Draft Western Australian Suicide Prevention Action Plan 2021 – 2025

Government of Western Australia Mental Health Commission

Western Australian Suicide Prevention Action Plan 2021 - 2025

Consultative draft October 2019

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 1 NOTE: THE STRATEGIES CONTAINED WITHIN THIS DOCUMENT AND SUBSEQUENT INVESTMENT REQUIRED ARE DEPENDENT ON GOVERNMENT FISCAL CAPACITY AND ARE SUBJECT TO NORMAL GOVERNMENT APPROVAL THROUGH BUDGETARY PROCESSES.

This resource was prepared by:

Mental Health Commission GPO Box X2299 Perth Business Centre WA 6847

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Acknowledgements

We remember those we have lost to suicide, and their families, friends, loved ones and others affected by their deaths.

We respectfully acknowledge and pay our respects to Aboriginal and Torres Strait Islander Elders, past, present and emerging, and acknowledge the diversity and strength of Aboriginal and Torres Strait Islander people and communities today.

The Western Australian Suicide Prevention Action Plan 2021 – 2025 (Suicide Prevention Action Plan 2025) is the result of contributions from many organisations and individuals from across the Western Australian community. These include:

Members of the steering committee, who provided content expertise and insight to further represent the voices of vulnerable populations and academic experts. Suicide prevention coordinators who were instrumental in bringing together service providers, local government, non-government, private sector, and community members from across the state, to ensure their needs were voiced.

Representatives of key state and federal government departments, who were involved in the Advisory Group and showed leadership and commitment to a whole-of-government approach to address suicide in our communities.

We sincerely thank the community and everyone who had any involvement with or contributed to the state-wide engagement and shared their experiences and for their dedicated commitment to address suicide in Western Australia.

Accessibility

This publication is available in alternative formats for people with a disability, on request to the Mental Health Commission.

Disclaimer

The information in this document has been included in good faith and is based on sources believed to be reliable and accurate at the time the document was developed. While every effort has been made to ensure that the information contained within is accurate and up to date, the Mental Health Commission and the State of Western Australia do not accept liability or responsibility for the content of the document or for any consequences arising from its use.

This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to an acknowledgement to the Mental Health Commission. Reproduction for purposes other than those above requires written permission of the Mental Health Commission.

Suggested citation: Mental Health Commission 2019. Draft Western Australian Suicide Prevention Action Plan 2021 to 2025, Mental Health Commission, Government of Western Australia.

2 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Table of contents

Acknowledgements Introduction 2 The Western Australia approach 5 The WA Suicide Prevention Action Plan 2025 9 The Action Plan at a Glance 10 Principles 11 Enablers 13 Priority area activities 15 Prevention Priority Area 16 Intervention Priority Area 20 Postvention Priority Area 24 Aboriginal People Priority Area 27 How we developed the plan 28 Everyone has a role in Suicide Prevention 30 Building blocks for a cross government approach 32 What works well 33 Evidence-based Models 33 Factors that influence suicidal behaviour 34 Monitoring, Evaluation and Reporting 39 Appendices, glossary and references 40 Need help 50

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 1 Introduction

2 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Introduction 2 Introduction

Everyone has a role in suicide territories (14.7 deaths per 100,000 understand how we as a community prevention. Reducing the rate people) its rate has been consistently can support those vulnerable to and impact of suicide in our higher than the national average suicide and self-harm, and those communities requires a whole- (12.1 deaths per 100,000 people) affected by suicide. of-population commitment; it is since 2008 . Building on existing programs not something any single agency, Between 2014 and 2018, WA had and aligned with State and level of government or community the highest age-standardised rate Commonwealth policy directions, can do alone. The impact of of suicide among Aboriginal people the Suicide Prevention Action Plan suicide is far-reaching and (37.9 deaths per 100,000 people). 2025 supports the WA Government’s long-lasting; it has a devastating This was considerably higher than existing commitments to tackling effect on families, friends and the national average for Aboriginal the complex issues of suicide and services which ripples throughout people over the same period (23.7 sets the direction for future action. It communities. A 2016 Australian deaths per 100,000). brings the voices of the community report indicates that 89% of and the sector together to provide Australians knew someone who Suicidal behaviour is complex; many understanding and guidance for had attempted suicide, and that factors and multiple pathways may individuals, communities, private and 85% knew someone who had died lead a person to attempt to take their non-government organisations and by suicide . For every person who life. In the quest for effective suicide government. takes their life, more than 135 prevention strategies, no single people experience intense grief or activity stands out above others. are otherwise affected. A range of strategies focusing on Western Australia statistics lowering the risks and increasing the In 2018, 3,046 people died by suicide Suicide is the leading cause of death protective elements is essential. It is among people aged 14 – 44 years. in Australia. For every suicide death imperative to remember that suicide Aboriginal people have a rate of as many as 25 people will attempt can be prevented if individuals, suicide three times higher non- suicide, meaning 78,000 Australian’s Aboriginal people in WA. communities, government and non- require appropriate, timely and 15.5% of LGBTI young people in the government sectors work together Growing up Queer study reported critical care to support their recovery and implement ongoing evidence- attempting suicide at some point in each year. Suicide was estimated their life. based, coordinated, multilevelled to account for 108,035 years of activity that supports the creation of a 48.1% of young transgender people potential life lost (YPLL) potential community that experiences optimal in the Trans Pathways study reported years of life lost for all persons in attempting suicide at some point in mental health and wellbeing. Australia in 2017 . their life. The Western Australian Suicide Problems related to substance use In 2018, 383 individuals died by Prevention Action Plan 2021 - 2025 were present in 29.4% of deaths by suicide in Western Australia (WA); suicide in Australia in 2018. (Suicide Prevention Action Plan this is more than one person a day. Mood disorders, including depression, 2025) aims to create a platform for were present in 43.9% of deaths by WA had the third-highest rate of all Western Australians to be better suicide in Australia in 2018. suicide of all Australian states and educated on suicidal behaviours, and

1 Reference to Aboriginal people throughout this document respectfully are inclusive of the Torres Strait Islanders.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 3 A note about language when talking about suicide

Please remember that suicide is a complex issue and arises from an interaction between many circumstances in a person’s life. Using safe and inclusive language is helpful when talking about suicide.

Don't say Why Do say 'unsuccessful suicide’ So as to not glamorise or ‘non-fatal’ or ‘made an attempt on his/her normalise a suicide attempt life’ ‘successful suicide’ So as to not present suicide as a ‘took their life’ or ‘ended their own life’ desired outcome ‘committed’ or ‘commit suicide’ So as to avoid the association ‘died by suicide’ or ‘deaths by suicide’ between suicide and ‘crime’ or ‘sin’ ‘suicide epidemic’ To avoid sensationalism and ‘concerning rates of suicide’ or ‘number of inaccuracy deaths’

4 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 The Western Australian approach

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 5 The Western Australian approach

Background During the implementation of National Mental Health Commission Suicide Prevention 2020, there were (NMHC) supported the development The WA State Government has so significant developments in the of the Fifth National Mental Health far been responsible for two suicide Australian and international suicide and Suicide Prevention Plan (the prevention strategies, covering the prevention literature and research. Fifth Plan). The Fifth Plan has been period from 2009 to the present. In addition, the Commonwealth and endorsed by the Council of Australian The Suicide Prevention Strategy - State and Territory Governments Governments (COAG) Health One Life, which ran from 2009 to committed to a more coordinated Council and sets a clear direction 2013, received funding of $24 million. approach to address suicide for coordinated action by the It was developed from an analysis of prevention across Australia. Commonwealth, state and territory governments. The Fifth Plan also almost 20 years of data on suicide Current research supports acknowledges the unique challenges and self-harm in Western Australia, implementing multiple strategies, faced by Aboriginal people with a comprehensive literature review delivered simultaneously across a the recommendation to develop of suicide prevention research, and range of areas which is referred to as a National Aboriginal and Torres an extensive state-wide consultation a systems-based approach. process. It was also aligned with the Strait Islander Suicide Prevention former National Suicide Prevention Systems-based approaches that and Implementation Plan. The Fifth Strategy: Living is for Everyone have emerged since the launch of plan outlines a commitment from (LIFE). Suicide Prevention 2020 include the government to develop a National Alliance Against Depression (AAD) Suicide Prevention Implementation One Life was succeeded by Suicide model, the LifeSpan Integrated Strategy (NSPIS), which is currently Prevention 2020: together we can Suicide Prevention (LifeSpan) under development. save lives (Suicide Prevention model, and the Aboriginal and Torres The Suicide Prevention Action 2020), which received funding of Strait Islander Suicide Prevention Plan 2025 was developed within a $33.9 million between May 2015 and Evaluation Project (ATSISPEP) framework that uses a whole-of- December 2020. Suicide Prevention framework. 2020 was organised under six key population approach and closely action areas and provided services To ensure consistency and a focus aligns with the Fifth Plan, the NSPIS and activities to at-risk populations in on a systems-based approach and some of the systems-based multiple locations across the state. to address the suicide rates, the approaches mentioned above.

6 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 The Suicide Prevention Action Plan Suicide Prevention commitment to improving the 2025 Framework (appendix One) mental health and wellbeing of has four major streams: prevention, Action Plan 2025 the community, and addresses intervention, postvention and The Suicide Prevention Action Plan suicide-related findings and Aboriginal people. Table 1 shows 2025 aims to build on the work of the recommendations of several the Suicide Prevention Action Plan previous strategies and the state’s reports, including the WA State 2025 approach across the suicide investment of approximately $55 Coroner's Inquest into the deaths prevention continuum. million over the past 10 years. of 13 children and young people in the Kimberley and the 2016 It is intended to support in part the Message Stick Inquiry into implementation of State Government Aboriginal youth suicide in remote strategic documents such as: areas. • The Western Australian Mental The Action Plan, was designed in Health, Alcohol and Other Drug consultation with the community, Services Plan 2015-2025; government, non-government • Gayaa Dhuwi (Proud Spirit) organisations, and the mental health Declaration; sector. It was developed using • The State Public Health Plan for the most current data, research, Western Australia. evaluation and reports, and the • It also expands on the State expertise of various working and Government’s continued steering groups.

2 In this document, 'vulnerable populations' refers to those populations who have a higher risk of suicide and suicidal behaviour. These include: Aboriginal people; persons who have experienced abuse, trauma, conflict or disaster; refugees and migrants; prisoners and others in contact with the justice system; lesbian, gay, bisexual, transgender and intersex persons (LGBTI); frontline workers, individuals who have had a previous attempt and people suicide bereaved.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 7 It has taken into consideration the intervention, postvention and The Suicide Prevention Action Plan voices of vulnerable populations as Aboriginal. 2025 is an action-orientated and well as the lived experiences of those dynamic document which recognises It can be used by state and who have been bereaved by suicide, the need for a mix of place based local government agencies, and those who have experienced and state-wide activities. It takes non-government and private being suicidal. into account the complexities of WA, organisations and communities to including the vast distances between The Suicide Prevention Action Plan help identify their role in suicide regions and diversity of populations, 2025 provides the framework for a prevention and guide the investment, and acknowledges the rapidly coordinated approach to address development, implementation and changing landscape as we continue suicide prevention activity in Western evaluation of suicide prevention to learn from the emerging evidence. Australia from 2021 to 2025 under activities. the four priority areas of prevention,

Table 1: Suicide Prevention Action Plan 2025 approach – The Suicide Prevention Continuum

Prevention Intervention Postvention

Priorities - anyone who could Priorities - individuals who are Priorities - people and communities benefit from learning, knowing, showing early signs of suicidal who have been affected by the death and doing more about mental behaviour, experiencing suicidal of someone from suicide. These health and wellbeing, and suicide crisis, including those who have strategies meet bereavement-related prevention. They may have no recently been suicidal, and the needs that may occur over a lifetime experience of being suicidal or people who support them. These and focus on providing support losing someone to suicide or strategies focus on decreasing and limiting the ongoing harmful they may have extensive personal suicidality and reducing the consequences of a suicide death for experience. likelihood of suicidal behaviour others. resulting in death. Strategies may target the whole >> Support for people and communities of population, groups within >> Options for people experiencing affected by a suicide death community and/or groups known suicidal crisis >> Streamlined notification processes to be at higher risk. Activities are >>Competent and confident aimed at preventing the onset of >> Build community capacity to respond assistance for people who are suicidal suicidal behaviour. to the needs of those affected by a >> Restricting the means of suicide suicide death >> Community engagement and awareness to support positive change >> Appropriate aftercare support >> Mental health and wellbeing education, and suicide prevention training for communities

>> Responsible reporting of suicide in the media

Aboriginal People

Priorities - Aboriginal People from a Social and Emotional Wellbeing (SEWB) approach. SEWB acknowledges that connections to land, culture, spirituality, family and community impact on the wellbeing of Aboriginal people.

>> Development of a Western Australian Aboriginal and Torres Strait Islander Suicide Prevention Strategy with dedicated regional streams.

8 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 The WA Suicide Prevention Action Plan 2025

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 9 The Action Plan at a glance

Vision Goal Purpose

A Western Australian community To reduce the rate of suicide To provide the framework for that experiences optimal mental attempts and death by suicide in a coordinated approach to health and wellbeing Western Australia address suicide prevention activity in Western Australia from 2021 to 2025

Guiding principles

Everyone has a role in suicide prevention Evidence-informed, integrated, cross- Communities are empowered to lead sectoral approaches are needed local efforts which are tailored to local Recognition that lived experience is circumstances and priorities essential to inform suicide prevention Quality and timely interventions are activity available across the lifespan Individuals, families and communities are supported to recover Community wellbeing and resilience are Earlier intervention to prevent and fundamental manage crisis A sustainable service system, which takes into account the limited resources Care is culturally appropriate and Support and care is matched to individual available compassionate needs and preferences

Enablers Better use of data, information Inclusiveness for all Western Partnerships, collaboration, Acknowledgment of the role and evidence to support suicide Australians, including those at and coordination of activities for that trauma and the social prevention increased risk better outcomes determinants of health have in suicide prevention

Priority areas

Prevention Intervention Postvention Aboriginal People

Community engagement and Options for people Support for people and Facilitate the development of a awareness to support positive experiencing suicidal crisis communities affected by a Western Australian Aboriginal change suicide death and Torres Strait Islander Competent and confident Suicide Prevention Strategy Mental health and wellbeing assistance for people who are Streamlined notification with dedicated regional education, and suicide suicidal processes streams. prevention training for communities Restricting the means of suicide Responsible reporting of suicide in the media Appropriate aftercare support following a suicide attempt

10 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Principles

Principles Recognition that lived experience Evidence-informed, integrated, is essential to inform suicide cross-sectoral approaches are These principles underpin the prevention activity needed Western Australian Suicide People with a lived experience of It is preferable for activities to be Prevention Action Plan 2021- attempted suicide or who have produced and implemented on the 2025. They are drawn from the been bereaved by suicide have basis of evidence about what does draft national suicide prevention great knowledge and expertise and does not work. When directly implementation strategy for as do their families, carers and relevant evidence is unavailable, Australia’s health system: 2020 -2023 communities. The development and programs informed by evidence and have been slightly modified implementation of suicide prevention and best practice methods in to present a Western Australian strategies must include their voices, similar fields can be implemented. perspective. In the development, and activities should be co-designed The insights of people with lived commissioning, and implementation with people with a lived experience. experience of suicide; traditional of suicide prevention activity it is forms of knowledge, such as from crucial these principles are adhered Community wellbeing and Aboriginal people and unique cultural to every step of the way. resilience are fundamental perspectives, can form part of the Connection to community, a sense Everyone has a role in suicide evidence base for effective suicide of belonging, equity and inclusion, prevention prevention. Continual development, willingness to engage in solutions implementation and evaluation Having a role in suicide prevention and safe gathering places all of existing and future initiatives is activities is in every person’s, contribute to community wellbeing crucial. community’s and government’s and resilience. Fostering social interest, because suicide impacts connections, creating community the entire community. It is far- safety and protecting against reaching and long-lasting, with adversity will enable communities the potential to touch everyone to adapt, recover and thrive through directly and indirectly. Whilst the times of change and unpredictability. reasons for suicide are complex and multifaceted, many suicides are preventable. Everyone is encouraged to take a role in suicide prevention, no matter how great or small.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 11 However, it is also important that any Support and care is matched to Communities are empowered evaluations of suicide prevention individual needs and preferences to lead local efforts which are programs or activities are open to It is essential that individuals, their tailored to local circumstances trialling new, innovative and non- families and communities have a and priorities. traditional initiatives for prevention voice: care must be tailored to the Suicide prevention approaches and early intervention. person’s circumstances, needs and are more effective when they are underlying causes of distress. For Quality and timely interventions community-driven and led, and some people this will involve mental are available across the lifespan reflect the social, emotional, cultural, health treatment or cultural healing. socio-economic and spiritual Evidence shows us that early For others relationship counselling, needs of the community. WA is an identification and effective employment or housing support expansive and diverse state, with management of individuals who could be what is needed most. each region having its own unique are seeking help is key to reducing circumstances and challenges. Local suicides. A variety of services need Care is culturally appropriate and people are best placed to determine to be equipped to deliver evidence- compassionate what is required for their community. informed and culturally secure The diversity of individuals and Their local knowledge, experiences interventions that prevent and communities needs to be valued and and stories are essential for making respond to psychological distress respected. Care which is kind and a difference. and suicide-related experience for compassionate without prejudice, people of all ages. racism, stigma or judgement is Individuals, families and essential. A compassionate approach communities are supported to Earlier intervention to prevent and requires an understanding of where recover manage crisis the person came from, what they are Compassion, understanding, and Shifting the focus to earlier connected to, how they got to where coordinated and practical support interventions, such as addressing they are now and how they can move is required over the long-term to aid risk and protective factors can have forward. People with lived experience recovery from the impact of suicide. significant advantages for the whole report compassionate care is vital to population. At the individual level, A sustainable service system, their successful recovery. early intervention is critical for those which takes into account the showing signs of suicidal crisis, as limited resources available is a SEWB holistic approach for Governments, service providers and Aboriginal people. communities must acknowledge resources fluctuate (sometimes dramatically) over time. Strategies for sustainability must be considered including the sharing of information, collaboration across services and working across governments.

12 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Enablers

Suicide Prevention Action Inclusiveness for all Partnerships, Plan 2025 activities can be implemented effectively only if the Western Australians, collaboration, and identified enablers are activated. including those at coordination of risk activities for better

Better use of data, The Western Australian population outcomes information and is diverse and prevalence of suicide Many of the factors that can influence evidence to support rates are skewed for certain groups. suicide prevention occur in non- suicide prevention Certain groups in the community are health settings. Close working disproportionately affected by suicide. relationships between governments Improving the quality of evidence Consideration of diverse cultures, at the local, state and national for suicide and suicide prevention languages, genders and sexualities level, private and non-government activities is fundamental for is essential. Equally essential is sectors, research institutions and the continuous improvement of the acknowledgment of situational key community groups are essential. community outcomes. Improved stresses (such as relationship Funding models must promote reporting of and learning from deaths breakdowns, job loss, draught etc) collaboration. by suicide needs to occur to help that can affect individuals, families Activities required to ensure enablers inform future suicide prevention and communities at different times. activities. Promoting evidence- are activated include: Activities required to ensure enablers informed innovation, accompanied by • The Mental Health Commission are activated include: thorough evaluation, will help build (MHC), with appropriate resource the evidence for new approaches. • Empowering the voices of allocation will utilise Suicide vulnerable populations, including Activities required to ensure enablers Prevention Action Plan 2025, as Aboriginal, youth, migrants, are activated include: a guiding document to facilitate refugees, LGBTI people, people and lead a coordinated whole-of- • Improved data collection, who have attempted suicide, government response to suicide in particularly at the community people who have been bereaved Western Australia. and population levels, relating to by suicide, people living in rural • Provision of appropriately qualified increased personal and community and remote areas, people in the metropolitan and regionally based resilience to suicide. justice system and first responders. staff who engage with local • Collection of both qualitative service providers, community and and quantitative data including stakeholders to coordinate and descriptive narratives from service support regional (and local) suicide providers. prevention initiatives. • More academic research and • Definition of the roles and practical information sharing responsibilities of federal, state, local between suicide prevention and non-government organisations professionals and communities in regards to suicide prevention, with lived experience. intervention and postvention in each region to address duplication and / or service gaps.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 13 • Provision of opportunities for MHC-funded service providers to engage with each other regularly to support a more cohesive approach We need to address the to strategy delivery and improve widespread pervasive consumer pathways. hopelessness and social • Greater alignment with mandated context rather than treating the Local Government Community symptomatic cycle of ‘argument Health Plans on practical /suicide threat / police / ED / initiatives. repeat’; The Office of the Chief Psychiatrist and the Mental Acknowledgment Health Commissioner should of the role that recognise the Uluru Statement from the Heart to show that trauma and the we recognise and support social determinants Aboriginal voices at the highest of health have in level. Suicide and hopelessness requires a system response suicide prevention to a system issue rather than Suicide prevention is more effective treatment solely as an individual when integrated with broad malaise. responses to the social and cultural Regional Service Provider (WA Suicide Prevention Action Plan 2021-2025 determinants of poor health and Engagement Report wellbeing, including childhood trauma, family violence, poverty, displacement, experiences of discrimination, lack of education opportunities, isolation, loneliness and alcohol and other drug use.

• Collaboration across governments in equitable partnerships with local communities to address the social contexts and determinants that drive hopelessness in communities. • Addressing homelessness, violence, child neglect, alcohol and other drug related-harms poverty etc.

14 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Priority area activities

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 15 Prevention priority area activities

Prevention priorities are aimed at 1.2 Addressing the stigma of mental anyone who could benefit from health and suicide in communities learning, knowing, and doing more through community designed and led about mental health and wellbeing, universal prevention and promotion Stigma and suicide prevention. They may initiatives at state, regional and Stigma related to suicide have no experience of being suicidal community levels. remains a major obstacle to or losing someone to suicide or suicide prevention efforts. 1.3 Expanding of public awareness they may have extensive personal Those who are left behind or ecampaigns to assist communities to experience. Strategies may target who have attempted suicide connect with the best mental health often face considerable stigma the whole-of-population, groups and suicide (prevention) information, within their communities, which within it, and/or groups known to be support, and services with the may prevent them from seeking at higher risk. Activities are aimed capacity to be localised as required. help. Stigma can subsequently at preventing the onset of suicidal become a barrier to accessing behaviour. 1.4 Celebrating those with diverse suicide prevention services. cultures, languages, genders and sexualities within the community and Community at the service provision level. engagement and 1.5 Recognising and empowering awareness to youth voices in mental health or support positive suicide prevention discussions change and leadership through greater participation in decision-making, co- Communities play a critical role in production of prevention initiatives suicide prevention. They are able and advice to services. to access knowledge to identify and implement specific suicide 1.6 Providing dedicated peer- prevention strategies relevant to based mental health and wellbeing their situation. This may include education and support for vulnerable enhancing broad government populations with a key focus on strategies by localising them and/ Aboriginal people, LGBTI young or coming up with specific activities people and men in rural and remote unique to their community. communities

1.1 Empowering local people 1.7 Investigating community-based to determine and deliver those initiatives to reduce loneliness and methods of suicide prevention increase social connections for high- that are most appropriate for their risk populations. community through increased and more accessible grassroots suicide prevention resourcing.

16 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Case study - Think Mental Health

The Think Mental A new TMH Men’s Campaign Baseline research was when prompted. At- risk (the campaign) was developed conducted prior to the launch men were significantly more Health Program in response to consistently of the campaign to understand likely to talk about their (TMH) has been built high suicide rates among men trends in community mental health needs with a in Western Australia (WA). knowledge, beliefs, attitudes, professional as well as with on the premise that In 2017 over 70 per cent of intentions and behaviours family/friends as a result of strategies developed suicide deaths in WA were in relation to mental health seeing the campaign. men. The highest prevalence and wellbeing, mental health for mental health of suicide was among men issues, help seeking, and Awareness of the campaign promotion will have aged 25 to 54 years who were barriers to help seeking was also high amongst family consequently chosen as (stigma). Research will be and friends with 29% of family a flow-on effect for the primary target audience conducted to monitor and and friends spontaneously for the current phase of the track attitudinal measures over aware of the campaign and suicide prevention. TMH Men’s Campaign. The time. 69% demonstrating awareness For example, building secondary target audience is when prompted. The campaign people who support men, such A post-campaign evaluation was also felt to strongly protective behaviours as partners, friends, family, or indicates that the messages educate family and friends: that promote mental colleagues. taken out by males were on 57% said it made them think target, with the availability about the mental health and health and wellbeing, The main communication of help and encouragement wellbeing of males close to or seeking early messages of the campaign of help-seeking registering them; 49% were made aware were designed to motivate strongly. As a result of of the TMH website; 48% were support when people who may be seeing the campaign more provided advice on how to mental health is experiencing mental health than a quarter (28%) of all approach someone they are issues, or family and friends males had taken some form concerned about; 38% were compromised, will of these people, to talk to each of action. When looking at made aware of the support other when things aren’t going the measures known to be tools and tips available; and translate into fewer so well and to connect them important in campaign cut- 37% were made aware of the incidents of suicidal with mental health information, through and effectiveness, symptoms of a mental health support and help appropriate the campaign performed issue. behaviour. to their situation and needs. extremely well amongst males The next phase of the This included: on Novelty, Affective Impact, campaign will build upon these TMH focuses on assisting • what to look out for when and Relevance - sitting within results to increase confidence people connect with the best you or someone else the top 25% of all Australian in recognising signs and information, support, and isn’t going so well; campaigns tracked to date. symptoms and supporting services for their particular • how to start the others in getting the right help situation. To achieve effective conversation and what At-risk men were those to support their mental health outcomes for mental health to say; with a diagnosed mental and wellbeing. and suicide prevention, a • options on getting help health condition or who had broader focus has been and support; and experienced a significant taken to emulate the success • what to do in a crisis life event in the previous achieved by other high-profile situation. two years. The campaign population based behaviour was particularly effective in change campaigns, such as reaching at-risk men with 70% tobacco control. recognising the campaign

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 17 Mental health and 2.2 Empowering peer support groups and networks that deal with mental wellbeing education, health and suicidal ideation through and suicide appropriate recognition, supervision prevention training and resourcing. for communities 2.3 Providing education and training that addresses the wider social Many people who are experiencing context within which mental health suicidal thoughts communicate and suicidal ideation develops, distress through their words or and focusing on building stronger actions but these warning signs protective behaviours in at-risk may be missed or misinterpreted. populations. Training can provide people with the knowledge and skills to identify 2.4 Providing mental health and warning signs that someone may be wellness education, and suicide suicidal, talk to them about suicidal prevention training in schools. thoughts and connect them with 2.5 Facilitating opportunities for professional care. reconnection to culture and country Activities required to ensure this for Aboriginal people. priority is achieved include:

2.1 Expanding mental health and suicide prevention training and education to a wider cross section of the community through easily accessible and culturally appropriate formats.

18 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Responsible Community suggestions • Co-designing and co-producing reporting of suicide Empowering local people to national and state based prevention determine those methods of in the media messages such as RUOK? suicide prevention that are most and Think Mental Health with Suicidal behaviour can be influenced apt for their community will community members to reflect a through the media. Media guidelines ensure local buy in, innovation, more localised approach. supporting the responsible reporting social inclusion and a sense of of suicide can reduce suicide rates, • Encouraging community members belonging. Every community and improve awareness and help- to actively check-in on, and listen appears to have the ‘right’ answer seeking . to, family and community members for addressing suicide in their Activities required to ensure this everyday. context and all display great priority is achieved: • Holding public events to showcase levels of insight and innovation cultural, language, gender and in methods. These methods 3.1 Working with journalists to sexuality awareness. often manifest in community increase their competency with and social engagement activities respect to the MindFrame reporting • Providing greater social outreach and whilst these initiatives may guidelines. opportunities through existing youth services. not always be evidence based, 3.2 Educating communities, they are critical to providing particularly school age youth and local ownership, hope and the parents, about identifying distress necessary community dialogue and cries for help on social media to support more evidence based, and the application of Mental Health prevention. First Aid-style principles in online Engagement summary 2019 environments.

19 Prioritising and Progressing Actions DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 19 Intervention Priority Area

Intervention priorities are aimed 4.3 Addressing the critical lack of Community Suggestions at individuals who are showing after-hours support for people in • Accessing options for those people early signs of suicidal behaviour, suicidal crisis outside of emergency who prefer to avoid local services experiencing suicidal crisis. This departments (EDs) and anonymous due to lack of anonymity in small includes those who have recently helplines, especially in rural and towns; been suicidal, and the people who remote settings. • Crisis helplines with the ability support them. These strategies 4.4 Providing alternatives to EDs to retain personal information focus on decreasing suicidality for those in mental distress and/or on previous callers that can be and reducing the likelihood of suicidal crisis. accessed upon request/permission suicidal behaviour resulting in to avoid having to retell personal death. 4.5 Reducing the stigma and fear stories; of calling the police for people experiencing acute mental distress • Opportunities for face-to-face Options for people and suicidal behaviour. connection in non-clinical safe experiencing haven café settings for open, 4.6 Redesigning existing EDs normal discussions without the suicidal crisis settings to more compassionately need to feel shame; Suicidal behaviour is complex cater for those in mental distress. • Expansion of the Police Mental and there are many reasons why 4.7 Increasing access to appropriate Health Co-Response model; someone may be having suicidal mental health and support services thoughts. Early intervention and • In emergency departments provide for the specific needs of targeted providing people with a range of safe, quiet, low light environments in vulnerable populations and including support and/or treatment options can separate rooms that lessen distress those relating to family and domestic reduce the risk of someone taking and can also account for cultural, violence, homelessness, alcohol and their life. language, gender or sexuality other drug use and/or trauma. security; Activities required to ensure this 4.8 Expanding access within schools • Increase resourcing for Aboriginal priority is achieved include: and specific services for children social and emotional wellbeing 4.1 Providing increased and equitable and young people in mental distress workers and Aboriginal liaison access to mental health and SEWB and suicidal crisis across the WA. officers across the State; and services for people in mental distress • Provide non-clinical youth worker and/or with suicidal ideation. style support and interventions. 4.2 Facilitating access to culturally appropriate healing-centred practices and recovery options for migrant and refugee populations. Suicide and self-harm are not black and white but the responses always are - ED or not, medication or not. You can still have those thoughts every day and self-harm but not want to act on them. You need complex help, and medication or ED shouldn’t be the first and only option.

Regional LGBTI Teenager

20 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Case study - Mental Health Co-Response Program

The Mental Health from frontline police officers to observe and screen Perth Watch House who suspect a member of the detainees as they are 8,671 detainees screen by the Co-Response community is experiencing processed and provide mental health practitioner. Program (MH-CR) a mental health episode; and further assessment if the admission of arrested needed. A total of 705 referrals were was implemented people with mental health 4. MH-CR Unit which co- made from the Perth Watch in January 2016 in issues or a history of mental locates WA Police and House (139 to mental health health intervention to the Perth Department of Health court liaison services, 383 to response to increased Watch House who require personnel and provides external mental health services demand on Police to assessment, monitoring and managerial oversight. and 183 to other community diversion pathways. services). attend and manage Over the course of the two- The MH-CR trial, which year trial the following results An independent evaluation incidents that involved incorporated mental health were achieved: of the trial showed benefits a mental health expertise at each stage of to resource allocation, the police involvement – from Police Operations Centre safety and wellbeing of element. the point of dispatch, to the 20,149 tasks reviewed by the officers and mental health point of physical contact at mental health practitioner consumers, and interagency This increase in demand the scene, and following arrest including welfare checks, collaboration at each stage coincided with national within the custody setting, was missing persons and mental of the model. Findings also concerns about the ability the first of its kind in Australia. health incidents. indicated that although Police of police officers to respond There are four components are being called to a growing appropriately to mental health which support the delivery of Mobile Teams number of mental health incidents. The MH-CR is a the MH-CR model: 2,907 mental health consumers incidents, the majority are not joint initiative between the 1. Police Operations Centre were engaged/assessed by criminal incidents. Interviews WA Police Force, the WA MHC where a Mental Health Co-Response teams (1,318 by revealed that mental health and Health Service Providers Practitioner is located to the South East Metropolitan consumers and their carers (HSPs), and enables police obtain and share relevant District mobile team and 1,589 engaged positively with the and mental health clinicians to information from health by the North West Metropolitan MH-CR model and saw it as a share information and jointly databases. District mobile team). significant improvement over attend crisis situations where 2. MH-CR Mobile Teams the traditional crisis response mental illness is identified as a which include an There were 328 and 389 used by police. The MH-CR has likely factor. Authorised Mental referrals to mental health and strengthened the partnership Health Practitioner and other community services by between the WA Police Force The MH-CR model provides a uniformed Police Officers the South East Metropolitan and mental health services, distinct multiagency service in an unmarked vehicle District mobile team and leading to improved overall responding to particular to respond to incidents the North West Metropolitan mental health and wellbeing mental health-related involving a mental health District mobile team outcomes for consumers. In circumstances, including calls crisis. respectively. response to the success of for assistance where a mental 3. Perth Watch House the trial, the MH-CR has since health or welfare concern has where an Authorised been expanded to cover the been indicated; requests for Mental Health whole Perth metropolitan advice, guidance or assistance Practitioner is on duty area.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 21 Competent and 5.5 Acknowledging the high burnout Restricting access to rates of staff, in particular those in confident assistance community prevention, isolated rural the means of suicide for people who are and remote counselling roles and Reducing access to the means of suicidal outreach and volunteer workers. suicide is one of the most effective suicide prevention strategies. Making Those who support people in suicidal 5.6 Providing local services with it more difficult for a person to access crisis need to have the knowledge access to more timely and accurate means, or by interrupting a person’s and skills to provide care that will regional self-harm, suicide attempt immediate means for taking their life, make the person seeking help feel and death by suicide data regionally allows time for the suicidal crisis to safe and reduce their risk. Community suggestions pass. This, coupled with encouraging Activities required to ensure this • Increase trauma-informed training help-seeking and the intervention of priority is achieved include: and practices embedded in WA a third party significantly reduces the potential for suicide. 5.1 Expanding Mental Health First Police and ED settings, and other Aid, ASIST, Gatekeeper and other human services such as Centrelink Activities required to ensure this culturally appropriate training to all and Department of Housing; priority is achieved include: health, mental health and primary • Providing for early intervention 6.1 Coordinating a multi-agency care staff. within schools through school collaboration across government psychologists and chaplains; 5.2 Embedding culturally secure, to identify and establish barriers or trauma informed and compassionate • Up-skill family members and mechanisms that can interrupt the procedures and responses into volunteers within communities suicidal process. EDs as well as crisis and support with strong yarning and distress 6.2 Manage alcohol and other drug- services. management skills (and pay them related harm in the community. as local suicide prevention liaison 5.3 Implementing consistent officers); 6.3 Establishing cross-functional assessment and early intervention • Provide free and easily accessible working groups on suicide means frameworks and services for suicidal counselling for community restriction as part of suicide ideation and behaviour. members, volunteers and families prevention planning. 5.4 Recognising and supporting peer who are ‘holding it together’ support and response models for for people in crisis within their people in acute mental distress and communities. suicide crisis

22 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Appropriate 7.2 Empowering, equipping and Community suggestions supporting families and carers to aftercare support • Regular follow up counselling of successfully navigate mental health high-risk individuals (beyond the following a suicide and suicide prevention networks and 10 sessions a year covered by attempt systems. Medicare rebates); Aftercare refers to the care, 7.3 Providing families and carers with • Create continuity of care with the treatment, help or supervision accessible and formal peer support, same professional staff to build received by people after a suicide community based support and up a rapport rather than having to attempt, and extends to family and education, and respite opportunities re-explain details to new staff at carers. Evidence tells us that a in the ongoing recovery phase each visit; suicide attempt is the strongest risk • Offer in-home support services factor for a subsequent suicide, and and home visitation; and the period of highest risk is following • Resource volunteer and peer release from hospital or medical support services during times of treatment. Appropriate aftercare is need to provide emotional and essential in suicide prevention. practical support. Activities required to ensure this priority is achieved include:

7.1 Address major breakdowns in after care following a suicide attempt through increased safety planning and referral pathways post discharge from hospital or medical treatment.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 23 Postvention Priority Area

Postvention refers to intervention Support for people 8.2 Providing ongoing practical and after a death by suicide, to financial support to families directly support affected individuals and and communities affected by a suicide in locally and communities. It aims to assist affected by a suicide culturally relevant ways. people who are bereaved (family, death 8.3 Increasing access to dedicated friends, professionals and peers) Bereavement due to suicide can be and ongoing postvention and to recover from trauma, major complicated. The often sudden and bereavement services for families, stressors, and cope with grief and sometimes unexpected nature of the communities, children and young loss. death can be extremely traumatic people bereaved by suicide. Postvention priorities target people and in addition to grief the bereaved 8.4 Educating service providers and communities who have been can experience shock, isolation, on suicide postvention evidence, affected by the death of someone questioning 'why' anger, rejection best practice models and available from suicide. These strategies meet and guilt. Bereavement by suicide pathways to support. bereavement-related needs that may is a specific risk factor for suicide occur over a lifetime and focus on attempt among young adults whether providing support and limiting the they are related to the deceased or ongoing harmful consequences of a not and it is important that people suicide death for others. and communities are supported appropriately to prevent further harm.

Activities required to ensure this priority is achieved include:

8.1 Establishing clear scope of service and protocols for suicide postvention coordination between existing federal, state and community based services and roles.

In the immediate aftermath of a suicide, the bereaved need immediate practical and financial support in order to be allowed the time to grieve. This includes meals, extended leave from workplaces and assistance preparing memorials. Person-centred care is required as there is no universal answer to postvention support. Engagement summary 2019 (WA Suicide Prevention Action Plan 2021-2025 Engagement Report)

24 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Build community Streamlined Community suggestions capacity to respond notification • Develop clear and agreed postvention network support to the needs of those processes pathways (at the local level) for affected by a suicide Real-time and better integrated families and affected communities. death data at the community level will help • Provide meals and 'sorry time' provide responsive suicide prevention specific foods, bedding and power- The painful experience of grief and services and supports. Systems cards for visiting family and friends. bereavement following suicide loss across government will assist with is further complicated by the effects • Provide transport for family support, suicide prevention policies and the of stigma and trauma. Increasing the and funeral arrangements;. transfer of research findings into skills and knowledge of communities • Educate services on how to support practice. to be able to respond safely, people bereaved by suicide and the appropriately and in a manner that Activities required to ensure this language to use. does not inadvertently cause harm is priority is achieved include: • Support community-based services essential. 10.1 Improving the timely and such as community groups and Activities required to ensure this accurate reporting of suicide deaths in events, yarning groups and priority is achieved include: Western Australia memorial activities.

9.1 Facilitating the development of 10.2 Establishing more consistent community-designed and agreed and timely reporting of WA Police and crisis/postvention plans and protocols hospital data on self-harm, suicidal for high-risk populations. ideation and suicide attempts to public mental health, Aboriginal Community 9.2 Providing dedicated opportunities Controlled Health Organisations and resourcing for ongoing (ACCHOs) and non-government community and peer level healing. services in the community.

As well as increasing public awareness of the impact of suicidal behaviour we must look to educate and empower individuals and communities in how to get help, give help and save lives. The Ripple Effect: Understanding the exposure and impact of suicide in Australia

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 25 Case study - Metropolitan Suicide Prevention Coordinator (SPC) Postvention Project

In 2018, members The proposed community In an Australian first, the The process of testing and postvention model would be Metropolitan SPC team has reviewing the effectiveness of of the Metropolitan informed by international and been working with Bowra & this community postvention SPC Postvention Australian evidence and be O’Dea to co-design and pilot model will continue to the end flexible enough to be adapted a community postvention of 2020 and is being formally Development to ‘best-fit’ by the broad range model which will equip staff evaluated by UWA and a group Group (over 30 of potential stakeholders in the to work appropriately with of experts with experience of metropolitan area. suicide bereavement funerals, working with people bereaved key government, including: by suicide. The findings • a training package covering: community and The first group which identified will consider the potential an interest in trialling such the use of appropriate application of this model to lived experience an approach was Bowra & language; de-mystifying broader community contexts. O’Dea Funeral Directors. Their stigma and myths around representatives) 112 staff perform over 3 500 suicide; understanding agreed to develop funerals in the metropolitan complex grief; and self-care area per annum. In Australia, for staff; and trial a community funeral service staff are the • a range of client and postvention model in most prevalent service used staff resources providing following a bereavement. While information about the Perth. they are on the frontline with experience of suicide families and friends following bereavement, referral and a suicide there has been little support services; acknowledgement of the role • a range of organisational of funeral service staff or interventions around their potential for playing an workflow and important part in community communication to further postvention. support good practice around suicide bereavement funerals.

26 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Aboriginal People Priority Area

For Aboriginal people and • A strong link between collective 11.2 Facilitate access to culturally their communities, SEWB is and individual wellbeing; appropriate healing-centred practices the foundation for a holistic • Recognition and promotion of and opportunities for reconnection concept of physical and mental the importance of family support; to culture and country for Aboriginal health. This concept is strongly prioritising the need to work with people. influenced by a connection the whole family and not just the 11.3 Develop and deliver a culturally between Aboriginal people individual; appropriate public awareness-raising and family, culture, country, • An understanding and campaign aimed to support Aboriginal community, spirituality and acknowledgement of connection to people. Elders. These connections work land and community; together to provide a culturally 11.4 Recognise and empower • Acceptance and understanding safe and appropriate environment Aboriginal youth voices in mental of the legacy of history and for Aboriginal people, and help health or suicide prevention contemporary impacts on health individuals to enhance their discussions and leadership through and wellbeing; SEWB. greater participation in decision • Flexible delivery of services making, co-production of prevention The wellbeing of Aboriginal people is including outreach, home support, initiatives and advice to services. influenced by physical health, mental on country and in schools; health, education, employment, 11.5 Provide increased and equitable economic engagement and cultural • Promotion of an ‘open door policy’ access to SEWB services for wellbeing. Addressing the impacts where there is no judgement or Aboriginal people in mental distress of trauma, grief, loss, discrimination exclusion; and/or with suicidal ideation, including and human rights issues experienced • Understanding the importance of the engagement of Elders and by Aboriginal people are also critical language, cultural healers, and Traditional Healers where required. elements. traditional medicines that are 11.6 Empower ACCHOs and trusted by the community. While the experience of SEWB Organisations and other community varies between different Aboriginal The following recommended organisations to provide culturally people, groups and locations, there activities aim to support the healing appropriate suicide intervention are common elements which help to and restoration to wellbeing and services for Aboriginal people. enhance SEWB. These include: mental health both individually and 11.7 Embed culturally secure, collectively for Aboriginal people • A holistic approach which extends trauma informed and compassionate (Gayaa Dhuwi Declaration). further than mental health, and procedures and responses into crisis focusses on the broader context 11.1 Facilitate the development of and support services. and life pathways of individuals and a Western Australian Aboriginal 11.8 Provide ongoing practical and families; and Torres Strait Islander Suicide financial support to families directly Prevention Strategy with dedicated affected by a suicide in locally and regional streams. culturally relevant ways.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 27 How we developed the plan

28 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 How we developed the plan

A program logic model Framework (The Suicide Prevention Framework for Western Australia 2021 – 2025, appendix 1) guided the development of the WA Suicide Prevention Action Plan 2025

Plan consultation Who we engaged What we heard • 554 individuals in 110 separate face-to-face engagements • Social determinants need to be addressed – housing, (yarns, focus groups, workshops), education, employment and health care… • 431 individuals via an online survey • Culture and country are important. • Revision and analysis of 19 previous consultation reports • We need to empower local communities for community- and papers published between January 2015 and June 2019 led suicide prevention activities that related to Suicide Prevention activity. • Suicide prevention education should be expanded to a • Steering committee: representatives from key agencies and wide cross section of the community community groups provided advice and guidance and helped • The is a need for a greater range of options for people to represent the voices of vulnerable populations, sector and experiencing suicidal crisis academic experts. • Pro-active follow up aftercare following a suicide attempt • Government Advisory Group: a mix of representatives from is needed federal and state government.

Emerging evidence and literature New Frameworks and literature From the literature we learnt • Alliance Against Depression (AAD) model Black Dog • A systems-based approach is essential: this means LifeSpan Integrated Suicide Prevention (LifeSpan) model multiple strategies, delivered simultaneously that focus • Aboriginal and Torres Strait Islander Suicide Prevention on individuals, high-risk groups and the whole population Evaluation Project (ATSISPEP) • Social determinants of health need to be addressed • Review of 15 strategic government documents that have • An Aboriginal-specific Suicide Prevention Plan must be direct or indirect involvement in addressing suicide within WA developed (Appendix 2) • Cross-government collaboration is required

Evaluation of Suicide Prevention 2020 How we evaluated Key Findings from the evaluation • Internal ongoing evaluation and monitoring of Suicide • We need better coordination at the local level and of Prevention 2020. community-led activities • Independent evaluation of Suicide Prevention 2020. • Aftercare (following a suicide attempt) should be addressed as a separate issue to postvention (following a suicide death). • Longer-term funding agreements for service providers are needed • Collection of quantitative and qualitative community-level data is important • Suicide prevention activity needs to be coordinated across government, non-government organisations and community groups

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 29 Everyone has a role in Suicide Prevention

30 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Everyone has a role in Suicide Prevention

The MHC acknowledges the vision Western Australian Government the Youth Advocacy Council of WA. of the Suicide Prevention Action The WA Government is responsible Non-government and private sector Plan 2021-2025 cannot be achieved for the development of state-wide organisations are also responsible in isolation. Identifying the roles strategies and plans and includes for providing employment and of government, organisations and the delivery and funding of programs workplaces that are safe and healthy. community efforts is important. and services that improve wellbeing Individuals and communities Many services and agencies which at the community, organisational Individuals, families and groups that do not have suicide prevention as and individual levels. These include make up our community share the part of their core business may not housing, employment, health, responsibility of providing safe and recognise they may be engaged disability and financial support, secure environments and building with some of the most vulnerable transport assistance, workplace supportive positive relationships members of the community. They supports, the justice system and between friends, families, have an important role in identifying education programs. neighbourhoods and community and responding to those who may Local Government groups. be vulnerable to suicidal behaviour Local governments are responsible due to risk factors such as financial for developing the local community hardship, relationship loss, trauma, in a socially just and environmentally Suicide is often caused by legal issues, and social isolation. responsible way. This can include situational, not mental, causes and Every life highlights the need for local infrastructure, parks and this needs to be recognised and suicide prevention activities to be recreation facilities, health services, addressed in a holistic, not siloed, embedded into the core business of building and planning licensing and approach. In fact, in some regions all agencies. the provision of cultural facilities and and communities, addressing Commonwealth Government events. the social determinants that drive hopelessness and have a The Commonwealth Government Non-government organisations, marked impact on an individual’s is responsible for the development and the private sector social context, mental health and implementation of national The non-government and private and suicidality is seen as the frameworks including the delivery of sector delivers a range of face-to- most pressing activity for funds, programs and services. For face and online services and plays suicide prevention in the near example the Primary Health Alliance a large role in supporting individuals and long term. These social develops regional suicide prevention and the community in advocating determinants include, but are not plans in partnership with hospital for change. This sectors includes limited to, domestic and family and health services and other key peak bodies such as the Aboriginal violence, alcohol and drug use, sectors. Health Council of WA, The WA homelessness and overcrowding, Association for Mental Health and and unemployment, poverty and hunger and require a whole of government response. Engagement summary 2019 (WA Suicide Prevention Action Plan 2021- 2025 Engagement Report)

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 31 Building blocks for • Aboriginal-specific Aboriginal communities, with • Social Determinants many recommending collaborative a cross government works or Aboriginal-led initiatives. • Other (Governance Issues and approach Several authors discussed the Research). need for Government leadership in To reduce the potential for duplication Figure 2 identifies the Priority collaborative approaches. of services and to further understand Areas listed within the Suicide the interaction between government Prevention Action Plan 2025 and their The MHC, with appropriate resource departments in relation to suicide relationship to the key documents. allocation will utilise the Suicide prevention activity, the MHC Prevention Action Plan 2025, as The desktop review identified suicide commissioned a desktop review of 15 a guiding document to facilitate prevention, suicide intervention key government documents. and lead a coordinated whole-of- and Aboriginal-specific as the government response to suicide in Suggestions, recommendations, priority areas covered in the highest Western Australian. strategies, priorities and actions from numbers of documents. The areas of within these documents were cross- postvention and social determinants referenced against the Priority Areas of health were covered in the fewest of the draft Suicide Prevention Action documents. Aboriginal suicide Plan 2025: prevention and intervention experts • Suicide Prevention strongly recommended culturally • Suicide Intervention secure strategies that recognise and utilise the knowledge within • Suicide Postvention

Figure 2: Number of papers that include elements of each major priority area

32 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 What works well

Evidence-based reporting of suicide in print, Awareness broadcasting and social media; models Establish public information campaigns to support the Access to services To address suicide effectively understanding that suicides are Promote increased access to accumulating evidence supports preventable; implementing multiple strategies, comprehensive services for those delivered simultaneously across vulnerable to suicidal behaviours and Stigma reduction a range of areas. This spans from remove barriers to care; Promote the use of health services; individual-level to public health Training and education Oversight and coordination interventions in localised regions. Maintain comprehensive training This is referred to as a systems- Utilise institutes or agencies to programs for identified gatekeepers; based approach. The World Health promote and coordinate research, training and service delivery in Organisation have identified the Treatment following 11 elements as priority response to suicidal behaviours. Improve the quality of clinical areas to focus on when addressing care and evidence-based clinical In Australia, the LifeSpan Model suicidevi: intervention, especially for individuals (appendix 2) developed by the Black Dog Institute is an evidence-based, Surveillance who present to hospital following a suicide attempt; integrated approach that combines Increase the quality and timeliness of nine strategies that have strong data on suicide and suicide attempts; Crisis intervention evidence for suicide prevention into Means restriction Ensure that communities have the one community-led approach. The capacity to respond to crises with AAD (formally the European Alliance Reduce the availability, accessibility appropriate interventions; Against Depression, (appendix 3) and attractiveness of the means to is another systems-based model suicide; Postvention focusing on improving care for Media Improve responses to, and care for, people living with depression and those affected by suicide and suicide Promote implementation of media preventing suicidal behaviour. attempts; guidelines to support responsible

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 33 Factors that country, and physical, emotional and At the other end of the spectrum spiritual wellbeing. protective factors can help reduce influence suicidal a person’s vulnerability to suicidal Although not exhaustive, table 1 behaviour behaviours and increase their provides a list of known risk factors capacity to cope with particularly Not all people who attempt or die for suicidal behaviour grouped difficult circumstances. Key protective by suicide have lived experience of into categories demonstrating the factors identified by the WHO are: mental health issues. Many factors multiple levels at which risk factors influence a person to attempt to take can operate. It also helps to reinforce • Strong personal relationships, their life. Most commonly, several the role that everyone has in suicide including connections to family, risk factors accumulate over time prevention. culture and community which can increase an individual’s Some populations and groups are • Lifestyle practices that includes vulnerability to suicide. These risk more vulnerable to suicide and positive coping strategies and factors can occur at the individual, suicidal behaviour. These include: general well-being. community or structural level and Aboriginal people; persons who have often interact. experienced abuse, trauma, conflict For Aboriginal people, health and or disaster; refugees and migrants; wellbeing is directly related to prisoners and others in contact with holistic determinants of health; any the justice system; lesbian, gay, disturbance to these determinants bisexual, transgender and intersex can increase risk of experiencing persons (LGBTI); frontline workers, Upstream approaches suicidal behaviour. These individuals who have had a previous determinates include; connection to attempt and people suicide bereaved. Use of “upstream approaches” such as addressing risk and protective factors early in community, family, land, culture and the life course has the potential to “shift the odds in favour of more adaptive outcomes” over time. Additionally upstream approaches may simultaneously impact a wide range of health and societal outcomes such as suicide, substance abuse, violence and crime.

Table 1: Risk factors (adapted from WHO, 2014vi)

Health systems Society Community Relationships Individual

Barriers to accessing Access to means Disaster, war and conflict Sense of isolation and lack of Previous suicide attempt health care social support Inappropriate media Stresses of acculturation and Mental disorders reporting dislocation Relationship conflict, discord or loss Harmful use of alcohol Stigma associated with help Discrimination and other drugs seeking behaviour Trauma or abuse Job or financial loss

Hopelessness

Chronic pain

Family history of suicide

Genetics and biological factors

34 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 The National suicide prevention Social Determinants social determinants of health. strategy for Australia’s health system: Aboriginal people and their 2020 – 2023 prioritises research of Health communities play an important role designed to increase “understanding Our health is largely determined by in identifying their health needs and of protective factors for suicide, factors outside the health system, shaping innovative local responses including why they are protective, including our environment, the to strengthen their SEWB and for whom and what universal choices we make and broader Mental Health. Central to Aboriginal interventions bolster these protective social factors. Social determinants health and well-being are cultural factors and address ‘upstream’ of health can be defined as, ‘the connections to family, community, issues”. circumstances in which people culture, language and culture, and grow, live, work, and age. The social It is important to acknowledge that spiritual, physical and emotional determinants of health are mostly the presence of risk factors does not wellbeing. responsible for health inequities’. necessarily mean a person will take Social determinants of health include Disconnection from these elements their life. Similarly, a person may socio-economic position, foundations can cause an individual to experience suicidal behaviour even if built in early life, social exclusion, experience an imbalance in their there are multiple protective factors social capital, employment and work, overall health and wellbeing, not in their life. It is also important to housing and residential environment. only from a medical point of view understand that risk and protective The physical environment also but from an Aboriginal and cultural factors are not simply opposites of influences our health. ‘Safe water perspective. This holistic approach to each other. and clean air, healthy workplaces, health recognises that for Aboriginal The literature continues to reference safe houses, communities and people and their communities’ good the social determinants of health as roads all contribute to good health. health is more than just the absence a factor in suicidal behaviour. The Employment and working conditions of disease or illness. social determinants of health, sit – people in employment are healthier, outside the health system but have particularly those who have more the potential to significantly affect the control over their working conditions’. health of populations. To reinforce across WA as part of this and other engagement processes, communities identify social determinants as one of the most important factors that needs to be addressed to prevent suicides and suicidal behaviour. Whilst the MHC can influence some of the direct factors influencing suicidal behaviour, there needs to be a commitment across government to acknowledge and address issues that affect the

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 35

inants erm et d al c ri P o Connection o t Connection l s to body it i to spirit, i H c spirituality & a l ancestors Connection to mind & d e

emotions t

Connection m

i to country n

Self Connection a

to family & n

t kinship s

Connection

to culture

Connection

t to

n community

n i

i c o S

Social and Emotional Wellbeing

Aboriginal peoples health itself is not understood as the concept often assumed by non-Aboriginal people, rather it is a culturally informed concept, conceived of as ‘social and emotional wellbeing’ – a term that is increasingly used in health policy but in this context carries a culturally distinct meaning: it connects the health of an Aboriginal individual to the health of their family, kin, community, and their connection to country, culture, spirituality and ancestry. It is a deep-rooted, more collective and holistic concept of health than that used in Western medicine.

36 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Figure 1. Prevention First Framework l (adapted for suicide prevention), Everymind (2015).

evention / Early dary Pr Interven Secon tion

Individuals showing early signs of Individuals experiencing a suicidal behaviour suicidal crisis on ti P n o e s v t e v r Communities or groups e P Actions to intervene early n known to be at higher t y and eﬀectively to reduce i r risk o a suicidal behaviour n Individuals and communities m i r aﬀect by suicide P The whole community or Actions to prevent Actions to lower the groups in the community the onset of suicidal impact of suicide behaviour Communities and individuals are healthy and able to respond to suicidal behaviour and its impacts

Actions to promote wellbeing

The whole community or groups Individuals who have lived in the community experience of suicidal behaviour

Promotion of Wellbeing

4 | Suicide Prevention (Adapted)Figure Framework 4:Prevention First Framework (adapted for suicide prevention)

Everymind Prevention First

The Everymind Prevention First Framework adapted occupation, family history or cultural heritage. While for suicide prevention (see Appendix 5 for further individuals may not currently express suicidal behaviours explanation) further provides a helpful overview for they may be at an increased risk. understanding the approach of the Suicide Prevention Action Plan 2025 as it relates to the priority areas of Indicated prevention, intervention and postvention. Interventions targeting specific vulnerable individuals within the population such as those showing early signs/ Suicide prevention interventions can be categorised behaviours linked to suicide potential or who have made a as follows: suicide attempt. Universal Interventions targeting the whole population, designed to maximise health and minimise suicide risk. Selective PreventionInterventions First Framework targeting (adapted vulnerable for suicide prevention),groups within Everymind a (2015) . Permissionpopulation required based on characteristics such as age, gender,

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 37 Monitoring, Evaluation and Reporting

38 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Evaluation strategies

Ongoing monitoring and Short and Postvention evaluation will be central to the intermediate-term • Improved care and support for those successful development and affected by a suicide implementation of the Suicide outcomes • Increased quality of data on suicide, Prevention Action Plan 2025. It is How will we know the activities • Increased timeliness of data on important the activities delivered are making a difference suicide as part of the Plan are informed by Program and/or service outcomes for evidence, promote safe practice, As longer-term community and the WA Government, service providers and are likely to achieve their state-wide population outcomes and communities to consider when intended outcomes. are influenced by other factors, they implementing activities are listed cannot be the sole responsibility Monitoring and evaluating the below. of the funded programs and Suicide Prevention Action Plan 2025 services. However, as the short and will allow the MHC to track what is Prevention intermediate- term outcomes feed in happening and support the continuous • Increased literacy surrounding to the long term outcomes, progress improvement of the individual mental health and wellbeing and towards these outcomes will be programs and services that are suicide prevention monitored as part of the delivery of the funded, as well as the overall action • Decreased stigma associated with Suicide Prevention Action Plan 2025. plan. mental health issues and suicide The Suicide Prevention Action Plan • Increased ability to seek help for Formative and 2025 has been developed with a oneself or for someone else program logic approach incorporated • Increased coping skills and ability to summative into the framework. Each of the priority manage difficult life experiences evaluations areas has several associated short and intermediate term outcomes to Intervention Short and intermediate-term outcomes will be monitored annually, with be achieved through implementing • Improved care and support for formative and summative evaluations the activities. Evaluating activities is individuals in crisis conducted periodically during the crucial to determining if what is being • Improved care and support for those delivery of the Suicide Prevention implemented is making a difference. assisting individuals in crisis Action Plan 2025. The formative Data to provide the evidence that these • Improved functioning following crisis evaluation will occur once the action outcomes have been achieved, or that • Decreased symptoms following plan commences in order to identify progress towards their achievement crisis any emerging issues with design and has been made, will be collected by • Decreased access to means for make improvements to how the action the programs and services funded those in crisis plan is implemented. A summative under the Suicide Prevention Action evaluation will be conducted after the • Improved response to suicidal Plan 2025. Suicide Prevention Action Plan 2025 behaviours progresses to determine the extent to • Increased quality of data on suicidal which the action plan has achieved, behaviours or contributed to, the intended Increased timeliness of data on outcomes. This is an important driver suicidal behaviours of accountability.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 39 Appendix, Glossary and References

40 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Appendix One Western Australian Suicide Prevention Action Plan 2021 – 2025 Framework

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 41 Appendix Two Desktop review of strategic government documents with direct or indirect involvement in addressing suicide within WA

1. COAG Health Council, 2017. The Fifth National 9. Mental Health Commission, 2019. Full Mental Health and Suicide Prevention Plan. Government Response to the Western Australian Department of Health, Commonwealth of Australia; Methamphetamine Taskforce Report. Mental Health Commission, Government of Western Australia. 2. Department of Health, 2018. National Foetal Alcohol Spectrum Disorder (FASD) Strategic Action Plan 10. Mental Health Commission, 2019(a). Western 2018-2028. Commonwealth of Australia; Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025 (Plan) Update 2018. 3. Department of Health (WA), 2019. State Public Mental Health Commission, Government of Western Health Plan for Western Australia: Objectives and Australia; Policy Priorities for 2019-2024. Government of Western Australia; 11. National Aboriginal and Torres Strait Islander Leadership in Mental Health (NATSILMH), 2015. 4. Department of Premier and Cabinet, 2019. Statement Gayaa Dhuwi (Proud Spirit) Declaration: A of Intent on Aboriginal Youth Suicide. Government of Companion Declaration to the Wharerātā Declaration Western Australia; for Use By Aboriginal and Torres Strait Islander 5. Dudgeon, P., Darwin, L., McPhee, R., Holland, C., Peoples. von Helle, S., and Halliday, L., 2018. Implementing 12. NATSILMH, 2017. Co-Designing Health in Integrated Suicide Prevention in Aboriginal and Culture: Gayaa Dhuwi (Proud Spirit) Declaration Torres Strait Islander Communities: A Guide for Implementation Guide. Primary Health Networks. Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide 13. National Mental Health Commission, 2019. Prevention and the Black Dog Institute. Monitoring Mental Health and Suicide Prevention Reform: National Report 2019. NMHC Sydney; 6. Government of Western Australia, 2019. Our Priorities: Sharing Prosperity. 14. National Suicide Prevention Project Reference Group (NSPPRG), 2019 (Draft). National Suicide Prevention 7. Kimberley Aboriginal Law and Cultural Centre Implementation Strategy for Australia’s Health (KALACC), 2019 (Draft), KALACC Feedback on the System 2020-2023. Draft for Comment as at 12 22nd May 2019 Statement of Intent on Aboriginal August 2019. Mental Health Principle Committee. Youth Suicide. KALACC May 2019. 15. Sustainable Health Review, 2019. Sustainable Health 8. Mental Health Commission, 2018. Western Australian Review: Final Report to the Western Australian Mental Health Promotion, Mental Illness, Alcohol Government. Department of Health, Western and Other Drug Prevention Plan 2018-2025. Mental Australia. Health Commission, Government of Western Australia;

42 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Appendix Three Lifespan model

LifeSpan involves the implementation of nine evidence-based strategies simultaneously within a localised area. For each strategy, LifeSpan selects and implements the interventions or programs that have the strongest evidence-base.

These strategies are based on the most up-to-date evidence drawn from similar, large-scale suicide prevention programs overseas that have shown positive results.

This integrated systems approach is expected to prevent 21% of suicide deaths, and 30% of suicide attempts.

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 43 Appendix Four Alliance Against Depression Framework

impact ctive olle d c an n o ti ra g e General t Primary care public: In and mental depression awareness healthcare campaign

GOAL Improved care

Patients: Community highrisk facilitators groups and and

relatives stakeholders

44 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Appendix Five Everymind Prevention First Framework everymind.org.au | 5 everymind.org.au Examples Reducing access to means; Altering media coverage of of media coverage means; Altering to access Reducing education about suicide community suicide; Providing families; Addressing stronger Creating prevention; of and the social determinants connectedness community health and wellbeing. the early signs detect assist to people training Gatekeeper and schools, workplaces of suicidal behaviour (including GPs, Referral Building pathways for self-help; services); community and primary care organisations, community pathways between specialist services. by support and psychological for people bereaved Practical risk reduce to communication about suicide suicide; Effective to the death. by or exposed others affected to for families and and support programs Psychoeducation skills suicide; Self-help, attempted friends of those who have of building and peer support experience for those with lived suicidal behaviour. Programs that empower, support and build skills in groups at support and build skills in groups that empower, Programs higher risk of suicide. These may include: people who have from discharged recently suicide, in detention, attempted or unemployed pain, recently hospital, living with chronic experiencing a life crisis. Workforce care; professional integrated Providing health, mental health and development for frontline community Effective staff;E-therapies; services emergency a suicide attempt. after follow-up housing, to social inclusion, access Ensuring safe communities, Evidence- education and other essentialtransport, services; in early childhood, schools, build resilience to based strategies etc. workplaces Interventions focus on reducing risk factors and enhancing risk factors focus on reducing Interventions of their regardless in whole communities factors protective specific address to level of risk. This also includes strategies in suicide and engaging communities social determinants intervention). action (universal prevention signs of suicidal Early identi fication of individuals showing behaviour and clear pathways to and other support (indicated intervention; d etection). appropriate services focused on supporting individuals, families Interventions affecteda suicide death. by and communities social, emotional and spiritual enhance to Interventions by suicide. and quality of life for people affected wellbeing or in the community within services can occur Initiatives and support). (ongoing care Interventions focusing on reducing risk factors and and risk factors focusing on reducing Interventions the onset of suicidal prevent to factors enhancing protective risk (selective be at increased to known behaviour in groups intervention). the lower to and interventions treatments Evidence-based of a suicidal crisis and/or severity and duration attempt support;(accessing treatment). social, emotional and spiritual enhance to Interventions with the whole can occur and quality of life. Initiatives wellbeing in any setting and can occur groups, population, or selected the home etc.). (including schools, workplaces, Whole community or Whole community in the community groups Individuals showing early signs of suicidal behaviour Individuals and affected communities suicide by Individuals with lived of suicide or experience suicidal behaviour Groups or individuals Groups with higher risk Individuals experiencing a suicidal crisis or Whole community in the community groups Primary Prevention Domain Groups Target Definition Secondary Prevention and Early Intervention Postvention Promotion Wellbeing of Actions to to Actions prevent suicidal onset of behaviour Focus to Actions early intervene to and effectively suicide reduce lower to Actions the impact of suicide to Actions promote wellbeing Table 1: Explaining the Concepts Table

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 45 Glossary

Key terms and preferred language Impacted by suicide Mental health promotion when taking about suicide are An individual impacted by suicide Involves actions to create living explained below. may experience a variety of conditions and environments that responses on a broad continuum – support mental health and allow Aftercare from immediate, short term emotional people to adopt and maintain healthy The care, treatment, help, or response, to long term, profound lifestyles. supervision given to persons distress. (Maple et al. 2016) following a suicide attempt. It can Mental illness prevention include hospitalisation or medical Intentional self-harm Initiatives which focus on reducing treatment. Aftercare is important for Engaging in an act of self-harm with risk factors for mental ill-health and family and carers, because a suicide the intention of suicide. Intentional enhancing protective factors. attempt is the strongest risk factor for self-harm will result in either a non- Non-Suicidal Self Injury (NSSI) subsequent suicide, and the highest fatal suicide attempt or a suicide risk period is shortly after release. death. Engaging in an act of self-injury without the intention of it resulting Attempted suicide Lived experience in suicide. Although suicide is not Attempted suicide refers to any having experienced suicidal the intention of NSSI, there is an non-fatal suicidal behaviour. In some thoughts, survived a suicide attempt, independent association between cases it can be difficult to determine cared for someone through suicidal NSSI and increased suicide risk. if a person intended their actions to crisis, or been bereaved by suicide result in death.

46 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Primary Prevention Suicidal crisis and suicidal behaviour than the Strategies aimed at preventing illness A situation in which an individual is general population. These include: by maintaining and/or enhancing the engaging in intentional self-harm Aboriginal people; persons who have wellbeing of the general population. with intent to die, or is seriously experienced abuse, trauma, conflict contemplating or planning to make an or disaster; refugees and migrants; Secondary Prevention/Intervention attempt on their own life. prisoners and others in contact with Seeks to lower the number of the justice system; lesbian, gay, cases of a disorder or illness in the Suicidal ideation bisexual, transgender and intersex population through early detection Suicidal thoughts, or suicidal ideation, persons (LGBTI); frontline workers, and treatment. means thinking about or planning individuals who have had a previous suicide. Suicidal ideation can range attempt and people suicide bereaved. Stigma from momentary passing thoughts The WHO defines stigma as a major of ending one’s own life to extensive cause of discrimination and exclusion: contemplation and detailed planning. it affects people‘s self-esteem, helps disrupt their family relationships and Suicidal behaviour limits their ability to socialise and Engaging in actions that have the obtain housing and jobs. potential to lead to suicide. Suicidal behaviour can range from role playing Suicide an intended suicide to making an A death resulting from an act of attempt. deliberate self-harm, with the belief the action will be likely to cause death Tertiary Prevention/Postvention and with the intention of ending one’s Interventions that reduce disability own life. enhance rehabilitation and prevent reoccurrences of the illness. Suicidality Thoughts and behaviours related to Vulnerable Populations suicide. Refers to those populations who have a higher risk of suicide

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 47 References

1. Maple, M., Kwan, M., Borrowdale, K., Murray, S. & 7. LifeSpan model Retrieved from: www. Sanford, R. (2016) ‘The Ripple Effect: Understanding blackdoginstitute.org.au/research/lifespan the Exposure and Impact of Suicide in Australia’. 8. Dudgeon, P., Milroy, J., Calma, T., Luxford, Y., Ring, Sydney: Suicide Prevention Australia I., Walker, R., Cox, A., Georgatos, G., and Holland, 2. Cerel J, Brown MM, Maple M, Singleton M, van de C., 2016. Solutions That Work: What the Evidence Venne J, Moore M, Flaherty C. (2018) How Many and Our People Tells Us. Aboriginal and Torres People Are Exposed to Suicide? Not Six. The Strait Islander Suicide Prevention Evaluation Project American Association of Suicidology Report. University of Western Australia, Crawley, Nov. 2016 3. https://www.lifeinmindaustralia.com.au/about-suicide/ suicide-data/suicide-facts-and-stats 9. Preventing suicide: a community engagement toolkit. Geneva: World Health Organization; 2018. Licence: 4. Australian Bureau of Statistics. Causes of Death CC BY-NC-SA 3.0 IGO 2018. Australia, 2018 cat no. 3303.0 10. National suicide prevention strategies: progress, 5. Krysinska, K., Batterham, P. J., Tye, M., Shand, F., examples and indicators. Geneva: World Health Calear, A., Cockayne, N., & Christensen, H. (2016). Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO Best practice strategies for reducing the suicide rate in Australia. The Australian and New Zealand Journal 11. Australian Bureau of Statistics. Causes of Death of Psychiatry, 50, 115-118 2016. 2017 cat no. 3303.0

6. Alliance Against Depression model Retrieved from: 12. Kantar Public (2018). Think Mental Health www.wapha.org.au/community/community-projects- Men’s Campaign Evaluation. WA Mental Health and-stories/alliance-against-depression/ Commission, Perth

48 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 13. www.blackdoginstitute.org.au/research/lifespan/ Suicide: a global health imperative (pg 44). lifespan-strategies-and-components/strategy-6 22. Unpublished, Draft National suicide prevention 14. www.blackdoginstitute.org.au/research/lifespan/ strategy for Australia’s health system: 2020 – 2023 lifespan-strategies-and-components/strategy-8 23. World Health Organization (2018). About Social 15. Black Dog Institute (2017). Means Restriction: Determinants of Health. Retrieved from: www.who.int/ Implementation Guide. Sydney. Black Dog Institute social_determinants/ sdh_definition/en/

16. Black Dog Institute (2016) An evidence-based 24. World Health Organization (2018). Health Impact systems approach to suicide prevention: guidance on Assessment: The Determinants of Health. Retrieved planning commissioning and monitoring from: www.who.int/hia/ evidence/doh/en/

17. Pitman AL, Osborn DPJ, Rantell K, et al. 25. Professor Pat Dudgeon, Professor Jill Milroy AM, Bereavement by suicide as a risk factor for suicide Professor Tom Calma AO, Dr Yvonne Luxford, attempt: a cross-sectional national UK-wide Professor Ian Ring, Associate Professor Roz Walker, stufy of 3432 young bereaved adults, BMJ Open Adele Cox, Gerry Georgatos and Christopher 2016;6:e009948.dio:10.1136/bmjopen-2015-009948 Holland., (2016) Solutions That Work: What the evidence and our people tell us - Aboriginal and 18. Gayaa Dhuwi (Proud Spirit) Declaration Torres Strait Islander Suicide Prevention Evaluation 19. Krysinska, K., Batterham, P. J., Tye, M., Shand, F., Project Report Calear, A., Cockayne, N., & Christensen, H. (2016). 26. World Health Organisation (2014) Preventing Suicide: Best practice strategies for reducing the suicide rate a global imperative (pg. 30) in Australia. The Australian and New Zealand Journal of Psychiatry, 50, 115-118 27. Everymind. (2015). Prevention First (adapted): A Framework for Suicide Prevention. Newcastle, 20. World Health Organisation (2014). Preventing Australia Suicide: a global health imperative.

21. World Health Organisation (2014). Preventing

DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 49 Needing help?

In an emergency call Suicide Call Back Service Carers Australia WA 000 or visit your local Telephone: 1300 659 467 Telephone: 1800 Carers (1300 227 emergency department Available: 24/7 across Australia 377) (free call) Website: suicidecallbackservice.org. Available: 8.30am – 4.30pm au Mental Health Emergency Counselling Line: 1800 007 332 (free Response Line (MHERL) call) 1300 555 788 (Perth Metro Samaritans Crisis Support Residents) Available: 8.30am – 7.30pm Telephone: 135 247 1800 676 822 (Peel Residents) Available 24/7 Available: 24/7 MATES In Construction 1300 642 111 RuralLink Other services that can provide www.matesinconstruction.org.au/wa/ Telephone: Freecall 1800 552 002 assistance for people having Available 4.30pm - 8.30am Monday thoughts of suicide include to Friday and 24 hours Saturday, If you are bereaved by suicide and Headspace Sunday and public holidays. During need help, the following service business hours you will be connected 1800 650 890 are able to assist to your local community mental health clinic. www.headspace.org.au Suicide Call Back Service 1300 659 467 QLife Lifeline www.suicidecallbackservice.org.au Telephone: 1800 184 527 Telephone: 13 11 14 Children and Young People Available: 24/7 Available: 3.00pm-midnight, Responsive Suicide Support everyday lifelinewa.org.au/ 1300 114 446 qlife.org.au www.cypress.org.au

Kids Helpline Active Response Bereavement Outreach (ARBOR) Telephone: 1800 551 800 (free call) beyondblue 1300 11 44 46 Available: 24/7 Telephone: 1300 224 636 kidshelpline.com.au Lifeline Available: 24/7 13 11 14 www.lifelinewa.org.au MensLine Australia beyondblue.org.au Stand By – support after suicide Telephone: 1300 78 99 78 ww.standbysupport.com.au www.mensline.org.au

50 DRAFT Western Australian Suicide Prevention Action Plan 2021 - 2025 Government of Western Australia Mental Health Commission

GPO Box X2299, Perth Business Centre WA 6847 Level 1, 1 Nash Street, Perth, WA 6000 T (08) 6553 0600 mhc.wa.gov.au