Acknowledgements
We acknowledge those people with a lived experience of mental health issues and suicide, their families, friends and supporters who provided input into the process and shared stories, along with the many people from different organisations and the general public who hold an interest in mental health and suicide prevention.
We also acknowledge Aboriginal and Torres Strait Islander people as the traditional owners of this country throughout Australia and their connection to land, waters and community. We pay respect to them and their cultures, and to the Elders both past and present. We thank the contribution of local Aboriginal communities to help shape our knowledge of their country and identity. We benefit from the generosity in sharing their country and their culture as part of these consultations.
We acknowledge and thank the more than 500 people who contributed to the National Suicide Prevention Trial community consultations; your voice and feedback has formed this report.
Background
While suicide is an infrequent occurrence in Australia, the effects and aftermath can be both traumatic and longlasting for families and communities alike. Across Australia, people residing in rural and remote communities have a higher risk of suicide than those living in metropolitan cities. Particular rural communities across the state experience significantly higher rates of attempts and deaths. Compared to the national average, South Australia’s suicide rate is slightly higher at 13.4 deaths per 100,000 compared to 12.61
Suicide can affect any person at any time, however there are sub groups of individuals that remain at higher risk than others. The reasons for suicide are complex and multifaceted, influenced by the vulnerabilities, risk factors and events in a person’s life and their interactions with other social, cultural, economic and environmental factors2
For people aged 15-44 years, suicide remains a major cause of death. Furthermore, across all age groups Aboriginal people are more than twice as likely to die by suicide compared to their non-Aboriginal counterparts1 In terms of gender, males account for the majority of deaths by suicide, while females often attempt at a higher rate. Males aged 25-44 years are dying at a higher rate than all other age groups in regional SA 1
The key aims of the trial are to respond to local needs and identify new learnings in relation to suicide prevention strategies. To achieve this aim, an established evidencebased suicide prevention model was selected, the LifeSpan model.
LifeSpan is an innovative, evidence-based, world-class approach to suicide prevention developed by the Black Dog Institute. Based on scientific modelling, LifeSpan is predicted to prevent 20% of suicide deaths and 30% of suicide attempts. The model involves the implementation of nine strategies simultaneously within a localised area. Active strategies that form part of the trial will include:
• Training for frontline workers, community members, young people and leaders;
• Coordination of referral networks and multidisciplinary teams; and
• The development of systems that can reduce suicide attempts and deaths in communities.
1 Government of South Australia (2018) South Australian Suicide Prevention Plan 2017-2021, SA Health. 2 World Health Organisation. (2014) Preventing Suicide: A Global Imperative. Geneva. WHO
About the National Suicide Prevention Trial
Country SA PHN is one of twelve sites nationally taking part in the trial which aims to reduce suicide at a local level.
The Federal Government is providing $4 million which will enable Country SA PHN to implement evidence-based integrated approaches to suicide prevention.
The three-year trial will adopt a systems-based approach to the delivery of suicide prevention services, targeting populations identified as ‘at-risk’.
The trial brings significant resources, activity and funding to areas of established need across the country. The selected area in South Australia is the Country North region, including Port Augusta, Whyalla, Port Lincoln, Port Pirie and the Yorke Peninsula.
The population targets within these regions were selected based on the Country SA PHN Needs Assessment in addition to state and national data sets in relation to death and/or suicide attempts due to intentional self-harm. The three populations are:
• Youth (15-24 years)
• Adult Males (25-54 years)
• Aboriginal and Torres Strait Islanders
The trial will work closely with local suicide prevention networks, state government and the Office of the Chief Psychiatrist to implement effective strategies and programs across the region. The consultation that forms the basis of this report will support the design of localised action plans that will continue after the trial end date in June 2020. All research, programs and strategies used within the trial will be evaluated upon completion to help inform policy and programs nationally.
Aims
The aims of the community consultations were to gauge the current community knowledge of suicide prevention, services available and areas of need within the Country North region as a prelude to the development of a community action plan.
To meet the aim, the following objectives were addressed in each of the consultations:
• Determine the level of need and service availability in the local regions
• Identify key barriers and obstacles to help-seeking and service access
• Brainstorm solutions to create multidisciplinary links between service providers, and
• Create achievable recommendations in conjunction with the LifeSpan model.
Methodology
Design
The project adopted a two-stage approach involving:
• Paper-based and online self-administered surveys; and
• Face-to-face community consultations in six regional centres in country South Australia.
Paper-based and online survey
The purpose of the survey was to assess the perceived needs and barriers in relation to suicide prevention in the regional hubs of South Australia.
Between late November 2017 and early February 2018, the CSAPHN conducted a survey, available online and as a paper-based version. The survey was promoted through social media and distributed in a paper-based form at community consultations throughout the region. The targeted catchment locations for the survey were Port Lincoln, Whyalla, Port Augusta, Port Pirie and the Yorke Peninsula in line with the targeted region for the National Suicide Prevention Trial (NSPT).
Community consultation
During the same period, face-to-face consultations were facilitated across the Country North region. To complete this process in a timely manner, Sevenseas Creative Australia was contracted to work with the Country SA PHN
Suicide Prevention Project Officer to conduct six Regional Suicide Prevention Forums. The aim of the forums was to gather community members who could contribute to the development of an effective regional approach to suicide prevention, with a focus on building the capacity of organisations and the community to better support individuals.
For the Aboriginal component of the consultation, interviews and group yarning sessions were utilised in addition to the six forums. The results of these are incorporated below.
The forums included leaders and influencers from the community, including Suicide Prevention Networks (SPNs), community groups, sporting clubs, government and non-government agencies, business, health, education, hospital, emergency responders, GPs, researchers, industry stakeholders, people with lived experience, consumers and carers who collectively identified the needs and actions required for the region in relation to suicide prevention.
Promotion of the community forums was through advertisements in local newspapers, formal invitations, Cash Classifieds and media campaigns via Facebook and the Country SA PHN website.
Results
Online survey findings
The survey was the first stage of the consultation process and was opened for a three-month period in line with the face-to-face community forums. During this period, 337 responses were collected from both community representatives and forum participants.
The survey in its entirety consisted of 26 questions identifying demographics, workforce capacity, level of need for suicide prevention and alignment with the nine LifeSpan strategies. The key findings are summarised below.
Age of respondents
38% of Yorke Peninsula respondents were bereaved by suicide.
86% of Yorke Peninsula respondents identified as having a lived experience of suicide.
Access to suicide prevention services in Yorke Peninsula
Clients with access: Youths and adults were perceived to have the highest level of access to suicide prevention services in the Yorke Peninsula. Additionally, males and Children and families were perceived to have the lowest level of access to services.
Barriers to access: Availability of suicide prevention services and waiting times were the main perceived barriers to access for survey respondents in Yorke Peninsula.
Needs and gaps: The three predominant needs and gaps highlighted in the Yorke Peninsula community were:
• Perceived stigma around mental health services
• Youth specific services
• Follow-up care for attempted suicide
To further measure community perceptions of suicide prevention services, a series of statements were listed allowing respondents to answer with agree, unsure or disagree. The following was found:
Knowledge of where to go for help is low
There are services for family and friends after a suicide ...
Support for someone feeling suicidal is easily accessible
Services are available for youth experiencing suicidal...
Support is available to carers and family
Access to social support is good
Access to psychiatrists is generally poor
GPs are appropriately equipped with Suicide...
Suicide Prevention promotion and education is provided
Early intervention is easily accessible
Notably, access to psychiatrists was perceived as poor by a high percentage of respondents as well as knowing where to go for help in a suicidal crisis. Furthermore, a need for more support for youths and their families during a crisis.
The top five factors contributing to suicide in Yorke Peninsula were:
• Poor understanding of suicide and mental health
• Lack of adequately trained health care providers
• Lack of support for families and carers of persons with ongoing suicidal thoughts
• Distance to appropriate services
• Drug and alcohol use.
Community forum findings
In the second stage of the methodology, six community forums were conducted across major regional centres. An estimated total of 500 people engaged in the forums and provided their feedback on the current state of suicide prevention in their region, key needs/ gaps and future plans to reduce suicidality.
In addition to community and service providers, local mayors and MPs were also engaged to form partnerships and strengthen the community focus. Fraser Ellis MP had the following to say on suicide in the region:
GPs to identify patients in need of support and tailor a treatment plan specialised to them without extending consultation times.
The community had a range of ideas regarding how to improve service gaps within their region, one of which being workforce development and multidisciplinary forums. These opportunities were perceived to encourage services to collaborate, upskill and create awareness of what is available within their region.
The upskilling of youth workers, teachers, school counsellors and school aged children was reiterated throughout the forum, where participants believed additional training such as YAM could be beneficial and help reduce the stigma around suicide and mental health in general.
Follow-up care and discharge planning following a suicide attempt
Concern was raised by the community around discharge planning with the belief that follow up care was not being undertaken. This was resulting in patients falling through the gaps and not receiving the treatment they required.
FRASER
ELLIS MP
“Suicide in country areas impacts the whole community, but thankfully the Yorke Peninsula community wants to play a role in recognising risk and supporting those who are struggling. I found the information and round table discussion both enlightening and a call to action and have since followed closely the activities of the two Suicide Prevention Networks that are doing such great work in the Narungga electorate – the Yorkes SOS group and the Copper Coast SOS network.”
Each forum highlighted ideas and issues unique to their specific region and key themes were deliberated. For the Yorke Peninsula, the key themes from the community forum were:
• Workforce development and upskilling
• Follow-up care and discharge planning
• Youth education and resilience building
• Referral pathways and early intervention
Workforce development and upskilling
The need for upskilling and suicide prevention training for frontline workers, allied health professionals and GPs was a key priority highlighted in the Yorke Peninsula community. Suggestions were made for new targeted education focussed on improving assessment skills, referrals and recognising the signs of suicidality for GPs and first responders alike. To aid GPs in this process, the community were receptive to trialling the ‘StepCare’ platform allowing
Suggestions to improve this problem included a review and redesign of current aftercare services and the development of a local multidisciplinary network with information sharing to provide follow-up care for individuals and their families following a suicide attempt.
Youth education and resilience building
Youth mental health was also a priority area raised for the region, particularly regarding education and resilience training. The incorporation of suicide prevention and mental health education into school curricula was suggested to reduce stigma and build resilience, and was strongly supported within the community forums. Upskilling for school counsellors and teachers alike to recognise the signs of suicide and to respond accordingly was thought to also complement this process.
Referral pathways and early intervention
The community perceived a need for better collaboration between services to streamline referrals, reduce waiting times and create a ‘no wrong door’ approach. There was a consensus with participants that the health system was currently disjointed, with services assuming suicide is catered for by other agencies, therefore highlighting the need for clear stepped care and service delineation.
Discussion
Upon the completion of the community forums and the closure of the online survey, data was analysed and compared to highlight consistent themes in the needs and gaps identified within the local area. Generally, the key issues and trends were highlighted and reflected in both methods, and no obvious disparities were found in the Yorke Peninsula data.
Education and upskilling was reiterated throughout the consultation process. The survey highlighted a generalised poor understanding of suicide and mental health, lack of adequately trained health care providers and lack of information for families and carers to support them in a crisis. This was reiterated during the forums, albeit with a targeted focus on service providers rather than the community.
Workforce collaboration was identified in both methodologies. Seventy-eight percent of survey respondents perceived no workforce collaboration taking place in the region, while forum participants believed the current system to be disjointed with services assuming suicide is cared for by other agencies, therefore, highlighting the need for clear stepped care and service delineation.
On reviewing the predominant needs and gaps identified through the forums and survey, an underlying need for upskilling and service coordination was evident. Overall, the findings from the community forums aligned with the online survey findings from the Country North region as a whole with the key gaps highlighted being follow up care, stigma around suicide, suicide prevention, training opportunities and workforce collaboration.
The key gaps identified within suicide prevention for the Yorke Peninsula community were:
Workforce development and upskilling
Follow
up
care
and discharge planning following a suicide attempt
Youth education and resilience building
Referral Pathways and early intervention
Upskilling and suicide prevention training for frontline workers, allied health professionals and GPs was a key priority.
Key recommendations
The themes and priorities identified through the consultation process were used to form recommendations to improve suicide prevention within each community and the region as a whole. The interventions and/ or programs recommended were, in turn, aligned with the LifeSpan
model and the nine evidence-based strategies. These strategies are based on the latest evidence drawn from large scale suicide prevention programs overseas that have shown positive results. The LifeSpan wheel and strategies are shown below.
Improving emergency and follow-up care for suicidal crisis
Improving safety and reducing access to means of suicide
Encouraging safe and purposeful media reporting
Using evidence-based treatment for suicidality
Engaging the community and providing opportunities to be part of the change
Training the community to recognise and respond to suicidality
Equipping primary care to identify and support people in distress
Improving the competency and confidence of frontline workers to deal with suicidal crisis
Promoting help-seeking, mental health and resilience in schools
The recommendations for Yorke Peninsula were:
Improving emergency and follow-up care for suicidal crisis
• Promote and expand aftercare services in the region to provide follow-up care for those who have made a suicide attempt. This includes providing continuity of care, coordination, across services and strong follow-up.
• Implement best practice care guidelines within the emergency departments and deliver training to emergency department personnel and hospital staff.
• Employ specialised mental health trained nurse practitioners to be based in emergency departments.
• Provide locally developed resource packs to patients, family and careers who have been in contact with crisis care.
• Develop a plan of how more support can be provided for young people under the age of 16.
• Create a ‘no wrong door’ approach.
Using evidence-based treatment for suicidality
• Improve information sharing between services, families and carers.
• Deliver Advanced Training in Suicide Prevention (ATSP) to clinicians including doctors, psychologists and psychiatrists.
• Encourage the use of Telehealth and e-Mental Health tools.
Equipping primary care to identify and support people in distress
• Provide further training opportunities for GPs and practice staff.
• Equip practices with a ‘stepped care’ model allowing GPs to easily identify patients in need of support and tailor a treatment plan that is right for them.
• Encourage the development of local multidisciplinary networks.
• Create linkages and collaborations between services to ensure streamlined referrals and aftercare support.
• Implement improved consent tools to enable better sharing of information between health services, as well as other support networks (e.g. family and friends).
Improving the competency and confidence of frontline workers to deal with suicidal crisis
• Provide targeted education and training for accident and emergency staff to refresh or upskill and build their capacity to support the community.
• Build awareness across first responders of local referral pathways.
• Develop a common, appropriate language across agencies and sectors.
• Encourage participation of frontline workers in multidisciplinary events such as Expert Insight forums.
Promoting help-seeking, mental health and resilience in schools
• Encourage the delivery of evidence-based programs, promoting help-seeking behaviours and building resilience.
• Provide suicide prevention training to all education staff.
• Provide Advanced Training in Suicide Prevention (ATSP) to school counsellors.
• Review school referral pathways to ensure at-risk students are being connected to appropriate care.
• Ensure information about local support services and programs is visible throughout local schools.
Training the community to recognise and respond to suicidality
• Implement Question Persuade Refer (QPR) strategies, targeting community members and health professionals alike.
• Provide training opportunities for the community to help recognise and respond to suicidality.
• Develop a local resource that provides people and agencies with a greater level of knowledge and information about who to contact when people are in crisis.
• Develop an online portal of services and agencies that is easily accessible.
• Work with local employers to include information about local support services in their employee induction process.
• Engage with local government to provide community support through venues, events and staff resources.
Engaging the community and providing opportunities to be part of the change
• Develop a high profile creative advertising campaign targeting suicide prevention with the inclusions of language, stigma reduction and help-seeking education.
• Establish suicide prevention representatives within organisations to promote help-seeking and suicide prevention awareness.
• Ensure information about support services and programs are accessible and visible in the local community 24/7.
• Develop posters on local service options that are visible and accessible across the community.
• Proactively communicate and engage with the local community using safe, targeted and consistent messaging to build awareness of how to help someone who is facing a suicide crisis and provide clear actions that people can take to make a difference in their community.
Encouraging safe and purposeful media reporting
• Facilitate Mindframe training for media and key spokespeople, including mayors, politicians, and others.
• Encourage proactive use of media to ensure promotion of support and resources.
Improving safety and reducing access to means of suicide
• Remain vigilant about emerging trends in means of suicide.
• Facilitate real-time electronic data collection by agencies to report and measure the level of suicidal crisis in the community.
