Port Pirie Suicide Prevention Trial Report

NATIONAL SUICIDE PREVENTION TRIAL:

PORT PIRIE COMMUNITY CONSULTATION REPORT JULY 2018

Head Office PO Box 868 NURIOOTPA SA 5355 SA Rural Health Network Limited trading as Country SA PHN ABN 27 152 430 914

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

Contents

Acknowledgements

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Background

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Aims

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Methodology

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Results

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Access to suicide prevention services in Port Pirie 9 Community forum findings 10 Discussion

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Key recommendations

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

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.

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National Suicide Prevention Trial: Port Pirie Community Consultation 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: •T raining for frontline workers, community members, young people and leaders; •C oordination of referral networks and multidisciplinary teams; and •T he 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.

National Suicide Prevention Trial: Port Pirie Community Consultation Report

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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).

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.

Community consultation

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.

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

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.

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

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

Workforce and need Gender

Age of respondents 11-20 years 21-30 years

15.6%

31-40 years

22.2% 26.7%

41-50 years 51-60 years

71-80 years

18% male 82% female

26.7%

61-70 years

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.

6.7%

Level of suicide prevention need

23%

44%

High Moderate Low

10%

Unsure

23%

1.8%

Lived experience 18%

Collaborative workforces

No

Yes

47%

No

Yes 53% 82%

82% of Port Pirie respondents identified as having a lived experience of suicide.

45% of Port Pirie respondents had cared for someone who attempted suicide.

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

Access to suicide prevention services in Port Pirie Clients with access: Adults and youth were believed to have the highest level of access to suicide prevention services in Port Pirie. The lowest level of access was for males specifically and children and families.

Needs and gaps: The three predominant needs and gaps highlighted in the Port Pirie community were: • Follow up care for attempted suicide

Barriers to access: Availability of services and waiting times for suicide prevention services were the main perceived barriers for access according to respondents in Port Pirie.

• Suicide Prevention Training Opportunities • Perceived Stigma around mental health services

To further measure community perceptions of suicide prevention services in Port Pirie, 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

0%

10%

20%

Agree

The top five factors contributing to suicide in Port Pirie were:

30%

40%

Unsure

50%

60%

70%

80%

100%

Disagree

• Family breakdown

• Distance to appropriate services

• Unemployment

• Poor understanding of suicide and mental health

• Lack of community coordination regarding mental health services

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

Community forum findings The community forums were the second stage of the methodology, with six forums conducted across the Country North in major regional centres. An estimated 500 people were engaged and provided their feedback on the current state of suicide prevention in their region, key needs/gaps and future actions/plans to reduce suicidality.

In addition to community and service providers, local mayors were engaged to form partnerships and strengthen the community focus. Local Mayor John Rohde had the following to say:

“Suicide in our community is not someone else’s problem. When someone takes their life it not only affects direct family members but a wider circle of people and the community as a whole. As a community leader it is important to recognise that we have a role to play, to work with agencies and other groups collaboratively.”

PORT PIRIE MAYOR JOHN ROHDE

Each forum highlighted ideas and issues unique to that specific region and key themes were deliberated. For Port Pirie, the key themes from the community forum were: • Training opportunities for suicide prevention across all sectors • Referral pathways and early intervention • Follow up care following a suicide attempt • Data collection and information sharing between services

Workforce capacity and upskilling A strong emphasis was placed on the need for further mental health and suicide prevention training, targeting front line workers and GPs around available referral pathways. Additionally, youth education and youth specific interventions in conjunction with community upskilling and training were suggested.

Upskilling of school staff and training for youth in schools were additional areas of perceived need. Suggestions around this issue included working collaboratively with school networks and community gatekeepers to promote help-seeking behaviours and equip youth with skills in suicide prevention such as talking about suicide and recognising the warning signs.

Referral pathways and early intervention The community perceived a need to improve collaboration between services in order to streamline referrals, reduce waiting times and build awareness around access. This need was particularly directed at first responders to suicidal crises as well as community members.

The development of a referral map highlighting existing services was a suggestion of how this could be achieved.

In conjunction with consistent and transparent referral pathways, the development of local multidisciplinary networks and professional development was strongly supported.

Follow up care following a suicide attempt Information and support following a suicide attempt was raised repeatedly throughout the forum. Ideas and suggestions to meet the current shortcomings in the community regarding follow up and support included the development of a suicide prevention network and accessible information packs. These packages would outline services and support including, cards, flyers, brochures, signs, pages or apps that communicate service options.

Data collection and information sharing between services Information sharing was perceived to be an area of concern with suggestions of creating a structured sharing platform. Overall, the need for more accessible information and education regarding who to contact for an individual in crisis was repeatedly raised throughout the session. Youth and individuals with disabilities were deemed to be the client groups with least access and a consensus to build resilience among these groups was strongly encouraged.

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

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 highlighted in one method were reflected in the other and for the Port Pirie data no obvious disparities were found.

Follow-up care, increased training opportunities and youth specific upskilling were reiterated throughout the online survey which in turn linked with the main priorities established at the community forum. An area of difference highlighted in the survey was a lack of community coordination and a focus on family breakdown and unemployment as main factors contributing to suicide in the region. This highlights a potential area of need around psychosocial services and financial counselling service availability.

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 Port Pirie community were:

Training opportunities for suicide prevention across all sectors

Referral Pathways and early intervention

Follow up care following a suicide attempt

Data collection and information sharing between services

The Port Pirie community welcomed the development of a local suicide prevention network, to help reduce stigma and drive change for suicide prevention.

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

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

Encouraging safe and purposeful media reporting

Equipping primary care to identify and support people in distress

Building a community safety net that helps prevent suicide

Engaging the community and providing opportunities to be part of the change

Improving the competency and conďŹ dence of frontline workers to deal with suicidal crisis Training the community to recognise and respond to suicidality

Co m mu nit ye ng age me nt

Promoting help-seeking, mental health and resilience in schools

ce an ern v o g ural Cult

n sio lu nc i d an

erience inclusion at every l evel d exp Live

ownership and adaptation Local

Improving safety and reducing access to means of suicide

Work forc e in for ma tio na nd de ve lo p Improving emergency and follow-up care for suicidal crisis Using evidence-based treatment for suicidality

t en m

king -ma ion s i ec nd ive r d aat D

model and the nine evidence-based strategies. These strategies are based on the most up-to-date evidence drawn from large scale suicide prevention programs overseas that have shown positive results. The LifeSpan wheel and strategies are shown below.

National Suicide Prevention Trial: Port Pirie Community Consultation Report

The recommendations for Port Pirie were:

Improving emergency and follow-up care for suicidal crisis • Implement a dedicated aftercare service, providing follow-up care for individuals who have made a suicide attempt, including providing continuity of care, coordination across services and follow-up.

• Provide locally developed resource packs to patients, family and carers who have been in contact with crisis care.

• Implement best practice care guidelines within the emergency departments and deliver training to emergency department staff.

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 health clinicians.

Equipping primary care to identify and support people in distress • Provide further training opportunities for GPs and practice staff.

• Establish clear referral mechanisms in the community.

• Equip practices with a ‘StepCare’ platform 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 their ability to support the community.

• Enhance information sharing which focuses on suicidal crisis and responses, including real time electronic data collection by these agencies to report and measure the level of suicidal crisis in the community.

Promoting help-seeking, mental health and resilience in schools • Encourage the delivery of the Youth Aware of Mental Health (YAM) program, promoting help-seeking and resilience in high school students.

• Create awareness of bulling through social media platforms and active strategies that reduce and or eliminate bullying from schools.

• Provide suicide prevention training to all education staff.

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National Suicide Prevention Trial: Port Pirie Community Consultation Report

Training the community to recognise and respond to suicidality • Raise awareness across community of what to do in a crisis, referrals and service access points.

• Implement Question. Persuade. Refer. (QPR) targeting community members and health professionals alike.

• Develop a local resource that provides a greater level of knowledge and information referral pathways.

Engaging the community and providing opportunities to be part of the change • Establishment of a suicide prevention network in Port Pirie.

• Targeted engagement with key stakeholders through training and information, encouraging positive change.

• Proactive use of social media to engage and inform the community.

• 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.

Encouraging safe and purposeful media reporting • Conduct 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 .

• Implement real time electronic data collection by agencies to report and measure the level of suicidal crisis in the community.