COSTS OF SUICIDE
This chapter will address term of reference (a) the personal, social and
financial costs of suicide in Australia. The circumstances surrounding each
suicide will vary, and so too will the consequences, the personal, social and
The inquiry received a large number of submissions outlining the
personal experiences of people who had attempted suicide, who cared for someone
who had attempted suicide or who had been bereaved by suicide. Often these
people described how their lives had been profoundly and negatively affected by
a suicide attempt or the completed suicide of someone close to them. The
Suicide is Preventable submission commented that those close to a person who
has completed suicide will often blame themselves for the decision of the
individual to take their own life and the 'combination of grief, guilt and
remorse can remain for years'.
One submission received by Committee described the feeling of personal loss
from a completed suicide as an 'emptiness in your very existence that will
never be filled again'.
Many submissions argued that suicide bereavement is different from
bereavement associated with other forms of death.
The Australian Institute of Family Studies commented:
Suicide-bereaved people tend to have more difficulties
understanding the meaning of the death, and can experience guilt and blame
(from self and others) for not preventing the death, feelings of rejection ...
isolation and abandonment, anger towards the deceased ...complicated grief... and
slower recovery. 
The Private Mental Health Consumer Carer Network Australia stated that
in addition to grief those bereaved by suicide often experienced 'emotions of
guilt, blame, anger and frustration'. They stated:
People find it hard to fathom why someone chooses to take
their own life. Both grief and guilt are often heightened for those left after
a suicide because of their belief that the death could have been avoided and that
in some way some responsibility rested with them and their inaction. Research shows
that people affected by the death by suicide of someone close to them are at a
greater risk of suicide themselves.
Many people who provided submissions to the inquiry described the
personal consequences of their experiences in losing a loved one to suicide.
These consequences included losing their employment, needing to seek
counselling, requiring medication such as antidepressants, becoming drug or
alcohol dependent, the destruction of relationships with partners, family and
friends and contemplation of suicide themselves.
The Lifeline Australia submission included a large number of
confidential personal stories from persons who had been affected by suicide.
Lifeline Australia noted there were common themes in relation to personal costs
In many instances, the bereaved by suicide left their
employment when the suicide occurred, and reported feeling as though they could
no longer live in the home they shared with the loved one, or even the same
city or town.
Some reported that close relationships with their own support
networks also suffered, often due to a friend not knowing what to say, and
avoiding the bereaved person. Having to grieve the often sudden and unexpected
loss of their loved one, paired with having to rebuild almost every aspect of
their lives, meant that many who were bereaved by a family member’s suicide
expressed that they began feeling suicidal themselves with the weight of the
The lack of community awareness and stigma around suicide can also be an
additional burden for those recovering from an attempted suicide or bereaved by
The bereaved may face community perceptions that the suicide resulted from a
failure, weakness or shortcoming of the deceased or their family. A common
situation in the stories received was that families would hide the fact a suicide
had occurred and invent another cause of death. A submission the Committee
received described how this stigma could also influence behaviour in less
My relationships with friends were affected but I could not
describe how. My close friends knew about my experiences, but even then they
preferred not to talk about the incident believing it would make me sad. The
contrary was in fact true, I needed to speak with someone who I trusted and
could open up to... Whilst my family are not very traditional, the stigma
associated to suicide is hard to shake and the lack of support from family and friends
did not help.
It was made clear during the inquiry that each completed suicide has a ripple
effect on the family and friends of the deceased as well as on work colleagues,
neighbours, school mates and the rest of the community. The number of people
estimated to be immediately affected by one completed suicide is six. 
The Suicide is Preventable submission noted that this 'measure probably
underestimates the number of people grieving each suicide death, the
ramifications of which are likely to extend more broadly'.
Ms Dulcie Bird of the Dr Edward Koch Foundation argued that whole
communities are often affected when a suicide occurs and described low
estimates of the number of people effected by suicide as 'a load of nonsense'.
She gave the example of the suicide of a 16-year-old boy in a small town and
noted her organisation had completed '43 face-to-face interventions for that
The Foundation commented that suicide results in the loss of the deceased
person's contribution to society as a whole. They argued:
This loss to society is then compounded through the impact of
that loss on the ability to function at an optimum level of productivity (both
within the home and the workplace) when people are massively impacted by
someone near to them suiciding. Also there is the wider impact on the broader
community’s psyche following an individual’s loss. There is as well, the fear
for the wellbeing of that person’s social network as this group has been
identified as being at greater risk of suicide in the postvention period.
The Australian Institute of Health and Welfare (AIHW) has assessed
causes of death in Australia according to potential years of life lost (PYLL)
between the age of death and 75. In this calculation suicide ranks second for
males and fourth for females as a leading specific cause of PYLL. The AIHW
noted that in 'contrast to the basic mortality measures where all deaths are
counted equally, PYLL highlights deaths (such as suicide) that occur at younger
The Australian Institute for Suicide Research and Prevention (AISRP)
also suggests PYLL may be a more appropriate measure to assess the social cost
of suicide. They argued:
The PYLL measure incorporates two quantitative measures (the
number of suicides and the age of suicide) into a single metric (or measure),
and is the more relevant measure when making social judgments. These two
variables, number of suicide and age at suicide, are easy to understand, and
most people who look at suicide data know there is a connection. It is commonplace
to hear people say something like the following: “Yes, the suicide rate is
staying much the same, but it is very worrying that there is so much youth
suicide.” The PYLL measure quantifies this unease with the headcount measure.
Ms Collen Krestensen from the Department of Health and Ageing (DoHA)
also noted that the AIHW studies have suggested that suicide comprises 2.2 per
cent of the total burden of disease in Australia.
A number of submissions suggested that the financial cost of suicide
could not be estimated until the number of suicides and attempted suicides in
Australia was accurately reported. Lifeline Australia's submission stated that attempts
to estimate the financial costs of suicide are hampered by debates about the
statistical value of life. They stated:
There continues to be robust debate amongst economic
theorists as to how to most accurately estimate the Value of a Statistical Life
(VoSL). In recent years, there has been heightened interest in the development
of health outcome measures that combine morbidity (quality of life) and
mortality (quantity of life) in a single measure. Proposed indices include the
Quality of Life Years, QALYs and Disability–adjusted Life Years, DALYs.
Discounting is commonly employed to reflect society’s preference for health gains
that accrue sooner rather than later in time, and costs that occur later rather
than sooner in time. A variety of methods have been used to value life and
health or the cost of illness. Examples include human capital (foregone
earnings), willingness-to-pay (WTP) estimated through indirect market methods
Lifeline highlighted recent research re-evaluating the cost of human
lives lost in car accidents in 2009 which estimated the average cost of a life
lost in a car accident at $6 million.
If a similar cost value was assumed for each of the approximately 2000 deaths
by suicide each year in Australia the total cost would be around $12 billion
The Suicide is Preventable submission noted that there are no reliable
national estimates available on the financial costs associated with suicide and
suicide attempts in Australia. It argued that more work was required to more
accurately and fully cost the economic impact of suicide and suicidal behaviour
on the Australian economy. Dr Michael Dudley from SPA also stated that:
We believe that suicide needs to be comprehensively costed in
Australia and that resources need to be allocated to do this.
The Suicide is Preventable submission suggested a number of possible
components for costing suicide and self harm in Australia. These included the
total number of suicides, lost production value, the cost of ambulatory
services, years of life lost due to premature mortality, productivity losses
for survivors, cost of insurances and superannuation claims, the cost of
prevention and intervention programs. They proposed that 'a conservative
estimate for the economic cost of suicide and suicidal behaviour in the
Australian community is $17.5 [billion] every year'.
In 1998, Jerry Moller estimated the cost of injury by suicide or
self-harm Australia in 1995-96 using data supplied by the National Injury
Surveillance Unit and a methodology developed by the Monash University Accident
Research Centre for estimating injury costs. These study estimated direct costs
of injury by suicide or self harm (relating to the treatment of injury) were
estimated at $208.2 million while the indirect costs (relating to the loss to
society of the productive efforts (both paid and unpaid) of injury victims)
were estimated to be $344.6 million (morbidity) and $1,477.9 million
In 2005 the New Zealand Ministry of Health commissioned a report titled
The Cost of Suicide to Society. It estimated in 2004 (in New Zealand
dollars) that the economic cost per suicide was $448,250 and the economic cost
per suicide attempt was $6,350. It also attempted to estimate non-economic
costs and values for lost life and quality of life. It judged the non-economic
cost per suicide was $2,483,000. It noted that on the calculations used it was
'the value of life component that dominates all others'.
A study assessing the cost of injury in California between 1999 and
2003 found that the cost of individual suicides based on costs incurred by
individuals, families, employers, government programs, insurers and tax payers could
be calculated at $4,781 (US) for the average medical cost and more than $1.2
million (US) for the average lifetime productivity loss. The average medical
cost per hospitalisation for a suicide attempt was more than $12,000 (US), and
the average work-loss per case was over $14,000. Based on these assumptions the
combined cost of suicides and attempted suicides in California was $4.2 billion
(US) per year
The economic costs of suicide identified during the inquiry were not
always in expected areas. The NSW Government noted that RailCorp estimated that
on average each suicide on the NSW railways costs the passenger service
operator $76,000 and an attempted suicide $6,021.
It was also noted that some research studies suggest that the premature deaths
resulting from suicide may actually derive savings to society from the avoidance
of having to treat the depressive and other psychiatric disorders of some of those
who complete suicide as well as the avoidance of other costs such as pensions,
social security and nursing home care costs.
While SPA outlined their concerns that some economic approaches to the
cost of suicide may be 'uncomfortably close to seeing human value in terms of
productivity', it also noted that estimates of the economic cost of suicide can
be useful in providing guidance as to where the burden is greatest and where
'research on developing new interventions might be best focused to give
greatest potential gain'. Consequently they recommended increased funding
towards research into the economic cost of suicide, including detailed
assessments of the burden of suicide by postcode to assist in advocating and
determining funding priorities by geographic need.
The limited nature of existing Australian research on the impact of
suicide was confirmed during the inquiry. AISRP indicated that they had
recently started to apply for research grants to examine the personal, social
and financial cost of suicide in detail.
DoHA acknowledged the Commonwealth government had previously not done any
economic modelling on the cost of suicide in Australia. Ms Rosemary Huxtable
To do a proper body of work on this issue would take
significant time. It would need to be allocated a priority from within a
government and the normal way this would occur would be through the engagement
of a body like the Productivity Commission that can apply the appropriate
robust methodologies to work like this.
The personal and social impacts of suicide and attempted suicide on
those affected cannot be quantified but are clearly enormous. For some of those
writing their personal stories to the Committee, it was the first time they had
recorded their experiences with suicide. It was apparent many struggled to find
the words to convey their feelings of personal loss and grief following the
suicide of a family member, partner or friend. In describing their experiences
with suicide, submitters described their lives as being 'scarred' and 'changed
Others who had attempted suicide, or cared for someone who had attempted
suicide, often expressed their feelings of confusion, shame and frustration at
the difficulties in finding assistance. While the financial impact of suicide in
Australia appears to be large, the Committee agrees with several of the submissions
which argued that the personal and social cost of suicide would always be more
significant than the financial cost. No matter what the economic cost of
suicide is calculated to be, a moral or a human obligation exists to assist
those at risk of suicide and those who have been bereaved by suicide.
The Committee also heard many stories from people who had come through
their experiences of suicide and had devoted themselves to assisting other
people at risk.
For example Ms Joanne Riley of SPA told the Committee:
In the months after Dad died, I made a personal commitment to
take some action. I thought that, if I could just stop one person from taking
their own life by drawing on my own experiences, while it would never bring Dad
back it would in some way honour his life.
Similarly Ms Lyn Mahboub described her 'journey of recovery' from mental
illness which had involved hospitalisation with suicidal ideation. She now
assists other people at risk through the Hearing Voices Australia Network.
The Committee was inspired to hear the personal stories of individuals who now
worked assist others at risk.
The financial cost of suicide in Australia is significant. Suicide clearly
imposes economic costs in a broad range of areas including health care, law
enforcement, emergency services and insurance. The Committee will not engage in
the economic debate about the statistical value of life. However the Committee
considers that a study of the financial cost of suicide would assist suicide
prevention activities in Australia. It would serve to identify areas where
suicide and attempted suicide have an economic impact, it would highlight the
cost of suicide to the community and would encourage policy makers to allocate
appropriate resources to the prevention of suicide.
2.28 The Committee recommends that the Commonwealth government commission a
detailed independent economic assessment of the cost of suicide and attempted
suicide in Australia, for example by the Productivity Commission.
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