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Orygen Raising the Bar for Youth Suicide Prevention Report Raising the bar for youth suicide prevention © Orygen, The National Centre of Excellence in Youth Mental Health 2016 This publication is copyright. Apart from use permitted under the Copyright Act 1968 and subsequent amendments, no part may be reproduced, stored or transmitted by any means without prior written permission of Orygen, The National Centre of Excellence in Youth Mental Health. ISBN 978-1-920718-41-1 Suggested citation Robinson, J, Bailey, E, Browne, V, Cox, G, & Hooper, C. Raising the bar for youth suicide prevention. Melbourne: Orygen, The National Centre of Excellence in Youth Mental Health, 2016. Disclaimer This information is provided for general educational and information purposes only. It is current as at the date of publication and is intended to be relevant for all Australian states and territories (unless stated otherwise) and may not be applicable in other jurisdictions. Any diagnosis and/or treatment decisions in respect of an individual patient should be made based on your professional investigations and opinions in the context of the clinical circumstances of the patient. To the extent permitted by law, Orygen, The National Centre of Excellence in Youth Mental Health will not be liable for any loss or damage arising from your use of or reliance on this information. You rely on your own professional skill and judgement in conducting your own health care practice. Orygen, The National Centre of Excellence in Youth Mental Health does not endorse or recommend any products, treatments or services referred to in this information.. Orygen, The National Centre of Excellence in Youth Mental Health Locked Bag 10 Parkville Vic 3052 Australia www.orygen.org.au Raising the bar for youth suicide prevention Contents 5 Introduction 29 Section 4 Areas and settings for action 6 Executive summary 29 National leadership and coordination 31 Youth mental health services 10 Section 1 and clinical care The situation 36 Technology and the internet 11 Overrepresented 39 Education settings 13 Suicide clusters 44 Community-based responses 14 Economic impact 48 Research priorities 16 Section 2 Why specific youth suicide prevention 49 Section 5 responses are needed A way forward 16 Individual factors for young people 52 References 17 Social and contextual factors for young people Appendices 1 and 2 available as separate 18 Help-seeking downloads at www.orygen.org.au 22 Section 3 Government responses to youth suicide in Australia 22 National suicide prevention policies 24 State/territory responses 25 Aboriginal and Torres Strait Islander suicide prevention strategies 26 Impact of policy responses 27 The new agenda – 2016 and beyond RAISING THE BAR FOR YOUTH SUICIDE PREVENTION 5 Introduction Much has already been achieved in youth suicide prevention. This has been due to the collective resources, skills and expertise developed over many decades in both the suicide prevention and youth mental health sectors. To recognise and build on their work, the advice provided in this report has been developed in consultation with representatives from these sectors and in partnership with young people. This process has involved an online consultation with sector leaders, two workshops with young people from Orygen’s National Youth Advisory and Youth Research Councils and a roundtable event held on 2 June 2016 with sector representatives and young people. This consultation has been underpinned by a comprehensive review of the national and international literature on youth suicide prevention undertaken by Orygen’s Suicide Prevention Research Team (current as at April 2016) and an analysis of suicide clusters among both young people and the general population prepared by Orygen and the University of Melbourne’s School of Population Health. Orygen would like to sincerely thank the following individuals and organisations for the valuable contributions they made in the development of this report. Dr Kairi Kolves Trevor Hazell Deepika Ratnaike Australian Institute for Suicide Centre for Rural and Remote and Victoria Blake Research and Prevention Mental Health Reachout Emeritus Professor Ian Webster AO Dr Steve Leicester Professor Jane Pirkis, Australian Suicide Prevention headspace National Youth Associate Professor Matthew Advisory Council Mental Health Foundation Spittal and Dr Lay San Too Sam Refshauge and Kristen Douglas School of Population Health, Stephanie Vasiliou and Karen Fletcher The University of Melbourne batyr headspace Schools Support Sue Murray Georgie Harman Jaelea Skeehan Suicide Prevention Australia beyondblue Hunter Institute of Mental Dr Michelle Blanchard Professor Helen Christensen Health Young and Well and Dr Fiona Shand Alessandro Donagh-De Marchi Cooperative Research Centre Black Dog Institute hY NRG (headspace) John Dalgleish and Jessica Redmond Alan Woodward Dr Sam Bachelor Blue Voices (beyondblue) Lifeline yourtown William Yeung Youth Advisory Council Brains Trust (Young and Well and Youth Research Council Cooperative Research Centre) Orygen, The National Centre of Excellence in Youth Mental Health RAISING THE BAR FOR 6 YOUTH SUICIDE PREVENTION Report development process Data analysis Literature review Consultation Workshops Online surveys Roundtable event Policy Report RAISING THE BAR FOR YOUTH SUICIDE PREVENTION 7 Executive summary In 2015 more young people aged 15–24 years of mental ill-health during this period of life, and died by suicide than any other means (including the well-documented elevated risk of suicide transport accidents and accidental poisonings). among those experiencing mental ill-health. Young Over the past 10 years, rather than making in- people with serious and complex experiences of roads into reducing the number of young lives lost mental ill-health, for example affective disorders, to suicide in Australia, there have instead been personality disorders and psychosis, are most at small but gradual increases in suicide rates. Twice risk of suicide and yet many are unable to access as many young women aged 15–19 years died by the youth focused specialist support services they suicide in 2015 than in 2005 and rates have also need. We need to urgently respond to this critical increased among young people under the age of gap in care. 14 years. Secondly rates of self-harm are unacceptably high This has mirrored high rates of self-harm among in this age group, which in itself should act as an young people. Recent reports indicate that early indication for service providers and policy approximately one in four young women aged makers that many young people are distressed 16–17 years have self-harmed in their lifetime and and crying out for help. hospitalisations for self-poisoning, again among young women, have spiked in recent years. Finally, a recent analysis of suicide cluster data has shown that a youth suicide is more likely to In 1995 Australia was one of the first countries in be part of a cluster than an adult suicide. As such the world to develop a suicide prevention strategy, researchers, sector experts and young people focused initially on young people. Successive themselves have suggested that responding to national and state/territory suicide prevention suicide among young people requires a different strategies have been released although available approach than for other age groups. Responding evaluations are unable to link these to reductions early to both suicide risk and mental ill-health in in suicide or suicide-related behaviours at a young people could provide one of the ‘best-bets’ national or community level. Further, an analysis for suicide prevention moving forward. of current suicide prevention policies across the country has identified gaps in evidence-based At the time of publishing this report, the and young person appropriate, accessible and Australian Government is reinvigorating its acceptable programs and services. We cannot suicide prevention strategy. This will include afford to continue to focus on policies, programs a significant role for the 31 Primary Health and activities for which limited evidence exists; Networks (PHNs) across Australia who will now the cost of these tragic and preventable deaths is plan and commission regionally focused suicide too great. prevention responses. It has also committed to the development of an equitable and integrated There are a number of reasons why a youth- youth mental health system, a digital gateway into specific response to suicide prevention is required. mental health care and a new end-to-end school- First is the increased susceptibility to the onset based mental health program. RAISING THE BAR FOR 8 YOUTH SUICIDE PREVENTION Thanks to strong advocacy from the suicide strategies and activities are robustly evaluated, prevention and mental health sector, most using methods and instruments to ensure they recently in the lead up to the 2016 Australian measure youth acceptability and appropriateness election, the Australian Government has identified as well as their impact on suicide-related further funding for suicide prevention research outcomes. and evaluation and additional regional suicide prevention trial sites. Through the review of available research evidence and input from both suicide prevention and As such, there are now timely opportunities mental health sector experts and young people to ensure that evidence-based youth suicide themselves, this report presents a number prevention responses are embedded in new of recommendations for future youth suicide arrangements and activities. It will be critical that prevention
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