. A psychology student will assess public attitude and knowledge as a part of her bachelor thesis, but it is too late for using it as baseline indicator.

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Country Reports of the EAAD network: Finland

FINLAND

STAKES HEALTH AND SOCIAL SERVICES WP 2: Management of local campaign / Establishment of local network Our project's time schedule is this: the project started in the beginning of September 2004 and it's going to last till the end of year 2007. The overall budget plan is being defined quite clearly, as the hospital districts pay one half of the basic costs and the state the other half. These basic costs include the wages of two project psychologists (Esa Aromaa and Jyrki Tuulari), some travelling expenses, money to print posters and leaflets, and so on. When it comes to the question about regional co-ordinators Mr. Aromaa is co-ordinating action on Wasa Hospital District and Mr. Tuulari on South-Ostrobothnia Hospital District. The local project team (Aromaa, Tuulari, Mrs. Irja Rantanen-Lakka (psychiatrist) and Mr. Antero Lassila (psychiatrist)) has also clear responsibilities and tasks, and the project's leading group includes twelve people, who represent psychia-try, general practice, social work, and the third sector. We will get a patron to give the project a strong spirit and face. This person will be one of the leading figures of Stakes, Finland. So far we have not made any efforts for further funding or sponsorship because we have decided to use only public funding. Our project psychologists are going to visit all units of the local medical health care system. The first inviting letter has already been sent, and the telephone contacts are going on just now. The purpose is that the visits are done by the end of March, and then we know how many units are motivated actively develop their practices. WP 5: Intervention level ‘General Public’ The opening event of public awareness campaign will be held in March, week 10 or 11. We are now in the middle of the process to produce posters for the campaign. When the opening event takes place, the EAAD and our local activities are presented as fully as possible. We have established relations to both press and radio. We are negotiating also to get a little time from local TV. The preparing of WWW-home page is also on progress. All these will be actively used after the opening event. We are preparing both posters and leaflets based on the EAAD material. The ques-tion do we prepare video tapes is still an open one. The production of information material is in progress, but we haven't disseminated it yet.

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WP 6: Intervention level ‘Cooperation with GPs’ At this point we have had two meetings with the GPs (in Seinäjoki and in Vaasa), and definitely there is more to come. As said before, the project psychologists are going to meet the GPs and other workers to all of our area's local medical health care sys-tem's units. We are inviting the GPs and nurses to participate to training courses on our visits to the above mentioned units. The needs of GPs and nurses (and other staff) are being assessed during the visit by filling a questionnaire. We have two psychiatrists ready to train GPs. And project psychologists are ready to train nurses and other staff. So the training courses are to come; we have not implemented them yet. Some material will be disseminated to GPs, nurses and other staff. What kind of ma-terial, that will depend on the needs of staff. WP 7: Intervention level ‘Community facilitators’ The training courses for community facilitators are being planed by project psycholo-gists. They have gathered a lot of information, articles, and so on, and have a large battery of education materials ready to be launched when the time is right. The first contacts with the community facilitators will be in this month when project psycholo-gists meet community psychologists. They are the key persons to gather other com-munal facilitators and their knowledge and contacts are crucial to get all the commu-nity facilitators together. Our plan is that we will specify target groups with community psychologists by the end of April 2005. WP 8: Intervention level ‘High risk groups, self-help’ We have not yet initiated self help groups . Crisis hotline has not been established. High risk groups are considered carefully in psychiatric units. Emergency cards have not been disseminated. WP 9: Evaluation of EAAD On intervention level `General Public´ we are preparing a baseline questionnaire where we ask about population's mental health literacy, use of services, attitudes, morbidity and disability. Our sample is 5000 and we are going to have a control area on south-west Finland. The first survey is coming in the end of January 2005 and the other at the end of the campaign. This study is done in collaboration with professor Kristian Wahlbeck (Stakes and the University of Helsinki) and Dr. Kjell Herberts (Åbo Akademi Wasa Unit). We have also plans concerning Media-analysis in collabora-tion with the University of Vaasa.

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Country Reports of the EAAD network: Finland

On ‘GP – level’ we are going to pick up a couple of high-interest local health care units with whom we try to develop a practical model which we can later launch for-wards. On these units we make a baseline survey using statistics (amounts of sui-cides and parasuicides, prescribed medication, referrals to psychiatric units and so on) interviews and questionnaires. Both quantitative and qualitative process evalua-tions are possible. Possible instruments are for example BDI, SCID, CIDI, MDI, MHI-5, GHQ-12, SCL-25 and WHO-5.

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FRANCE

ACCUEIL PSYCHIATRIQUE HOPITAL RENE DUBOS WP 2: Management of local campaign / Establishment of local network Dr Taleb is the regional co-ordinator and the initiator of the program. The program is directed at local level in a collegial way by a group of psychiatrists of the Pontoise Hospital. The local project team constituted itself gradually since April 2004. Some-body in charge of actions implementation and coordination have been recruited in January 2005. A local steering committee was made up. It already met three times (on September 14, 2004, on November 19, 2004 and on February 1st, 2005). Its 14 members are representatives of the various local institutional partners in the social and medical sectors and actors of the health system (Departmental Direction of Social and Medi-cal Affairs, General Council, hospital psychiatrists, Departmental Committee of Health Education, general practitioners, the Social Security Organism, and the local association of works doctors AMETIF). The Hospital Center Rene Dubos of Pontoise is the main co-financor of the program. Its financial participation includes the wages of the person in charge of program ac-tions implementation and coordination (full-time mission during 11 months) and an important logistical support (room, furniture office, computer). The creation of an local association aiming to develop a network city-hospital on de-pression (the REDEP) is being prepared. This one should be born before March 2005. It should gather the whole of the actors of the health system concerned by the problem of the depression. It should constitute an important support with the devel-opment of the co-operation between the psychiatrists and the general practitioners in particular. The whole of the local actors working in contact with depressive populations or inter-vening in the assumption of responsibility of these populations have been informed about the program by mail, e-mail or telephone. They have been invited at a first meeting on the january 27, 2005. A poster about the EAAD program was presented at the time of the 3rd Congress of „l’encephale“ (scientific congress) in January 2005 (cf. Revue de psychiatrie clinique, biologique et therapeutique, book 3, 12/2004, p.21). An oral intervention to present the program was made at the time of one evening of continuous medical training for some general practitioners of the Pontoise agglom-eration. An information article on the starting of the EAAD program was put online on the website of the Pontoise Hospital: (http://www.ch-pontoise.fr/pages/homepage.php?page=evenement). WP 5: Intervention level ‘General Public’ No opening event to inform on the aims and activities of EAAD was organized until today. No direct relationship with press and media have been established to date. However, official supports, but not yet formalized, were already obtained about the organization of General public awareness campaign : by the General Direction of Health (ministe-rial level) and by the Communication Services of the General Council of „Val d’Oise“. A census of the media by which information must be disseminated will be made be-

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http://www.ch-pontoise.fr/pages/homepage.php?page=evenement

Country Reports of the EAAD network: France

fore April 2005. A press conference starting EAAD program is planned for October 2005. The already existing materials within the framework of EAAD program were not adapted to the local context, nor translated yet. This work will be made in collabora-tion with specialized services of communication, when the co-operation with these services will be formalized (the end of this work is planned to may 2005). The supports to disseminate the EAAD information materials haven’t been choosen yet (posters on the buses, folders available at the main partners relay of the program, articles in the local press, etc.). A complete census of those should be carried out before April 2005, and then it will be decided which one we will use. It’s planned to not disseminate the EAAD information material before the date of opening event to launch the general public awareness campaign, in October 2005. As regards their production, this one is not organized yet. WP 6: Intervention level ‘Cooperation with GPs’ A mail was sent to the whole of GPs of the sector to inform them of the EAAD pro-gram. A first meeting took place on January 27, 2005. Contacts with potential trainers were made (Prs Rouillon and Terra). The training of 3 local trainers on the depression is scheduled in March 2005. The modules of trainig concepts were not defined yet, because the GPs needs are in the process of as-sessment. If the motivation of GPs to participate on the program is low, it is planned to go to meet them individually to identify their needs, and to be able to adapt the program on their interests (meetings planned as from mid-March 2005). No training course for GPs took already place. None is planned precisely. At least one training course should be organized before July 2005. No material was diffused with the general practitioners yet. WP 7: Intervention level ‘Community facilitators’ The main groups of community facilitators were identified : - Medical professionals within the university and school framework - Doctors of work - Supervisors and medical staff of jail sector - Police officers - Staff of the health networks for the old people living at home - Staff of the old people’s home - City pharmacists - Social assistants, psychologists and teachers working in associations acting as

relays of information for general public (point sante jeunes, etc.) Detailed inventory of the community facilitators of interest for the program is in pro-gress. Simultaneously, analysis of the administrative steps to carry out in order to be able to train these groups of populations is conducted. Mails of information on EAAD program were sent to some community facilitators which were already identified on the sector. Contacts with potential trainers were established (Pr Terra). The training of 3 local trainers on the depression is scheduled in March 2005. The modules of training con-cepts were not defined yet. No training course for community facilitators took already place. None is planned precisely. At least one training course should be organized before July 2005. No material was diffused with the community facilitators yet.

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WP 8: Intervention level ‘High risk groups, self-help’ A program of assumption of responsibility and follow-up of persons after suicide at-tempt started in December 2004 within the Pontoise hospital. The local project team will coordinate its actions with the team charged to set up this program. An emergency card for the persons after suicide attempt is under development. It will be produced with 1000 specimens and then diffused to the whole of persons after suicide attempt to urgently support them in the event of suicidal crisis. WP 9: Evaluation of EAAD There is no control region. EAAD evaluation indicators are not defined precisely yet. The most probable indicators which will be used (they don’t require a collection of additional specific data) are : - Average Number of suicide attempts received at the Pontoise hospital - Number of days of hospitalization for depression and/or suicide attempt at the

Pontoise hospital The other indicators that we’ll try to use are : - Number of deaths by suicide in the intervention region - Number of days of working stop for depression - Average number or frequency per year of the contacts exchanged between hos-

pital psychiatrist and GP.

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Country Reports of the EAAD network: Germany

GERMANY

BAYERISCHE JULIUS-MAXIMILIANS-UNIVERSITÄT WÜRZBURG WP 2: Management of local campaign / Establishment of local network Timetable: In 2004 and in January 2005 three contact meetings of the psychosocial working groups in Würzburg took place. Themes were the foundation of the Würz-burg Union against Depression, the participating organisations and the themes and dates of the future workshops and public events (detailed work plan). As a result of these workshops the foundation meeting was planned for the 2nd of February 2005 in the Psychiatric Clinic of Würzburg. About 70 persons from 30 organisations participa-ted in this meeting. Additionally already three major reports in the three major newspapers of the Würzburg region (Main-Post, Main-Echo and Volksblatt) were launched as well as reports in the local TV (TV Touring) and Radio-Station (Bayern 1). On the 24th of February 2005 a press seminar and a press conference will also take place. Main purpose is again the presentation of the Alliance and a presentation about media effects on reporting of suicidal behaviour and recommendations for re-porting. The official public Kick-off meeting will take place on the 15th of March in the Toscana Room in the Castle in Würzburg. For this meeting about 200 invitations to all institutions and interested people (stake holders and gate keepers) already were sent out. Many public persons will participate (Mayor of Würzburg, Mayor for social affairs of Würzburg, Vice-President of the university, Head of the state clinics for Psychiatry and Psychotherapy, representatives of churches). The meeting will also be publicly announced for the city and county of Würzburg. Other relevant meetings, which already took place, were a National Press Confer-ence in connection with the WHO World Suicide Prevention Day, 9th of September 2004, in Berlin and a meeting of the National Suicide Prevention Programme for Germany (NaSPro) in November 2004 in Berlin, organised by the Würzburg Group. At this meeting the Chairman of the Committee for Health and Social Security of the German Federal Parliament, MdB Klaus Kirschner, participated. The Chairman prom-ised a hearing in the German Parliament in summer 2005. Also already a local event (Wildwasser e. V.) about depression after misuse was mooted. Members of the Würzburg Group also participated in November 2004 in a workshop in a psychiatric state hospital (Werneck) about special psychiatric problems of Russian Migrants. Also some minor presentations at local events took place. At this stage we recieved much interest from persons, institutions and voluntary workers. Many want to partici-pate and co-work. Establishment of basic organisational structure: Leading centre: Department for Clinical Psychology, Clinic for Psychiatry and Psychotherapy, University of Würzburg (Head: Prof. Armin Schmidte, Secretary: DP Roxane Sell, Assistant: Dr. Cordula Löhr). Planned is a Steering Group with 5 members of the participating major organi-sations. Budget Plan and estimated cost overview: The estimated costs are not yet finally cal-culated. Up to now we estimated 25.000 € for material and reading material costs

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(negotiations with sponsors). The Budget plan is also not yet finally defined. The ex-pected date of completion is July 2005. Local Patron: At this stage negotiations with the Mayor of Würzburg, respectively with the Mayor for social affairs of Würzburg, are taking place. WP 5: Intervention level ‘General Public’ We already publicated a general brochure for the environment and survivors “How to deal with suicidal persons and survivors after a suicide” (own material, NaSPro) in January 2005 (5000 copies). Additional film-clips were prepared concerning suicide prevention for youths and eld-erly (own material). Anti-Depression posters (1000 copies) will be distributed in Würzburg city and county (local shops, public buildings, libraries, institutions of churches, doctors´ practices). The distribution is planned in March 2005. Posters to prevent suicide were already developed (own material). The distribution started in January 2005. Local Flyers with the organisations, institutions (additional EAAD Fly-ers ordered) were developed to be distributed via all local institutions and organisa-tions in the field of prevention of psychic disorders and also via internet (own mate-rial). National Suicide Prevention Programme (NaSPro) flyers and posters were de-veloped (distributed via doctors´ practices, institutions, GPs, schools) (own material). We are also planning to distribute video clips for patients and environment (500 cop-ies) via psychiatrists and GPs (Material from Nüremberg Alliance against Depres-sion). A media campaign in local TV-stations is already negotiated, starting in April 2005 and ending in June 2005. WP 6: Intervention level ‘Cooperation with GPs’ An information meeting was held on the 2nd of February 2005. Diverse lectures on suicide prevention were given (GPs, students, teachers). Further presentations for GPs have been prepared. The recruitment of GP trainers was successful. Many cooperation partners for lec-tures were found. The KV (Association of GPs and specialists) in the social security system is coworking. Planning of several further training meetings for General Practi-tioners will take place. The dissemination of videomaterial started via GPs and spe-cialists. WP 7: Intervention level ‘Community facilitators’ As mentioned above the official Kick-off meeting will take place at the 15th of march 2005 in the Toscana Room in the Castle of Würzburg . Besides presentations of the leading centre and the officials also some musical drama, readings of poems and picture presenations are planned. All relevant associations of doctors and psycho-therapists are invited to participate. An education meeting for the local press and local TV is planned for the 24th of Feb-ruary 2005 (up to now 10 participants).

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Country Reports of the EAAD network: Germany

Activities in the frame of press reports of suicidal behaviour (letters for better report-ing after “bad reports” and TV clips) are in progress (also press material by WHO and the German Association for Suicide Prevention). We will develop diverse lectures on suicide prevention (GPs, students, teachers) and a brochure on prevention of suicidal behaviour of elderly persons (NaSPro) is in press. Invited for cooperation at this intervention level were police forces, teachers, psychia-trists, media people, hot line personnel, associations of nurses, care givers in homes for elderly, politicians and stake holders. A cooperation with a youth pedagogical theatre (Berlin) exists. Themes are plays about suicidal behaviour. An event with the Würzburg opera house on “Suicide in the opera” will take place in 2005. We also cooperate with the university: two major events for students (on depression) and university counsellors for students are planned. And a lecture about depression in Africans will take place in summer 2005 (in conncetion with the African Festival in Würzburg). WP 8: Intervention level ‘High risk groups, self-help’ We participated in a seminar for psychiatrists and psychotherapists on mental prob-lems and therapy of Russian Migrants in the clinic in Werneck in November 2004. As mentioned above we also publicated a brochure for survivors of suicidal persons in January 2005. In summer 2005 seminars for therapists of “Borderline personality disorders”, semi-nars for teachers and seminars for police forces will take place. WP 9: Evaluation of EAAD We are monitoring suicides and suicide attempts in the Würzburg area (ongoing in the framework of the WHO/EURO Network on Suicide Research and Prevention (half-time research worker). For this monitoring up to now the WHO monitoring form is used. A revision of this monitoring form is in preparation, after a WHO/EURO meet-ing (12th and 13th of February 2005). Time series for suicides and suicides attempts since 1989 are available on a yearly basis, broken down for age and sex-groups, diagnoses, some biographical variables and the recommended aftercare. Changes of suicide attempt rates in 2003 have not yet been analysed. Evaluation of press reports (in connection with the University of Würzburg (Depart-ment of Media)) and evaluation of attitudes about depression and suicidal behaviour among GPs, psychiatrists and nurses are planned at this intervention level. The ex-pected date of completion is in the end of 2006.

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HUNGARY

SEMMELWEIS UNIVERSITY BUDAPEST, INSTITUTE OF BEHAVIOURAL SCIENCES WP 2: Management of local campaign / Establishment of local network A project action plan with time schedule and budget plan has been defined. Starting date of the trainings and opening meeting will be in the first half of April. The local campaign is currently being organized. As the first step – after selecting the intervention and the control regions - we determined the important actions and the relevant budget plan for the local interventions. We contacted the local psychiatrists and appointed the local coordinator, Dr. Mária Bagi, who is the head of the Psychiat-ric Outpatient Department, Hetényi Géza Hospital, Szolnok. The leadership of the hospital (Dr. István Baksai, director) supports the project as much as possible. Their team is aware of their responsibilities and tasks. Other regional patrons, such as the Szolnok City Major, Head Public Health Officer, Head District Nurse, Head of the Educational Board are in the process of being contacted. We keep the contact with the local medical health care system in different ways. We communicate with them in writing, through telephone, and also we travel there and maintain the contact by personal visits. The contact person in the control region (Cegléd) will be Dr. Zsuzsa Keresztes, head of the Psychiatric Outpatient Dept. She will give us baseline and follow-up data for comparison with the intervention area. We contacted several possible sponsors in different areas, such as telephone com-panies and banks, but have not received positive answer yet. WP 5: Intervention level ‘General Public’ The opening event for the public is under organisation. Its planned date is in the mid-dle of April. We agreed to organise this event after the first training course for GPs and community facilitators, to get them "educated and prepared" for proper action steps if patients visit them after the opening event for the public. Meanwhile we will finish the production of the campaign materials: translation of leaflets and posters is complete, printing has been organised and is planned to be finished till the end of February. Leaflets and brochures will be disseminated at and around the starting date of the intervention, We translated almost all training materials, and plan to syn-chronize the videos (2 out of 3) as well. In the meantime different press and media relations have been established, such as TV, radio reports, magazine and newspa-per articles. We presented the EAAD project at two press conferences: - Budapest Satellite Meeting of the 8th Congress of the International Society of

Behavioural Medicine, - National Congress of the Hungarian Psychiatric Association. We also produced some own information materials on depression and suicide, which can be found on the web-site. We prepared a public web-site, and also information leaflets for teachers, students and also about crisis hotlines. WP 6: Intervention level ‘Cooperation with GPs’ Due to the Hungarian medical financing system, which much differs to the German one, the role of the GP's in the treatment of depression is not so essential in Hun-gary, although their recognizing function should have the same importance. That is

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Country Reports of the EAAD network: Hungary

why this part of the campaign has a great importance in Hungary. For this reason we plan to combine the training of GP-s also with a meeting and communication with the local psychiatrists involved in the campaign. On the other hand we aim to strengthen the - surprisingly poor - communication with all the other "gatekeepers" in the EAAD campaign, and have a local EAAD network. We translated and adapted the EAAD training course presentation for GP-s, and recruited trainers and lecturers for the training course. We will organise it in the middle of April, preceding the local public opening event. According to our goals above the program for this training workshop will include a common opening introduction of the EAAD campaign for participants of all intervention levels: GPs, psychiatrists, nurses, social workers, and community fa-cilitators. Next GP-s, teachers, nurses, social workers, etc. will go for separate paral-lel workshops. After their separate training we will have a common round table dis-cussion where all participants can share their ideas and build their relationships. Course for the GP-s will be a part of their Continuous Medical Education. Participants of this first training workshop could be future trainers, as well. WP 7: Intervention level ‘Community facilitators’ First we defined the target groups regarding the facilitators to aim the project at. These are priests, policemen, teachers, pharmacists, social workers, district nurses, librarians and civil associations living and working in the region of Szolnok. The role of civil associations is very important locally, because they disseminate information and organize public events for people living in underprivileged areas. We've con-tacted the representatives of these groups and agreed on the trainings. We planned different modules of training concepts for the different groups, recruited the appropri-ate trainers and lecturers. Major representatives of these target groups will be invited for the first training workshop (see GPs) right before the opening events for the gen-eral public. These participants will be future trainers of further training courses in their own intervention level. The EAAD web-site will have specific modules for this target groups as well. WP 8: Intervention level ‘High risk groups, self-help’ According to the main concept of the project we defined the most threatened high-risk groups in Hungary, first of all including adolescents, adolescents not attending school, mother's on maternity leave, battered women, unemployed and the elderly. An action plan was developed, stating the sites, materials, and methods with which we can reach these groups. We took the first steps to contact the facilitators who have access to these groups, e.g. agreed with teachers as to disseminating emer-gency cards in schools. Regarding the old population we have a cooperation with the National Institute for Family and Social Policy so as to involve social workers working in this field and to contact with the elderly care system. We put important information for these high-risk groups on our web site such as treatment possibilities, contact persons and so on. We established a crisis hotline for them. The dissemination of emergency cards will begin together with all other mate-rials. WP 9: Evaluation of EAAD We plan to use the following evaluation indicators: suicide rate, number of suicide attempts, number of visits to GP due to depressive symptoms or suicidal problems, evaluation of suicide and depression related attitudes, number of telephone calls to

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local crisis hot-line. A telephone interview, to assess GP and population attitudes is under development. Our selected catchment areas: - intervention: Szolnok region, - control region: Cegléd region We work together with different institutions to collect the datas such as Central Statis-tical Office, Szolnok County Hospital, Szolnok County Out-patient Service, Cegléd City Hospital, Family Practice Institution, Crisis Hot-lines (telephone emergency ser-vices). At the moment we have background information on the basis of the national repre-sentative health survey: Hungarostudy 2002 and suicide rate data from the Central Statistics Office. Baseline data have been collected for the intervention and control region. For assessment of baseline date we have used the following instruments: Beck Depression Inventory, self-reported rate of suicide thoughts and attempts, Ill-ness Intrusiveness Rating Scale, WHO-5 Well Being Index.. We will have a follow-up of this questionnaire screening with the same instruments, and with additional ones, such as the Beck Inventory for Suicidal Ideation.

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Country Reports of the EAAD network: Iceland

ICELAND

DIRECTORATE OF HEALTH WP 2: Management of local campaign / Establishment of local network An Action Plan and Budget have been defined. As our campaign was initiated al-ready in 2003 we are still working according to the plan made then but with revisions implemented according to EAAD requirements. Högni Óskarsson is the Regional Co-Ordinator with Salbjörg Bjarnadóttir being re-sponsible for implementations. There are eight members on the project team, each with own responsibilities. The Minister of Health in Iceland is the patron of the campaign. As we started in 2003 we had guaranteed funding from several sources, mostly pri-vate, one for three years, others for one year. A few of those in the latter category have continued their sponsorship through 2004 and some will continue in 2005. In late 2004 a new sponsor came on board. We have also received support in the form of lowered advertisement costs WP 5: Intervention level ‘General Public’ An opening event has been held. We have had a press conference and multiple appearances in the news, in special report sections and shows on radio, TV and in newspapers. Furthermore we have had a series of educational articles published in newspapers. We have had a whole-page ad in the largest newspaper on the Mental Health Day, October 10th. We have negotiated with two widely accessed webpages to have a banner advertis-ing the EAAD campaign and a brief questionnaire intended to increase depression awareness and knowledge of where professional help is to be found. We have a contract with the largest cinema theatre chain in Iceland to run our ads in all their theatres. EAAD posters and pamphlets have been translated and distributed very widely, in the healthcare system, schools, social services, churches etc. Video tapes have been dubbed and distributed in almost all healthcare stations in Iceland and in vari-ous other institutions. We have our own website with EAAD material as well as our own presentations. We have special booklets, Lifeline cards, own posters and postcards. WP 6: Intervention level ‘Cooperation with GPs’ Meetings have been held, describing aims and methods as well as eliciting sugges-tions. We did not assess specifically the needs of GP in Iceland. We have relied on the EAAD modules in an adapted form and have as well developed our own modu-les. We have a group of six professionals from our Project Team who alternate run-ning the workshops. We usually do the workshops in groups of two or three, depen-ding upon the size of the audience. We have covered 50 of the 53 healthcare centers in Iceland and professional staff in the remaining three except GPs. This has been completed in 2003 and 2004 From Jan 1st to April 1st 2004: 4 training courses for GPs. From April 1st to December 31st 2004: 13 training courses for GPs.

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Education material such as posters, pamphlets, videotapes for patients and staff have been distributed. In terms of numbers we have only the numbers of total distri-bution, not the numbers specifically distributed through the general healthcare sys-tem: - Pamphlets: 14,000 - Posters (German posters with translation): 300 of each, a total of 1,200 - WHO-5: 10,000 - Videotapes for professional staff: 200 - Videotapes for patients and families: 500 - Emergency cards: 20,000 - New posters, four editions: 1,500 of each, total of 6,000 - Life Compass: 15,000 WP 7: Intervention level ‘Community facilitators’ Our workshops in healthcare centers have always included all professional staff in addition to GPs, as well as police, clergy and others We have held specially tailored workshops for school counsellors, home visiting nurses and nursing aids at the Social Services in Reykjavík and Akureyri (the second largest town). We have had workshops for youth counsellors, staff at the largest alcohol treatment facility, for school counsellors and teachers in several undergraduate schools (stu-dent age 16-20), for professional and voluntary staff at the Red Cross hotline. That group also receives regular supervision from our project group. From January 1st to April 1st : 2 training courses, both the regular and a briefer version; also educational meetings for above groups and lectures. From April 15th to December 31st: 31 training courses, both the regular and a briefer version; also educational meetings for above groups and lectures. WP 8: Intervention level ‘High risk groups, self-help’ Formal contacts and collaboration on projects with self-help groups of grieving and loss, with a newly formed organization of mental patients which emphasizes self-help and de-stigmatization (Hugarafl, Mental Power), with an association of mental pa-tients and family members (Gedhjalp, Mental Assistance). A hotline was launched in January 2004. The expected number of calls per month has increased tenfold during the year, in November the calls were over 1.500, De-cember has not been counted yet but holiday call traffic was very intense. This has by far exceeded the highest predictions of calls. The training of staff and supervision is in part supported by us. High-risk groups have been informed by contacting and educating those in contact with high-risk groups, such as young addicts, people in geriatric homes, gays and lesbians, adolescents in foster homes or custodial care. All suicide attempters who need medical assistance are offered counselling and pro-fessional support. Our emergency cards have been widely distributed. WP 9: Evaluation of EAAD We have proposed to assess several outcome indicators pre-and post campaign. The indicators are suicide attempts, completed suicides, use of antidepressants and anxiolytics, pattern of follow-up after diagnosis and initiation of treatment of depres-sion by GPs and psychiatrists.

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Country Reports of the EAAD network: Iceland

Due to ethical problems we are unable to have a control group in Iceland. The Directorate of Healthcare in Iceland is ultimately responsible for data collection. Baseline for suicides completed. Baseline numbers for medication use available. Suicide attempts in 2004 in progress. Baseline suicide attempts still in preparation, but documented already in medical charts. Treatment pattern assessment still in preparation..

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IRELAND

NATIONAL SUICIDE RESEARCH FOUNDATION WP 2: Management of local campaign / Establishment of local network Regional coordinator: The recruitment and appointment of a regional coordinator oc-curred in June 2004. The title of the position was decided upon as Research Fellow. Ms Mary Moore-Corry started 1st September and is working on a part-time basis of four days a week having started on 2 days for Sept-Nov, on the four-level community based intervention study. The reason for this change was due to the successful ap-plication to the Health Research Board (HRB) and the increasing work volume of the project. Target groups: During the baseline period of September to December 2004, prepara-tions were made by first defining target groups. Decisions on target groups were taken in collaboration with the Southern Health Board. The final definition of target groups was addressed at the meeting with the Advisory Panel (9th December) and shall be finalised by the end of February (24th) at the next Advisory Panel meeting and GP Launch. Local partners: The recruitment of local partners started during the preparation months of June, July and August 2004 and during the baseline period (Sept-Dec). By the end of the baseline period, all partners were actively involved. Advisory Panel: The Advisory Panel was brought together during the preparation and baseline period. The first meeting was held 9th December and the next shall coincide with the GP Launch (24th February). The members of the Advisory Panel hold the following areas: Health Promotion Officer, Psychiatrist: Dept. of Pharmacol-ogy/Therapeutics, General Practitioner/Head of the Department of General Practice, General Practitioner: The Park Family Practice & Postgraduate training, Director ICGP, Postgraduate Resource Centre, Head of the Department of Applied Psychol-ogy, Clinical psychologist: Cork University Hospital, Geriatric specialist, Head of the Department of Epidemiology & Public Health, Samaritans, Lord Mayor /Assist. Lord Mayor, Minister for Health and Children, Juvenile Liaison Officer: Togher, Diocese of Cork: Catholic Church, Diocese of Cork: Church of Ireland, Retired Head of Colaiste an Spioraid Naoimh Bishopstown, President Cork Chamber of Commerce, Research and Resource Officer, Irish Association of Suicidology, Regional Co-ordinator of Planning and Development, Directorate of Mental Health, Planning and Development of Mental Health, Director of Prison Healthcare, Education committee, Cork Youth association Ongoing public relation activities: We have our GP Launch provisionally booked for 24th February and the Official General Public Launch for the 24th March. Along with other PR aspects such as Press Releases, Radio programmes, newspaper articles (e.g. Medicine Weekly, January 12), Journal articles and internet articles, we are working in collaboration with the Southern Health Board Media Strategy Officer, Ms Angie O’ Brien and the Southern Health Board Mental Health Resource Officer, Ms Brenda Crowley for all public relation activities.

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Country Reports of the EAAD network: Ireland

Recruitment and training of lecturers: The recruitment of trainers shall be continuous over the intervention period as potential Implementers hear of the study or take part in the training and desire to be involved. Any potential Implementer shall have to un-dergo screening and fit a profile, which has been devised under recommendation by Dr Arensman and Ms Moore-Corry. Application for additional funds: The application for the Health Research Board Ire-land to obtain additional funds has been successful. Over the next two weeks we will evaluate and plan our dissemination of the additional funding. We made an additional application through the Irish College of General Practitioners and we propose to ap-ply for further funding with the Ireland funds for our media strategy. Further public events: We have our GP Launch provisionally booked for 24th Febru-ary and the Official General Public Launch for the 24th March. We are working in col-laboration with the Southern Health Board Media Strategy Officer, Ms Angie O’ Brien and the Southern Health Board Mental Health Resource Officer, Ms Brenda Crowley for all public events. Basic structure, special work groups: The definitions of a basic structure and estab-lishment of special workgroups were finalised at the Advisory Panel’s first meeting (9th December) (See annex1). Regional patron: We await a response from the President of Ireland, Mary McAleese. Opening event: There shall be two main opening events planned for GPs on the 24th February and the 24th March for the General Public. Preparations for both opening events are currently underway. Informed group: This group is made up of members of the community with specialist roles. Their experience and knowledge of their community is gained less directly than the Advisory Panel. This group shall grow in number throughout the baseline and intervention period. They were informed about the Intervention Study during the baseline period and shall be updated every six months. They are also asked for sup-port and advice. WP 5: Intervention level ‘General Public’ Adaptation of information material: The adaptation of information material such as the defining content and graphical work shall be finalised by the start of February. This work is in collaboration with the Southern Health Board. Adaptation videos/cinema spots: The adaptation of videotapes/cinema spots shall depend upon sponsoring and the application, which shall be submitted by the end of January to the Ireland Funds. We will also be working with the Media Strategy Officer of the Southern Health Board to collaborate on the development of a cinema spot. Dr Arensman and Ms Moore-Corry to increase the likelihood of a successful campaign have investigated materials and previous research of media campaigns. Videos and DVDs that are already available are being assessed for adaptation to this study. Production of posters, flyers etc.: We will finalise the work with regard to posters, fly-ers, and brochures by the end of January and shall be in production during February

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2005. The work involved in preparing videotapes and cinema spots will be done in collaboration with the Southern Health Board (see previous point) Public information events: Organisation of public information events, which would lead to a type of support/information group. The number of events will depend on feedback of community facilitators, potentially 1 every month; starting February 2005. Certain public information events shall be For example: A type of depression forum and panic attacks forum is planned to work in conjunction with workshops (1 Day). An Deliberate Self Harm and Suicide aware-ness workshop for adult vocational learning students and teachers (10 February). Dissemination of information material: From September 2004 there has been a dis-semination of information about the intervention study itself. The material (posters, leaflets, videos) via GP practices, hospitals, public institutions, and pharmacies will be distributed by the end of February and over the intervention period. The number of materials to be distributed shall dependent upon the individual service use of the various organisations. Cinema spot from Jun-Dec 2005: The cinema spots shall depend upon sponsoring and the application, which shall be submitted by the end of January to the Ireland Funds. We will also be working with the Media Strategy Officer of the Southern Health Board to collaborate on the development of a cinema spot. Dr Arensman and Ms Moore-Corry to increase the likelihood of a successful campaign have investiga-ted materials and previous research of media campaigns. Press releases from Jan 2005: There will be a continuous delivery of press releases and a planned implementation/adjustment of media guidelines in the intervention re-gion starting 2005. Dr Arensman has been invited on to the writers board of Medicine Weekly (13 January) and will be advising about such items as the media and mental health over the coming years. The first press release shall be the end of January. We plan to allow these to be available through our Foundations website and potentially the EAAD webpage. WP 6: Intervention level ‘Cooperation with GPs’ Accreditation for GP workshops & GP Multiplier: We are awaiting confirmation of ac-creditation for the specialist workshops for GPs & GP Implementers with the Irish College of General Practitioners, which should be by the middle of January 2005. 10 GP trainings from Jan 2005: The training of GPs and other relevant multipliers shall comprise of 10 training courses. We will start training GPs and other relevant multipliers from February/March onwards, after completion of the baseline assess-ment among GPs and the General Public. Videos + structured patient files from Jan 2005: Distribution of information videos and structured patient files following training sessions and information nights. Interested GPs shall receive training on files and an information video. The quantity of materials to be distributed will depend upon the level of demand. The study is awaiting the findings of a search for relevant Irish or UK produced DVDs and videos already available rather than going into the production costs of new mate-rials unnecessarily.

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Information for GPs from Oct 2004: Communications / meetings to inform GPs about the programme: Depending on need, 1-3 meetings will be starting in October 2004 with working part-ners in General Practice and with the representatives from the same area on the Ad-visory Panel. To the general population of GPs in the intervention region, a number of communications and mediums shall be used 1. Information via questionnaires requesting interest for the workshops as well as training workshops 2. There will also be a focus group of potential trainers requesting issues to be addressed in training 3. Articles in relevant GP magazines and papers 4. CME tutors Hotline: A GP Hotline shall be set up for the duration of the intervention period. This hotline is offered over two days a week for advice on patients or information requests etc.. This hotline shall provide an advice service to GPs who have taken part in the training or GP implementers & for practical purposes such as information requests. It shall comprise of the project co-ordinator & panel of advisors if expert advice is requi-red WP 7: Intervention level ‘Community facilitators’ Training of multipliers: Training of GPs & other relevant implementers will start after completion of the baseline assessment among GPs and the General Public. Informa-tion about attending the first specialist workshop is being disseminated at present along with train-the-trainer. Training of police from Jan 2005: It is planned to carry out 10 training courses for the police from January 2005. Along with the collaboration of the advisory panel and pri-marily the assistance with the representative on the Panel with the police force we shall be confirming dates. Training at request from Jan 2005: Training courses for groups which the advisory committee or community facilitators request; from January 2005 (No. of courses: de-pendent on need/requests). The study has received many requests for training from various organisations, some dates have been confirmed and others await confirma-tion. Evaluation of training courses from Jan 2005: The evaluation of both the training and the train-the-trainer courses will start during January-May 2005 (dependent on com-pletion of course). A suitable method of evaluation shall be tested on the first 10 training courses given. This pilot shall subsequently be reviewed and revised if ne-cessary. Training of priests from Jan 2005: It is planned to carry out 10 training courses for priests from January 2005. Along with the collaboration of the Advisory Panel and primarily the assistance with the representatives on the Panel from the two main churches in the intervention region, we shall be confirming dates.

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Training of volunteers from Jan 2005: It is planned to carry out 10 training courses for voluntary organisations from January 2005. Along with the collaboration of the Advi-sory Panel and primarily the assistance with the representatives on the Panel from the main voluntary organisations and charities in the intervention region, we shall be confirming dates. Train-the-trainer courses from Jan 2005: It is planned to carry out 5-10 train-the-trainer courses; i.e. 1-2 depending on number of interested parties from community representatives including school teachers, geriatric nurses and caregivers, priests, police and voluntary organisations. This shall start from January 2005, following the completion of initial general training courses. Although we have had requests for placements and have confirmed dates for train-the-trainer courses we are awaiting until we have finalised our screening procedure and profile of suitable candidates. Training of geriatric nurses from Jan 2005: It is planned to carry out 10 training courses for geriatric nurses and caregivers from January 2005. Along with the colla-boration of the Advisory Panel and primarily the assistance of the representative on the Panel from the main geriatric unit in the intervention, we will confirm dates. Training of schoolteachers from Jan 2005: It is planned to carry out 10 training courses for school teachers from January 2005. Along with the collaboration of the Advisory Panel and the Southern Health Board and primarily the assistance of the representative on the Panel and the Informed Group from teacher’s organisations in the intervention region, we will confirm dates. WP 8: Intervention level ‘High risk groups, self-help’ Emergency cards: Dissemination of emergency cards relevant contact details. For DSH patients in one of the A&E Wards of a General Hospital, an Emergency card is already available. A suicide Helpline (6-10 pm) has available in the Southern Health Board for the past 2 years. We are exploring possibilities to expand the avai-lability of the helpline, updating the existing Emergency card and extending it to all hospitals and GP clinics. Initiation/support of self-help from Jan 2005 : Initiation and / or support of self-help activities: 1. Initiation of self-help groups (number depending on need) 2. Support of existing self-help activities and essential support for newly founded groups This work will be carried out in collaboration with the Southern Health Board and will start in January, following completion of the baseline assessment of GPs and the General Public. For example, there are plans to set up a Panic Attack/Anxiety open forum. Support of Hotline: A Hotline which offers advice on depression, deliberate self harm and suicide is available in the Southern Health Board (Intervention region). This initiative shall be supported by such methods as a radio media campaign targe-ted at young people.

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WP 9: Evaluation of EAAD Evaluation of training seminars: This involves the evaluation of training seminars for GPs and multipliers and the development of instruments to do so (September). Deve-lopment of instruments for the 1st seminars for GPs are prepared. These shall be piloted on the first 5 and shall be implemented once any revisions are made if nee-ded. Monitoring of deliberate self harm: Information on all hospital treated cases of DSH is being obtained through the National parasuicide Registry and will be available mid way through the following year (information on DSH cases in GP practice will be monitored also). Ethical approval: Ethical approval was obtained form the Ethics Committee of the Cork Teaching Hospitals on 5th October 2004. Intervention / control area: Our intervention region is confirmed. One of the compari-son regions (Mid Western Health Board) has confirmed involvement and we are cur-rently discussing this issue with the Programme Managers of the South Eastern Health Board as a second comparison region. Assessment of prescription profiles – baseline: Assessment of changes in prescrip-tion profiles shall take place during the baseline data collection time frame of Jan 2004 - Dec 2004 and shall be completed February 2005. A complete baseline analy-sis shall be completed using IMS and GMS data, GP prescription rates and pharma-ceutical companies. Assessment of training effects among Community Facilitators –baseline: Assessment of training effects among community facilitators shall took place during the baseline period (Jan 2004 - Dec 2004) and will be completed by the end of February 2005. This covers the available training and it's success among community facilitators on a few different levels. This will be completed with the aid of the National Suicide Re-view Group's Research Officers. Assessment of training effects among GPs –baseline: Assessment of training effects among GPs took place during the baseline period (Nov 2004 - Dec 2004) and will be completed February 2005. This covers the available training and it's success among GPs on a few different levels. This shall be completed with the aid of our Manage-ment Group members involved in General Practice. Changes in public attitudes – baseline: This involves the assessment of changes in knowledge and attitudes of the general public. The pilot run of the questionnaire is reaching completion. The successful collection of data allows us to continue with our questionnaire however we are awaiting the agreement of European partners on core variable approach to items. Assessment of suicide attempts / DSH – baseline: The National Parasuicide Registry shall provide information on the suicide attempts/deliberate self harm behaviour in 2004, this information has been compiled and shall be available at the end of 2005.

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Measurement of completed suicides – baseline: Baseline information on completed suicides has been collected by the CSO (Central Statistics Office) however the report and data release is pending any court cases inquests. Assessment of training effects among Community Facilitators- intervention: Interven-tion data collection will take place during Jan 2005 - Dec 2006 for the assessment of training effects among community facilitators. A pilot run shall be completed to as-sess the first 10 training sessions and shall be introduced across all training sessions once the results are successful or items in the assessment shall be suitably revised. Assessment of prescription profiles – intervention: Intervention data collection will be carried out from Jan 2005 - Dec 2006 for the assessment of changes in prescription profiles. A complete baseline analysis shall be completed using IMS and GMS data, GP prescription rates and pharmaceutical companies. Assessment of training effects among GPs- intervention: Intervention data collection will be carried out from Jan 2005 - Dec 2006 for the assessment of training effects among GPs. A pilot run shall be completed to assessment the first 5 training ses-sions and shall be introduced across all training sessions once the results are suc-cessful or items in the assessment shall be suitably revised. Measurement of completed suicides – intervention: Intervention data collection will be carried out from Jan 2005 - Dec 2006 for the Measurement of completed suicides The Central Statistics Office is currently collecting any data on completed suicides. Changes in public attitudes – intervention: The assessment of changes in knowledge and attitudes of the general public shall begin after the intervention period has been completed. Assessment of suicide attempts / DSH – Intervention: The National Parasuicide Reg-ister is presenting collecting information on the suicide attempts/deliberate self harm behaviour in the intervention region and comparison regions. Annex 1: Project framework – structure Cork Ireland

EAAD

Ireland(Cork)

Management Group

NSRF SouthernHealth Board

Trainees

Trainers

Trainees

Acute GroupCommunity Facilitators General PublicGeneral

Pracitioners

Trainers

Informed Group

MWHB & (SEHB)

Advisory panel

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Country Reports of the EAAD network: Italy

ITALY

GESUNDHEITSASSESSORAT DER AUTONOMEN PROVINZ BOZEN WP 2: Management of local campaign / Establishment of local network Establishment of the basic organisational structure on regional level: A regional steering team was established in March 2004, consisting of four local coordinators (one for each of the four local public health services into which the territory is divided) and the representatives of the central public health directory. In April 2004, four inter-disciplinary subgroups were founded (comprising psychiatrists, psychologist, self-help-group representatives, GPs) and have been working ever since in order to deal with the four intervention levels. In each of the subgroups there is one of the four co-ordinators present, whereas the responsible of each subgroup was elected among the other members. Subsequently an action plan including time schedule has been developed, defining as kick-off day April, 1st, 2005. Up to now, an elementary, not a comprehensive, budget plan was defined and accepted by the directory (still to be enlarged and diversified). Involvement of regional patron: Two patrons of as well regional, national and interna-tional reputation could be won for the campaign: Reinhold Messner (mountain-climber, EU-politician), Antonella Bellutti (sports) Applications for further funding and sponsorship: Up to now we have been dealing with sponsors only in local action programs. According to the agreement made in Munich, 24/25/01/05, there is no big single sponsor existing nor planned. We are thinking about contacting other public institutions on regional and national level (e.g. National Ministry for Public Education). Recruitment of representatives of the local medical helath care system: Everybody in the steering-team is member of the medical health care system. The whole campaign is run as a public health system’s project. Sometimes, this is a difficulty indeed, when it comes to do two jobs at the same time: running the project without neglecting eve-ryday’s duty and emergency tasks. WP 5: Intervention level ‘General Public’ Organisation of public events including opening event: On Oct., 9th 2004 (worldwide celebration of psychic health activities), a first regional meeting and public activities concerning depression and suicide were held. In this occasion, we invited Tim Pfeif-fer as official representative of the Munich steering team who announced the immi-nent start of the regional EAAD campaign. Talking and informing about self-help groups and cooperation between experts and GPs were other subjects. Several workshops were run to present different paramedical ways of therapeutic aid. A great opening event will take place this year at Bozen on April, 1st, including an official inaugural celebration with representatives of the major groups of social impor-tance, the patrons, a written greeting sent from the Italian State President Carlo Aze-glio Ciampi, representatives of the regional government. Afterwards there will be a series of magistral lectures held by renowned experts in the field of depression and

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suicide, both in Italian and German language. The same day, there will also be the opening celebration of an art exposition, dealing with the argument, which will be ex-hibited first in the general hospital of Bozen to stay there for two months and then pass to the other three main hospitals of the region. Establishment of press and media relations: A press conference is foreseen for March, 31st; 2005, i.e. the day before the Opening event. Good relationships are ex-isting towards any sector of media. The official media expert of the public health di-rectory will be instructed about our campaign and contacted as a consultant. Up to now we have not planned cinema spots yet. Adaptation, production and dissemination of EAAD information material: Posters (three motives: couple, young woman, old man) and one brochure of the official campaign material were adapted and translated. We are now waiting for the O.K. from Munich concerning the royalities. The printing of the material is foreseen for February 2005; the first exhibition of the larger posters is foreseen for April 2005 (to be repeated twice a year for the whole duration of the campaign); smaller ones will be sent to all public health ambulatories, to GPs and other public services. We are thinking about changing the motives in the further course of the campaign. Other species of information material (brochures, educational material of the ttt-seminairies) are about to be prepared, translated and printed in order to be distrib-uted later on (from the Inaugural Event on). Production of own information material: We renewed a brochure which had been de-veloped in South Tyrol before. Another guideline for health services operators and GPs, elaborated by an interdisciplinary work group of the Public Health Service of Bozen, is already in use and can be integrated into the campaign in a revised way. WP 6: Intervention level ‘Cooperation with GPs’ Networking activities: The regional association of GPS nominated a representative for the GPs’ working subgroup in order to stay informed about the development of the campaign and in order to be able to participate and introduce own suggestions. Preparation of training courses for GPs: Two ttt-seminaries have been run up to now, with the participation of several GPs (8 of the 30 participants). The concrete definition of instructive seminars for GPs (Who? When? Where?) will be made on Febr. 28 th., 2005. There are four seminars foreseen, one for each regional public health service area, to be realized within fall 2005. We are thinking about contacting the recently established Regional Academy for GPS’ Instruction in order to plan widerly spread didactic activities. Six of the ttt-attendants are psychiatrists and might run specific lectures, too. Information material for GPs: Among the “jury” (steering team and members of the sub-groups) the video tape did not find a sufficient appreciation. Structured patient files as well as files in order to evaluate the training sessions are still in discussion.

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Country Reports of the EAAD network: Italy

WP 7: Intervention level ‘Community facilitators’ As to ttt-seminaries, further interest has been expressed by public health service psychologists, and we shall try to organize at least one more ttt-seminary. We are also thinking about getting infant psychiatrists and infant psychotherapists “into the boat”, which may be interesting for other foreign partners, too. More specific informa-tion and didactic material may be necessary or to be developed. Specific target groups will be priests, teachers, pharmacists, geriatric and health care operators. The trainers and lecturers will be recruited from the 30 participants of the ttt-seminaries; they will use the EAAD-material, and there will be especially adaptations to meet the conditions of the ECM-system, valid for each professional group. Any training-team ought to be composed of at least one “psyche”-professional and a peer. The training courses for community facilitators are still in the planning phase. WP 8: Intervention level ‘High risk groups, self-help’ Support and initiation of self-help groups: Since a lot of years, there have been exist-ing two self-help-organisations in South-Tyrol. One main goal of the regional cam-paign is to intensify and spread wider their activities: A regionwide comprehensive list of self-help groups dealing with depression and suicide was made in summer 2004. As a consequence three more groups are planned or founded: - one Italian speaking group in Bozen was founded; - one organizing team for the foundation of Ladinian speaking self-help groups has

started its activities in the Ladinian area; - one new logistic platform for improved contact and communication between self-

help groups and public institutions was founded in Bozen, - a project for intensified psychohygienic didactical activies with parents of mentally

harmed persons is foreseen. Beside this there are group-activities within the public health services, run or to be run by the psychiatric services which we shall try to support and to make proliferate. Establishment of crisis hotline: There is no new crisis-hotline foreseen. But there are hotlines existing (one emergency-hotline for children only, two for everybody). Part of the action program is to get into contact with these services and to intensify commu-nication mutually. Special offers for high risk groups and persons after suicide attempt: No activities are planned except for evaluation activities. However, activities of this type are part of the obligatory work of the public psychiatric and psychologic services. Emergency cards: We do not plan to produce and disseminate emergency cards. WP 9: Evaluation of EAAD Actual state of evaluation activities: We are still waiting for the EAAD evaluation work group’s decisions concerning the official tools. We are interested in tools concerning teachers, priests, psychologists.

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We are in contact with Prof. Richter/Hamburg who is already acknowledged as offi-cial consultant of our campaign. There is a well circumscribed pool of four schools in the city of Sterzing, which takes part in a psychiatric prevention project and which could be evaluated under defined conditions. In cooperation with the regional center of pharmacologic statistics (part of the public health service) we shall elaborate data concerning the use of psychopharmacologic drugs and the respective changes during the campaign (comprising baseline and follow-up). It is to clarify up to which extent these data can be elaborated and broken down in a sociological dimension. We have been running suicide rates-statistics for several years and will continue sampling these data for the following years. As to suicide attempts we are still in phase of planning. Evaluation instruments: We are still using the suicide-questionnaire, which was de-veloped in South Tyrol about 10 years ago and revised several times by now. It is planned to introduce a new one. As to the community facilitators we shall use a ques-tionnaire elaborated by Prof. Richter. Possibly an integration with the EAAD ques-tionnaires (to be defined) could be realized. Psychopharmacological drugs: see above.

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Country Reports of the EAAD network: Portugal

PORTUGAL

DIRECÇÃO-GERAL DA SAÚDE, DIRECÇÃO DE SERVIÇOS DE PSIQUIATRIA E SAÚDE MENTAL WP 2: Management of local campaign / Establishment of local network A detailed project action plan is still under scrutiny. Nevertheless, a lot of work has been done in order to assure that EAAD will be the frontline for the Portuguese Fight-ing Depression Programme and articulated with the Life Style Programme, both in-cluded within the Health National Plan 2004-2010. The Fighting Depression Pro-gramme has the general aim of improving access to effective treatment for de-pressed patients through depression management improvement in primary care liaised with specialized mental health care and population education campaign. A general chronogram for EAAD Portugal is defined until the end of 2008. A financial budget for the EAAD is still not defined though some financing proposals are ongo-ing. Because the EAAD is a part of a broader programme there has been some structural organizational difficulties, namely lack of financial autonomy and clear role definitions undermining efficiency. This diagnosis done, solutions are underway. Also, the actual regions where the project will take place are not defined – probably Lisboa and Alentejo – and therefore nor is the regional co-ordinator or a regional pa-tron. What is being foreseen is the possibility of engaging both a rural and a urban setting within the same intervention and control regions. There will be three presentations on national data on depression until the 31st Octo-ber aimed at the regional leaders namely health centre heads and GP of the future selected regions. Preparatory meetings are taking place for some time now. Responsibilities and tasks due to local project teams are defined. Until the 31st of October 2005 all the issues pertaining to the establishment of local networks will have to be completed. WP 5: Intervention level ‘General Public’ Adaptation of information material, translation and production of own material is start-ing and expected to be completed until the 31st October. Afterwards, opening events until the end of the year and media links will be undertaken and maintained. WP 6: Intervention level ‘Cooperation with GPs’ Programmes, trainers and budgets for training courses are defined. GP training needs are fully assessed and defined at the national lever per region. Training and dissemination of materials will not start before the end of the year 2005. WP 7: Intervention level ‘Community facilitators’ No intervention anticipated at this point. WP 8: Intervention level ‘High risk groups, self-help’ No intervention anticipated at this point.

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WP 9: Evaluation of EAAD EAAD core general evaluation items and instruments will be adopted as much as possible:

1) survey for the general population on depression and attitudes on suicidality 2) assessment of suicide attempts (DSH will be far more difficult to implement) 3) assessment of immediate training effects on GP 4) assessment of GP knowledge, beliefs and attitudes on depression and suici-

dality 5) assessment of GP depression management processes

a. depression prevalence in primary care (national baseline, gold standard SCAN 22%);

b. GP depression recognition rate (national baseline, 45%); c. GP depression appropriate treatment prevalence (national baseline;

4%) 6) evaluation of prescription profiles is under study namely DDD´s. Direct evalua-

tion on clinical notes seems more probable even if on a sample basis. Instruments will be translated and data collection and analysis will be done by the Clínica Universitária de Psiquiatria e Saúde Mental, Faculdade de Ciências Médicas de Lisboa. Financial budget is undefined.

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Country Reports of the EAAD network: Scotland

SCOTLAND

UNIVERSITY OF EDINBURGH, DEPARTMENT OF COMMUNITY HEALTH SCIENCES, GENERAL PRACTICE SECTION WP 2: Management of local campaign / Establishment of local network Engagement of local partners: From August 2004 until December 2004 local meet-ings were held with senior members of Lothian Health to establish the feasibility of Lothian becoming involved as an EAAD regional site. In December 2004, the English speaking partners in EAAD (from England and Ireland) met in Edinburgh with EAAD project leads from Germany. The outcome of this meeting was that Lothian moved from the feasibility phase to a ‘planning implementation’ phase. From Jan 2005 on-wards the local campaign intends to increase in intensity, beginning with increasing the number and range of local partners. Regional project team: The original ‘feasibility’ planning group will form the core of the project team but will endeavour to broaden its membership, beyond Lothian Health, over the coming months. Links with other initiatives: One of the main criteria for Lothian health becoming in-volved with EAAD is that it should be done in conjunction with other local initiatives. The EAAD project lead (Margaret Maxwell) and other members of the project and evaluation teams have links to other national programmes in Scotland for mental health awareness and the management of depression. Specifically, links have been made with those involved in a national initiative ‘Doing Well by People with Depres-sion’, the National Strategy for Suicide Prevention, the National Programme for Men-tal health and Well-being, ‘See Me’ a national anti-stigma campaign, ‘Breathing Space’ a national helpline for mental health, ‘Depression in Teenagers’ interactive materials developed by the Young People’s Unit within Lothian Primary Care Trust, and Lothian Psychological Therapies Review Group. Regional Patron: Subject to final management approval (due in February 2005), the regional patron will be NHS Lothian. Additional funding: NHS Lothian plans to embed EAAD activities within planned changes for mental health services in Lothian. This will ensure local input of re-sources for training. The Scottish Executive have also indicated that they are willing to input additional funding to support the establishment of EAAD in Lothian As a level 3 partner in EAAD I, Scotland has made good progress and is on target to become a level 1 partner in EAAD II. Contribution to overall project co-ordination: Scotland has made a contribution to the EAAD website. Scotland has attended two project meetings in Germany to learn from other regions and to share knowledge and materials with other regional partners. Margaret Maxwell has also endeavoured to promote EAAD in other potential sites across Scotland, particularly rural sites, and to promote EAAD within the Scottish Ex-ecutive, and in academic circles. A paper describing EAAD and its activities has been

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written for the Healthcare Counselling and Psychotherapy Journal (in press for April 2005). Overall, Scotland considers that during the remaining months of EAAD I (until October 2005) it will have progressed sufficiently in the above activities to enter EAAD II as a level 1 partner and implement the full range of EAAD activities. WP 5: Intervention level ‘General Public’ A meeting was held in Edinburgh in December 2004 between the English speaking EAAD partners to discuss sharing of information and resources, including collabora-tion on the production of EAAD campaign materials in English. This will help share costs and prevent duplication of effort. A further meeting of English speaking partners is planned for May 2005. This will fo-cus more specifically on the production of materials. A paper has been submitted to the Healthcare Counselling and Psychotherapy Jour-nal to promote EAAD among professional groups. WP 6: Intervention level ‘Cooperation with GPs’ A GP representative in Lothian has been invited to the local project team meetings. This GP has experience in mental health awareness training for primary care profes-sionals. WP 7: Intervention level ‘Community facilitators’ Links have been made with those involved in ‘training the trainers’ for mental health first aid and also those involved in delivering ASIST training for the assessment of suicide risk. These resources will provide a useful starting point for providing training courses to target groups. Lothian has already begun to identify some of the target groups for training and to identify sources of potential trainers and lecturers. WP 8: Intervention level ‘High risk groups, self-help’ Links have been made with a new national crisis hotline – it is hoped that this re-source can act as a contact point on posters and leaflets. WP 9: Evaluation of EAAD Funding for evaluation: Negotiations are underway with Lothian health and the Scot-tish executive for each to match support funding for this project and its evaluation. The amount of funding to be secured should be finalised by April 2005. Information: Discussions have started with the National Suicide Prevention Strategy Information Team to discuss the need of the project. The availability of other national databases has been established via the Information and Statistics Division of the Na-tional Health Service in Scotland. Therefore data relating to completed suicides, sui-cidal acts and prescribing patterns should be readily available within Scotland. The current national public opinion survey will provide baseline data for future compari-son. Decisions remain as to the inclusion of a GP attitude/knowledge survey.

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Country Reports of the EAAD network: Scotland

Evaluation team: A local evaluation team has been established involving several sen-ior academics from the University of Edinburgh. Control site: A potential control site is still to be identified. This will be attended to once the involvement of Lothian Health has been ratified at senior management level.

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SLOVENIA

INSTITUT ZA VAROVANJE ZDRAVJA RS WP 2: Management of local campaign / Establishment of local network Management of Slovene EAAD campaign is proceeding well. We have defined the project action plan, the budget plan and the time schedule of our activities. Slovene EAAD project has been trying to achieve results using the EAAD 4 – level approach in three selected Slovene regions: Celje region, Koroska region and Pomurje region. Celje, Koroska and Pomurje are the most suicide affected Slovene regions along with Maribor region, which is the control region of the Slovene EAAD project. There are approximately 497.000 inhabitants (in total) living in the three case regions of Celje (300.000), Koroska (74.000) and Pomurje (123.000). We have established an effective working system with a very clear structure of re-sponsibilities and tasks. The project is managed and administrated at IVZ RS (Insti-tute of Public Health of the Republic of Slovenia) by the IVZ RS project team: Dr. An-drej Marusic (project leader and coordinator), Saska Roskar, Maja Zorko, Milan Mir-janic and Teja Fattori. We have established the project local network: we have made an agreement of col-laboration with the Regional Health Care centres in the three case regions of Celje, Koroska and Pomurje. The local project coordinators are: Dr. Nusa Konec – Juricic (Celje region), Evgen Janet (Koroska region) and Teodora Petras (Pomurje region). We are still discussing the involvement of a potential regional patron and we are try-ing to establish a multilevel collaboration with selected sponsors and enterprises. We have also applied to Slovene Ministry of Health for granting EAAD project. WP 5: Intervention level ‘General Public’ The Slovene EAAD opening event took place on 10. September 2004 (World Suicide Prevention Day) on which we organised a press conference and a lecture. Eight journalists participated to the press conference and another seven journalists have received a press release. We have also organised a lecture on depression and sui-cidal behaviour. At the end of the lecture we have distributed informational material to the listeners (approximately 30 persons). Another press conference regarding depression and mental health took place on World Mental Health Day (10. October 2004). Seven journalists participated to the press conference and another eight journalists have received a press release. Our speaker participated in January 2005 to a TV show on the Slovene national TV station. The same speaker will participate to another TV show on the same TV sta-tion in February 2005. The show has been already recorded. We are planning further similar events in collaboration with the Slovene national TV station for the near fu-ture. We have made the time schedule for the general public awareness campaign. We have decided to perform the biggest part of our communication effort from March to

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Country Reports of the EAAD network: Slovenia

May 2005. In that period we will deliver the majority of the materials we have planned to produce. Until now we have already produced an EAAD informational leaflet (30.000 pieces) that will be delivered in the case regions via a very popular Slovene newspaper named ‘Nedeljski dnevnik’, which has a big share of readers in these re-gions (on average 1/3 of the population). The leaflet has a clear reference to the EAAD project (visual image, logo, reference to the European Commission). We have planned to prepare the other materials (50 posters, 13.000 postcards, cinema spot) to be ready for dissemination from March to May 2005. We have also planned to or-ganise a press conference or a public event at the beginning of our spring general public awareness campaign. We have planned to translate the EAAD movie/cinema spot. We have planned to perform this task in the next few months. WP 6: Intervention level ‘Cooperation with GPs’ We have prepared a detailed plan for the cooperation with GPs. In this task we were assisted by the Regional Health Care centres. We have assessed the needs and in-terest of GPs regarding educational programmes about depression and suicide du-ring the Slovene Gotland study, which was a project of cooperation with GPs that we managed before EAAD project. In this project we have assessed that GPs are quite interested in learning more about depression and mental health related topics, but also that they face big difficulties in joining such educational programmes and lectu-res because of long travels and lack of available time. In addition to that we must consider the big number of educational and training programmes that are constantly submitted to GPs. Because of all these arguments we have planned to perform the lectures/training for GPs at different sites in order to bring the educational pro-gramme closer to GPs. We have distributed 400 educational booklets and 7000 leaflets about suicide, de-pression and stress to primary care professionals via Regional Health Care centres in November 2004. This material has not been directly related to EAAD logo or visual image. We have also produced an informational booklet (1.500 pieces) about depression for patients and their relatives and/or friends. The material has been designed and adap-ted according to EAAD project (visual image, logo, reference to the European Com-mission). The material will be distributed/donated to GPs during the educatio-nal/training sessions. The GPs will later distribute these booklets to patients. We have already developed training modules and recruited trainers and lecturers for the GPs educational programme . The lecturers and/or trainers are Dr. Andrej Maru-sic, Dr. Mojca Z. Dernovsek, Dr. Rok Tavcar and Dr. Urban Groleger. We contacted GPs in the Pomurje region and performed a one-day educational pro-gramme in Murska Sobota (two short lectures followed by a longer workshop). We have planned to organise at least 6 such one-day training sessions in Koroska and Celje region. We expect to reach and educate about 150 to 200 GPs via this educati-onal programme.

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WP 7: Intervention level ‘Community facilitators’ We have prepared a plan for the training of community facilitators. We have defined target groups, which will include priests, police officers and geriatric nurses. We contacted Slovene Roman – Catholic Church representatives. We have submit-ted a proposal of collaboration to the Pastor Office of the Diocese of Maribor and we wait for response. The Diocese of Maribor includes the whole territory of the three case regions. We have placed emphasis on the collaboration with priests because of the big influence that they have on the believers, especially in rural areas. We are negotiating with the Police Department the possibility to prepare training ses-sions for police officers about depression and suicide. We have planned to perform these training sessions in May or June 2005. The exact number of sessions is not yet set. We would prepare the training modules in collaboration with police trainers in order to shape the educational programme in a suitable form for police officers. We have decided to involve geriatric nurses in the Slovene EAAD program, because in Slovenia we face with high suicide rates among elders. About this we have already performed few pilot training sessions in Celje region. More training sessions will be performed in the next months. WP 8: Intervention level ‘High risk groups, self-help’ We have already detected regions in Slovenia that are most affected by suicide. These regions are Celje region, Maribor region, Pomurje region and Koroska region. Celje region and Maribor region are very similar in number of inhabitants and in many health risk indicators (including suicide rate), so we have decided to define Maribor as control region and Celje, along with Koroska and Pomurje, as case regions. We have assessed that the group with highest risk for suicide are men in middle age, especially if they are unmarried, divorced or widowed and if they have a lower degree of formal education. We have also assessed that in Slovenia we have a very high suicide rate among elders and that the suicide rate among youngsters is growing. We have started a detection survey in order to find all already existing self help groups and crisis hotlines in case regions. We want to establish a partnership with already existing self help groups. We would provide informational and/or promotional material to self help groups and if necessary we would organise training sessions for self help group moderators. WP 9: Evaluation of EAAD We have elaborated a very detailed evaluation concept that combines assessment of several evaluative indicators in different fields of intervention. In the process of data collection are involved the Institute of Public Health of the Republic of Slovenia and Regional Health Care centres in Koroska, Celje, Pomurje and Maribor regions. Within evaluation we will compare measurements in the three case regions (Celje, Koroska and Pomurje) with measurements in the control region of Maribor. We have planned to measure changes in prescription profiles by GPs, number of completed suicides and training effects among community facilitators. We have also planned to calculate the economic burden of depression and suicide in a given region in a given period of a year in comparison to years before the education. We will do this via the calculation

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Country Reports of the EAAD network: Slovenia

of cost for prescription of drugs and treatment, absenteeism from work, premature mortality etc. We are also planning an opinion survey at the end of the general public awareness campaign in order to evaluate the perception and the recognition of the EAAD awareness campaign material by the general public. Until now we have al-ready completed the following measurements: a) Assessment of changes in prescription profiles – baseline data collection. We

have gathered the baseline data for the period before the education: March – December 2002. We have made a baseline comparison between case and con-trol regions in the prescribing ratio of antidepressants and anxiolytics by GPs. The measurement has been based on ambulance prescriptions of medicaments (anti-depressants, anxiolytics) by primary care doctors in Slovenia.

b) Measurement of completed suicides – baseline data collection. We have gathered the baseline data using the mortality database for the period from March 2002 to March 2003. Case and control regions have been compared as regards to suicide rates.

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SPAIN

HOSPITAL DE LA SANTA CRUE I SANTA PAU WP 2: Management of local campaign / Establishment of local network We defined a time schedule of our project action plan (see annex 1). Our local pro-ject team has no organisational structure so far, but we have very clear division of responsibilities and tasks. The regional patron Plan integral de Salud Mental has been evolved and we man-aged to get extra finaciacion from the Generalitat de Catalunya for development of other project within the frames of EAAD which consists of evaluation of the pro-gramme and interventions in the high risk groups. In June 2004 we have presented the EAAD programme in the local press. WP 5: Intervention level ‘General Public’ Opening event: The opening event is planned in February 2005. Establishment of press and media relations: We have prepared a press conference in June 2004. Preparation of EAAD information material: All the campaign materials are being pre-pared right now. All posters and leaflets have been translated and prepared. Preparation of own information material: We have prepared our own video. WP 6: Intervention level ‘Cooperation with GPs’ Organisation of meetings for GPs to inform about the EAAD programme: We have organised several meetings with the GPs and also we have formed and trained two pilot groups with very positive results. Implementation of training courses for GPs: We have implemented 2 courses (2 groups- 6 GPs in each). Dissemination of information material for GPs: No information materials disseminate yet. WP 8: Intervention level ‘High risk groups, self-help’ All necessary actions will be established within the smaller project, financed by the Generalitat de Catalunya (Local government). WP 9: Evaluation of EAAD Evaluation using the indicators such as:

- Changes in the prescription of the psychoactive pharmaceuticals: ddd (defined daily dose), obtained from the central data bases of the Catalan Health Institute for the selected area (data from 3 previous years)

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Country Reports of the EAAD network: Spain

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- Number of suicides and/or suicides attempts in the regional area (sector 21) re-ceived at the Psychiatric Emergencies Department of Sant Pau Hospital (HSCPS) (information from 5 previous years)

- Number of suicides and/or suicides attempts in the regional area (sector 21) re-ceived at the 061 Emergency Line (information from 3 previous years)

- Number of suicides/ year (10 previous years) Annex 1: time schedule of project action plan:

This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of thecontractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarilyrepresent the view of the Commission or the Directorate General for Health and Consumer Protection. The EuropeanCommission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use madethereof.

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