What is The Alliance Against Depression?

Established in 2008 The European Alliance Against Depression (EAAD) is an international non-profit organisation delivering world’s best practice in optimising the care of people with depression, anxiety and preventing suicidal behaviour through a community based four-level-intervention framework.

Isn’t this a European model? How is it adaptable to Australia?

The EAAD was trialled and founded in Germany.  Since 2008 The European Alliance Against Depression has coordinated further rollout of this framework throughout Europe and countries abroad.

The EAAD is now being implemented outside of Germany including in Canada, Chile, Italy, Netherlands, Hungary and UK.

WAPHA is implementing The Alliance Against Depression (AAD) framework within two Commonwealth funded suicide prevention trial sites in WA: the Mid-West and Peel-Rockingham-Kwinana region.  WAPHA will be adapting the framework in consultation and collaboration within these local communities. The EAAD framework indicates the need for a contextualised response which may look different dependent on the community and place.

Why a focus on depression?

Depression is a high prevalence, at times severe and often life-threatening mental health disorder, affecting the lives of many Australians every day. It is often associated with deep suffering and can be an enormous burden to those affected. There are different types of depressive disorders with symptoms ranging from relatively minor (yet still disabling) through to severe.

Many people at times can experience loss, heartache, and sadness which is momentary and not permanently debilitating. It is when these feelings of intense hopelessness last for many days and affect regular functioning that a person can develop diagnosed depression.

The close link between suicidal behaviour and depression is well documented. Research from the American Association of Sociology suggests the risk of suicide is as high as 15 per cent amongst patients with severe and recurrent depressive disorders. Therefore a renewed focus on preventative actions to improve the care and treatment for people dealing with depression is required. This holistic approach can result in a reduction of suicide at a whole of population level.

Aboriginal-led social and emotional wellbeing and The Alliance Against Depression

Indigenous suicide is a significant population health challenge for Australia. Suicide has emerged in the past half century as a major cause of Indigenous premature mortality and is a contributor to the overall Indigenous health and life expectancy gap (ATSISPEP, 2016).  WAPHA is committed to working with Aboriginal services, communities and individuals to prevent suicide in Aboriginal communities.

Contemporary Aboriginal-led approaches to suicide prevention are premised on the social and emotional wellbeing (SEWB) concept (Dudgeon, P, et al 2016, Solutions that work: What the evidence and our people tell us. Aboriginal and Torres Strait Islander Suicide prevention Evaluation Project Report – ATSISPEP).

SEWB is a ‘systems’ approach to health and happiness, as is the Alliance Against Depression.  From a SEWB perspective, a person’s wellbeing is linked to his or her connection to land, culture, spirituality, family and community.  Many factors contribute to an undermining of social and emotional wellbeing, ranging from everyday stressors, to major life events to trauma.

The identification and treatment of depression, and associated steps to heal trauma and build resilience to stressors, is an integral component of what is needed for a rebuilding of social and emotional wellbeing. WAPHA is engaging with Aboriginal and Torres Strait Islander stakeholders to ensure WAPHA’s approach is a community-based intervention focussed on cultural appropriateness and suitability, with the EAAD action framework aligned with the ATSISPEP success factors.

Is this adaptable for Aboriginal communities?

Aboriginal-led approaches to suicide prevention using the SEWB approach are consistent with the Alliance Against Depression framework, which has an emphasis on a need to tailor intervention levels to the needs of individuals in the context of the social, cultural, human service, community and family systems they are in,  rather than sticking to a rigid model.

WAPHA is committed to ensuring a continued focus on person centred care and intervention that is developed and implemented in ways that are based upon local needs, and is community driven and owned.  As such WAPHA supports Aboriginal-led SEWB approaches to suicide prevention in accordance with the findings of the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP).

Is this applicable to CALD communities?

WAPHA believes the Alliance Against Depression is translatable to all communities irrespective of race, gender, sexual orientation, geographical location, etc.  WAPHA is committed to working within high-risk communities including; LGBTQI, young people, Aboriginal and Torres Strait Islanders, older populations, people with disabilities, and other vulnerable communities.

The EAAD framework indicates the need for a contextualised response which may look different dependent on the community and place.

What do you mean by ‘place-based’?

More than just a geographical locale at times, not static, not simply associated to one people group, not time bound, represents the past, present and future. CONTEXT is everything.

Who is The Alliance and who are involved?

The Alliance is made up of members within a community who form a stakeholder group to implement the Alliance Against Depression within their community.

This collective can include: individuals, families, primary care, funders, service providers, governments, business, basically the whole of community.

How can we be involved?

Local alliances can be formed in a number of ways.  A local coordinator is required to chair and bring stakeholders together to form the alliance.  Alliance members may choose to attend every meeting or may simply agree to participate in training or other events the alliance selects to establish.

WAPHA is forming a statewide Alliance to promote this framework and provide expert advice and knowledge around suicide prevention, treatment of depression and the continued rollout of Alliances throughout Australia.  If you would lie to become involved in this broad Alliance, please contact Felicity Hatzis: alliance@wapha.org.au

Who owns The Alliance?

Each Alliance can be managed and coordinated in a number of ways. WAPHA can provide support to local community members or businesses who wish to establish their own Alliance.  This support can be accessed by contacting the WAPHA Alliance Centre: alliance@wapha.org.au

Upon agreeing to form an Alliance, the local Coordinator will be provided with a suite of material and resources from WAPHA to assist in the establishment of the Alliance.  The local Alliance will need to establish a sustainable plan for funding and resourcing beyond support available from WAPHA.

What is the role of the Local Alliance Coordinator?

The local Alliance Coordinator is tasked with both the establishment and ongoing management of the Alliance. Further tasks may include: coordination and organisation of meetings and public events; coordination with WAPHA on publication and production of campaign and awareness materials; and if required,  involvement in evaluation and data gathering within the four pillars of the Alliance Against Depression framework.

The Coordinator will be the point of contact for their local community to become involved in the Alliance and any related activities.

Who leads The Alliance/keeps it going?

The local Alliance Coordinator is tasked with ongoing management of activities, interventions and coordination of the Alliance.  The sustainability of the Alliance relies on continual engagement from Alliance members and the community.  WAPHA is committed to assisting local Alliances in their  rollout out of community based interventions.

Can Alliances be formed anywhere?

An Alliance can be formed within any context.  WAPHA encourages Alliances to be formed within local communities, business, agencies, government departments, sporting teams, etc. The purpose of these Alliances is to implement the Alliance Against Depression framework to better identify and treat anxiety and depression to reduce suicidality.

If a group would like assistance in applying the Alliance Against Depression framework, WAPHA can provide assistance through the WAPHA Coordination Centre.

Are all four elements required to be implemented within a region an Alliance is formed?

Prof. Dr. Ulrich Hegerl (President EAAD) suggests that the combination of integrating these 4 pillars within a community is the most effective strategy to reducing suicidality.

Often the focus of other suicide prevention strategies is on one or two priority areas and fails to adequately address the whole system.  Strong synergistic effects can be expected from a cooperative and comprehensive approach integrating all four elements within a community.

To provide activity and interventions within all four categories will require the Alliance to engage with stakeholders across the whole of community including  primary care, community based services, local leaders, media, consumers and carers.

Is this framework just about the reduction of suicide?

The Alliance Against Depression is an evidence-based framework that has been proven to reduce suicidality (In Nuremberg, -24% reduction in suicidality in two years compared to the control region- 2000- 2002).

WAPHA will be implementing the Alliance Against Depression within two suicide prevention trial sites as part of the Australian Government’s $46 million investment into suicide prevention across Australia.

What does the Patron do, and who are they?

A patron is someone with a high public profile who can provide wide media and public support to the establishment and activities of the Alliance. The patron will also assist in facilitating the ongoing support and cooperation from a wide range of partners and stakeholders.

The Patron does not necessarily need to have a personal or lived experience of depression or suicidality but should be competent in speaking publicly about these issues and the work of the Alliance.

Former Chief of the Defence Force, Air Chief Marshal Sir Angus Houston AK, AFC (Ret’d), will undertake the role as The Alliance Australian Chapter Patron. WAPHA is excited by the support provided by Sir Angus and is confident his engagement, along with the Alliance approach, will reshape how mental health, particularly suicide, is recognised, treated and perceived.

WAPHA encourages local Alliances to engage their own local patron, and are invited to utilise the expertise and broad reach of the National Chapter Patron as appropriate.

How does The Alliance framework empower communities?

The Alliance Against Depression is a community-driven development framework targeting areas of primary care, community intervention, access to care and treatment, destigmatising depression and raising awareness of suicide prevention and depression.  The implementation of the framework provides opportunity for members of the community to engage in intervention, planning and further alliance activities.  It also provides resourcing and empowerment at the local community level, building a sustainable model to continue to ensure suicidal rates reduce.

Does The Alliance Against Depression recognise and involve consumers and cares in rolling out this framework?

Yes. Consumers and carers are involved in every aspect of intervention level within the Alliance Against Depression framework. Consumers and carers are consulted and inform primary care training and workshops delivered. Consumers and carers are engaged and equipped to provide mental health training to their communities through the delivery of Train the Trainer programs. Consumers and carers become local gatekeepers within their own communities.

Consumers and carers are engaged, consulted and inform the delivery and messages delivered through a destigmatising campaign, both at the local and state level.

Consumers and carers are key members of a local alliance.

Why is WAPHA involved?

WAPHA’s approach to the Alliance Against Depression principles will focus on integrating all available local resources, ensuring general practitioners are equipped to recognise and respond to depression, communities have increased awareness that depression is treatable, a general focus on high risk groups, and full engagement of community facilitators and stakeholders at all points in the process.  WAPHA is interested in working with like-minded individuals and organisations to building a robust and responsive patient centred primary health and social care system.  The Alliance Against Depression framework provides guiding principles to deliver upon this vision within place and community.

Are there other alliances in Australia?

Yes. Further information about Alliance partners can be found on the EAAD website.

Why is this any different from any other program trying to reduce suicide and treat depression?

Many recent multi-level programmes have failed to link the ‘strategy’ being implemented to the needs and requirements of the community. Often the focus of these strategies is only on one or two priority areas and fails to adequately address the whole system.

The Alliance Against Depression accepts that best practice in suicide prevention requires a whole of community approach, with all four elements of this framework requiring integration. The Alliance Against Depression also accepts that a focus upon depression and corresponding treatment enhanced the result of suicidality reduction.

Targeting depression and suicidality has had generalising effects (destigmatisation) for other mental health conditions.  Knowledge and attitudes were found to have increased around all mental health issues within implementation of the AAD.

The Alliance Against Depression framework evolves differently from place to place, community to community.  The framework can be applied to most if not all community settings as current and future interventions are not limited or dictated.

How will you measure its success?

The intensity of the measures and application of the framework within Nuremberg and corresponding trial sites with control regions provided clear evidence of a reduction in suicidality.  Without a control region to measure success against, success cannot be demonstrated with the same rigor as is the case for studies with randomized placebo controlled trials.

However, one of the main principles underlying The Alliance Against Depression relates to context. Prof. Paul Bates suggests context is everything.  Prof. Dr. Hegerl concluded that research and evaluation usually exists without context.  Most researchers will agree that by removing the context within the sample provides clearer and less confusing results but does not provide the full picture of why the results occurred and under what circumstances they occurred in.

The Alliance framework implies the need to contextualise the process by which suicidality reduces or increases including how integration occurred, how the Alliance was established and implemented, and how the four pillars were addressed collectively within place.

Success within an Alliance (especially within the two Commonwealth funded suicide prevention trials) will involve elements of both qualitative and contextualised data about the process followed and how the framework was integrated.

What is the coordination hub you talk about and where can I find it / contact it?

The Alliance Against Depression Coordination Centre is funded and managed by WAPHA. A team of advisors, project managers, researchers and suicide prevention experts can be made available to local Alliances to provide support in establishing Alliances across Australia.

You can contact the centre via the following methods  (08) 6278 7948, email: alliance@wapha.org.au or receive more info through our website.

Are there new services available? If so who pays for them?

Within each of the four pillars of the Alliance Against Depression framework, interventions can be implemented based upon the place and context of an Alliance. For example, if identification and treatment of depression within primary care needs are high but supply is low, additional primary care clinician training to raise awareness, and additional options for treatment and therapy, can be provided .

Who funds the Alliance and for how long?

Part of the Australian Government’s $46 million investment into suicide prevention will fund the two suicide prevention trial sites within WA will fund Alliance activities throughout the trial period within these places.

Local Alliances that are to be established are expected to plan for funding and resourcing beyond what is provided by WAPHA.

Who governs the Alliance and monitors performance or outcomes?

WAPHA has a relationship with the EAAD Coordination Centre in Germany who will work with WAPHA as the National Chapter to ensure fidelity and consistency of the Alliance approach throughout all implemented Alliances in WA.

WAPHA ‘s Alliance Patron Sir Angus Houston will provide further support, guidance and advise on the adaptability of The Alliance framework within the Australian context.

WAPHA will also draw on expert advice and guidance from Alliance partners and members including consumers and carers.