Submission No 51 PREVENTION OF YOUTH SUICIDE IN NEW SOUTH WALES Organisation: Beyond Blue Name: Ms Susan Anderson Position: Acting CEO Date Received: 13 September 2017 beyondblue Information Paper: Suicide Prevention This Information Paper has been developed to provide an in-depth understanding of suicide prevention. It provides an overview of suicide, effective suicide prevention strategies and beyondblue’s approach to preventing suicide. It also outlines the national and state/territory-based policy frameworks that underpin suicide prevention initiatives in Australia, and includes recommendations to prevent suicide and suicidal behaviour. This Information Paper may be used as a reference document to inform the development and implementation of suicide prevention strategies, and communications relating to suicide. Contents beyondblue Information Paper: Suicide Prevention ......................................................................................... 1 Introduction ....................................................................................................................................................... 2 Suicide – an overview ........................................................................................................................................ 3 Effective suicide prevention interventions ...................................................................................................... 13 The policy framework ...................................................................................................................................... 17 Recommendations to prevent suicide and suicide attempts .......................................................................... 18 Appendix A – Glossary of terms ...................................................................................................................... 20 Appendix B – Australian suicide statistics ....................................................................................................... 22 Appendix C - beyondblue suicide prevention strategies ................................................................................. 24 References ....................................................................................................................................................... 29 Introduction In a typical year, about 3,000 people in Australia die by suicide. This is more than eight people every day. Tens of thousands more people attempt suicide each year. For every suicide, and suicide attempt, there are tragic ripple effects for friends, families, colleagues and the broader community. beyondblue believes that suicide is largely preventable, and everyone can play a role in preventing suicidal behaviour, whether by being more open about the issue to raise awareness and fight stigma, by looking out for and providing support to vulnerable individuals or those bereaved by suicide, or through more formal measures. To be effective, action needs to be based on accurate data and contemporary evidence about what works to prevent suicide. Suicide has been the subject of extensive social, psychological and medical research over many decades. There is a wealth of epidemiological data documenting associations and trends in suicide and suicidal behaviour and considerable evidence on ‘what works’ to prevent suicide. Overall, this includes a mix of universal strategies, which improve health and reduce suicide risk of the whole population; selective strategies, which target vulnerable groups within a population; and indicated strategies, which target specific vulnerable individuals within a population. However, there are also still gaps in knowledge as well as poor uptake of proven approaches. Australia’s current approach to suicide prevention has been described as being piecemeal, uncoordinated, and under-resourced. This has contributed to a situation in which the suicide rate has not changed significantly over the past 10 years. It is therefore time to rethink our approach to suicide prevention. We need a new approach that ensures the full and effective implementation of existing evidence-based approaches coupled with continued research into new and better interventions, through a nationally-led and regionally-delivered suicide prevention framework. We need leadership, commitment and action by individuals, family members, health professionals, educators, employers, community leaders, the media and all levels of government. beyondblue is committed to playing its role by generating a national conversation about suicide and advocating for effective reforms, as well as by continuing to implement our projects, programs and services directed to suicide prevention, and trialling new, innovative approaches to reduce suicidal behaviour. In doing so, beyondblue will ensure its initiatives are underpinned and informed by the experiences of people affected by suicide and we will advocate for, and champion the needs of people affected by suicide. We will partner with others working to prevent suicide and we will also continue to implement broader strategies which focus on improving the mental health of the whole population and reducing the stigma and discrimination associated with depression, anxiety and suicide, through school, workplace, community and online programs. ©Beyond Blue Ltd beyondblue Information Paper – Suicide prevention July 2016 Page 2 of 33 Suicide – an overview Suicide is the deliberate act of taking one’s life and it is mostly preventable. Suicide can be considered as part of a continuum of suicidality ranging from ideation, planning, and attempts, to death by suicide. The prevalence of suicidality There is a lack of reliable and valid data across the continuum of suicidality, which makes it difficult to fully quantify the extent of this issue. Suicide Prevention Australia (2015) has compiled information from the 2007 National Survey of Mental Health and Wellbeing and the Australian Bureau of Statistics suicide data (2016), to indicate the prevalence of suicidal behaviour – including suicidal ideation, suicide planning, suicide attempts, and suicide deaths – as described in Figure 1 and Figure 2. This data shows that females are far more likely to attempt suicide than males, while males are more likely to die by suicide. Overall, the proportion of women experiencing some form of suicidality (ideation, planning, and/or attempts) is nearly 1 per cent higher than their male counterparts.1 Figure 1: Australian 12-month prevalence of suicidality by gender (2007, 2016)2,3 Women % Women no. Men % Men no. All persons All persons no. % Suicidal ideation 2.7 221,300 1.9 146,700 2.3 370,000 Suicide planning 0.7 57,500 0.4 33,500 0.6 91,000 Suicide attempts 0.5 42,700 0.3 22,600 0.4 65,000 Any suicidality 2.8 n/a 1.9 n/a 2.4 380,000 Suicides 24 735 76 2,292 100 3,027 N/A: reflects data that is not easily derived from the ABS spreadsheet Figure 2: Australian 12-month prevalence of suicidality by gender (2007, 2016)4,5 ©Beyond Blue Ltd beyondblue Information Paper – Suicide prevention July 2016 Page 3 of 33 The suicide rate In a typical year, about 3,000 people in Australia die by suicide. This is more than eight people every day6 – almost double the national road toll. Tragically, most people who die by suicide are in the prime of their life. Australia’s official suicide rate has not changed significantly over the past 10 years, however it has been slightly higher in recent years than it was at the start of the decade (Australia’s suicide rate was 10.5 in 2004, and 12.6 in 2015).7 It is unclear whether this trend is because more people are taking their own life or because data has become more reliable. Suicide itself accounts for a relatively small proportion of all deaths in Australia (1.9 per cent);8 however, it accounts for a significantly greater proportion of deaths within certain population groups. Population groups that have higher suicide rates than others include: • Men – Men are at least three times more likely to die by suicide than women.9 • Aboriginal and Torres Strait Islander people – The suicide rate is twice as high for Aboriginal and Torres Strait Islander people than non-Indigenous Australians.10 • People with a mental health condition or substance misuse – There is a strong association between mental health conditions and suicidal behaviour (For more information see ‘The links between mental health conditions and suicide’ below).11 • People with a previous history of attempted suicide12 – The occurrence of any level of suicidality, but in particular suicide attempts, is a risk factor for suicide.13,14,15 A prior suicide attempt is the single most important risk factor for suicide in the general population.16 The latest data from 2007 indicates that at least 65,000 people attempted suicide in Australia in the previous year.17 Based on Australia’s current population, this would equate to around 75,000 suicide attempts each year. International research suggests that 15 - 25 per cent of those who have attempted suicide re-attempt, and 5 - 10 per cent die by suicide.18,19,20 The highest risk period to die by suicide is in the first three months following an attempt.21 • People living in rural and remote communities – Remoteness is a major risk factor contributing to suicide and the likelihood that someone will die by suicide appears to increase the further away they live from a city.22 The geographic and social isolation, unemployment and economic issues, the misuse of alcohol and other drugs,23