Australia will only reduce its national suicide toll if policymakers are held to account on poverty, education, bullying, and Indigenous disadvantage, Gerry Georgatos writes.
Australia’s suicide prevention plans remain misdirected and lack a much-needed focus on early intervention.
Raising awareness of suicide and potential tipping points is not suicide prevention. Early intervention means preventing people from reaching the disordered thinking that is suicidal ideation, which culminates in toxic internalised grief, a negative psychosocial self, aberrant behaviour, and ultimately a suicide attempt.
Australia’s current focus is much further down the spiral than ideation. Too often, interventions take place so late in the piece that they have little chance of making a difference.
Any argument that there have been substantial investments by governments into suicide prevention is a false narrative. Money is being directed to perpetual research, with little of what is recommended going on to influence policy. The investments are forever in the being-seen-to-be-doing-something basket, such as research, roundtables, trial sites, awareness and reductionist education campaigns – all which are relatively cheap to fund.
The suicide prevention trial sites are a misspend – an exercise to ‘integrate’ existing services in the health and allied health spaces and to squeeze more out of underfunded and overstretched services.
Where’s the focus on outreach? The seriously at-risk will never walk into any support service. Where are the calls for more specialist personnel? People need people, both during critical periods and in long-haul throughcare. Where’s the investment in improving the life circumstances of the acutely disadvantaged? The intersection of suicide with poverty is indisputable.
As a nation we lay claim to responding to the suicide crisis. We are one of only 28 nations with a ‘suicide prevention plan’.
But the plan is paper-thin. It’s about encouraging services to work collaboratively in suicide prevention and postvention, and that is the least of what should be done.
Australia’s suicide rate today is equal to 2015 as the highest it has been in ten years. To reduce suicide we must reduce not only the number of attempted suicides, but also the hospital admission rate for self-harm, the rate of domestic violence, the prevalence of bullying, and the least discussed tragedy in the nation – child sexual abuse. We also can’t ignore the –isms: racism, sexism, ableism, and classism.
We need to reach elevated suicide risk groups with tailor-made support. Individuals removed as children from their families are at highest risk, followed by recently released former inmates, followed by the homeless, followed closely by members of families that have been recently evicted from public housing.
In the last several years, I have responded to many families affected by suicide and trauma. I have found that a significant proportion of children and youth who commit suicide had been removed from their biological families. A significant proportion of fathers and mothers who took their lives had also been removed from their parents. The removal of a child from his or her family goes straight to the validity of identity. It hurts, and for many this pain is unbearable.
In working with suicide-affected families across the nation, I have found that at least one in four child suicides involved bullying. What is painfully bewildering is that in only a third of cases has the child told someone that they were contemplating suicide.
Child suicides are no longer rare – rates are the highest they have ever been. Annually, more than 40,000 children between 12 and 17 years of age are estimated to have made a suicide attempt. One-quarter of 16-year-old females self-harm.
And sadly, the child suicide toll does discriminate. Suicide takes more Aboriginal and Torres Strait Islander children, as well as migrant children from non-English speaking cultural backgrounds, than it does others.
Aboriginal and Torres Strait Islander suicides comprise seven per cent of Australia’s total child population, and yet a shocking 80 per cent of Australia’s child suicides aged 12 years and under are of Aboriginal children. As many as 30 per cent of child suicides up to age 17 are Aboriginal children.
Vulnerable Aboriginal and Torres Strait Islander children are at elevated risk. Aboriginal and Torres Strait Islander children who live below the poverty line are 20 times more prone to self-harm and attempting suicide due to bullying.
In general, the more financially disadvantaged someone is, the more susceptible they are to bullying and suicidal ideation.
Migrant children are also often neglected in suicide prevention discourse. They are at an elevated risk primarily because of racism, and the perception that they must ‘fit in’. This can lead to disordered thinking, internalised conflict, shame, and a diminution of the self.
A multitude of stories must be told to demand anti-bullying education campaigns, to provide protection for potential victims, and to teach perpetrators that what they’re doing is wrong. We must counter bullying with the same intensity as other public health issues, such as smoking and domestic violence. We do not need endless research, but action.
Education campaigns cannot be limited to schools because a significant proportion of Aboriginal children who took their own lives did not attend school. They lived in impoverished remote communities, where completing secondary school is rare.
The majority of the national prison population has not completed year 12 – in fact, the majority have not completed year 9. High levels of education are a more significant protective factor in reducing suicidal ideation and negative aberrant behaviour than full-time employment.
The National Mental Health and Suicide Prevention Plan 2017 to 2022 is fixated on the provision of support by self-referral, effectively at the near-death experience. Improving life circumstances and early intervention approaches must be the focus.
As a nation, we have not prioritised this harrowing crisis. There is no greater legacy that any government can have than to prioritise and invest in the improving, changing, and saving of lives. If we do not hold policymakers and governments to account, then rest assured there is next-to-no-hope of significantly reducing the national suicide toll.
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