Suicide is one of the most complex phenomenons affecting Australia. A public health issue affecting individuals, families, workplaces and communities, the issue is multifaceted and subject to environmental, psychological, emotional, socio-economic, cultural and religious factor among others.
Suicide remains the leading cause of death for Australians between 15 and 24 years old. According to Life in Mind, the rates of suicide are particularly high among people with an experience of mental ill-health, Aboriginal and Torres Strait Islander youth, the LGBTI community, those living in rural and remote areas, youth in contact with statutory care systems, and youth who have been exposed to acts of suicide.
While the government has poured $47 million into suicide prevention over the past year, the ongoing prevalence in society stresses the need for an evidence-based, multi-stakeholder approach to the issue. Growing evidence indicates that multi-component approaches are the most successful way of preventing youth suicide, given the many factors contributing to suicide.
Australia became the first nation to take a nationally coordinated approach to suicide prevention with the development of the National Youth Suicide Prevention Strategy, emerging from the need for a concerted and coordinated approach to prevention of suicide among young people.
This was later replaced with the National Suicide Prevention Strategy which expanded the focus across the lifespan.
A core focus of both strategies has been to take a coordinated approach to suicide prevention by effectively linking local services to provide a seamless experience, coordinating program and policy through partnerships between government, peak and professional bodies and non-government organisations, in combination with integrating regional approaches.
In the ‘Evaluation of the National Youth Suicide Prevention Strategy’ by Australian Institute of Family Studies, however, it was found that the Strategy “cannot be considered to be a fully ‘comprehensive nationally coordinated approach’ to youth suicide prevention throughout Australia. Rather, it is more accurately understood as a phase of developmental research.”
The evaluation also found the service systems with the greatest responsibility for suicide prevention are operating under conditions of severe resource limitations.
Government is in a position to lead coordination between multiple stakeholders who otherwise may not have been able to connect.
The importance of a multi-sectoral approach has also been stressed by the World Health Organisation. In their 2014 world suicide prevention report, the DirectorGeneral made a call to action for countries to employ a “multisectoral approach which addresses suicide in a comprehensive manner, which brings together different stakeholders, and which is based on their current resources and contexts.”
Australian Psychiatry’s report, ‘A comparison of multi-component systems approaches to suicide prevention’ evaluates the success of several multi-component intervention models; LifeSpan, European Alliance Against Depression and Zero Suicide.
Developed by the Black Dog Institute and the Australian National Health and Medical Research Council Centre of Research Excellence in Suicide Prevention, “LifeSpan focuses on simultaneous implementation of all nine evidence-based interventions and governance at a local level to coordinate action.”
As part of the approach, a PHN or local health district leads a locally-based, multistakeholder implementation team comprised of NGOs, education, police and community groups. This team engages with people with lived experience of suicide, undertakes a suicide audit of local data and a review of existing services and activities, develops and implements a comprehensive LifeSpan Suicide Prevention Action Plan and assists with systematic monitoring and evaluation of outcomes.
Currently being delivered in four PHN regions of New South Wales, estimates suggest that it may be possible to prevent 21% of suicide deaths and 30% of suicide attempts.
Meanwhile, the European Alliance Against Depression is a community-based intervention model which operates at four levels of intervention: cooperation with primary and mental healthcare with a focus on training general practitioners, public awareness campaigns, cooperation with community facilitators and stakeholders, and support for people at high risk and their relatives.
“Studies have variously shown: a 24% reduction in the number of suicidal acts (suicide attempts and suicide deaths), sustained two years post-intervention; a significant reduction in the rate of suicide over a five-year period; and a significant reduction in the rate of suicide over a two-year period, sustained one year post-intervention but not two and three years post-intervention.”
Initially developed in 2011 by the Clinical Care and Intervention Task Force, National Action Alliance for Suicide Prevention, United States of America, more than 200 organisations are now implementing Zero Suicide.
“Evaluations suggest that an initiative called Perfect Depression Care, which had a formative influence on Zero Suicide, reduced the rate of suicide in the Henry Ford Health System of Michigan by 75% and that this reduction remained for several years.
“But scepticism exists regarding the extent to which this evidence supports Zero Suicide: Critics say that Zero Suicide deviates from Perfect Depression Care and that the data and outcomes are overstated. Preliminary findings following the implementation of Zero Suicide in a community-based behavioural healthcare organisation (Centerstone of Tennessee) point to a 65% reduction in the rate of suicide.”
All three models emphasise training for healthcare professionals and frontline staff. ZeroSuicide, however, focuses on healthcare settings, LieSpan and EAAD incorporate community-based interventions.
LifeSpan integrates evidence-based interventions into school settings, where interventions can be delivered conveniently and cost-effectively. LifeSpan also provides practical guidance for planning an appropriate response to suicide, including care and support for bereaved families and friends and others affected.
LifeSpan and EAAD both focus on simultaneous implementation of multiple interventions in recognition of the many factors that contribute to suicide and in anticipation of synergistic benefits. They also both have a multistakeholder implementation plan, which can extend the reach of implementation. In contrast, Zero Suicide is a specific set of strategies and tools for healthcare.
The Australian Youth Suicide Prevention Conference is running at CQ Functions Melbourne from 12 – 15 November 2019. The event draws together organisations from across sectors including healthcare, government, NGOs, education and psychology services, in a first of its kind national multi-sector event dedicated to addressing and preventing youth suicide.
If you or someone you know is in immediate danger, please call 000 or visit your nearest hospital emergency.
Kids Helpline: 1800 55 1800
Headspace: 1800 650 890
Lifeline: 13 11 14
Suicide Call Back Service: 1300 659 467