TARGETED PROGRAMS AND UNIVERSAL INTERVENTIONS
This chapter will deal with term of reference (f) the role of targeted
programs and services that address the particular circumstances of high risk
groups. While the terms of reference specifically mention Indigenous youth and
rural communities, many other high risk groups in the community were
highlighted during the inquiry. These high risk groups include men, people who
attempt suicide or self harm, children and young people, people bereaved by
suicide, people with mental illness, LGBTI people as well as CALD people.
The Committee also received evidence regarding universal interventions,
telephone services, 'suicide hotspots' and access to means of suicide. The
appropriate balance between programs and projects aimed at the whole community
and those targeted at high risk groups was also discussed.
Universal, selective and indicated interventions
Suicide prevention interventions were generally categorised as universal
(directed at the entire population), selective (targeting groups at high risk)
and indicated (aiming to identify and treat individuals at risk). DoHA stated
that it funded over $5.2 million during 2008-09 to projects which took a
universal approach to suicide prevention. In particular DoHA highlighted universal
interventions to improve media coverage of suicide and mental health (Mindframe
initiative) and to embed mental health promotion in school communities (Mindmatters
and Kidmatters programs).
There was broad support for a diverse approach to suicide prevention
initiatives which addressed Australians universally, as well as the particular
circumstances of groups identified as being at high risk. The Suicide is
Preventable submission argued that a 'diverse approach to suicide prevention is
essential, because there is no single, readily identifiable, high risk
population that constitutes a sizeable proportion of overall suicides and yet
is small enough to easily target and have an effect'.
However some submissions had a preference for either targeted or
universal approaches to suicide prevention. Orygen Youth Health Research Centre
argued for '... a more targeted approach whereby a greater proportion of funded
activity specifically targets those most vulnerable to suicide'. They stated:
We believe that there is an urgent need for suicide
prevention activity to actively target people known to be at high risk in such a
way that reduced suicidal behaviour is a measurable outcome... We advocate that
more attention be given at a national level to evidence-based, targeted
interventions addressing those at risk during peak periods of risk, with general
health and associated mental health services being the most obvious (although
not the only) channels for intervention.
Lifeline Australia acknowledged that targeted programs have an important
role in any suicide prevention strategy but noted that there are limitations
and dangers with an over-reliance on this approach. In particular they
emphasised that restricting suicide vigilance to high risk groups could mean
other individuals at risk could be overlooked.
Telephone support services
Lifeline Australia highlighted the significant role their organisation
played in the area of suicide prevention. The Lifeline national helpline
receives approximately 450,000 calls each year with 5.8 per cent of these calls
involving a high risk of suicide. 3 to 4 calls each year are from someone who
has already initiated an act of suicide.
They emphasised large part suicide affects those calling their service:
Lifeline has recently undertaken analysis of the calls to 13
11 14 where a high risk of suicide is identified. This analysis found that
76.2% of these calls related to the caller’s suicidality, 7.6% bereavement
after suicide and 16.8% of calls concerned another person’s suicide risk. This
indicates that 13 11 14 is not only used by people considering suicide, but that
it provides a vital role to support third party care givers. Almost two thirds
(64.8%) of the suicide-related calls were from women and 35.0% were from men.
More than half of the calls about current suicide thoughts (59.1%) also mentioned
prior suicide behaviour, which places these callers at a much higher suicide risk. 
A key barrier identified for clients accessing the Lifeline telephone
services was call costs. Lifeline noted that callers from mobile phones make up
more than half of all their calls and frequently they pay higher call costs.
Similarly Boystown described call costs as 'immediate barriers to accessing
assistance' to the Kids Helpline they provide. They also noted a trend towards
children and young people preferring mobiles and handheld devices to access assistance.
Mr John Dalgleish stated:
Currently, if any young person uses a landline to call the
1800 number that we have, that call is free. If they use a mobile—and, now,
around 62 per cent of our telephone contacts are by mobile—unless they are on
the Optus network, which also includes Vodafone, they have to pay for that
The Psychotherapy and Counselling Federation of Australia also
...young people and those who are socially disadvantaged with
mobile phone access only may not have enough credits to call and/or stay on the
phone. There currently is no provision for crisis services to take mobile calls
without cost. A dedicated line to a national Suicide Prevention service with a
free number would be of great benefit.
Smaller community organisations told the Committee they often received
the overflow calls to the major telephone services when the capacity of these
services to take calls could not keep up with the demand. Mr Darrin Larney
The demand on Lifeline, Kids Helpline, MensLine and all of
the services that are currently in place is huge. They do not necessarily have
the facilities or perhaps the infrastructure to be able to cope with the number
of calls that they are getting. So we by default get a significant amount of
A major recommendation of the Lifeline Australia submission was that the
main Lifeline 13 11 14 helpline be officially mandated and funded as an
essential suicide intervention service. They noted that currently:
The National Suicide Prevention Strategy in Australia
contains no direct reference or mandated role for Lifeline 13 11 14 – despite
the widespread usage, promotion and referral to the service in the community
generally, and by health care professionals.
Access to means and suicide hotspots
The removal of access to means used for suicide is important in the
management of the care of individuals at risk of suicide and changes to general
access to dangerous means have been recognised as an effective policy in suicide
prevention at the population level.
However DoHA has noted that most access to means interventions 'lie outside the
area of influence for health departments'.
On the unrevised ABS figures from 2007 more than half of all deaths
recorded as suicide were the result of hanging (including strangulation and
suffocation). Poisoning by drugs was used in 12 per cent of suicides and
poisoning by other methods, including by motor vehicle exhaust accounted for
another 12 per cent. Suicides using firearms made up 8.9 per cent of deaths.
The Suicide is Preventable submission noted that despite the large number of
suicides by hanging, this method of suicide is difficult to prevent as the '...means
for hanging are readily available and it is infeasible to restrict access to
all the materials that could be used'.
Other areas for restricting access to means were also discussed. For
example RANZCP recommended that access to paracetamol should be reduced through
Professor Joan Ozanne-Smith of NCIS told the Committee that a number of
suicides had been recently recognised as using helium and a plastic bag and
that a simple regulatory control could reduce these types of suicide.
Mr John Dalgleish of Boystown also noted that the preferred methods of suicide
of young people are different from adults. He stated:
In our data we identified that many of the drugs that young
people stated that they could access were prescription drugs, often prescribed
for depression, anxiety and psychosis. Educational programs needed to be
conducted to raise awareness of the risks involved in allowing uncontrolled
access to these drugs by young people.
Suicide hotspots and the Gap
Both in Australia and overseas specific places or landmarks have been
recognised as a result of the high number of completed and attempted suicides
which take place at that location. One 'suicide hotspot' that received
considerable attention during the inquiry is the Gap, an ocean cliff in eastern
Sydney. The inquiry received evidence from Ms Dianne Gaddin regarding the
suicide of her daughter at the Gap in 2004.
Ms Gaddin described the regular occurrence of suicides at the Gap as a
I cannot understand why nothing has ever been done to prevent
suicides at any of the hotspots in Australia. There is conclusive evidence from
both the UK and New Zealand, showing that when there are steps to make access
to hotspots difficult, that the suicide rate drops significantly. There is also
anecdotal evidence to show that when this is done, it does not follow that a
person would seek somewhere else.
The Committee also received a submission from the Woollahra Municipal
Council which covers Watson Bay where the Gap is located. The Council has
developed a Gap Park Masterplan in consultation with residents, mental health
providers, local police and relevant stakeholders. The plan would involve
infrastructure modifications such as purpose built fencing, improved lighting
and closed-circuit television (CCTV) coverage and on site telephone support to
Lifeline and signage of messages of hope and support. Additionally the plan
would include measures to practical coping and resilience skills to improve
mental health in the community through provision of workshops and a mental
health resource kit.
The Committee understands the Woollahra Council application for $2.1 million in
funding was recently rejected.
DoHA stated that, together with ASPAC, it had been 'examining the
evidence behind restricting access to suicide ‘hot spots’ such as bridges or
clifftops known to be frequently used suicide locations'. It noted that funding
physical infrastructure to reduce access is outside of the scope of the NSPP
program, but 'funding advice on reduction of access to means in this way is
within the remit of the NSPS'. They stated:
Work is currently underway to provide guidelines for local
government authorities and others with responsibility for infrastructure development
on the evidence and best practice methods behind reduction of deaths by jumping
through restricting access.
The Suicide Prevention Taskforce argued:
In terms of local government involvement, suicide prevention
efforts are largely ad hoc and reactive to a suicide cluster and focussed on
physical barriers at known suicide sites. However, there is no evidence of a coordinated
national response through the Local Government association or other peak bodies.
DoHA stated that over time there has been change in the methods of
suicide reported. Following the gun restrictions introduced after the Port
Arthur deaths in 1996, there was a decline in deaths due to this means but this
has reversed more recently.
SPA noted that access to firearms in rural and remote areas is an issue of
concern 'given that the high lethality of such methods may convert many
attempts into completed suicides as a consequence of the presence of a firearm'.
Alcohol and drugs
The role of alcohol and drug abuse in completed suicides was frequently
mentioned during the inquiry. Alcohol or substance abuse disorders are often
comorbid with other conditions which have an increased risk of suicide.
Alcohol and drugs were seen as significant risk factors for impulsive
suicides, particular in Indigenous communities. Dr Julia Butt from the
Indigenous team at the National Drug Research Institute (NDRI) told the
In the Indigenous community and certainly in other sectors of
Australian society, impulsive suicide becomes a much greater risk, and that is often
in the context of alcohol and other drug use. It is much more difficult to
predict; it is much more difficult to respond to.
The Committee also received a submission from the Kimberley Aboriginal
Law and Culture Centre which noted that a high level of correlation had been
found between drug and alcohol use and the high incidence of suicide in the
Kimberley. They were urgently seeking the implementation of a Kimberley
Regional Alcohol Management Plan as 'alcohol and drugs are the principal
drivers of suicide' in their region.
The Alcohol and other Drugs Council of Australia noted research by the
NDRI which identified alcohol-related suicides as the third-leading
alcohol-related cause of death for males and alcohol-related suicide attempts
as the fifth most common cause of hospitalisation for females in Australia.
The LIFE Framework documents identified a number of groups as higher
risk of suicide. These include:
....men aged 20-54 and over 75, men in Aboriginal and Torres
Strait Islander communities, people with a mental illness, people with
substance use problems, people in contact with the justice system, people who
attempt suicide, people in rural and remote communities, gay and lesbian
communities, and people bereaved by suicide.
Some of these groups at higher risk were recognised in the DoHA
submission as receiving funding under the NSPP.
Broadly, male suicides account for around three quarters of all suicide
deaths in Australia. The Committee was often told during the inquiry that men
make up the majority of completed suicides because they usually choose more
lethal means (ie hanging and firearms). Men were seen as being less adept than women
in seeking help and assistance, putting them at greater risk of suicide. DoHA
noted that 'the vulnerability of separated and divorced men, particularly those
involved in custody disputes and negotiated settlements, has been raised as a
key factor' in the increased numbers of male deaths.
The DoHA summary of 2008-09 NSPP expenditure indicates nine projects
focused on men as a population group at higher risk of suicide with
approximately $2.2 million spent. DoHA outlined several projects funded under
the NSPP which are 'aimed specifically at providing support and reducing
suicidal behaviour amongst men, given the high proportion of male suicides, and
the specific characteristics of help-seeking
behaviour that are often attributed to men'.
The Committee received evidence regarding several programs which
targeted men at risk of suicide. The Australian Men's Sheds Association seeks
to provide men with safe, supportive environments in which they can work on
projects '...which give them a sense of purpose, which contribute to self-esteem
and which help men to resume their rightful place as useful and productive
members of their community'. The Association noted these activities provide
valuable suicide protective factors.
Mr Mort Shearer told the Committee that the Men's Sheds were a good way to
sidestep the stigma of suicide prevention and mental health '...because a lot of
men are not keen on pursuing their own health issues'.
The OzHelp Foundation suicide prevention activities are workplace based
in the (predominantly male) building, construction and mining industries. The
OzHelp Foundation provides a number of support based programs, often on-site,
focusing on early intervention and prevention.
The OzHelp Foundation indicated there was considerable unrecognised demand for
mental health and support services for men:
Every Tradies Tune-up event that we run on site is booked
out. Every time we are in the van, guys openly talk about what is going on for them.
That disproves this idea that they will not seek help and will not talk about
their issues. It is about finding the ways that they will talk about their
issues, because they will; it is just creating the right environment to do so.
The Inspire Foundation also noted the opportunities they were exploring
to access young men via internet and gaming forums. Ms Kerry Graham said their
organisation was undertaking research to understand how young men seek help and
how they use technology as well as how to use that overlap.
SPA argued that it was essential that the concept of 'help-seeking' is
normalised among Australian men. In particular they highlighted the potential
of sporting clubs, recreational clubs, workplaces and other organisations more
generally to construct supportive social networks in places where men of all
ages frequent in an attempt to lessen harmful behaviours and practices.
Given the much higher rates of male deaths the Private Mental Health
Consumer Carer Network Australia argued '... men must be a more highly targeted
group for suicide promotion strategies'.
Similarly the Freemasons Foundation of Men's Health noted the relatively few
targeted suicide prevention programs and services for men and supported the development
of interventions in a number of areas. These included:
- emotional literacy of boys;
- improved depression diagnosis and treatment for men;
- support services for men experiencing significant life stress,
especially relationship breakdown and employment problems; and
- routine depression and suicide screening for the seriously ill,
particularly heart disease patients.
Of the 2,472 deaths registered across Australia in 2008 where the
deceased person was identified as being of Aboriginal or Torres Strait origin,
103 (74 male/29 female) were coded as Intentional self-harm [Suicide].
This proportion of suicide deaths is significantly higher than the average in
the Australian population. Many submitters noted that Indigenous suicides are often
not effectively identified by authorities, which suggests a significant level
of underreporting also exists. SPA noted that the ABS does not currently report
suicides by children under 14 years, which are extremely rare in the general
community but in recent decades have been increasingly reported in some
It was observed that suicide was not common in traditional Indigenous
society and is considered a relatively recent phenomenon. However by the 1980's
'...the situation had become endemic in some Aboriginal communities and in the
past decade suicide has become a significant contributor to premature
The summary of 2008-09 NSPP expenditure for groups at higher risk of
suicide stated 16 projects directed at Indigenous communities were funded for
approximately $3.6 million. DoHA highlighted two projects which focus on
A project which focuses on Indigenous youth is the Yiriman
Project coordinated by the Kimberley Law and Aboriginal Cultural Centre in
Western Australia. The project runs youth activities with support from senior
cultural men and has established links with local agencies such as cultural
activities and camps that build strong relationships, self identity and
confidence in young people. Further, the Something Better project funded
through the Queensland Police-Citizens
Youth Welfare Association aims to assist and support young indigenous people in
a number of Aboriginal communities in Queensland who are at risk of suicide
through sporting activities outside of their community by a suitably trained
and dedicated local person.
The MHCA emphasised that Indigenous youth are the most 'at-risk' group
in Australia for suicide. They recommended that the Commonwealth Government
should invest in the development of a series of Indigenous Suicide Response
Workshops 'to gain an accurate picture of what Aboriginal communities see as
the problem, and to develop possible solutions to inform future Indigenous
specific suicide prevention strategies, particularly amongst Indigenous youth'.
Lifeline Australia noted that Indigenous communities 'are often in a
constant state of grief and loss, through deaths, separation, addictions,
disease and children being taken into care'.
Vulnerability to suicide is common in Indigenous communities
that are in a constant state of stress. In this environment, it is difficult to
locate people in families or communities who are available, and free enough of
their own stresses, to give their full attention to a suicidal person.
The inability of Indigenous remote communities to access people with
suicide prevention training or mental health services was highlighted during
the inquiry. The high turnover of public sector and community services staff in
remote Indigenous communities means suicide intervention and prevention skill
training needs to be delivered on a regular basis. The Indigenous team of the
NDRI commented that most suicide prevention training in WA does not address
whole community risks factors, impulsive suicidality and '...has little time dedicated
to the needs, strengths and struggles of Indigenous communities'.
The Mental Health Council of Central Australia stated:
Few mental health service providers are located in remote communities
in Central Australia. Depending on the severity of the injuries, suicide
attempts are commonly dealt with on communities rather than transporting people
to hospital in town...
The system of monitoring suicidal people or people at risk of
suicide who live remotely or in town camps is inadequate. Any expectation that
this could be done effectively by the already over-stretched mental health
service or the SEWB branch of the Aboriginal health service is unrealistic. In
remote communities, mental health specialists are visiting services
The importance of consultation and engagement with Indigenous
communities and recognition of the differences between Indigenous groups in
developing responses to suicides and attempted suicides was emphasised by many
For example DoHA noted that it '...recognises the need to gain advice on suicide
prevention and mental health issues in Aboriginal and Torres Strait Islander
communities from representatives of those communities who also hold expertise
in mental health and suicide prevention'.
Central Australian Aboriginal Congress (Congress) provided the inquiry
with an article on proposed guidelines for effective family support and
counselling programs targeting bereavement and suicide prevention in Central
Australian Indigenous communities. This suggested:
The cornerstone of any effective local Aboriginal bereavement
and suicide prevention services will be the employment of senior Aboriginal
people in the delivery of intervention programs. We need to build meaningful
and sustainable local Aboriginal employment pathways for senior Aboriginal community
members as family support workers, bereavement counsellors, and crisis response
Congress reported that the threat of suicide '...is now used as a threat
by some young people to get attention and access to money for alcohol and other
drugs from other community members'. The Indigenous team of the NDRI also noted
'...in some areas suicide appears to have taken on martyrdom symbolism as a
consequence of disempowerment'.
A number of submissions also noted a high level of correlation between drug and
alcohol abuse and the high incidence of suicide in Indigenous communities.
SPA argued that 'in developing and implementing Indigenous suicide
prevention strategies, it is important to recognise that no ‘quick fix’ solution
exists to the complex web of underlying sociocultural and economic problems and
conditions found to greatly contribute to increased occurrences of at-risk
individuals and endemic rates of suicide and self-harm among Indigenous peoples'.
During the inquiry the Committee visited the Perth offices of the Understanding
& Building Resilience in the South West Project. One component delivered
was workshops based on the 'Map of Loss' which was used for both Indigenous and
non-Indigenous clients to teach how to self-diagnose their emotional state and
to develop skills to manage their emotions.
Indigenous communities were identified as being particularly vulnerable
to clusters of suicides. SPA commented:
In rural and remote Aboriginal areas, suicide deaths often
spark clusters of suicides... Suicide deaths, particularly by hanging, are
frequently witnessed by many members of an Indigenous community. In some instances,
high levels of exposure to both death and suicide have resulted in a
de-sensitisation among members of Indigenous communities, where 'suicide and
self-harm behaviour becomes normal, and even expected (though by no means
Mr Clinton Shultz of the Australian Indigenous Psychologists Association
noted the strong community connections amongst Indigenous people meant the
impact of a suicide was more widespread. He stated:
If there is a suicide in a community, that impacts on
everybody in the community, which then has that flow-on effect of constant
grief, constant loss, without the services to deal with that, which then can
lead to the formation of clusters.
Ms Leonore Hanssens, researcher into Indigenous suicide stated in her
Suicide contagion, particularly behavioral contagion is
endemic particularly substance abuse, and familial contagion appears to be
universal in most Indigenous communities, even the urban settings. This
contagion results in imitative suicides which then produce suicide clusters. When
suicide occurs in such close knit communities the ‘reach of news’ is widespread
and is quickly communicated, which also spreads the contagion. 
Ms Leonore Hanssens noted the timely reporting of suicides in Indigenous
communities could allow effective postvention actions to be taken to reduce the
risk of further suicides occurring. These could include interventions to
'reduce alcohol availability in certain situations (during ‘sorry business’
related to suicide or sudden unexpected deaths), increase policing in certain
jurisdictions, increased mental health personnel, increase in grief and trauma counsellors
and critical incident debriefing in postvention support'.
A separate strategy
The Indigenous Team of the NDRI observed there was '...an acute and
chronic need for targeted programs that address the circumstances of Indigenous
Australians'. These included holistic services, improved mental health
services, integration of alcohol and other drug and mental health services,
community and government services capable to responding to whole of community
risk factors and intervening to prevent suicide 'contagion', and services and
community interventions which are capable of responding to impulsive suicide
There was also discussion during the inquiry whether the unique
circumstances of Indigenous communities in relation to suicide required a
separate suicide prevention strategy rather than simply targeted programs. The
Australian Indigenous Psychologists Association stated that despite clear
differences in the needs of Indigenous and non-Indigenous communities '...Aboriginal
suicide continues to be addressed under the same framework as the general
population by national suicide prevention strategies...[and] Aboriginal
initiatives continue to be adapted from existing non-Aboriginal models, which
are based on non-Aboriginal understandings of suicide, health, healthcare and
Ms Leda Barnett commented:
I think it would be better to have strategies that are
specific for Indigenous populations and perhaps even a strategy for Aboriginal
people and a strategy for Torres Strait Islanders, separate ones. I think the
benefits of that are because the contexts are so different...
Children and Young People
While suicide accounts for only a small proportion of all deaths it
accounts for a much greater proportion of deaths within specific age groups. In
2008, 24 per cent of all male deaths aged 15-24 years were due to suicide.
The ABS does not report suicide for people under 15 years of age due to the
small number and the sensitivities around suicide, however the latest Causes
of Death included the following:
There was an average of 10.1 suicide deaths per year of
children under 15 years over the period 1999 to 2008. For boys, the average
number of [s]uicides per year was 6.9, while for girls the average number was 3.2.
Ms Angela Ritchie from the Commission for Children and Young People and
the Child Guardian (CCYPCG) Queensland noted there had been a changing approach
to the intentionality for children. She stated that in past there were questions
about the capacity of a child to understand the consequences and
irreversibility of their actions but '...increasingly the research literature is
suggesting that children do know enough to contemplate suicide...'.
DoHA noted that the youth focused projects funded under the NSPP 'tend
to centre on building resilience and developing coping strategies and support
networks for young people to increase the number of protective factors for
suicide amongst vulnerable youth'.
The DoHA summary of 2008-09 NSPP expenditure for groups at higher risk of
suicide indicated 25 projects directed at young people received approximately
The role of schools and teachers was emphasised in managing the impact
of suicide by children and young people. SPA recommended the introduction of 'mandatory
suicide (and attempted suicide) postvention guidelines across all Australian educational
institutions and schools...'.
A key schools program funded in the NSPP was the Mind Matters initiative
delivered by Principles Australia. This is a national mental health, promotion,
prevention and early intervention program delivered in 3000 Australian
Also funded under the NSPP was Peer Support, a national peer led program which fosters
the mental, physical and social wellbeing of young people and their community
by supporting positive cultural change within schools.
Mr John Dalgleish of Boystown also highlighted the benefit of placing at
risk youth in social enterprises and vocational training to develop protective
factors and resilience. He stressed the importance of 'community engagement
strategies around employment and psychological support which are critical to
divert young people from suicidal behaviour'.
The risk of familial and imitative contagion for children and young
people was highlighted by the CCYPCG Queensland. The Commission's child death
review had found 42 per cent of young people who completed suicide did so after
the suicide, or attempted suicide of a friend, family or community member.
Ms Angela Ritchie from CCYCPG Queensland noted this data '...reinforces the
importance of detailed suicide prevention and postvention guidelines being put
in place' to support children when suicides take place.
The CCYPCG Queensland also outlined their preliminary findings that many children
and young people had contact with a variety of human service agencies prior to
their suicide including educational institutes, police, child safety, health
and mental health services and the youth justice system.
Bullying and cyber-bullying
The NSW Legislative Council General Purpose Standing Committee report
into bullying and young people acknowledged the problematic relationship
between bullying and suicide. SPA highlighted the report's recommendations to
the Committee including better assistance to schools to identify effective
anti-bullying programs, better training for teachers, that the State education
department seek annual feedback from young people on anti-bullying initiatives,
protocols for schools to report on their anti-bullying polices and a greater
research focus on cyber-bullying.
Boystown also noted 'a high correlation between suicidality and cyberbullying
and even face-to-face bullying'.
The internet was seen as both a blessing and curse in relation to
suicide prevention for children and young people. A number of witnesses and
submitters noted some internet websites included inappropriate information
about suicide including instructions for those who intend to attempt suicide.
On the other hand some recognised that social networking and mobile phones
decreased the social isolation for children and young people.
The Inspire Foundation emphasised the positive role internet and
communication technologies had played in their activities such as ReachOut.com.
They recommended that these technologies be seen as 'enablers of young people's
mental health and wellbeing and an important setting in which a spectrum of
interventions can be undertaken'. The Inspire Foundation commented:
The Internet is accessible, anonymous, engaging and informative,
providing a space where young people can feel empowered and confident to talk
about sensitive issues... ICT therefore offers significant potential as a tool and
setting for mental health promotion and suicide prevention for all young people...
The Suicide is Preventable submission stated that help seeking and help
pathways for young people at risk of suicide can be limited.
Although not funded through the NSPP, DoHA noted the headspace initiative which,
through 30 shopfronts, '...provides access for youth to general practitioners and
allied health professionals with skills and experience in alcohol and drug
treatment and mental health, as well as access to other social and vocational
The APGN commented that the '...headspace model delivers more than collocated
services, with provision of youth specific education and training to headspace
providers, and development of local referral pathways so that care providers
are linked and the youth people presenting do not fall between the cracks'.
People who attempt suicide or self harm
The programs directed to those who have attempted suicide have been addressed
in the section in Chapter 4 dealing with discharge, follow up, coordination of
care and stepped accommodation. However it was also recognised that many of
those who attempt suicide or self harm do not present to hospital, medical care
or mental health care.
Self-harm was distinguished from attempted suicide during the inquiry as
a form of behaviour in its own right. The Suicide is Preventable submission
commented that self harm could be defined as '...the deliberate destruction or
alteration of ones’ own body tissue without suicidal intent (including cutting,
branding and beating oneself) and is a risk factor for further episodes of self
harm and attempted and completed suicide'.
The table summary of 2008-09 NSPP expenditure grouped people who had
previously attempted suicide or self harmed with people with a mental illness.
33 projects were funded for approximately $2.9 million.
DoHA noted data on hospital admissions which indicated around 30,000
admissions to public hospitals each year 'with one-and-a-half to twice as many
admissions of females as admissions of males'.
It noted that not every person who attempts suicide would necessarily be
admitted to hospital. The results of the National Survey of Mental Health and
Wellbeing in 2007 showed that:
...13.3% of Australians aged 16-85
years have, at some point in their lives, experienced some form of suicide ideation,
4.0% had made a suicide plan and 3.3% had attempted suicide. This is equivalent
to over 2.1 million Australians having thought about taking their own life,
over 600,000 making a suicide plan and over 500,000 making a suicide attempt
during their lifetime...
In the 12 months prior to interview, 2.4% of the total
population or just over 380,000 people reported some form of suicidality. Of
these, 2.3% or around 370,000 people experienced suicidal ideation, 0.6% or
91,000 made suicide plans and 0.4% or 65,000 made a suicide attempt.
The MHCA emphasised that 'every suicide attempt is serious and warrants
attention'. They stated:
Because men tend to choose more lethal means than women, it
is more likely to result in a fatal outcome... however, this does not of itself
make an attempt any less serious in the first instance.
Lifeline noted research which indicated those with prior suicidal
behaviour had 'over 30 times the risk of people in the general population'. 
They emphasised the need for follow-up services for those who had previously
attempted suicide as well as outlining the operation of their Lifeline Suicide
Crisis Support Program.
Lifeline Australia also highlighted that those who have attempted suicide and
their families have different ongoing support needs than those bereaved by
suicide. They argued that to 'try and place those bereaved by suicide with
those who have had someone close to them attempt suicide in the same support
groups will not cater to their unique circumstances'.
People with mental illness
While the suicide of a person is often a complex event with many
interrelated factors, one of the most common and significant contributing
factors is mental illness. The strong associations between mental illness and
suicide include persons with clinical depression, bipolar disorder, schizophrenia,
alcohol and other substance use disorders, borderline personality disorder, and
behavioural disorders in children and adolescents.
The MHCA outlined the results of the National Survey of Mental Health and
Wellbeing which indicated that people with mental illness are much more likely
to have serious suicidal thought than other people (8.3 per cent compared to
less than 1 per cent).
The Survey also found 73.4 per cent of people who reported making a suicide
attempt had used mental health services in the previous 12 months.
SANE Australia highlighted the increased risk of suicide for people with
mental illness particularly bipolar disorders and schizophrenia. They stated:
Suicide is the pre-eminent cause of death for people with
bipolar disorder, with a lifetime risk of 15% (compared to approximately 1% in
the general population). It is estimated that around one in eight of all suicides
(12%) are by people with bipolar disorder. Of those who die by suicide, it is
estimated that 60% have received inadequate treatment.
Suicide is a prominent cause of death for people with
schizophrenia. Suicidal ideation is common, experienced by 68% of those with
this diagnosis. Over 40% attempt suicide at least once, and WHO calculates the
lifetime risk of suicide for people with schizophrenia at 10-13% (compared to
approximately 1% in the general population). As with bipolar disorder, research
indicates that suicide is more likely to occur in those who are not receiving
However evidence received during the inquiry suggested that the relationship
between mental illness and suicide is complex. The Committee heard many stories
of people who had completed suicide who exhibited no sign of mental health
issues or had any previous contact with mental health services.
SPA commented that:
Many people who experience mental illness do not display
suicidal thoughts or behaviour and not everyone who takes their own life can be
said to be mentally ill – that is, a person does not need to have a mental
illness for suicide risk to still be present.
Professor Patrick McGorry argued that the link between mental illness
and suicide has been underestimated in Australia. He believed that '...90-plus per
cent of people who successfully complete suicide have been suffering from an
untreated, partially treated or poorly treated mental health problem or mental
Similarly Professor Robert Goldney stated:
Thus Population Attributable Risk studies demonstrate that by
far the most impact on suicidal behaviours could be made by ensuring the optimum
management of mental disorders. That is where the bulk of suicide prevention
measures should be focussed: on boosting existing Mental Health services and facilities,
rather than developing parallel services purportedly addressing suicidal
SANE Australia emphasised that mental illness was the primary risk
factor for suicide in all demographic groups and this was an attribute subject to
intervention. They argued this approach '...was our best opportunity to reduce suicidal
behaviour across the board'.
Rural and remote areas
An AIHW report on mortality in rural, regional and remote areas found
that deaths by suicide in regional areas were 20-30 per cent higher than in
While death rates for females in remote areas appeared similar to those in
major cities the rate of suicide for males in remote and very remote areas were
around 1.7 and 2.6 times as high. DoHA noted this analysis was supported by QSR
data as well as information produced by the NCIS which indicated that deaths by
suicide were highly associated with remoteness, with rates of sucide
significantly higher in remote and very remote areas (20.7 and 21.8 deaths per
The challenges for residents in rural and remote areas in accessing
health care and mental health care as well as retaining mental health
professionals was frequently highlighted.
Many submissions and witnesses indicated a number of other interrelated reasons
for these higher rates of suicide in regional, rural and remote areas.
- the pressures on rural communities and farmers of prolonged severe
drought conditions and adverse economic conditions leading to financial
difficulties, bankruptcy and the loss of family farms;
the shrinking of rural communities and increased social
- traditional attitudes of stoicism and independence discouraging
- the lack of confidentiality and medical privacy in small
- easier access to lethal means of suicide such as firearms.
DoHA outlined several NSPP funded projects in rural and remote areas
which focus on 'on community capacity building and gatekeeper training, which
helps maximise use of scarce community resources'. The 2008-09 NSPP summary of
expenditure for groups at high risk of suicide indicated 11 projects received
approximately $1.9 million.
An example was the Rural Alive and Well project delivered by the
Southern Midlands Council in Tasmania, which aimed to build resilience and
capacity of men, their families and the community to react to challenging life
experience with a specific focus on suicide.
In the area of mental health DoHA also outlined the Mental Health Services
in Rural and Remote Areas (MHSRRA) Program which 'will fund non-government organisations
up to $91 million for the delivery of mental health services by appropriately trained
mental health care workers in communities that would otherwise have little or
no access to mental health services'. DoHA noted that workers employed under
the MHSRRA program will have access to adapted suicide prevention training to
'enhance the capacity of primary care workers in rural and remote Australia to
work with clients who are suicidal'.
The Mental Health Support for Drought Affected Communities
initiative was also mentioned by the AGPN as a program '... building the capacity
of rural and remote drought affected communities to respond to the
psychological impact of drought'. The initiative provides community outreach
and crisis counselling for distressed individuals and communities in drought
affected rural and remote areas as well as raising community awareness and
providing education and training to enable health workers and community leaders
to recognise and respond to the early warnings of emotional stress.
Access to services
The lack of access to services in rural, regional and remote areas was
seen to increase the risk of suicide for people in those areas. Professor Ian Hickie
described this as an area where ' the health system have let people down to the
greatest degree'. He noted that older farmers who are seeking help will have
great trouble accessing help through the lack of primary care services and
through lack of additional allied health services.
Lifeline Australia commented on the feedback they had received:
People who wrote about their experience with suicide and
living in rural and remote areas expressed that often help is not available in
the local town, forcing people to either travel to major centres, or wait for a
scheduled time when relevant professionals travel to a town from a major
centre. In some cases, this delay may be too late. Frustration was also
expressed about long waiting lists, and often having no alternatives for the
suicidal person’s care.
The AMA emphasised that in rural and remote areas a local GP is '...likely
to be the only provider of mental health services....'. They recommended
practical support for these GPs including: opportunities for education and
professional development on issues of rural and remote suicide; a database of
risk factors and recall system for patients considered at risk of suicide;
professional and peer support programs for general practitioners particularly
for those likely to be sole provider of mental health services in smaller rural
and remote communities.
The Australian Institute of Family Studies noted that stoicism is seen
as an important concept that regulates access to help in rural areas. They
In the case of farmers, stoicism may arise from a crucial
imperative to fulfil the farming role, as the number of workers on a farm is
often small, and time off for illness would have a significant impact on productivity.
As such, men perceive taking practical steps, remaining optimistic and getting
on with the job as the most useful strategies to deal with problems
Professor Brian Kelly noted that while GPs were important for suicide
prevention in rural and remote areas other health providers such as community
nurses were also critical points of contact. He noted '...it has been very
important for us to work with the sort of agencies that have day-to-day contact
with people in isolated circumstances'.
SPA also argued that individuals in rural, remote and regional areas such as
Rural Financial Counsellors, support workers, teachers, sports coaches, and
small businesspeople '...should be provided with the requisite training to
independently refer clients in crisis to the most appropriate and available
mental health and health care services and resources.
The Suicide is Preventable submission recognised that the development of
online communication would enhance timely access to suicide prevention
interventions and support services and this would particularly benefit people
living in regional, rural and remote areas.
Lesbian, gay, bisexual, transgender and intersex (LGBTI) people
LGBTI people were identified as a high risk group for suicide in
research. The Suicide is Preventable submission noted that 'same-sex attracted
youth attempt suicide at between 3.5 and 14 times the rate of their
heterosexual peers, while the prevalence of attempted suicides among transgender
people ranges between 16 and 47 per cent higher'.
Suicide by LGBTI people is likely to be underreported as sexual orientation or
gender identity may not necessarily be widely known at the time of death. Issues
relating to sexual preference may also be avoided by authorities or not
acknowledged by family members of the deceased. However the DoHA LIFE Research
document comments that same-sex orientation is a risk factor for nonfatal behaviour
and ideation, especially amongst adolescents and young people, however 'based
upon results of (scarce) studies conducted to date, completed suicide rates do
not appear to be increased among the gay and lesbian populations'.
MHCA noted the lack of information regarding suicide and LGBTI people
but commented it was clear that 'the stigma and discrimination experienced by
GLBT(I) youth is likely to seriously impact on their mental health, increasing
their chances of experiencing social isolation and family rejection'. They
The evidence also suggests that most suicide attempts by GLBT(I)
people occur while still coming to terms with their sexuality and/or gender
identity, and often prior to disclosing their identity to others ... or, for
transgender individuals, before engaging in any gender-related treatment, such
as counselling or therapy.
The MHCA recommended further research be conducted to understand the
exact nature and extent of mental health issues impacting GLBT youth as well
as the extent of suicide and attempted suicide within these groups.
Access to appropriate services
A number of LGBTI organisations considered that the priorities and needs
of LGBTI people had not been recognised in government policy relating to mental
health and suicide such as the NSPS or by related organisations such as Beyondblue.
The Gay & Lesbian Counselling Service of NSW noted that LGBTI
individuals face challenges such as overt and subvert homophobia in accessing
services and have needs that are not specific to the general population. They
Targeted programs are of great importance as people and
groups have specific needs to be met and programs have to find the right
audience. For instance, some gay and lesbian people in rural areas have little
contact with the ‘gay community’ and can feel cut off, isolated and unable to
identify with anything – they just don’t fit.
The National LGBT Health Alliance noted there were complex factors
relating to the access of LGBTI people to services. Ms Gabi Rosenstreich
We also know that current initiatives are not working for
these populations and that the rates remain really high. We know that that has
something to do with the lack of acknowledgement of social determinants and the
pure invisibility of these communities. We know that it has something to do
with the lack of targeted services and resources and that LGBT people tend not
to use mainstream services. They fear discrimination and sometimes they experience
discrimination if they use them. Often if they do use them they hide the fact
that they are dealing with issues of sexuality or gender identity, which means
they are not getting effective care.
Gender Agenda also highlighted the lack of discrete services and
information for sex and gender diverse people. They noted that not all sex and
gender diverse people were comfortable 'accessing services designed for meet
specific needs of gays and lesbians'.
A state study conducted by the Tasmanian Government identified key
health and well-being issues for the LGBTI population including '...a lack of support
networks and a sense of ‘community’, the need for access to support services during
the critical ‘coming out’ life stage for individuals, the impact of homophobia/transphobia
ranging from underlying apprehension to violence and bullying, and discrimination
and ignorance by health workers resulting in reduced access to health services'.
SPA noted studies which support 'the proposition that GLBT(I) people
utilise the internet as a primary means of learning more about sexuality and
gender identity, as well as a way to connect with peers through participation
in online communities and social networks'.
The difficulty is in effectively identifying same-sex-attracted
youth, because of course they do not talk about it openly often, and so often they
suffer in silence or the issues are kept within the family.
Elderly LGBTI people
Dr Jo Harrison highlighted for the Committee the lack of recognition of
the needs of elderly LGBTI people in aged care and mental health support as well
as suicide prevention activities. She commented:
Older GLBTI people are at an increased risk of social
isolation and lack of support networks compared to non-GLBTI people. They are
also less likely to approach services for support until the point of desperation,
due to fear of homophobic retribution and abuse.
The GLBTI Retirement Association (GRAI) emphasised the majority of older
LGBTI people '...have grown up in an environment where they have had to hide
their sexual orientation... [many] have been subjected to overt discrimination,
prejudice and violence'. They noted the apprehensions of LGBTI people regarding
entering aged care facilities.
People bereaved by suicide
The Committee was told that grief is greatly exacerbated in suicide survivors,
who report that feelings of stigmatisation, shame and embarrassment sets them apart
from those who grieve a non-suicidal death.
Those bereaved through a suicide death of a significant other had a
fivefold increased suicide risk compared to the rest of the population. Suicide
deaths can also spark clusters of suicides where the suicide or attempted
suicide of one person may trigger suicidal behaviours in others.
The summary of 2008-09 NSPP expenditure indicated 12 projects were
funded for those bereaved by suicide for approximately $3.4 million.
DoHA told the Committee that in '...the five year period 2006-07 to 2010-11 over
$18m will have been expended on suicide bereavement projects...'. This was
equivalent to 17.5 per cent of total NSPP allocation over that period.
DoHA also highlighted a number of bereavement programs funded under the
NSPP. These included:
StandBy Bereavement Response Service is an active 24-hour postvention
service which provides support and assistance for those affected by suicide, as
well as management of the bereavement circumstance. It coordinates local
services, agencies and individuals to form a referral pathway to support to
people bereaved by suicide.
The Hope for Life suicide bereavement support project run by
the Salvation Army provides support for persons bereaved by suicide through a
telephone help line, website, online and face to face suicide prevention
gatekeeper training, and a resource kit for frontline Salvation Army staff
dealing with people who are bereaved by suicide.
The Active Response Bereavement Outreach Model is a pro-active model of
postvention which focuses on early engagement of those bereaved, including
Indigenous people, within the Perth metropolitan area
Support for people bereaved by suicide within rural and metropolitan
Victoria is available through the Support after Suicide Service coordinated by
Jesuit Social Services.
The Suicide is Preventable submission noted that a National Suicide
Bereavement Strategy had been completed in 2006 but had not been released by
government. DoHA provided the Committee with information on this matter. In
2005 a National Bereavement Reference Group (NBRG) was established to oversee
the development of national activities targeting people bereaved by suicide,
including exploring options for national coordination of suicide bereavement
activities. While the NBRG membership included a range of experts in
postvention, DoHA stated that the NBRG 'did not provide jurisdictional
representation at senior levels'. In 2006 DoHA contracted a provider to
undertake a the National Activities on Suicide Bereavement Project regarding a
range of activity in line with the purposes of the NBRG, however the contract
not require the provision of a national suicide bereavement strategy for
While the report produced has not been publicly releasd DoHA stated it
has used the report 'as a practical guide in taking forward significant
activity targeted for those bereaved by suicide'. They noted:
To achieve genuine engagement with States and Territories,
any national strategy requires involvement of States and Territories in scoping
the need for, development of and endorsing of the strategy. The NBRG did not
offer this level of input and so was not able to formally recommend the final
outline for a national bereavement strategy that was put to it.
One of the issues raised during the inquiry was the most appropriate way
to offer assistance to bereaved families following a suicide. For example coroners'
offices often include a counselling service who offer personal support to those
involved in coronial processes, including those bereaved by suicide. However
the Committee heard these services were often under resourced.
Wesley Misson told the Committee that as a result of community demand
Wesley LifeForce has in partnership with the Penrith Suicide Prevention and
Support Network established a suicide bereavement self help support group in
the Penrith area of Sydney. The group aims to provide emotional, psychological
and moral support for its members.
Jesuit Social Services recommended that the feasibility of establishing
a National Postvention Consultancy Service be investigated. This service would
provide resources and secondary consultation to professionals, communities or
organisations working with the suicide bereaved. They noted:
People bereaved by suicide are at increased risk of suicide
and face significant barriers to effective care. There is an urgent need to
increase the availability of care to the suicide bereaved through the provision
of more specialist services that provide individual counselling, group-work and
intensive outreach services. These services must be provided by professional
counsellors expert in dealing with both grief and trauma and be free of charge.
They also must have the ability to provide long-term support to clients.
The ACT Government also recommended that consideration be given to
providing a scheme to assist counselling and support to those bereaved by
suicide which does not link bereavement counselling with mental illness as well
as increasing the number of bulk billing clinics providing counselling to those
bereaved by suicide.
Commemoration and memorials
The importance of assisting those bereaved by suicide work through their
grief was highlighted during the inquiry. For example SPA commented that encouraging
people to tell their stories regarding those lost to suicide can also serve as
an effective outlet for grief and may assist in the individual healing process.
The Committee received evidence regarding the Salvation Army’s Hope
for Life National Lifekeeper Memory Quilt. The quilt initiative was
designed as a memorial to people who have died by suicide and serves as creative
outlet for survivors’ grief as well as a visual reminder of those lost to
suicide. The Salvation Army stated:
The clear messages emanating from this initiative are that
many families need an opportunity to grieve openly and share with others.
Sensitive rituals are very important in the grieving process and families need
to know that they are not alone and that they have the support of a concerned
Similarly Wesley Mission noted the Wesley LifeForce Memorial Day
Services were community events to 'enable those who have been impacted by
suicide to have a place to come together in the ‘spirit of comfort and hope...'.
The LifeForce Memorial Day Services are important postvention
activities which not only support those bereaved by suicide but also raise
awareness and the public profile of the issue of suicide thereby working to
reduce the stigma associated with suicide by publicly acknowledging the
surrounding the subject.
Culturally and linguistically diverse people (CALD)
The effect of moving to a new country can vary for each person depending
on a range of social, economic, environmental and personal factors. Different
cultures can also have different understandings and reactions to suicide.
Both these factors are relevant to Australia because of its culturally and
linguistically diverse population. In the 2006 Census, almost 44 per cent of
Australian were born overseas or had at least one parent born overseas. Around
15 per cent of Australians speak a language other than English at home. 
The Transcultural Mental Health Centre (TMHC) pointed to research which
indicated migrant populations had a higher risk of suicide.
Similarly the MHCA commented that while '...suicide rates tend to reflect the
rates of suicide in the country of origin, existing evidence suggests that the
average suicide rate for migrants is consistently higher in Australia
than in the country of origin'.
The LIFE factsheet for people from CALD backgrounds lists a number of risk
factors for immigrants including: decreased in socioeconomic status; social
isolation and lack of support; separation from families, friends and culture;
and language and cultural barriers to accessing mental health services.
In addition to migrants, the large number of international students
studying in Australia was also identified as a CALD community with a higher risk
The Psychotherapy and Counselling Federation of Australia noted that
international students were a group at risk who frequently experience extreme
isolation, are often not provided with counselling and welfare services by
educational institutions and are not eligible for Medicare funded services.
The MHCA also outlined a number of CALD sub-groups which had been identified as
having a heightened risk of suicide. These includes the elderly; asylum seekers
and refugees; male immigrants in rural and remote areas and women.
Stigma issues were highlighted as particularly difficult for CALD
communities where there were often '...high levels of stigma surrounding mental
health issues'. 
This was seen as preventing early recognition of mental health issues which
were a risk for suicide and discouraging help-seeking behaviour.
MHCA noted that a lack of coordination exists between multicultural
community services and mental health services which 'hampers efforts to address
suicide in CALD communities'. MMHA highlighted the language barriers faced by
people from CALD backgrounds and recommended a multilingual telephone crisis
and counselling service similar to the Lifeline model to assist these CALD
consumers and carers when faced with suicide.
The Ethnic Communities Council of Western Australia noted a lack of culturally
competent, culturally responsive, and culturally and linguistically appropriate
mental health and suicide prevention services for CALD consumers.
The TMHC recommended targeted and collaborative suicide prevention activities
in line with the NSW Multicultural Mental Health Plan 2008-12 which include
'...improving the use of interpreters and translators, stigma reduction
campaigns, developing mental health literacy and resources particularly for new
and emerging communities'.
Only one NSPP program specifically mentioned CALD communities as a
targeted group. The Reducing Suicide and Traumatic Aftermath in Culturally
Diverse Communities in Tasmania provided by the Migrant Resource Centre focuses
on reducing the suicide risk and increasing the capacity to respond to suicide
crises within CALD communities and CALD individuals.
DoHA also highlighted another project which focuses on young people from
refugee backgrounds. The NEXUS Project coordinated by the Queensland Program of
Assistance to Survivors of Torture aims to promote well being and resilience
building in refugees aged 12-24
in Brisbane and Toowoomba by increasing three of the major protective factors
for suicide: connectedness, locus of control and perceived academic
Suicide and self harming behaviour in prisons has been a significant
issue in Australia. In particular, the increase in Aboriginal deaths in prison
in the 1980s led to the Royal Commission into Aboriginal Deaths in Custody. Prisoners
and those in custody were identified as an important group with an increased at
risk of suicide during the Committee's inquiry. For example the Tasmania
Government stated that among '...a ten per cent sample of men who presented at
prison health services in March - April 2008, 25 per cent exhibited suicide and
The Victorian Institute of Forensic Mental Health stated:
It is... undeniable that people in prisons generally have poor
health and mental health profiles and include vulnerable groups that
traditionally have the highest risk of suicide – eg. young males, the socially disenfranchised
and isolated, people with substance use problems and those who have previously displayed
suicidal behaviours. In addition, the psychological impact of imprisonment and
the daily stressors associated with the prison environment are challenging to
even the most robust of prisoners.
SPA noted that suicide attempts by those in prison are significantly
higher than in the general population. They noted that many who die through
suicide within '...the first 24 hours of confinement tend to be charged with
minor, non-violent alcohol and/or drug-related charges, with many of these
individuals being acutely intoxicated at the time'.
Mr Michael Barnes, the Queensland Coroner stated that hanging points in prison
cells and '...resulting suicide by hanging continue to be a blight on
The time following release from prison was also seen as a period of increased
risk for former prisoners.
Ms Jenna Bateman from the Mental health Coordinating Council commented:
Studies suggest that the initial adjustment period after
release is a time of extreme vulnerability, particularly for men. On return to
the community, variables associated with suicide, such as hopelessness,
significant loss, social isolation, lack of support and poor coping skills, are
especially significant for this group. An Australian study of recently released
prisoners found that in the immediate six-month post release period the suicide
rate is three times higher than in the general population.
Mental Health ACT is currently undertaking a quality improvement program
to provide follow-up to those people released from prison who have been
identified as having a mental health problem by a follow up contact within seven
days of release from prison.
Boystown also noted the benefits of their program Participate in Prosperity,
designed to give vocational training and other support to young people coming
from detention centres and prisons.
Despite a reduction in overall suicide rates, RANZCP expected the number
of suicides among older men to rise given they constitute a fast growing
segment of the population. They stated:
Suicide rates reach a second peak (after the 25-44 age group)
in older men aged over 85 years. Men aged 75 years and over remain a high risk
group. Contributing factors in old age suicide may include physical or economic
dependency, mental and/or physical health problems, chronic pain, grief,
loneliness, alcoholism or carer stress.
The Salvation Army also saw an increasing need to target resilience
programs and suicide prevention programs to elderly people.
Similarly Professor Brian Draper considered suicide in old age remained a
neglected topic. He commented that the circumstances leading up to a suicide
attempt in old age frequently involve '...declining health including chronic
pain, in combination with social isolation, lack of social support, and
evolving depression & hopelessness'. He noted:
Suicide is likely to be under-reported in the elderly with
GPs and other doctors being more likely to record deaths in frail elderly as
being due to natural causes to avoid stigma for families and possibly in some
circumstances to cover up assisted suicides. There is an issue of overlap with
euthanasia but this would affect less than 10% of late life suicides.
Professor Draper noted that the NSPS had been developed out of a youth
suicide strategy and had '...yet to fully grasp a lifespan approach other than in
the words used' and 'few specific strategies targeting older people have been
The AMA noted that elderly people are likely to have established
relationships with medical practitioners, including a GP. They suggested that
this '...offers a significant opportunity for suicide prevention, including the
identification of those elderly people who may be at an increased risk of
suicide'. They recommended awareness raising amongst medical professionals to
highlight the risk of suicide in the elderly.
The Committee received a number of personal submissions from elderly
people highlighting the challenges, indignities and lack of choices frequently faced
by those nearing the end of their lives. The submissions received often made
valid and persuasive arguments that this area of policy should be reviewed. While
the Committee has made a decision not to focus on the issue of euthanasia in
the inquiry it has noted this topic has attracted significant interest.
A number of other groups were also identified as being at increased risk
of suicide or attempted suicide during the inquiry, including the long term
and junior doctors. 
Victims of childhood physical and
Adults Surviving Child Abuse highlighted that research studies from
Australia and overseas '...consistently demonstrate that adult survivors of child
abuse and neglect are at risk of a range of mental health problems, such as
depressive and anxiety disorders, substance abuse, eating disorders,
post-traumatic stress disorders and suicidality'.
The Suicide is Preventable submission also stated:
The evidence linking exposure in childhood to violence,
trauma, abuse and neglect with mental illnesses, self-harm, suicide and a range
of other health compromising behaviours in later life is increasingly
A joint submission by the Alliance of Forgotten Australians (AFA) and
Care Leavers of Australia Network (CLAN) recalled the Committee's inquiry into
the Forgotten Australians. The inquiry found that care leavers were
subjected to emotional, physical and sexual abuse and this lead to a range of
major health and mental health problems including depression, anxiety, post-traumatic
stress disorders, drug and alcohol problems. The anecdotal evidence received
during that inquiry showed an abnormally large percentage of suicides among
The Committee recommended that Commonwealth and State Governments, in providing
funding for health care and in the development of health prevention programs
(including suicide prevention), recognise and cater for the health needs and
requirements of care leavers.
Telephone support services
Telephone crisis and support services provide vital assistance to those
who may be at risk of suicide. These services have the advantage of being
available to almost all callers at anytime regardless of their location.
However as telecommunications technology changes, consumers are moving to
mobile and wireless devices which incur increased call costs. The Committee was
concerned to hear that the cost of calls could be restricting access to
telephone support services for people in need. The Committee considers access
to crisis telephone support and counselling a critical component of suicide
prevention activity in Australia. The services provided by Lifeline, Kidsline,
Mensline and the other telephone services should be available at minimal cost
to the user. The Committee considers that steps should be taken to ensure
access to these services is maintained and not inhibited by cost disincentives.
6.127 The Committee recommends that the Commonwealth government ensure telecommunications
providers provide affordable access to telephone and online counselling
services from mobile and wireless devices.
The Committee recognises the important work done by the volunteers of
Lifeline Australia. The proposal made to mandate Lifeline as a toll-free
national crisis telephone support service has considerable merit. The
implementation of a national crisis line to assist people at risk of suicide
should be independently assessed.
6.129 The Committee recommends that the Commonwealth government commission an implementation
study for a national toll-free crisis support telephone service to assist those
at risk of suicide.
Access to means
Submissions received by the Committee made it clear there is strong evidence
for restricting access to means as a suicide prevention activity. Possible
areas to reduce access to the means of suicide cover a number of policy areas
and may require whole of government action to initiate reform.
The Committee does not see adequate reason for the NSPP to be unable to
fund infrastructure and other projects for the purposes of suicide prevention
at 'suicide hotspots'. In particular the Committee considers that NSPS funding
should be available to implement changes at locations such as the Gap in
Sydney. These interventions should be completed after appropriate assessment,
be evidence based and according the best practice guidelines being prepared by
6.132 The Committee recommends that the National Suicide Prevention Program
include funding for projects to reduce access to means of suicide and
prevention measures at identified 'suicide hotspots'. These interventions
should be evidence based and in accordance with agreed guidelines.
The Committee notes the comparatively low number of projects and level
of expenditure focused on men as a population group at higher risk of suicide.
While men at risk of suicide are also covered by other targeted programs such
those aimed at rural and remote areas the Committee considers this should be given
greater priority in the future given the proportion of men who complete suicide.
6.134 The Committee recommends that the National Suicide Prevention Program
should increase the funding and number of projects targeting men at risk of
The possibility of a separate suicide prevention strategy for Indigenous
communities was discussed during the inquiry. The high impact of suicide on
Indigenous communities suggests a separate strategy is justified. A risk exists
that the creation of a separate strategy could create a disincentive for people
in Indigenous communities to access mainstream suicide prevention support
services. However in the view of the Committee, a separate strategy would
assist Indigenous communities by targeting specific suicide prevention services
and programs to the unique characteristics and features of these communities.
This Indigenous suicide prevention strategy should form part of the overall
Suicide clusters were identified as a phenomenon which
disproportionately affects Indigenous people. In the view of the Committee the
potential for government and community services to rapidly react to suicides in
Indigenous communities to reduce the risks of suicide clusters should be
6.137 The Committee recommends that the Commonwealth governments develop a
separate suicide prevention strategy for Indigenous communities within the
National Suicide Prevention Strategy. This should include programs to rapidly
implement postvention services to Indigenous communities following a suicide to
reduce the risk of further suicides occurring.
Children and young people
The Inspire Foundation has demonstrated that the internet and
communication technology can be a significant means to assist children and
young people. However the online environment can also have negative influences
on children. The Committee is concerned by the links between bullying and
cyber-bullying and suicidal behaviour by young people. The Committee notes the current
Joint Select Committee on Cyber-Safety is focusing on the issue of
cyber-bullying. The Committee anticipates the inquiry will be able to address
this topic in greater detail.
The Committee recognises the valuable work done in secondary schools
around Australia by teachers and other school staff who assist young people
through the Mind Matters initiative. However the Committee was concerned the
availability of this program was dependent on the willingness of school staff
to participate. More should be done to promote the benefits of this program and
other young focused suicide prevention programs to schools.
The Committee was also impressed by the important work being undertaken
by the Queensland Commission for Children and Young People and the Child
Guardian in studying the factors influencing child deaths. The fact that
Australian children complete suicide is a terrible tragedy, but this does not
mean that public agencies and policy makers should not acknowledge these events
occur. The Committee recognises there are additional sensitivities with finding
and recording child suicides. Care and tact should be taken where the recording
of low incidence numbers in particular areas could impact on the privacy of
bereaved families. However the reluctance by the ABS to track child suicides by
those under 15 years of age does not encourage official acknowledgement of this
important issue or assist policy makers to develop preventative measures.
6.141 The Committee recommends that the Australian Bureau of Statistics and
other public agencies which collect health data record and track completed
suicides and attempted suicides of those under 15 years of age.
People who have attempted suicide
or self harmed
In the programs funded under the NSPP there did not appear to be an emphasis
on community based support groups for those who had attempted suicide or self
harmed. It was recognised during the inquiry that it may not be appropriate for
this group to access the community support which exists for other people
affected by suicide. The personal stories the Committee received from people
who had attempted suicide indicated that some with this history would benefit
from access to community based support groups.
6.143 The Committee recommends that targeted programs be developed to provide
community support group assistance for people who have attempted suicide and
those who self harm.
People with mental illness
There are strong linkages between suicide and mental illness. Programs
which seek to diagnose and treat mental illness undoubtedly also operate to
reduce the rates of suicide and attempted suicide in the community. However
many who take their own lives will not be mentally ill or will have previously used
mental health services. The Committee has previously inquired into mental
health services in Australia and recommended that services and support for the
mentally ill need to be increased.
The evidence received during this inquiry has reiterated the need for mental
health services to be widely accessible and adequately resourced.
6.145 The Committee recommends that additional resources be provided by
Commonwealth, State and Territory governments to mental health services. These
services are recognised as functioning to reduce the rate of suicide and
attempted suicide in Australia.
People in regional, rural and
The lack of access to health and mental health care services was seen as
a key risk factor for people living in regional, rural and remote areas.
Community resilience was seen as a key factor in reducing suicides. It was
recognised that suicide prevention training should be directed to people who
are in regional, rural and remote areas and have day-to-day contact with those
who may be at risk.
6.147 The Committee recommends that additional 'gatekeeper' suicide awareness
and risk assessment training be directed to people living in regional, rural
and remote areas.
Lesbian, gay, bisexual, transgender
The Committee supports the Suicide is Preventable submission recommendation
that LGBTI people be recognised as a higher risk group in suicide prevention strategies,
policies and programs, and that funding for targeted approaches to prevent
suicide in LGBTI communities be made available.
6.149 The Committee recommends that lesbian, gay bisexual, transgender and
intersex people be recognised as a higher risk group in suicide prevention
strategies, policies and programs, and that funding for targeted approaches to
assist these groups be developed.
People bereaved by suicide
The personal impact of suicide on people with close relationships with deceased
is enormous. During the inquiry the Committee received evidence regarding a
range of programs and projects to support people bereaved by suicide. However
it also received evidence from those bereaved by suicide who experienced
difficulty in finding and accessing assistance. In the view of the Committee
there could be more coordination and consistency amongst the various programs and
projects intended to assist people bereaved by suicide. The Committee supports
the SPA recommendation for the development and promotion of a National Suicide
Bereavement Strategy with a commitment by government to long-term funding and
improved transparency and coordination.
6.151 The Committee recommends that the Commonwealth, State and Territory
governments together with community organisations implement a national suicide bereavement
An identified gap in the suicide prevention programs and assistance
directed to prisoners was during the time following release. The Committee
considers a NSPP targeted program or project to assist those who have been
recently released from jail should be assessed the next time funding is
6.153 The Committee recommends the development of a National Suicide
Prevention Program initiative targeting assistance to people recently released
from correctional services.
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