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 their 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 survey; 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.
Demographics
Age of respondents
50% of Port Lincoln respondents have experienced suicidal thoughts.
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.
85% of Port Lincoln respondents identified as having a lived experience of suicide.
Access to suicide prevention services in Port Lincoln
Clients with access: Youths and adults were believed to have the highest level of access to suicide prevention services in Port Lincoln. Additionally, males and people bereaved by suicide 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 Port Lincoln.
Needs and gaps: The three predominant needs and gaps highlighted in the Port Lincoln community were:
• Follow-up care for attempted suicide
• Suicide prevention training opportunities
• Discharge planning from health facilities.
To further measure community perceptions of suicide prevention services in Port Lincoln, 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
GP’s 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, access to early intervention services was highlighted as an issue along with general support for an individual in crisis.
The top five factors contributing to suicide in Port Lincoln were:
• Drug and alcohol use
• Family breakdown
• Distance to appropriate services
• Stigma associated with suicide
• Poor understanding of suicide and mental health.
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 were also engaged to form partnerships and strengthen the community focus. Local Mayor Bruce Green had the following to say on suicide in their region:
“For many of us, suicide is too close to home. To understand, assist and receive practical information was valuable for me. All our community should talk about this.”
PORT LINCOLN MAYOR BRUCE GREEN
Each forum highlighted ideas and issues unique to their specific region and key themes were deliberated. For Port Lincoln, the key themes from the community forum were:
• Workforce development and upskilling
• Afterhours support
• Youth education and resilience building
• Referral pathways and early intervention
Workforce capacity and upskilling
Workforce development and upskilling was identified as a priority for both the community and service providers in the region. Emphasis was placed on education and training for frontline workers and general practitioners (GPs) in assessment skills and use of suitable referral pathways. There was participant acknowledgement surrounding the high demand for GP services in regional areas and that introducing a model of stepped care could increase early prevention of mental health issues.
A unique priority was also raised surrounding the creation of a wellbeing committee which could educate people about recognising and responding to suicidality and supporting each other in critical events (e.g. drought, fire, accident, trauma).
After-hours support
After-hours support and discharge planning were priorities for the Port Lincoln community. The community identified a lack of available information without a specialist appointment. Participants proposed exploring the implementation of an online portal in accompaniment to information packs being available 24/7 at emergency departments.
To improve current discharge planning procedures, it was suggested the whole family should be involved in the process, and not just the individual in crisis, to ensure supportive and inclusive environments are created. Furthermore, engagement with community and sporting groups to provide an additional level of support to community members was also encouraged by those present.
Youth education and resilience building
Youth mental health was also a priority area raised, 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 increased collaboration between services to streamline referrals, reduce waiting times and create a ‘no wrong door’ approach. The creation of an online portal to direct individuals to available services in their region was discussed to meet this requirement in accompaniment to information packs being available 24/7 at emergency departments.
Furthermore, the implementation of a stepped care model with a person-centred approach, aiming to increase early intervention and prevention of mental health issues was suggested to improve the current referral issues.
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 Port Lincoln. Generally, the key issues and trends for the community were prevalent in both the forum and survey with limited differences noted.
There was a strong focus on upskilling and workforce development, particularly around the youth sector in Port Lincoln. Furthermore, incorporation of suicide prevention and mental health education into school curricula was encouraged through both the survey and forum. Referral pathways and early intervention were also key themes consistent across data collection methods. On review, while services are available in the region, the promotion of such services and awareness of their reach is lacking for both community members and service providers alike.
A point unique to follow-up care in Port Lincoln was the need for services to extend beyond usual operating hours and create adequate after-hours services. While this issue was raised in other regions, it was a particular priority for Port Lincoln.
On reviewing the predominant needs and gaps identified in 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 Port Lincoln community were:
Workforce
development and upskilling
Afterhours support
Youth
education and resilience building
Referral Pathways and early
intervention
Streamlined services and community upskilling encompassing the community was strongly supported.
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 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 Port Lincoln were:
Improving emergency and follow-up care for suicidal crisis
• Engage people with a lived experience who can inform of changes to the referral process to assist with improving emergency and follow-up care.
• Implement a dedicated aftercare service 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 emergency departments and deliver training to emergency department personnel and hospital staff.
• Provide locally developed resource packs to patients, family and carers who have been in contact with crisis care.
• Develop a service level agreement and structured systems to ensure support can be ongoing and agencies provide services aligned to their expertise.
Using evidence-based treatment for suicidality
• Improve information sharing between services, families and carers.
• Encourage the use of Telehealth and e-Mental Health tools.
• Deliver Advanced Training in Suicide Prevention (ATSP) to clinicians including doctors, psychologists and psychiatrists.
Equipping primary care to identify and support people in distress
• Provide further training opportunities for GPs and practice staff.
• Establish clear referral mechanisms within the community.
• Develop posters, cards and information brochures on local service options that are visible and accessible across all primary care facilities.
• Equip practices with a ‘stepped care’ model that allows GPs to easily identify patients in need of support and tailor a treatment plan that is right for them.
• 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
• Develop a common appropriate language across agencies and sectors.
• Provide targeted education and training for accident and emergency staff to refresh or upskill and build their capacity to support the community.
• Facilitate real-time electronic data collection by agencies to report and measure the level of suicidal crisis within the community.
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.
• Create awareness of bullying through social media platforms and active strategies that reduce and or eliminate bullying from schools.
• Ensure information about local support services and programs are visible throughout local schools
Training the community to recognise and respond to suicidality
• Raise awareness across the community of what to do in a crisis, referrals and service access points.
• Establish an area within the emergency department and the local library where people can access information on support services available.
• Develop an easy-to-access online portal of services and agencies.
• Provide training opportunities for the community to help recognise and respond to suicidality.
• Provide training opportunities for people with a lived experience of suicide to share their story to create understanding and awareness.
• Work with local employers to include information about local support services in their employee induction process.
Engaging the community and providing opportunities to be part of the change
• Provide targeted engagement with key stakeholders through training and information that activates positive change and builds the capacity for people to support each other and respond in a crisis.
• Pro-active use of social media to engage and inform the community.
• Engage with community and sporting groups to build capacity and promote help seeking behaviours.
• 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.
• Identify and train a range of LifeSpan Champions who can influence key stakeholders and communicate change to key groups and forums, or act as spokespeople.
• Create a wellbeing committee aiming to educate people about recognising and responding to suicidality and support each other in times of crisis.
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 promote support and resources.
Improving safety and reducing access to means of suicide
• Remain vigilant about emerging trends in means .
• Facilitate real-time electronic data collection by agencies to report and measure the level of suicidal crisis in the community.
