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Four human service professionals (in psychiatry, psychology and social work) collaborated with the provincial and state governments of Alberta and California, and the Alberta Division of the Canadian Mental Health Association to develop suicide intervention training programs for front-line caregivers/gatekeepers of all disciplines and occupational groups. They formed a partnership Ramsay, Tanney, Tierney and Lang (RTTL) in 1983 and created LivingWorks Education Inc. as a public service corporation in 1991.
One of the four principals died in 1997. A new partner has been added, Tarie Kinzel, and the corporation has reorganized to ensure its long-term survival and commitment to public service. LivingWorks is dedicated to enhancing suicide intervention skills at the community level, and committed to making its suicide prevention training programs widely available, cost effective, interactive and easy to learn, with practical applications designed for all types of caregivers.
Its programs are delivered through an extensive network of community-based registered trainers in Canada, Australia, Norway and the United States. Smaller numbers of trainers are located in Guam, Hong Kong, Russia, and Singapore. Trainers are qualified to present the ASIST (Applied Suicide Intervention Skills Training) workshop through a five-day Training for Trainers (T4T) course. The LivingWorks objective is to register qualified trainers in local communities, who in turn can prepare front-line gatekeepers with the confidence and competence to apply first aid suicide intervention in times of individual and family crises.
Participants in ASIST (formerly the Suicide Intervention Workshop, and before that the Foundation Workshop) include provincial, state, and federal government departments and agencies involved in alcohol and drug abuse, family and children, mental health, military, police and corrections services; public school boards, hospital departments, native communities, and non-governmental community mental health and crisis intervention organizations.
LivingWorks has trained and registered more than 2,500 locally-based suicide intervention workshop instructors since 1983. These workshop trainers have provided first aid suicide intervention training to more than 500,000 community participants from all walks of life. An average of over 25,000 participants annually attend ASIST. ASIST is by far the most widely used, acclaimed and researched program of its kind in the world.
ASIST workshops are user-financed through institutional sponsorships and individual registration fees. As a result of the ASIST experience, caregivers fears about “suicide” are reduced, and their knowledge and skills are increased. In essence, they feel empowered to effectively deal with suicidal situations. Participants come away from ASIST knowing that suicide is a preventable problem.
There is evidence that suicide prevention programs, properly integrated and coordinated with other community prevention and health promotion programs, can reduce rates of suicide in prison populations, public school regions, First Nations communities, and small rural-urban catchment areas. Studies from Australia, Calgary, California and the State of Washington confirm that the intended outcomes of ASIST occur. The impact on workshop participants has been considerable. Individual caregivers consistently report increased competence and confidence in first-aid skills, provide frequent anecdotal reports of life-saving interventions and 99% recommend the program for others.
In designing, developing, and implementing a standardized suicide intervention training program, the developers were faced with the need to be culturally sensitive and respectful of a wide range of participant background skills and experience. Equally challenging was maintaining high levels of quality control among a multidisciplinary and widely dispersed network of instructors, who would be the means for dissemination on a large scale.
The persistence and patience of the four principals made it possible to overcome the many developmental obstacles. Their ability to sustain a partnership over the past 21 years allowed for the kind of dedicated refinement that creates a mature program. Also critical was their adherence to a rigorous research and development methodology throughout all program development processes.
In 1981 the Alberta government, representing a population of 2.5 million, budgeted $800,000 for a comprehensive and coordinated approach to suicide prevention. An annual allocation, now roughly $1.5 million, has been approved ever since. Start-up grants of close to $75,000 were provided to pilot and field test ASIST and the 5-day Training for Trainers (T4T) course. The Canadian Mental Health Association (Alberta) invested $30,000 in initial curriculum and film development grants. The Alberta dissemination of the program has received an $50,000 per annum implementation grant since 1985. Between 1986 and 1996, the California Department of Mental invested close to $600,000 to implement the program state-wide. Others who have invested in the implementation of the program on a system or a state-wide basis include the Correctional Services of Canada, Calgary Board of Education, New Brunswick Mental Health Commission Saskatchewan Adolescent Suicide Awareness and Prevention Program, Washington Department of Health, Colorado Office of Suicide Prevention and the Virginia Department of Health, the United States Army and the Australian Department of Health.
A program originally developed to reduce the problem of suicide for individuals and families in Alberta has spread far beyond its original mandate. In addition to its widespread use in Canada, Australia, Norway and the states of California, Washington, Colorado, and Virginia, there is county or region-wide dissemination in San Antonio, Texas, the state of Oregon, Nashville, Tennessee. There are smaller numbers of trainers in Hong Kong, Singapore, Guam and Russia.
The United States. Army (5th Corps) in Germany implemented the program in 1990. Successful demonstrations have been made in Mexico, Singapore and Russia. The programs have been successfully presented in a wide range of settings: family and child welfare services, school systems, correctional institutions, northern communities, hospital departments, police programs, mental health agencies, peer group programs, employee assistance programs, college and university settings, etc.
In 1991, LivingWorks principals were invited by the United Nations to co-sponsor the first ever inter-regional experts meeting on suicide prevention. Working with the UN Department of Policy Coordination and Sustainable Development and the WHO, a national strategy guideline was drafted in 1993 and published in 1996 for worldwide distribution. The guideline was used to establish a grass roots survivor group SPAN (Suicide Prevention Advocacy Network) to advocate for a national strategy in the U.S. With leadership from the Surgeon General and collaborative partnerships with government and non-government agencies, professional associations and business corporations, the first U.S. National Strategy for Suicide Prevention was released in 2001.
Public users in the form of community agencies report increased grant support from charitable foundations; large correctional services have improved their community service image by providing trainers free-of-charge for community workshops; and the United States Army was sufficiently impacted that they had the developers provide critical incident stress debriefing and bereavement service training in Frankfurt, Germany during the Gulf War. In 2001, LivingWorks programs were incorporated as a core component of a revised Army-wide suicide prevention campaign.