Ian Webster. Suicide prevention.

September 10th was World Suicide Prevention Day – Suicide Prevention – One World Connected and from the 5th to the 12th October Mental Health Week ran in Australia. The week’s highlight was the ABC’s “Mental as” which ran through the whole week. Over three nights “Changing Minds – the inside story” on ABC TV involved us with the staff and patients of Liverpool Hospital’s in-patient mental health unit. It was riveting television. The program portrayed the relationships between staff and patients with disordered minds as they slowly regained their sanity. There was much humanity.

A constant thread during Mental Health Week was the risk of suicide, but mental illness is not the only pathway to suicide.

In September, Dr. Margaret Chan, Director-General, World Health Organisation said in launching the first WHO report on suicide prevention, “Preventing Suicide: A global imperative”:

“The burden of suicide does not weigh solely on the health sector; it has multiple impacts on many sectors and on society as a whole. Thus, to start a successful journey towards the prevention of suicide, countries should employ a multisectoral approach that addresses suicide in a comprehensive manner, bringing together the different sectors and stakeholders most relevant to each context”.

Suicide exacts an unacceptable toll of more than 2200 lives each year in Australia.  Three quarters are men in the prime period of their lives. From the 1990s to 2010 suicide rates declined by 17 per cent, mainly from reduced suicides in young males. But the decline has stalled and Australia must look to new approaches at national and local community levels.

Suicide is not an act which occurs in isolation. It arises out of interactions between long-term vulnerabilities, trigger events and accumulating adverse factors in a person’s life. Disadvantaged communities are the hardest hit.

Sadness and ‘sorry business’ pervade too many Aboriginal and Torres Strait Islander communities leading to an inexorable downward spiral in community spirit and well-being. Between 15 and 19 years of age Aboriginal and Torres Strait Islander young people die from suicide four to six times the rate of other young Australians. Urgent action is needed in these communities.

People with continuing mental illness; those with distressing physical illnesses, disability and pain; people who identify as lesbian, gay, bisexual, transgender or intersex; armed service veterans; and those living in rural or remote areas have high risks of suicide. The Northern Territory and Tasmania have higher rates than the rest of Australia. Each community, region or group poses special challenges for actions to prevent suicide.

Not only are families and friends devastated by suicide and left with unanswered questions and bewilderment as workplaces, schools, clubs, emergency services and whole communities can be affected.

We know that 75% of people who take their lives will have attended a general practitioner or hospital in the three months before they died. And many of the 65,000 people who attempt suicide each year will also have been in contact with homeless shelters, schools and colleges, workplaces, Centrelink, police and courts.

Herein lies a key piece in the jigsaw. These points of early contact are opportunities to connect a person to on-going follow-up and support to enable them to re-establish  meaningful relationships and community involvement. But this ‘chain of care’ can only be as strong as each link in the chain.

There are hopeful signs that this is happening in different parts of Australia as communities galvanise around the issue of suicide. These local suicide prevention networks aim to build connections to prevent suicides and to support those who have been bereaved. It is a paradox that it takes such tragic events to re-kindle relationships which have been lost.

There is no single strategy which can reduce the rates of suicide as the pathways to risk in childhood and adolescence, young adults, middle age and in later life, involve different vulnerabilities, exposures and experiences. But community connectedness and resilience are relevant at every step along these paths.

As the WHO says this is where our efforts can be most effective. In other words governments and service providers have to understand that suicide prevention can’t be left to mental health services alone; it must involve all emergency service personnel, health and social services, local communities and especially primary health care.

Ian W Webster, National Mental Health Commissioner, 2012-2014, Chair, Australian Suicide Prevention Advisory Council, 1998 – 2014.

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