Government and governance, Social policy, Health | Australia

19 November 2018

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.

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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.

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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.

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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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4 Responses

  1. Donna Read says:

    Hear, hear

  2. Alan Woodward says:

    While there is much to agree with in this article, it is marred by some fundamental misunderstandings of suicide prevention policy in Australia and the environment in which that is occurring:

    – It is correct to point out that underlying issues surrounding suicide need to be addressed, including the ísms’ and poverty, but what about the main ones in relation to suicidal behaviours: men and their notions of masculinity/self-identity, employment or lack thereof, and alcohol availability and abuse.

    – The article makes no mention of the importance of áftercare’ for people who have presented to hospital/health services following a suicide attempt. This is a crucial period where action to prevent re-attempts of suicide and during which attention to the underlying reasons for a person becoming suicidal is possible. The Fifth National Mental Health and Suicide Prevention Plan explicitly mentions aftercare and this should be acknowledged as a critical and well-based policy shift from earlier Plans.

    – It is incorrect to state that most of the suicide prevention funding goes on research and ‘talking’ activities such as forums. The National Suicide Prevention Program itself provides around $40m for specific services and programs for suicide prevention and we have in Australia some that are absolutely world-leading like Mates In Construction, MindFrame, LifeForce.

    – The nationally funded Trial Sites are actually about different models for a ‘systems approach’ to suicide prevention on a regional basis – reflecting a well-founded policy shift towards location based, integrated responses for suicide prevention. The Trial Sites are being evaluated through a large-scale national evaluation project. While we may be concerned about governments putting money into what is learnt from those trials, the comments in the article are not really showing an understanding of the purpose of the Trial Sites initiative.

    – The author seems unaware that the Governments have through COAG Health Ministers agreed to create an Implementation Plan for Suicide Prevention. This could be a game changer if it introduces a level of specific action and accountability for suicide prevention across jurisdictions.

    It is good to see the Policy Forum addressing suicide prevention and I hope there may be more articles and discussion as this is a key issue for Australia at this time.

  3. Gerry Georgatos says:

    Alan, thank you for your comments. With due respect, they are your views, and maybe similarly so of others, that there are “misunderstandings” of the “definitions” of suicide prevention policy. Policy should be in step with need and not less than. I live and breathe suicide prevention, trauma recovery and work alongside people to improve their life circumstances and to reduce future risk of aberrant behaviour and disordered thinking, assisting people from negative psychosocial selves and circumstance to positive psychosocial selves and circumstance.

    It is my experience and view that the suicide prevention space remains largely at best reductionist, minimalist, inauthentic. It fails elevated risk groups.

    Of course, lack of employment and underemployment in an otherwise GDP strong, high income median economy are causal to suicidal ideation. In addition to the accumulation of socioeconomic life stressors there are arise non-socioeconomic stressors compounding traumas.

    An even more profound protective factor than employment is education. 86 per cent of the national prison population has not completed Year 12 – with nearly 100 per cent of First Nations inmates without a Year 12 completion. This is why I work alongside or sponsor record breaking pathway programs to education and training to employment projects for former inmates, the homeless, the impoverished.

    Less than 10 per cent of remote living First Nations children complete school.

    I disagree with your assessment and defence of the Mental Health Plan – it is shallow and inadequate. I agree with the need for “aftercare” however the plan’s aftercare blueprint is dramatically inadequate.

    There was a focus in my article on the earliest possible intervention and beginning of life supports.

    However, if we focus on “aftercare” which in my own work I do so intensely then the Mental Health Plan needs to redefine traditional forms of “aftercare” which are at tragically inadequate levels of actual support and culminate in premature disengagement.

    I disagree with your argument that MindFrame and LifeForce as suicide prevention – they are not. At best they are information and resources. If they are to be argued as suicide prevention per se then in my view all hope is lost. Mates in Construction is a tailormade support much needed.

    In my view, the trial sites are worthless and have cruelly hijacked the suicide prevention discourses. They will fail in improving ‘systems’. The Implementation Plan is next-to-nothing. The COAG should be embarrassed of its inactions. Overall, the suicide prevention space should be embarrassed and its ‘peak bodies’ should own up the failures and increasing unmet needs and not portray that there is a right direction trend. I have in the past strongly campaigned for a Royal Commission into the national suicide toll and the systemic failures and governmental and institutional neglect. Kindly, Gerry

  4. Jeff Nelson says:

    Thankyou for being correct. SP has become an industry. Social and economic contributions to distress are viewed as too difficult to shift.

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