What is The Alliance Against Depression?

    The European Alliance Against Depression (EAAD), established in Germany, is based on evaluated trials and is recognised as the world’s best practice for the care of people with depression and in the reduction of suicide.  It draws our focus on the individual, the community and the system altogether. It suggests four well-integrated pillars of focus or interventions within a community can increase the diagnosis and treatment of depression and reduce suicide.

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

    The EAAD framework was trialed in Germany.  Since 2008 there has been a coordinated rollout of the framework throughout Europe and countries abroad. The EAAD is now being implemented outside Germany including in Canada, Chile, Ireland, Italy, Netherlands, Hungary, Norway and the UK.

    WA Primary Health Alliance (WAPHA) is using the principles of EAAD to inform our mental health commissioning and related activities throughout WA. We believe this framework provides the platform to come together as stakeholders, partners and communities to treat depression and reduce deaths by suicide in WA.

    From July 2019, WAPHA will support communities to establish local Alliance Against Depression (AAD) using the EAAD framework.  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 focused 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'?

    Context is everything.  Interventions are localised based upon the place and needs of a community.

    Who is The Alliance and who are involved?

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

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

    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, government, business, basically the whole of community.

    How can I 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 has formed an AAD Coordination Centre to provide expert advice and knowledge to communities wishing to form their own Alliance.  If you would like to find out more, please contact the AAD Coordination Centre on alliance@wapha.org.au

    Who owns the Alliance?

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

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

    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. They will be the point of contact for their local community to become involved in the Alliance and its related activities.

    Who leads The Alliance/keeps it going?

    The local Alliance Coordinator is tasked with ongoing management of activities and coordination of the Alliance.  The sustainability of the Alliance relies on continual engagement from Alliance members and the community.  The AAD Coordination Centre is available for support.

    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 AAD framework to better identify and treat anxiety and depression to reduce suicidality.

    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 EAAD framework is based on evaluated trials and is recognised as the world’s best practice for the care of people with depression and in the reduction of suicide.  There was a 24% reduction in suicide in the trial site of Nuremberg (eaad.net).

    How does The Alliance framework empower communities?

    The AAD is a community-driven 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 planning, intervention and further alliance activities.  It also provides 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 carers 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 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.

    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 AAD accepts that best practice in suicide prevention requires a whole of community approach, with all four elements of this framework requiring integration. The AAD also accepts that a focus upon depression and corresponding treatment enhances 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 AAD 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 AAD 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 AAD 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 will involve elements of both qualitative and contextualised data about the process followed and how the framework was integrated.

    Who funds a local Alliance and for how long?

    Local Alliances are expected to plan for their own funding and resourcing.

    The AAD Coordination Centre will provide a new Alliance with a suite of resources and continued support. WAPHAs regional teams can also offer support at a local level.

    What is the AAD Coordination Centre you talk about and where can I find it / contact it?

    The AAD Coordination Centre at WAPHA is a team of advisors, project managers, researchers and suicide prevention experts who can provide support to local Alliances across Western Australia.

    You can contact the AAD Coordination Centre on (08) 6278 7948 or email:alliance@wapha.org.au. Alternatively you can find more information on our website phexchange.wapha.org.au/AAD .

    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 AAD approach throughout all implemented Alliances in WA.

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