Dec 5 2018
Alan Woodward is one of Australia’s leading experts in suicide prevention
Suicide is a problem in this country. Despite Australia being possibly the richest people in the world according to recent data on median wealth levels, despite having a peaceful existence far away from the world’s conflicts and despite the opportunities and quality of life prospects we enjoy, for more than a decade we have seen suicide rates that remain around the same – each year more than 3,000 people die and an estimated 80,000 suicide attempts occur. An estimated 400,000 Australians each year are impacted by suicide deaths to a point where their own well-being is affected.
More can and must be done to prevent loss of life and human tragedy. There are several areas in which priority attention is warranted for suicide prevention:
Crisis Response and Aftercare
This refers to the clinical and personal responses made through our hospitals, mental health services and other community supports for the person who has become suicidal – who may become visible because they have enacted on those feelings through a suicide attempt or an experience of personal crisis. These crisis responses need to be quick, proficient and accessible; they need to be effective in preventing the loss of life.
Yet, a one-off crisis response action is not enough. We need to address the volatile and fluctuating nature of suicidality. We should realise that one suicidal crisis is likely to be followed by another unless the underlying reasons that a person has for wanting to die are addressed in personal and practical ways. We need to create pathways for change and recovery. This can be enabled through follow up supports and the offer of coordinated services, both clinical and non-clinical in nature.
There is no higher priority for suicide prevention than reform to the overall service responses for suicidal persons who present looking for help. For it is these people who are most vulnerable to dying by suicide. Three key reforms would be:
– a requirement to provide a comprehensive psycho-social assessment for every suicidal person to inform the mix of services to meet their needs;
– the removal of suicide risk profile stratifications that are unreliable and only serve to restrict some ‘low risk’ person’s access to service;
– and the creation of specialist programs including short stay residential care that directly address a person’s suicidality.
These changes would represent greater quality care for suicide in our service system. They would shift the response from ‘prevention of death’ alone to ‘recovery and changed futures’.
Practical Help on Life Situations
Suicidal behaviour is often triggered by events or a person’s circumstances, reinforced by that individual’s sense of being unable to escape or deal with them. This sense of entrapment is often what becomes the tipping point. Research and theory development by Professor Rory O’Connor and others at University of Glasgow is helping us better understand this.
So, suicide prevention must have a practical orientation if it is to be relevant and effective. Services must be able to show a suicidal person how their immediate difficulties can be addressed. Linkages must be formed across a variety of services including housing, financial counselling, relationships, alcohol and drugs, domestic violence, employment and responses to trauma and abuse.
Social Dimensions to Suicidal Behaviours
Third, we must consider the question of how a person sees themselves and the world around them. There is a social dimension to suicide.
Men account for three out of four suicide deaths in Australia. It is time to examine what leads men to want to end their lives, to better understand the pressures and the challenges that men may face. In particular, the ManUp series and associated research including the Ten to Men longitudinal study have demonstrated that outdated concepts of masculinity are barriers to male emotional well-being.
Reaching men in meaningful ways and addressing the attitudes and beliefs associated with concepts of masculinity will make a difference in their behaviours. This will require social change.
Aboriginal and Torres Strait Islander suicide prevention has rightly been recognised as a priority, with a national strategy and additional resources on program development and services. However, indigenous leaders have identified the importance of culture in their communities, which is directly and intrinsically related to recognition, respect and inclusion in Australian society. It is simply not possible for suicide prevention in Aboriginal and Torres Strait Islander communities to be effective without the realisation of rights to culture, self-determination and recognition. This requires social action.
Broadly, social inclusion looms as one of the big challenges for Australian society and for suicide prevention. During a period of considerable social change, there is the risk that those who are vulnerable or different get left out. So many people are now experiencing profound loneliness in our modern society. There is a chance we shall isolate or marginalise some people while we struggle with the pace of change and the complexity of challenges before us.
Taking the words of Hugh Mackay from his latest book on Australian society – we need big hearts and open minds to reduce the collective anxiety that is fueling overly simplistic solutions and appeals to fear while at the same time drawing on compassion and understanding for each other.
Social connection and compassion are essential ingredients for suicide prevention. They are the fuel for hope. They are protective factors that we need in place.
Our response to suicide must address human suffering. Amongst all other things, suicide prevention should be regarded as a humanitarian cause. This is recognised by Norwegian American writer Siri Hustvedt who concluded after listening to the stories of many individuals who had survived suicide attempts: “Despair and pain is a feature of suicidal experiences. Every suicidal person has a story of suffering.”
So, suicide prevention requires multiple actions, some that are individually focused, others that require us all to contribute to a society that is more supportive to people going through tough times, more open and accepting of difference amongst people and more protective in the prevention of suicide.