Suicide Prevention

Suicide prevention is a complex issue. Causes of suicidal behaviour can stem from a complex mix of factors such as adverse life events, social and geographical isolation, socio-economic disadvantage, mental and physical health, lack of support structures and individual levels of resilience. In addition to the premature loss of life, suicide can have a profound and lasting negative impact on families, workplaces and communities.

Identified Need SP 1- Community-led approaches to Suicide prevention Key Issue

Rates of self-harm and suicide increase with remoteness, suggesting that there are significant mental health issues to be addressed in rural and remote areas. Across all states and territories, the suicide rate was lower in capital cities compared to regional areas.

Country SA PHN region

In country SA, from 2015 to 2016 rates of suicide have decreased across all age groups with the exclusion of the 2444 age cohort, which has increased by 8%. Approximately 504 suicides (2007-2015) and 1,830 suicide attempts were reported within the Country SA PHN region between 2013 and 2016. In 2017, 224 deaths in South Australia were attributed to suicide or intentional self-harm (164 males, 60 females). Overall 7.2% of deaths reported were linked to suicide in South Australia. The highest rate of suicide was in Eyre Peninsula and South West, Yorke Peninsula and Murray and Mallee, while the highest attempt rates were found in the Limestone Coast, Murray and Mallee and Eyre Peninsula and South West regions. Additionally, the Outback North East experienced high rates of suicide, however limited data is available throughout their LGAs. ∙ ABS - Suicides, Australia, 2010 ∙ ABS - Causes of Death, 2017 ∙ SA Health Hospital Separations 2015-16 ∙ NCIS – Intentional Self Harm Fatalities in Specified South Australia Local

Government Areas (2007-2015) ∙ NSPT – Survey Data Report, 2018 ∙ Stakeholder consultation (Data ∙ Australian Bureau of Statistics (ABS) Catalogue 3303.0 Cause of Death

Australia, 2015

Description of Evidence

Identified Need SP 1- Community-led approaches to Suicide

prevention - continued

SP 2- Rural and male specific suicide prevention services and activity. Rural and male specific suicide prevention services and activity Key Issue Suicide prevention/aftercare services delivered

Over the 2013-16 period, 840 males and 1393 females were identified through intentional self-harm hospital separations. Within the overall catchment the Murray Bridge (Murray Mallee) followed closely by Whyalla (Eyre Peninsula) and South West. Additionally, for the reporting period 511 people were followed up by a PHN commissioned service following a recent suicide attempt.

National Suicide Prevention Trial

The National Suicide Prevention Trial has been operating in the North and West region of the CSAPHN catchment, the process involved extensive community consultations reaching 16,000 people. Key gaps highlighted within the region were: ∙ Follow up care ∙ Reducing the stigma around suicide ∙ Suicide prevention training ∙ Workforce collaboration Furthermore, the key factors contributing to suicide in the region were believed to be due to: ∙ Drug and alcohol use ∙ Family breakdown ∙ Poor mental health literacy ∙ Unemployment

Through the National Suicide Prevention Trial small grants scheme, approximately 1,714 persons have been reached with the aim to promote help-seeking and train the community to recognise and respond to suicidality. See above…

Description of Evidence

Identified Need SP 2- Rural and male specific suicide prevention services and activity. Rural and male specific suicide prevention services

and activity - continued

SP 3- Intentional self-harm and hospital separations

SP 4- Community- led culturally appropriate approaches to Suicide Prevention Key Issue

Gender difference

Males in the country SA region accounted for 79% of all deaths by suicide, a ratio of more than 3:1. However females accounted for the highest rates of suicide attempts. ABS statistics (2001-2010) show males in South Australia suicided at a rate (1.8 per 10,000) three times than that of females (0.5 per 10,000). With slightly higher rates for males in ‘rest of SA’ (1.9 per 10,000) and slightly lower rates for females in ‘rest of SA’ (0.4 per 10,000).

Hospital separations for intentional self-harm

Females are more likely to be hospitalized than males for intentional self-harm. This difference is likely due to males being more than three times more likely to complete suicide than females. This is not a difference in need for suicide prevention, but a reflection on lethality of mechanism. The most common mechanism used for suicide was asphyxiation (hanging) compared to poisoning in most cases of attempt.

Areas above the CSAPHN annual average rate (2.5 per 1,000) were: ∙ Yorke Peninsula (3.6) ∙ Limestone Coast (3.1) ∙ Fleurieu - Kangaroo Island (2.9) ∙ Gawler – Two Wells (2.7) ∙ Murray and Mallee (2.7) ∙ Barossa (2.7) See above…

Indigenous suicide prevention

Aboriginal and Torres Strait Islander South Australians completed suicide at a rate more than twice that of nonAboriginal and Torres Strait Islander people in South Australia, at 25.5 deaths to 12.5 per 100,000 respectively.

Description of Evidence

Identified Need

Priority Community- led approaches to suicide

prevention (SP 1)

Rural and male specific suicide prevention services

and activity (SP 2)

Key Issue

Suicide was the second leading cause of death among Aboriginal and Torres Strait Islander men at a rate of 39.2 per 100,000

Possible Options

1. Develop partnerships within local communities to implement community-specific response and support models to address episodic mental health occurrences in the after-hours period through the delivery of suicide prevention trainings.

2. Implementation of a stepped care model through mental health and alcohol and other drugs reform. 3. Analysis of market for successful models and expansion through targeted commissioning to meet areas of need. 4. Co-design activity through flexible funds.

5. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs. 6. Plan, develop and implement National Suicide

Prevention Trial in the Country North region. ∙ Better connection of community local delivery of services. Local ownership of community mental health and Suicide Prevention.

∙ Reduction in stigma around suicide. ∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care.

∙ An increase in sustainable suicide prevention and suicide aftercare programs across the Country North and Yorke Peninsula regions. ∙ Reduction in preventable suicides through workforce capacity building and upskilling of rural/remote staff. ∙ The six regional Local Health

Networks

∙ Black Dog Institute ∙ Commonwealth

∙ CSAPHN ∙ Suicide Prevention Networks

1. Implementation of a stepped care model through mental health and alcohol and other drugs reform. 2. Analysis of market for successful models and expansion through targeted commissioning to meet areas of need. 3. Co-design activity through flexible funds. ∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ CSAPHN/the six regional

Local Health

Networks/Hospitals ∙ Black Dog Institute

Description of Evidence

Expected Outcome Potential Lead

Priority Rural and male specific suicide prevention services

and activity (SP 2) continued

Intentional self-harm and

hospital separations (SP 3)

Possible Options

4. Plan, develop and implement National Suicide

Prevention Trial in the Country North region. ∙ An increase in sustainable malefriendly suicide prevention and suicide aftercare programs. ∙ Reduction in preventable suicides through workforce capacity building and upskilling of rural/remote staff. ∙ Reduction in the stigma associated with suicide and help-seeking behaviour. ∙ Commonwealth

∙ CSAPHN

∙ Suicide Prevention Networks

See above

1. Implementation of a stepped care model through mental health and alcohol and other drugs reform. 2. Explorations of early intervention options and linkage into youth health services. 3. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs. ∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ Increased options of evidence-based models of counselling to areas of need.

∙ Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care. ∙ CSAPHN/six regional LHNs/Hospitals

Expected Outcome Potential Lead

Priority Community-led culturally appropriate approaches to

Suicide Prevention (SP 4)

Possible Options

1. Develop partnerships within Aboriginal communities to implement community-specific response and support models to address episodic mental health occurrences in the after-hours period through the delivery of training and education 2. Implementation of a stepped care model through mental health and alcohol and other drugs reform 3. Analysis of market for successful models and expansion through targeted commissioning to meet areas of need 4. Co-design activity through flexible funds 5. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs 6. Continuation of Aboriginal and Torres Strait Islander suicide prevention through psychological therapy for underserviced groups 7. Plan, develop and implement National Suicide

Prevention Trial in the Country North region. ∙ Better connection of community to

ACCHO’s AMS and local delivery of services. Local ownership of community mental health. ∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ Increased options of evidence-based models of counselling to areas of need.

∙ Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care.

∙ An increase in sustainable suicide prevention and suicide aftercare programs across the Country North and Yorke Peninsula regions. ∙ Reduction in preventable suicides through workforce capacity building and upskilling of rural/remote staff. ∙ Culturally appropriate suicide prevention services. ∙ CSAPHN/ACCHOS ∙ Black Dog Institute ∙ Commonwealth

∙ CSAPHN

∙ Suicide Prevention Networks

Expected Outcome Potential Lead

Psychosocial Support

The National Psychosocial Support Measure (NPSM) is available for people with severe mental illness who are not more appropriately funded through the National Disability Insurance Scheme (NDIS) to increase their ability to do everyday activities through a range of non-clinical community-based supports. Identified Need Key Issue Description of Evidence

NPS 1 - Commission Psychosocial health

existing funded Currently the reporting mechanisms for psychosocial needs psychosocial support and trends within country South Australia is limited at best. Service Providers to deliver Previously such data was collected in collaboration with Transitional Support for 12 mental health data and thus is difficult to isolate. The months estimates reached were mainly drawn from Government pension numbers, carers support, PHaMs (Personal Helpers COS 1 - Commission and Mentors Service) and Partners in Recovery (PIR) provider existing Commonwealth statistics.

funded psychosocial support Evidence and data

For the 2017 period ABS data for country South Australia

COS 2 - Commission new

reported 18,011 persons on a disability support pension and

psychosocial services

under Continuity of 5,436 persons receiving a carer payment. Overall, 6.2% of Support country South Australians needed assistance with core daily for Country South Australia activities and approximately 11,133 were unemployed. Psychological Distress Measurements revealed 13% of country South Australian’s experienced high or very high levels of distress, compared to the state average of 11.9%. Furthermore, this level increased for Aboriginal and Torres Strait Islander people with distress levels equating to 31.8%. PHaMs data was similar to ABS statistics with 2,152 participants registered in the 2014/15 reporting period.

PIR Client’s Needs Assessment files in 2016/18 highlighted 2,041 clients with needs, with 1,095 of these needs remained unmet. Despite services being in place to assist clients, the demand exceeded capacity, thus for regions without PIR would equate to a higher percentage of unmet