PUBLIC AWARENESS CAMPAIGNS
This chapter deals with term of reference (d) the effectiveness, to
date, of public awareness programs and their relative success in providing
information, encouraging help-seeking and enhancing public discussion of
suicide. It will also address the related issues of the community stigma
concerning suicide and the reporting of suicide in the media.
Awareness in the community
A mother whose daughter died by suicide, talked about her
anger at seeing everything turning pink in October. “Why can’t the community
have the same reaction and response to suicide?”
The Committee heard great concern about the lack of awareness about
suicide that currently exists in the Australian community. For example, the
State Coroner of SA, Mr Mark Johns, was one of a number of persons who
commented on the common lack of awareness of the 'reality' suicide in the
The Salvation Army outlined the results of a Roy Morgan survey
commissioned to examine the level of community awareness about suicide and to
gauge knowledge levels in the community regarding how to help a person who may
be contemplating suicide. While 80 per cent of the survey respondents were not
aware of the level of suicide in Australia, over 64 per cent stated they had
known someone who had died by suicide. Around 24 per cent did not know any
services or organisations in the community that provide support for people who
The Salvation Army therefore commented:
The results of the survey confirm our belief that there is
still a sense of ignorance about the full extent of suicide in Australia. We
know that more people die by suicide in a single year than through road trauma
and yet the awareness levels of the issues surrounding these two social issues
in Australia is vastly different. We are constantly reminded through public
awareness campaigns about the extent of the road toll and how we can remain
safe on our roads and yet the issue of suicide remains shrouded in mystery and
seems to be seen as an individual issue and not fully recognised as the public
health issue that it is.
SPA submitted to the Committee that a lack of awareness in the community
has also resulted in the existence of damaging misconceptions about suicide. These
include 'if they talk about it, they won’t do it'; 'talking about it gives
people ideas'; 'not much can be done to prevent it, as people who are serious
about it will do it no matter what anyone tries to do'.
SPA also directed the Committee to literature and stakeholder consultations
that indicate a perception that suicide is only a medical problem or a response
to mental illness. SPA stated that this misconception ignores the complexities
of suicide, and the many 'social determinants of suicide and self-harm in
The Committee heard that improved awareness about suicide is important
to ensure that suicidal cues are identified and support can be provided:
A person who is suicidal may not be in the best position to
be seeking the help...As a community, Australians need to ensure that when
someone does reach out for help, they are linked with someone who is equipped
to provide them with appropriate support. In order to do this, the Australian
community needs a basic knowledge of what signs of suicidality to look out for,
how to have safe conversations around suicide, and how to access appropriate
Dr Darryl Watson from the RANZCP told the Committee that good awareness
about suicide was particularly important in some occupations:
People working in education, social security and community
services often see people in distress. Improved awareness of suicide risk
factors and education to reduce stigma can be broadly targeted in this area.
Mental health literacy should be a key skill.
Submissions also presented a strong view that there is a need to
'promote openness, acknowledgement and understanding of suicide in the
in order to overcome misunderstandings and encourage the Australian community
to become involved in suicide prevention.
We need to break down the barriers so that the community will
get involved, so that it will start taking an interest or offer its support or
its help. Breaking down the barriers will by definition reduce the rate of
suicide in Australia.
Improving public awareness was not necessarily seen as straightforward
however, with submissions highlighting research by Professor Robert Goldney and
Ms Laura Fisher which examined initiatives in Australia between 1998 and 2004
to enhance public and professional knowledge about mental orders, particularly
depression. This study found that while these initiatives had improved mental
health literacy and help seeking, there was less change for those most in need
of intervention (those with major depression and suicidal ideation).
A number of submissions presented serious concerns about the lack of
conversation, the "silence" and the stigma that exists around suicide
in the Australian community. Many submissions consider that the lack of
awareness and understanding about suicide contributes to this stigma:
Across Australia, there is poor awareness and understanding
of the risk factors and warning signs for suicide and the most appropriate
responses or actions to take to prevent suicide or following a suicide event.
This can lead to feelings of stigma and shame for people bereaved by suicide
and reduce their capacity or willingness to seek help and support.
Lifeline Australia also commented that 'ignorance, stigma, fear and
uncertainly about what to say or do clearly remain barriers to the provision of
support by community members when a suicide occurs'.
Ms Kate Matherson provided an insight into the stigma that exists for people
who experience suicidal ideation:
The stigma that surrounds depression and suicide makes it
hard for one to ever return to the somewhat normal life that they may have had
before, it makes them feel ashamed, unworthy, disgusting, different and
alienated all things I have experienced recently.
Similarly, SPA presented to the Committee a large number of alarming
personal stories they had received that were associated with the experience of
social stigma around suicide.
For a long time I felt intense
embarrassment... about attempting to commit suicide...I found that suicide was
still very much a taboo issue within society and I felt guilt and shame
associated with it. It would be great if we could be more open and honest about
this issue within society as it affects many people. Perhaps if we could speak
more freely and honestly, we could prevent the devastation caused by suicide.
We live a daily horror that we
can’t share or discuss with anyone else... I feel like I am on a merry-go-round
that will not stop and I cannot get off.
Queensland Alliance further argued that stigma, particularly that which
is associated with mental health issues, is not only about attitudes in the
broader community but also self-stigma and 'internalised discrimination':
...they identify themselves as an illness. 'Hi, I’ve got
schizophrenia and my name’s John.’ They are very focused on what their
diagnosis term is and forget that there is a human being in there that is
valuable and can contribute to a community. 
It is internalised discrimination. There are a lot of people
with mental illness out there running the country, but they are not going to
tell us. That is discrimination, that is stigma. Similarly, in business and
with people who you are working with, as soon as you start going down that
mental health path, men, and I think women as well, are just like, ‘No way, I
might be a bit odd, or I might be feeling down, but I’m not crazy!’ It acts as
a barrier to people seeking help and telling their wife, husband, friends,
Submitters noted considerable efforts to increase mental health literacy
in the Australian community, recognising the significant relationship between
mental health issues and suicide. However, it was presented to the Committee
that despite large-scale mental health awareness-raising campaigns such as Beyondblue,
there have been far fewer attempts to raise community awareness about suicide.
Professor Diego De Leo, in discussing the approach of the Life house project
for suicide prevention, further outlined the need to focus awareness-raising
efforts on suicide, not just mental health. He stated:
One of the key issues is that when a suicide attempter...If I
mingle with people like me I can hope to be understood. But if I am with other
people – a psychotic guy, a bipolar a panic attack and severely disordered et
cetera – I will be the most stigmatised of the patients.
Stigma and help-seeking
Many submitters expressed a strong view that the stigma that is associated
with suicide acts as significant barrier for people to seek help, and
contributes to an experience of discrimination from health professionals,
community members and peers.
The Suicide is Preventable submission also argued that the fear of being
stigmatised contributes to many who attempt suicide failing to seek help from
health care professionals, and less than half receiving medical attention.
Mr David Crosbie from the MHCA also commented:
It is my belief that there are many suicide attempts that we
do not see, we do not record and we do not intervene in. I am not sure of the
exact number; I know there are estimates, but I think there is still very much
a stigma, a barrier, to people acknowledging that they are experiencing mental
health issues or feeling suicidal, which means that people can go through a
process of making a decision to suicide, attempting suicide, recovering from
that suicide and people around them do not know...It is really frightening that
people can go through that whole process and there is no point of intervention,
no service or acceptance that that is needed.
Clinical Associate Professor David Horgan from the Australian Suicide
Prevention Foundation also noted that given the effect of stigma in discouraging
people to seek help and the difficulty in overcoming this stigma, treatment and
intervention should be sensitive to this issue, and provide people with support
that 'does not stigmatise them any further'.
Stigma and bereavement
The Committee heard that the stigma and "taboo" that exists
around suicide significantly affects the bereaved and their recovery process,
including cases of 'complete isolation of individuals during the period
immediately following the suicide or suicide attempt'.
SPA told the Committee that the misunderstandings about suicide, and the
isolation, shame or social stigma experienced by those who have been bereaved
by suicide 'can detrimentally impact a bereaved person’s sense of self-worth
and can result in a general reluctance towards help-seeking and any discussion
of their clinical needs, concerns and emotional experiences, which can have a
number of negative follow-on effects'.
The Committee heard a number of stories about suicides that have been
"kept secret" or "covered up" because of shame or social
stigma, and the inability of the bereaved to talk about it. Lifeline Australia
further highlighted cases of suicide that have been labelled 'as "a heart
attack" or similar, to prevent their community from knowing the real cause
and cases discussed with local funeral directors where 'the families of people
who have died by suicide have the funeral notice request funds to the “Cancer
Foundation or Heart Foundation”, so that the general public thinks that the person
died as a result of these causes, and not from suicide'.
Public discussion of suicide
...my view is we must keep the conversation alive to keep the
person alive. Peer support is critical; those that have attempted suicide and
are here to share the experience of coming back from that choice are essential
weapons of the power of their story to be given to those that believe there is
no choice. 
The Committee received concerns about the difficulty that exists for
people who have thoughts about or attempt suicide and those around them to talk
about their experience, due to a lack of awareness and social stigma. It was
recommended to the Committee that suicide prevention should include as a
central element efforts to make it easier for 'future generations to discuss
and address suicide', and to provide the community 'with the tools to
recognise, acknowledge and prevent suicide'.
The Suicide is Preventable submission noted that a Newspoll Omnibus
Survey commissioned by Lifeline Australia had found a low proportion of
respondents believe that those who were suicidal would tell someone about it. It
was argued that this showed an investment needs to be made in suicide awareness
education and campaigns within Australia.
A significant segment of the community are unable to talk
about suicide or suicidality. It could also be argued that many respondents are
not empowered to ‘read-the-signs’ of someone who is suicidal and trying to
communicate their sense of hopelessness.
RANZCP, while recognising that reducing stigma associated with suicide
and self-harm remains controversial, stated:
Suicide should be able to be discussed without fear and, as
part of public awareness programs, there is a need for debate on how to talk
about suicide. This includes the need for those bereaved through suicide, and
also suicide attempt survivors, to talk openly about their experiences.
Suicide awareness programs
The NSPS, which is guided by the LIFE Framework adopts a 'whole of
community approach to suicide prevention to extend and enhance public
understanding of suicide and its causes'. Funding is provided through the NSPP
for a variety of programs, many of which include suicide awareness raising
For example, the Life Matters project delivered by Lifeline Newcastle Hunter
(LLNH) conducted 36 suicide awareness presentations and two community forums
provided to 465 participants.
DoHA has informed the Committee that Commonwealth Government investment
into suicide prevention activities has included training for frontline staff,
early intervention and the promotion of help-seeking. DoHA also given evidence
of other Commonwealth Government programs which 'play a significant role in
upstream support for people who may be at risk of suicide'. This includes
investment in mental health promotion and prevention activities such as
Beyondblue, mental health programs targeting groups at high-risk of suicide
such as the Mental Health Services for People in Rural and Remote areas
initiative, Indigenous specific mental health programs and the Victorian bushfire
mental health response.
DoHA informed the Committee that the NSPS and the NSPP have had 'significant
and positive' impacts, and have included the creation of mental health programs
which have lead to programs such as the Headspace Youth Mental Health
The NSPP also provides funding for the R U OK? Day which encourages
Australians to connect with family and people in the community if they have
concerns about their mental health and wellbeing through coordinated promotion
SANE Australia commented to the Committee that programs that encourage
help-seeking as soon as possible such as MindMatters, KidsMatters and the
Headspace Youth Mental Health Initiative are also showing encouraging results.
The Department of Veterans' Affairs (DVA) has informed the Committee of
programs run for veterans and their families such as At Ease mental health
awareness campaign which focuses on increasing awareness and education about
the importance of mental health and self help management strategies, and The
Right Mix health and alcohol promotion strategy that provides information to
assist with choices around alcohol consumption and opportunities to reduce
alcohol-related harm in the veteran community.
Queensland Alliance also highlighted the VicHealth Mental Health
Promotion Framework as a local example of a strategy that acknowledges the
complexity and context of mental health issues for individuals.
A strong feeling presented by submitters and witnesses was that DoHA and
the programs implemented and funded under the NSPS did not adequately focus on
raising public awareness about suicide through a coordinated approach, and that
the Commonwealth Government had not taken a lead role in such matters to date.
DoHA made the following comments:
I will just say that the work plan – or what we call the
action framework for what we and ASPAC (Australian Suicide Prevention Advisory
Council) are doing does not have a specific heading around community awareness
at the moment. I suppose it is not on our agenda to take froward in that
respect. Clearly issues about reducing stigma and promoting help seeking –
those kind of issues – are right there on the agenda and it overlaps with those
RANZCP commented that while there were some good campaigns that focus on
suicide prevention, '...these are rarely supported by meaningful ongoing
community supports other than crisis telephone lines'. They argued that suicide
prevention awareness campaigns should not only focus on prevention, but also
increase community awareness regarding treatment and support options, including
the role of different mental health practitioners, in order to be beneficial
for consumers, carers and their families.
The Kentish Regional Clinic recommended that a 'public awareness program
is developed which directly addresses the issue of suicide and is not "hidden"
under any other name and is treated as a stand alone issue'.
Media guidelines and reporting
DOHA has told the Committee that as part of NSPS activities, the Commonwealth
Government has worked with the media to improve the communication of key
messages about mental illness and suicide prevention, in particular to develop
media reporting guidelines through the MindFrame initiative that reduce the
stigma of mental illness, encourage help-seeking and reduce copycat suicide.
The Committee received a significant amount of comment regarding media
guidelines for the reporting of suicide.
The Suicide is Preventable submission notes that the way a suicide is
reported can influence increases or decreases in suicide rates:
The “toning down” of media reports of suicide has previously
been highlighted by the World Health Organisation as being one of six elementary
steps for suicide prevention...Similarly, there is strong evidence to suggest
that the media may be an important influencer of community attitudes towards
mental illness. In particular, negative media images can result in the
development of further negative beliefs about mental illness, which may in turn
lead to stigma and discrimination.
The MindFrame initiative was developed in 2000 and is funded through the
NSPP. MindFrame is the primary source of guidance for media professionals and
those who interact with the media. MindFrame aims to 'encourage responsible,
accurate and sensitive media representation of mental illness and suicide, and
to advocate on behalf of community concerns about media depictions that
stigmatise mental illness or promote self-harm'.
The key elements of the MindFrame initiative include: the Hunter
Institute's MindFrame resources for media and other professionals; the SANE
Australia Stimgawatch which monitors the Australian media to ensure accurate and
respectful representation of mental illness and suicide; and the National Media
and Mental Health Group which brings together media representatives with mental
health professionals and the Commonwealth to develop strategies for improving
media understanding and reporting of suicide and mental illness.
The Committee was told by various witnesses that the MindFrame
initiative is a well respected, important, and successful collaboration between
the Australian Government, mental health advocates and the media industry 'to
de-stigmatise mental illness and to influence public discussions about suicide
and self harm'.
DoHA also outlined two studies of the Media Monitoring Project to track
reporting of suicide and mental illness in the Australian media, the first in
2000-01 and the second in 2006-07. The second study found a significant
improvement in the quality of media reporting of these matters.
As a result of this engagement and the guidelines developed
voluntarily with the media sector, Australia has seen significant improvements
in both the quality of media reporting in these areas and the volume of
publicly reported suicide cases. For example, recent research has shown that,
between 2000-01 and 2006-07, there was a twofold increase in the number of
media reports about suicide. Importantly, the study found that the quality of
those reports also improved greatly, with significant reductions in the use of inappropriate
language, details of method and images of the location or the body of the
deceased and significant improvements in the provision of help-seeking
A tension has developed, however, between the recognised need to ensure
responsible and accurate media representation of mental illness and suicide,
and to increase public awareness and knowledge about the incidence of suicide
For example, the SA Coroner related the lack of public awareness about
suicide to underreporting in the media, noting that 'the media is very nervous
about the risk of copycatting and as a result...it (suicide) tends to be
underexposed in the popular press'.
Similarly, SPA expressed concern that media guidelines could be 'interpreted as
not to refer to suicide at all or to avoid suicide reporting' and that any
reporting about suicide, including information about research, is avoided by
Professor Patrick McGorry from Orygen Youth Health Research Centre told
the Committee that underreporting of suicide in the media is linked to the
stigma that exists within the community, and may impede efforts to reduce rates
I think the fundamental problem with the suicide issue in
Australia is the tremendous taboo and silence that surrounds it still. That is
evident in...the issue of the media guidelines....
But no-one has measured the death toll that arises from not
talking about suicide and not reporting it in an active way, in the way that we
report on the road toll...
Similarly Mrs Jennifer Allen from Youth Focus Inc. argued that the
restrictions on the media, and on educators, in discussing suicide could
further the associated stigma:
So I do understand why the media is nervous about addressing
the issue of suicide, but not to talk about it all, pretty much, I think only
reinforces the belief that it is wrong to talk about suicide. It makes people
feel like they are alone...When we go into schools at the present time, we cannot
mention the word suicide and we certainly cannot talk about self-harm event
thought that is what we really need to do, because there is a lot of fear
around: "Gosh, you're going to actually create it; you're going to
encourage people to go and try self-harm". But how can we break down those
stigmas if we are not actually hitting it head on?
While recognising that some styles of reporting could result in ''copy
cat" acts or increased suicide, the Suicide is Preventable submission also
argued that appropriate reporting can help to reduce incidences of suicide,
citing evidence that '(r)eporting that positions suicide as a tragic waste and
an avoidable loss, and focuses on the devastating impact of the act on others,
has been linked to reduced rates of suicide'.
Ms Barbara Hocking noted therefore that 'we have to keep with our
message that media presentation should be done responsibly and balanced against
the public’s right to know'.
The Committee was also told that the NCSRS have identified the need to more
effectively 'communicate the positive actions being undertaken and the true
state of suicide prevention' as a key area for future investigation, with a
view to 'develop a communications strategy in consultation with the Mindframe
Initiative. This strategy will ensure accurate, non-sensationalised information
is provided to the media and all key stakeholders'.
Similarly, Orygen Youth Health Research Centre noted the intention and
importance of media guidelines for the reporting of suicide, however
recommended that the MindFrame initiative and current media reporting practices
should now be reviewed to ensure that public discussion about suicide is not
being inhibited. In particular, Orygen Youth Health Research Centre recommended
Social networking sites such as My Space and Facebook are the
means by which young people communicate. Such communication should not be
discouraged; rather, healthy ways of using the internet for communication and
information sharing need to be found and promoted. Such investigations need to
form part of a national suicide prevention research agenda and the findings
should inform a review of the current practice around media reporting.
A National Suicide Awareness Campaign
A number of submitters and witnesses recommended to the Committee that a
well-funded, long-term, national community awareness, anti-stigma and suicide
prevention campaign should be developed and implemented.
The Suicide is Preventable submission recommended that a five-year national
anti-stigma and suicide prevention awareness program (with a minimum budget of
$10 million per year) was required 'to address existing community knowledge
deficits and attitudes towards suicide'.
Lifeline Australia suggested that such campaign should focus on reducing
stigma by encouraging safe, open discussions of suicide, providing the
Australian community with awareness about suicide warning signs, and providing
information about options for seeking and providing help.
It was strongly argued by submitters that there should also be a focus
on overcoming public misunderstandings about suicide in an effort to reduce
Submissions noted the success of other health promotion and social awareness
campaigns, including those for heart disease, breast cancer, diabetes, smoking
related illnesses, HIV/AIDS, road trauma and Beyondblue which have made these
As noted by one submitter these awareness campaigns 'also provide basic
information to the community such as early warning signs and where to seek
The Committee was advised that in order to be effective, such a campaign
must be sustained over time, well-funded, appropriately resourced and delivered
through innovative and targeted mediums, including through new technology, to
ensure comprehensive coverage.
Mr Jeff Kennett, Chairman of Beyondblue told the Committee:
You do not want a campaign just because it is an easy
recommendation; you would want a campaign because you know that it was going to
be consistently delivered – not just a media campaign but a campaign that is
backed up by people who are out in the field, going to the town hall meetings
and talking to media – for 10 years. It is a hard ask, and then you have to
have people who are absolutely committed to it and for the right reasons.
Recognising the complex social, cultural, economic, psychological and
familial factors that can contribute to suicide, SPA identifies the need for a
suicide awareness campaign to 'engage with and form connections with other
relevant social agenda issues, including homelessness, bullying, and substance
abuse (drugs and alcohol), and the impacts of ongoing challenges such as the
global financial crisis and climate change'.
SPA also recommended to the Committee that a way in which to address the
social stigma associated with suicide, without glamorising suicide itself, is
to give suicide a 'face' and encourage the personal stories of those involved
in suicide prevention or postvention, including suicide attempt survivors and
those bereaved by suicide.
Maybe a way to demystify suicide is by telling real stories
of how suicide affects people or an awareness of why suicide occurs in the
first place? I think there is a tendency to want to ignore the specific grief
and loss from suicide and I think these truths are not made apparent on a
The topic of
suicide needs to be taken out of the shadows. Make the people who die this
way, come alive by telling their stories. Make them more than a statistic.
Doing so would help to alleviate the unspoken sense of shame about [this] way of death...
Examples of suicide awareness
The Committee was directed to the LivingWorks program SuicideTALK as an
example of life-promotion and suicide prevention activities for communities.
LLNH also submitted that feedback received for the LivingWorks, ASIST and
safeTALK programs, Building Personal Resilience workshops and Seasons for
Growth Adult workshop has clearly demonstrated a need for these programs, with
participants grateful for the knowledge and skills they attained.
Many submissions and witnesses referred the Committee to an overseas
example of an 'exemplary' suicide awareness and prevention strategy: the Choose
Life: a national strategy and action plan to prevent suicide in Scotland,
developed as part of the National Programme for Improving Mental Health and
Wellbeing in Scotland.
Launched in December 2002, Choose Life is a ten year plan aimed
at reducing suicides in Scotland by 20 per cent by the year 2013. The objectives
of Choose Life include:
- Promoting greater public awareness raising and encouraging people
to seek help early; and
- Supporting the media in reporting of suicide.
The Choose Life website is designed to be a central portal of
information about suicide prevention in Scotland, and helps to raise awareness
among the general public about when and how to seek and provide support, and to
correct misconceptions about suicide. The Choose Life strategy also
includes the national 'Suicide. Don't hide it. Talk about it.' campaign which
specifically targets the stigma associated with suicide. This campaign includes
advertising and information materials, as well as advice about speaking to
someone who may be suicidal.
The Choose Life strategy identifies that in order to reduce rates
of suicide, action must take place across areas of disadvantage in society,
including eradicating poverty, addressing social exclusion and inequality, and
improving health and education opportunities.
The Choose Life strategy particularly aims to reduce suicide and
improve awareness about suicide and mental health from a community perspective.
There are Local Choose Life Plans in 32 local areas, each implemented
under the supervision of local Choose Life Coordinators.
The Committee was also told that the US Air Force Suicide Prevention
Program demonstrates the potential effectiveness of a comprehensive suicide
prevention strategy that aims to reduce stigma within a community:
the program’s implementation was associated with a 33 per
cent reduction in risk for suicide. Importantly, training was embedded in a
whole-of-community strategy that targeted stigma (making it ‘career enhancing’ to seek help). It aimed to strengthen social networks, increase help-seeking
behaviours and improve understanding of mental health. The initiative had an
early intervention focus to identify problems before they escalated to
potentially include suicide risk. It adopted community based, stress management
strategies alongside medical services. Leadership support from all levels of
the organisation was enlisted.
Targeted awareness-raising programs
The Committee also heard strong evidence supporting the need for
awareness-raising to be targeted to high-risk groups and communities that
requires the consideration of particular sensitivities, including young people,
people in rural and remote areas, men, Indigenous populations, the LGBTI and
SPA told the Committee that a range of mental health issues and
disorders present during adolescence and young adulthood.
Further, the Inspire Foundation refers to an 'almost-two-fold increase in rates
of intentional self-harm, the increase of female youth suicide in 2007, and the
even higher levels of male youth suicide' as evidence of the need to target
efforts to reduce stigma and encourage help-seeking among young people.
Inspire Foundation also presented to the Committee views from young
people that community attitudes and stigma remained a major barrier in their help-seeking
In further evidence, it was highlighted to the Committee that the Office for
Youth's report on the State of Australia's Young People national survey identified
that social considerations including fear, embarrassment, stigma,
confidentiality and self-perception created barriers that inhibited young
people from seeking help with 'only one-fifth of teenagers with mental health
problems seeking professional support'.
As explained by the Inspire Foundation, the internet is 'a way of life'
for young people, and the Committee particularly acknowledges the Inspire
Foundation's ReachOut.com which 'looks to the internet for health promotion and
prevention' and aims to 'provide young people with access to and online
community and trusted information'.
The Committee also notes research conducted by the Inspire Foundation,
'Breaking the Digital Divide', which found that many youth service providers
'lack the skills and confidence to provide support to young people using
technology', and 'have a poor understanding of the role technology plays in
young people's lives'. Recognising this, the Inspire Foundation's Reach Out
Pro 'provides access and advice for health care professionals on a range of
technologies and online resources that can be used to enhance the effectiveness
of the psychosocial support and mental health care provided to young people'.
People in rural and regional
The Australian Medical Association told the committee:
In Australia, rates of suicide and suicide attempts are
higher in rural and remote populations, with very remote regions having suicide
rates more than double that of major capital cities...social stigma appears to
be a major inhibiting factor to seeking help in rural and remote communities...
The Committee also repeatedly heard stories of stigma and concerns about
confidentiality as a particular barrier to help-seeking in rural and remote
communities. This was recognised in addition to a shortage of medical and
health professionals in rural areas.
Even where appropriate services are available, there may be a
reluctance to seek help because it is seen as a sign of
weakness...confidentiality cannot always be guaranteed in small communities to
the same extent it can in the city and this is a major disincentive to seek
They (callers from regional and country areas) often report
being afraid that others in their small communities ‘find out’ eg. ‘My boss is
the doctor and everyone says I’m strong and reliable’, ‘My friends might see me
if I go to the doctors’...
The Committee heard a great deal of evidence that the incidence of
suicide in men outnumbers suicide in women, and that men are more reluctant to
For this reason, it was presented to the committee that there is a
particular need to increase awareness and understanding about suicide among men
in order to change attitudes towards seeking help.
Given that one of the most significant risk factors
associated with male suicide is a lack of support and the reluctance and/or
inability of men to recognise and identify their own risks...it is essential
that the concept of ‘help-seeking’ is normalised among Australian men – starting at school and continuing across the lifespan.
The Committee heard that efforts to raise awareness about suicide in
Indigenous communities will require particular cultural sensitivity. Ms Laurencia
Grant from the Mental Health Association of Central Australia told the
The other issue is that suicide is a recent problem for
Indigenous people here...it seems that it has been difficult for Aboriginal
people to fit suicide into their cultural understanding.
Ms Grant described to the committee the Life Promotion program that she manages,
which aims to encourage discussion about suicide in Indigenous communities:
Life Promotion...began to focus on developing resources that
would be useful to work with Aboriginal people on the issue of suicide. Suicide
Story is a training resource that was developed over time through this program
and as a result of input from local people...It was driven from awareness that we
needed to listen to how Aboriginal people understood this problem and what they
were currently doing to support one another.
A number of submitters told the committee that stigma around suicide is
a particular issue in CALD communities and 'is a significant barrier to seeking
help by those who may need suicide interventions and prevents family members
left behind from being able to seek help within their own community...
According to Multicultural Mental Health Australia (MMHA), the high
degree of stigma that is associated with suicide and mental health in some
cultural and religions communities can lead to 'shame', and social rejection
for a person who has attempted suicide or bereaved persons, which can have
further consequences for these individuals. This social pressure could result in,
for example, family conflict or breakdown.
The Public Advocacy Centre also submitted that people from refugee or
non-english speaking backgrounds in Australia 'are likely to have come from
countries where investigations of deaths may be conducted in an entirely
different way to the model that Australia has inherited from the UK', and may therefore
have a very different view about coronial processes, police and the criminal
The committee has heard that it is also necessary to provide culturally
sensitive and culturally specific support in order to improve suicide
prevention and awareness in the LGBTI community.
SPA told the Committee that health and community services do not always
have the appropriate awareness and training to deliver programs and health
promotion to this group, and received the following personal story:
Obviously, for me the counsellor or service I am dealing with
needs to be open to my sexuality...My sexuality is not something I am prepared to
hide in order to access help. This needs to be taken into account across all
services. They need to be open to a variety of backgrounds and the staff need
to leave their prejudices at the door.
Issues for consideration
The Committee heard from a number of submitters that the use of
internet-based technologies to increase public awareness about suicide could
enable access to 'hard to reach' groups, and could be of particular benefit in
targeting young people.
The Committee particularly notes the work of the Inspire Foundation with
ReachOut.com and Research Pro in this area. The Committee also heard that the
internet enables the opportunity for convenient and anonymous access to
information and support, including for those in geographically isolated areas.
The Committee also received some concern about the incidence of
'cybersuicide' (attempted or completed suicide influenced by the internet), and
the risk of young people seeking attention or recognition by referring to
suicide and suicide ideation online.
Submitters noted that this risk of "glamorising" suicide must be
DOHA further told the Committee that there are some significant risks
associated with efforts raise awareness about suicide:
It is imperative to emphasise that, in the area of suicide
prevention, there is the capacity to do harm – to unintentionally cause harm to
those bereaved by suicide or even increase rates of suicide...
SANE Australia also raised concerns that 'some well-intentioned projects
to "raise awareness" have the capacity to engender anxiety, stress
and thoughts of suicide and self harm'.
It was seen as important that efforts to raise community awareness and deliver
a public message about suicide should be considered carefully, and there should
be clarity about what that message should be, in order to avoid any adverse
The Committee further examined the fear that by raising awareness about
suicide that it could become "normalised" or "glamorised",
and considered as an acceptable thing to do. However, Lifeline explained to the
The clear evidence now is that talking about suicide does not
people at risk of suicide, as long as the discussion and the conversation is
done in a sensitive and careful way, that we are not sensationalising suicide,
we are not glorifying it, we are not glamorised in it, because there is
certainly nothing glamorous about it, but that it is spoken about in terms of
how we keep people safe, that the impact of suicide is incredibly negative on
family and friends and that every life is worth living and as a society we must
do everything we can to help a person living and to find reasons to live....
The emphasis needs to be on normalising human experience,
including misery, and normalising help-seeking and creating a community that
Professor McGorry from Orygen Youth Health Research Centre used the
example of reporting road tolls:
We do not report the road toll in a sensationalist way; we
report it factually. We show the actual damage that is done to people's lives
and to the lives of survivors.
Similarly, the Inspire Foundation recommended that, like the release of
statistics of road tolls that raises the public and political attention
regarding road deaths, regular public reporting of statistics about suicide
could help raise awareness about the extent of suicide in Australia and reduce stigma.
Ms LeonieYoung from Beyondblue recommended that one way to overcome the
risk of glamorising suicide in an awareness-raising campaign would be to avoid
calling it a suicide prevention antistigma campaign. Referring to advice she
had received during involvement in a campaign to reduce petrol sniffing in the
Northern Territory, Ms Young explained:
We had some funding for petrol sniffing, and she absolutely
decried calling it 'petrol-sniffing' prevention or 'suicide prevention'. She
said it is like a club; if you call it that, people will want to be part of it.
It has been further submitted to the Committee that while there may be
possible risks and social adjustment associated with raising awareness and
attempting to increase public discussion about suicide, these risks must be
considered against the impacts of stigma, that will continue to exist if the
Australian public remain 'silent' on the issue:
This silence around suicide inhibits our ability to teach
people what to do when faced with a suicidal crisis, including where and how to
seek effective help...To break this silence we believe we need to create not only
an awareness of suicide but also a safe environment to talk openly and debate
Very well-meaning people say things that are inappropriate.
There is risk, and we do need to be cognisant of that. But I think silence
breeds stigma and stigma breeds silence and we have to break through that and
be able to talk about suicide in a way that encourages people to understand it
better, to seek help and to become more informed.
The Committee notes the extensive evidence received about the stigma
that exists around suicide in Australia, particularly as a result of a lack of public
awareness and understanding about suicide and its risk factors.
The Committee further recognises that this stigma can have a detrimental
impact on people's help-seeking behaviour, and the process of recovery for people
who have attempted or considered suicide, or bereaved persons.
The Committee notes the considerable effort in recent times to increase mental
health literacy in the Australian public through initiatives such as
Beyondblue. The committee also notes programs and projects initiated through
the NSPS such as Headspace.
The Committee considers that a national suicide awareness campaign which
appropriately avoids stigmatising or sensationalising suicide, developed in
consultation with community groups, would be beneficial in raising the profile
of the issue of suicide and encouraging help-seeking behaviour by those at risk.
The Committee recognises that a national suicide awareness campaign
should be a long-term and ongoing project that will require the commitment of
significant resources for development, implementation and evaluation.
The Committee notes that risks associated with "normalising"
or "glamorising" suicide must be carefully managed, and close
consultation with stakeholder groups will be necessary.
5.92 The Committee recommends that the Commonwealth government fund a
national suicide prevention and awareness campaign that provides information to
all Australians about the risks and misconceptions of suicide, and advice on
how to seek and provide help for those who may be dealing with these issues.
This campaign should utilise a range of media, including television, radio,
print and online, and other methods of dissemination in order to best reach the
maximum possible audience. This campaign should also create links with efforts
to alleviate other public health and social issues, such as mental health,
homelessness, and alcohol and drug use.
5.93 The Committee recommends that the development of a national suicide
prevention and awareness campaign should recognise the risks of normalising and
glamorising suicide, and draw on wide consultation with stakeholders and a
solid evidence base.
5.94 The Committee recommends that a national suicide prevention and
awareness campaign, once developed, should operate for at least 5 years, and
with adequate and sustained resources. This should include the provision of
additional resources, support and suicide awareness training for health care
The Committee notes the evidence received regarding media practices for
reporting suicide, and particularly the MindFrame initiative. The Committee
recognises evidence of the important contribution of MindFrame media guidelines
in ensuring the accurate and respectful reporting of mental health and suicide.
It is the Committee's view that the media has a critical role in raising
community awareness and reducing stigma associated health and welfare issues
such as suicide. The Committee therefore encourages that issues associated with
the reporting of suicide and guidelines such as those of MindFrame are
well-identified throughout the media industry, including in the education and
training of media workers. The Committee welcomes initiatives such as the SPA
Life Awards which recognise organisations or individuals in print and non-print
media who accurately and effectively report matters associated with suicide,
and contribute to public awareness and education about suicide prevention.
However, the Committee is concerned by suggestions from witnesses that
the media may avoid the reporting of suicide and related issues including such
as research, and this lack of media reporting may inhibit public discussion of
The Committee notes evidence of a need to identify better and more
"active" ways to report and inform the Australian public about
suicide, including the appropriate use of mainstream news media, the internet
and social networking sites.
The Committee also recognises suggestions to provide better information
to the Australian public about the extent of suicide in an effort to raise
awareness. The Committee considers that the release of national suicide statistics,
on a biannual basis could be useful to focus the attention of governments and
the public on the incidence of suicide in the community. This would also present
an opportunity for targeted dissemination of information about the services and
support that are available to those who may be affected.
5.100 The Committee recommends that the Mindframe guidelines and current media
practices for the reporting of suicide are reviewed. Research should be
undertaken to determine the most appropriate ways to better inform the
Australian public about suicide through the media, including mainstream news
reporting, as well as through internet and social networking sites.
5.101 The Committee recommends that national figures on suicide should be
released to the Australian public, at a minimum, biannually, in an effort to
raise community awareness about suicide, and should be provided together with
information about available services and support.
The Committee recognises the evidence received regarding the particular
circumstances and needs of high-risk groups, notably young people, people in rural
and remote areas, men, Indigenous populations, LGBTI and CALD communities.
The Committee notes suggestions for reaching young people through
schools and via the internet. The committee also recognises the need to ensure
that culturally appropriate services and information are available to
Indigenous and CALD communities, and that the dissemination needs of men, people
in rural and remote areas and the LGBTI community are identified in order to
best target these high-risk groups.
It is the Committee's view, therefore, that the development of a
national suicide prevention and awareness campaign should also identify the most
effective, culturally sensitive, and situation appropriate methods to encourage
awareness and understanding about suicide within these groups.
5.105 The Committee recommends that a national suicide prevention and
awareness campaign should include a targeted approach to high-risk groups, in
particular young people, people in rural and remote areas, men, Indigenous
populations, lesbian, gay, bisexual, transgender and intersex people and the
culturally and linguistically diverse communities. This approach should include
the provision of culturally sensitive and appropriate information and services.
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