What Can Be Done to Decrease Suicidal Behaviour in Australia? a Call to Action
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Black Dog Institute What can be done to decrease suicidal behaviour in Australia? A call to action. October | 2020 Foreword In Australia, suicide rates have continued to rise over the last decade. The challenge to bend this curve is immense. One of the biggest challenges of contemporary suicide prevention is that initiatives, policies and programs to prevent and respond to suicide are often unable to benefit from research evidence. This is not so much because this evidence is ignored, but because in many cases it does not exist. In response, I’m delighted to present What can be done to decrease suicidal behaviour in Australia? A call to action, a white paper from the Black Dog Institute that takes a major step towards addressing this critical research gap. As one of only two medical research institutes in Australia dedicated to mental health and suicide prevention, we take seriously our role to support and guide the development of strategic, evidence- based suicide prevention policy, programs and services, both within the Institute and beyond. This white paper is our contribution to the contemporary conversation on suicide prevention in Australia. It builds on the tireless efforts of our peers and collaborators in the suicide prevention domain over the last decade to present a body of new and synthesised knowledge across four key areas: • Meeting the needs of people in suicidal crisis with new models and integrated care • The impact of social determinants on suicide and how policy settings can help • Suicide awareness campaigns: are they a valid prevention strategy? • Views regarding new directions in innovation in suicide prevention This document is an exploration and review of the existing data as it relates to suicide prevention and delivers a series of evidence-based recommendations to guide suicide prevention initiatives. Each chapter is a standalone section written by leading researchers within the Black Dog Institute and shaped by their unique voices. In developing this white paper, we turned to those whose experiences must guide current and future conversations around suicide prevention. Our draft content was reviewed by people with lived experience of suicide—the real innovators in shaping our newer models of care—as well as by an Indigenous reviewer who provided a crucial Aboriginal and Torres Strait Islander perspective on our work. Editorial team The inclusion of this expertise reflects the way we work at the Black Dog Institute: informed by evidence, shaped by the communities we serve, and leading through science, compassion and action. And, with the Federal Government now re-committing efforts towards reducing suicide, there has never been a more critical time to provide a clear evidence base to support these efforts. Director: Helen Christensen | Executive Editor: Katherine Boydell We are proud to deliver research commentary on major issues confronting Australia in suicide prevention. We wish to thank the following individuals for their review of this report: Now, we are keen to hear your voices refine and extend our recommendations as we walk together to achieve Caroline Allen | Ann Dadich | Leilani Darwin | Carrie Lumby | Nicole Scott | Claire Thompson the change that we need to see. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. We would also like to acknowledge the work of Fiona Sawyer in bringing together this publication. Helen Christensen Black Dog Institute. What can be done to decrease suicidal behaviour in Australia? A call to action. Director, Black Dog Institute White Paper. October 1, 2020. Sydney, AU: Black Dog Institute. Contents Executive Summary ................................................................................................................................................................... i Summary of Recommendations ......................................................................................................................................... vii 1. Meeting the needs of those in suicidal crisis with new models and integrated care ......................... 2 Recommendations ............................................................................................................................................................................................................................. 10 2. The impact of social determinants on suicide and how policy settings can help .............................. 16 Recommendations ............................................................................................................................................................................................................................. 23 3. Suicide awareness campaigns: are they a valid prevention strategy? ...................................................... 28 Recommendations ............................................................................................................................................................................................................................. 35 4. Needs driven, community integrated and data informed: next steps for suicide prevention ...... 40 Recommendations ............................................................................................................................................................................................................................. 52 i What can be done to decrease suicidal behaviour in Australia? A call to action Executive Summary ii Executive Summary What can be done to decrease suicidal behaviour in Australia? A call to action represents suicide awareness campaigns as well as scientific alternative models are often staffed by trained peer an opportunity to consider emerging research and experiential evidence and its potential and research innovations in suicide prevention. workers or volunteers, some with their own lived to drive system reform and reduce suicide. Thematic chapters address each of these important experience of mental illness and/or suicidality, who topics, drawing on the best available evidence sit with visitors to discuss their feelings. These models More people die by suicide than in road accidents impact of Black Dog Institute’s LifeSpan integrated and lived experience wisdom. Each chapter was can reduce the burden on existing services, including every year. The causes of and motivations behind suicide prevention framework and other multi-level reviewed by individuals with lived experience, as ambulance services, police services and emergency suicide are complex, influenced by factors such models of suicide prevention in Australia are not well as an Indigenous reviewer. departments, and thus can be cost effective8. as a person’s age, gender, sexual orientation, yet known. However, an international review of all Digital interventions that directly target suicide can socioeconomic status and cultural background, evidence on suicide prevention concluded that Chapter 1: Meeting the needs of those in suicidal reduce suicidal ideation9. The recent emergence as well as the intersections between them. no single strategy is superior to another; rather, crisis with new models and integrated care of peer telephonic warm line models reflects combinations of both individual-, community- Contributors to suicidal crisis can include historic Evaluation of the research base is a critical first community demand for telephone-based support. and population-level strategies should be assessed or distal factors such as childhood adversity, family step to guide evidence-based suicide prevention Online communities can provide stigma-free with rigorous research designs5. While each of these 6 history of suicide or mental illness, and previous policy ; however, the experiential wisdom and social connections10, yet there is limited research models, if implemented well and with enough reach suicide attempt, as well as proximal factors like evidence from lived experience perspectives regarding their effectiveness in reducing suicidal and dose, can prevent many suicides, more physical and mental health problems, discrimination are equally important. Chapter 1 draws upon thoughts. This clearly represents an opportunity is required to decrease the high and continued and a range of adverse life events (e.g. interpersonal the research evidence base and is underpinned worthy of examination. conflict, relationship breakdown, disrupted rates we are seeing and ultimately prevent suicide. by lived experience wisdom. Individuals with Digital offerings, including automated text messaging community or cultural obligations, unemployment, These evidence-based practices must be supported lived experience of suicide have indicated the applications, can reduce suicidal ideation when housing, financial or legal problems)2-5. Distal health system often fails to provide effective by policy settings that focus on improving the social 9 care. Even when current best practice is they directly target suicide . Telephone, internet risk factors can increase the likelihood of and conditions in which people live so that regional, state applied, the support needs of many help-seekers and digital automatised and blended interventions vulnerability to proximal factors, and the effects and national strategies are working hand-in-hand. goes unmet. Further, many people experiencing can provide scale and reach and might