Best Practice Research
The aim of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) Clearing House for best practice research is to provide a central resource point that collects, organises and disseminates information about valuable research in the field of Aboriginal and Torres Strait Islander suicide prevention.
Research and a strong evidence base can enable communities, consumers and policy makers to readily distinguish programs and policies that are successful and are also in keeping with the aspirations of Aboriginal and Torres Strait Islander peoples.
The Clearing House for best practice research provides high quality and culturally relevant research, publications, resources to inform the work of Aboriginal and Torres Strait Islander communities, organisations, mental health practitioners, policy makers and program providers. This includes:
• Peer reviewed studies
• Other relevant publications
• Community project reports
Guidelines for Ethical Conduct
The CBPATSISP is informed by the principles contained in the NHMRC values and ethics. The NHMRC guidelines acknowledge that historically research has not always benefited Indigenous peoples. The NHMRC guidelines state that ethical research with Aboriginal and Torres Strait Islander peoples and communities should:
- Improve the way all researchers work with Aboriginal and Torres Strait Islander people and their communities
- Develop and/or strengthen research capabilities of Aboriginal and Torres Strait Islander people and their communities
- Enhance the rights of Aboriginal and Torres Strait Islander people as researchers, research partners, collaborators and participants in research (NHMRC, 2018, p.1)
The NHMRC guidelines have six core values:
An underlying assumption in our work is Aboriginal and Torres Strait Islander disadvantage, high rates of ill health and poor mental health, in particular, high rates of suicide can be attributed to the impacts of colonisation. For the Indigenous peoples of Australia colonisation was, and continues to be, a destructive process that displaces people from their country and their culture. The impacts of colonisation continue to influence Indigenous lives as seen in social exclusion and lack of recognition of cultural difference. Further, there needs to be recognition that Aboriginal and Torres Strait Islander peoples and communities have great strengths and capacity. This focus on strengths and capacity needs to be highlighted and enacted in any research. Processes need to strengthen direction and inclusion, enact self-determination and value culture in order to bring about meaningful outcomes and positive social change. Until recent times, research into Aboriginal and Torres Strait Islander issues was largely exploitative and oppressive, serving the agendas and the priorities of the researcher rather than the people and communities.
Our approach, as seen in the National Empowerment Project, the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project and other initiatives, takes a decolonising approach prioritising a holistic and whole-of-life view of health and mental health. This approach encompasses the social, emotional and cultural wellbeing of the whole community, and acknowledges those distinctive cultural and spiritual relationships, such as connection to land, culture, spirituality, ancestry, family and community, which are of utmost importance. It has a focus on strength and resilience for Aboriginal and Torres Strait Islander peoples. Outcomes will be translated into strength-based preventative mental health policies and strategies.
Aboriginal and Torres Strait Islander researchers lead our work at the CBPATSISP and they come with considerable experience and commitment to social justice. The shared values between researchers and our research group not only ensure a partnership, but also a commitment to personal or community level action to renew and protect identity, culture and life.
The work of the CBPATSISP will contribute to strengthening and improving suicide prevention strategies and services for Aboriginal and Torres Strait Islander peoples nationally. Aboriginal and Torres Strait Islander communities must determine appropriate responses to suicide prevention themselves. As such, self–determination and community ownership of the integral roles of culture and lived experience must be explored with Indigenous communities.
Our work is concerned with safe guarding against discrimination and devaluing of Aboriginal and Torres Strait Islander peoples and cultures by engaging in ongoing consultation and feedback from Indigenous experts. This process further supports the critical role of culture within effective and appropriate suicide prevention strategies and ensures that Aboriginal and Torres Strait Islander peoples’ unique cultural distinctiveness (and associated service provision requirements) are respected and upheld. Further, Aboriginal and Torres Strait Islander values and perspectives will continue to underpin all recommendations, developed frameworks and outcomes to ensure appropriateness and maintenance of Aboriginal and Torres Strait Islander identity.
Equity is at the heart of our work that intends to advance Aboriginal and Torres Strait Islander lived experience understandings as well as suicide prevention strategies. Our work strongly connects to community, regional, state and national Indigenous health priorities and responds to ongoing and consistent needs articulated by Aboriginal and Torres Strait Islander peoples and communities nationally regarding culturally responsive suicide prevention. The work of the CBPATSISP will provide a clear benefit for Indigenous communities.
An acknowledgement of the diversity of Aboriginal and Torres Strait Islander peoples across the country and within communities is reflected through engagements undertaken by the CBPATSISP in recruiting participants for past research projects, such as the National Empowerment Project and the Aboriginal and Torres Strait Islander Lived Experience Project. Further, the CBPATSISP is committed to establishing equitable partnerships between researchers, participants and communities. This commitment is demonstrated through the active inclusion of participants and communities in the research process. For example, whenever possible and appropriate, participants are invited to be co-authors of reports and papers.
The School of Indigenous Studies and Poche Centre for Indigenous Health at UWA has a long-established record of full and proper engagement with Aboriginal and Torres Strait Islander communities. This continues with the work of the CBPATSISP. Where possible, Participatory Action Research (PAR) processes will be utilised. In a PAR process, the connections between the Aboriginal researcher and Aboriginal community are inseparable and as such, any work is being driven by clear, well documented, and self-determined community needs.
Research findings concerning Aboriginal and Torres Strait Islander suicide demonstrate a significant and disproportionate rate of suicide and self–harm when compared to the non-Indigenous Australian population, with a clear need for culturally responsive service provision. Further, a holistic approach that encompasses all facets of Aboriginal and Torres Strait Islander social and emotional wellbeing including cultural and whole of community (collective) wellbeing, as well as spirituality, connection to ancestry, land and culture are integral to appropriate responses to Aboriginal and Torres Strait Islander suicide prevention.
Consequently, research outcomes and recommendations formulated from Aboriginal and Torres Strait Islander participation in the work of the CBPATSISP will contribute to decreasing a gap in existing knowledge regarding Aboriginal and Torres Strait Islander suicide prevention. Such knowledge will assist in culturally responsive and appropriate service provision for suicide prevention strategies, programs and evaluation measures that can be utilised by key stakeholders and service providers to the benefit of Aboriginal and Torres Strait Islander peoples.
The work of the CBPATSISP is predicated upon respectful partnerships with Aboriginal and Torres Strait Islander communities. The CBPATSISP work process encourages the generation of genuine partnerships with Indigenous experts across a number of different areas. The CBPATSISP respects Aboriginal understandings of culture and cultural safety, social and emotional wellbeing, suicide prevention and mental health, and facilitates the inclusion of Aboriginal and Torres Strait Islander knowledges. The researchers at the CBPATSISP have considerable experience working in research that is community based, capacity building and empowering. For example, the National Empowerment Project worked with 11 communities across the country, in partnerships with community-controlled organisations in each site and with two local co-researchers in each site.
Further, the CBPATSISP actively involves Aboriginal and Torres Strait Islander peoples in decision-making processes through engagement with the National Governance Committee (NGC) and the Expert Advisory Panel.
The NGC has been established to provide expert guidance, advice, and coordination regarding the work of the CBPATSISP. The NGC coordinates activities across the consortium and provides high level advice to support suicide prevention initiatives for Aboriginal and Torres Strait Islander peoples and communities. The NGC is made up of members representing the national consortium and partners associated with the CBPATSISP. The NCG also includes relevant stakeholders and organisations in the field of Aboriginal and Torres Strait Islander suicide prevention.
An Expert Advisory Panel (EAP) was convened to establish a culturally appropriate best practice framework for the evaluation of suicide prevention programs and services and to identify relevant suicide prevention research in Aboriginal and Torres Strait Islander communities. The EAP also provides expert advice with respect to reviewing and promoting best practice Aboriginal and Torres Strait Islander suicide prevention programs, services and initiatives that will be part of the CBPATSISP Clearing House Website. The EAP is made up of experts in the fields of culturally appropriate healing, mental health and suicide prevention and program evaluation in Aboriginal and Torres Strait Islander communities.
The CBPATSISP will examine factors involved in appropriate and culturally responsive suicide prevention from the perspectives of Indigenous peoples themselves.
In all various projects, ongoing consultation with Aboriginal and Torres Strait Islander peoples nationally will be adhered to ensure appropriate review and community participation. This ongoing feedback process with Indigenous experts ensures the integrity of all CBPATSISP work processes and outcomes.
Reports and papers as outcomes will also acknowledge the significant cultural and intellectual contributions of Aboriginal and Torres Strait Islander communities and individuals in every instance and, whenever possible and appropriate, participants are invited to be co-authors of reports and papers.
Currently, the CBPATSISP has collected literature and information in accordance with three categories:
- Peer Reviewed Literature
- Other Literature
- Community programs and projects of interest
The Journal of Indigenous Wellbeing: Te Mauri – Primatisiwin is an online open access scholarly journal that focuses on Indigenous wellbeing. In 2017 the Journal published a Special Edition (Volume 2, Issue 2) on Indigenous Suicide prevention.
Northern Public Affairs
The volunteer not-for-profit group Northern Public Affairs publishes a print and online magazine. The Special edition of Northern Public Affairs, Volume 5 Issue 3, April 2018 is entitled “The fight of our lives – preventing suicide among Indigenous peoples.” “This edition highlights that the impact of Adverse Childhood Experiences on suicidal behaviour over the life course is ‘of an order of magnitude rarely observed in epidemiology and public health data’ (Dube et al., 2001). In following, this edition highlights the importance of suicide prevention and intervention targeted towards improving childhood development and decreasing adversity.”
Barker, B., Goodman, A. & DeBeck, K. (2017). Reclaiming Indigenous identities: Culture as strength against suicide among Indigenous youth in Canada. Can J Public Health, 108(2):e208-e210. doi: 10.17269/CJPH.108.5754
“Addressing Indigenous youth suicide and other health-related disparities is a concern, not only for formal health professionals, but for anyone committed to promoting health and social justice. While the majority of suicide interventions to date are under the purview of clinical-based health services and associated professionals, there is a growing understanding that Indigenous youth suicide needs to be thought of differently. We as a nation need to acknowledge that Indigenous suicide is the product of cultural, community and historical oppression, and not an individual response to personal pathology. These measures call for a change to the discourse surrounding suicide, and Indigenous health more broadly, where the traditional knowledge of Indigenous peoples is valued and their capacity to devise solutions to their own health is recognized.”
Collins, P.Y., Delgado, R., Pringle, B.A., Roca, C., & Phillips, A. (2017). Suicide prevention in Arctic Indigenous communities. The Lancet Psychiatry, 4(2), 92-94. doi:10.1016/S2215-0366(16)30349-2
“… from 2009 to 2013, of the 12 areas of Alaska listed in the Native Regional Corporation, seven regions did not list suicide among their top five leading causes of death. 3 The reasons for these differences are not clear, however, regions and villages differ with respect to their experiences of colonisation, degrees of isolation, policies on alcohol sales, and maintenance of tribal traditions, all of which have been shown to affect rates of suicide. 7
…. a much broader reach is required to have maximum public health impact across the Arctic. Such a reach will be realised only through the strategic, cooperative harnessing of science, community-grounded and Indigenous knowledge, resources, political will, and public accountability.
In Canada, these considerations are reflected in the National Inuit Suicide Prevention Strategy, prepared by the Inuit Tapiriit Kanatami, which seeks to promote a shared understanding of both the context and risk factors related to suicide in Inuit communities. 9 The document also guides policy on evidence-based approaches to suicide prevention and forms the basis for a historic partnership between the Inuit Tapiriit Kanatami and the federal agency Health Canada, with the allocation of CAD$9 million for Inuit-specific approaches to improving mental wellbeing. As indicated by these recent developments in Canada, the conversation extends beyond research contributions to the need for pragmatic action.
Reducing the Incidence of Suicide in Indigenous Groups: Strengths United through Networks (RISING SUN) is an Arctic Council project led by the USA, the present chair of the Council, which aims to improve mental wellbeing in Arctic communities.
The initiative aims to develop a toolkit of common measures to assess suicide prevention efforts across the Arctic. Through regional face-to-face meetings, community-based group discussions, and the activities of a Delphi panel, 11 a diverse group of key stakeholders is working to identify the most important outcomes of suicide prevention interventions for Indigenous communities in the circumpolar north. Ultimately, the use of common outcome measures, developed in consultation with Indigenous peoples’ organisations, community leaders, and mental health experts, should facilitate knowledge sharing, contextually relevant research, and assessment of the effectiveness of interventions across several health and social service settings in the Arctic regions.”
Crawford, A. (2016). Inuit take action towards suicide prevention. The Lancet, 388(10049): 1036-1038. DOI:10.1016/S0140-6736(16)31463-5
“Inuit Tapiriit Kanatami (ITK), a political organisation representing Inuit in Canada, launched its National Inuit Suicide Prevention Strategy (NISPS) on July 27, 2016, in Kuujjuaq, Nunavik. The Inuit leadership, self-determination, process of engagement, focus, and scope of the NISPS are beginning to do the work of making suicide prevention specific for Inuit. ITK is also committed to evaluating the NISPS, which will bolster its own as well as international efforts in suicide prevention by guiding others, particularly other Indigenous groups, in bridging available evidence and community-specific and culturally specific needs. This approach is compatible with other recent suggested approaches to address global health disparities for Indigenous peoples. The research and knowledge gaps are considerable— and they present a dilemma for health-care and public health professionals who engage in developing policy and interventions with Indigenous people. At our most discerning, policy makers and mental health practitioners can continue to generate and use available evidence. However, best practices will only emerge through working in partnerships, particularly those guided by Indigenous leadership who create suicide prevention approaches by and for Indigenous peoples. We need to connect with and across Indigenous communities to advance local and collective efforts.”
Hatcher, S. (2016). Indigenous suicide: A global perspective with a New Zealand focus. Canadian Journal of Psychiatry, 61(11): 684-687. DOI:10.1177/0706743716644147
“This perspective article describes the problem of Canadian indigenous suicide from a non-Canadian viewpoint. In particular, the article compares both similarities and differences in suicide prevention between Maori in New Zealand and indigenous peoples in Canada. It emphasises that the problem of indigenous suicide is not being indigenous but coping with losses secondary to colonisation. A useful way to translate this into helpful clinical conversations and actions is to think about loss of belonging. Culture and belonging are key components of identity and as such should be considered in all psychiatric encounters, not just in those who are considered minorities or ‘other.’ The article concludes by suggesting how some of the experiences of addressing health inequalities and suicide in Maori may be applied in Canada.”
Hatcher, S., Crawford, A. & Coupe, N. (2017). Preventing suicide in indigenous communities. Current Opinion in Psychiatry, 30(1), 21-25.
This 2017 review provides an update on recent studies on suicide prevention in Indigenous populations with a focus on recently colonised indigenous peoples in Canada, the United State, Australia and New Zealand and finds that there is little available research evidence on effective interventions. The authors identify four reasons for the limited evidence: “a lack of ring fenced funding, a lack of research infrastructure, the problem of high rates of suicide but small numbers, and the difficulty in creating effective collaborations between researchers and communities.”
Kral, M. (2016). Suicide and suicide prevention among Inuit in Canada. Canadian Journal of Psychiatry, 61(11), 688-695.
“The most negative effect of this colonialism/imperialism for Inuit has been on their family and sexual relationships. Many Inuit youth feel alone and rejected. Suicide prevention has been taking place, the most successful being community-driven programs developed and run by Inuit. Mental health factors for Indigenous peoples are often cultural. It is recommended that practitioners work with the community and with Inuit organizations. Empowered communities can be healing. This paper concludes that the most successful programs are community-driven, developed and run by Inuit.”
Lawson-Te Aho, K., & Liu, J.H. (2015). Indigenous suicide and colonization: The legacy of violence and the necessity of self-determination. International Journal of conflict and Violence, 4(1). DOI: 10.4119/UNIBI/ijcv.65
Lawson-Te Aho and Liu (2015) present a theoretical case study and analysis of contemporary suicide among Maori youth in New Zealand. They describe community empowerment practices and social policy environments that offer pathways forward from colonisation towards indigenous self-determination, noting significant obstacles along the way.
Mehl-Madrona, L. (2016). Indigenous knowledge approach to successful psychotherapies with Aboriginal suicide attempters. Canadian Journal of Psychiatry, 61(11): 696-699.
“The idea of personal and cultural continuity is essential to understanding suicide among First Nations youth. Interventions targeted to the individual’s beliefs about death, purpose for suicide, and consistent with the life story (plot) in which they find themselves may be more successful than one-size-fits-all programs developed outside of aboriginal communities.”
Robinson, J., Lay San Too, Pirkis, J., & Spittal, M.J. (2016). Spatial suicide clusters in Australia between 2010 and 2012: a comparison of cluster and non-cluster among young people and adults. BMC Psychiatry, 16. DOI:10.1186/s12888-016-1127-8
“Suicide clusters have a significant negative impact on the communities in which they occur. As a result it is important to find effective ways of managing and containing suicide clusters. To date there is limited evidence for the effectiveness of those strategies typically employed, in particular in Indigenous settings, and developing this evidence base needs to be a future priority. Future research that examines in more depth the socio-demographic and clinical factors associated with suicide clusters is also warranted in order that appropriate interventions can be developed.”
Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice 2nd ed. (2014)
The first and second editions of The Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice books have been written by recognised experts, practitioners and researchers in a range of disciplines within the mental health field and have presented a variety of perspectives related to the causes and possible solutions to many of the social and emotional and mental health issues experienced by Aboriginal and Torres Strait Islander people
Yap, M. & Yu, E. (2016) Community wellbeing from the ground up: A Yawuru example. Bankwest Curtin Economics Centre Research Report No. 3/16 August.
The information in the ‘Community wellbeing from the ground up: A Yawuru example’ report (2016) “is intended to provide a baseline for Yawuru as a collective to plan and design programs around what might bring about improvements in wellbeing. It also provides a valuable tool for monitoring wellbeing over time, based on measures identified by Yawuru themselves according to their definitions of what might be considered success markers of living well” (p.12).
Journeys to Healing and Strong Wellbeing A project conducted by the Lowitja Institute for the National Mental Health Commission Final Report – June 2018
The overall purpose of the project was to identify areas of focus and action that support good mental health among Aboriginal and Torres Strait Islander people on their own terms. Our findings and recommendations are based advice and guidance from an expert reference group, focus groups and interviews held in Brisbane, Melbourne and Broome, and a workshop with Aboriginal and Torres Strait Islander stakeholders held in Canberra.
Peer Reviewed Publications
The Australian context
Campbell, A., Chapman, M., McHugh, C., Sng, A., & Balaratnasingam, S. (2016). Rising Indigenous suicide rates in Kimberley and implications for suicide prevention. Australasian Psychiatry, 24(6), 561–564. doi:10.1177/1039856216665281
Campbell et al (2016) audited suicide deaths reported to Kimberley Mental Health and Drug Service during 2005-2014 and found that rates in the Kimberley region had dramatically increased in this decade, with an overall trend upwards in Indigenous youth suicide and Indigenous female suicide. The authors report that ‘these findings highlight the need for culturally informed and youth focussed suicide prevention interventions within the Kimberley region”.
Dudgeon, P., & Holland, C. (2018). Recent developments in suicide prevention among the Indigenous peoples of Australia. Australasian Psychiatry: Bulletin Of Royal Australian And New Zealand College Of Psychiatrists, 26(2), 166-169. doi:10.1177/1039856218757637
This paper summarises the success factors in Indigenous suicide prevention identified through the Aboriginal and Torres Strait Islander Suicide Prevention Project (ATSISPEP).
McCalman, J., Bainbridge, R., Russo, S., Rutherford, K., Tsey, K., Wenitong, M., Shakeshaft, A., et al. (2016). Psycho-social resilience, vulnerability and suicide prevention: Impact evaluation of a mentoring approach to modify suicide risk for remote Indigenous Australian students at boarding school. Health policies, systems and management in high-income countries. BMC Public Health, 16(1), . doi:10.1186/s12889-016-2762-1
This “research addresses the findings of multiple Indigenous-specific publication reviews that there is currently an over-representation of descriptive research in the peer-reviewed published literature and insufficient impact-outcome evaluation research.” (p.9). A 5-year study will investigate the impact and outcomes of enhanced multi-component mentoring intervention to increase levels of psychosocial resilience among 515 remote Aboriginal and Torres Strait Islander students from Cape York and Palm Island.
Nasir, B., Kisely, S., Hides, L., Ranmuthugala, G., Brennan-Olsen, S., et al. (2017). An Australian Indigenous community-led suicide intervention skills training program: community consultation findings. BMC Psychiatry, 17:219. DOI:10.1186/s12888-017-1380-5
“Existing models of Indigenous gatekeeper training and other suicide prevention models are not culturally tailored and do not empower Indigenous peoples. Practical suicide prevention programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations. Developing such programs requires a community-led approach to identify gaps in models developed for mainstream populations and to identify key elements that would make the program specific to Indigenous communities. Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.”
Tighe, J., Shand, F., Ridani, R., Mackinnon, A., De La Mata, N., & Christensen, H. (2017). Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: a pilot randomised controlled trial. BMJ Open, 7(1). doi:10.1136/bmjopen-2016-013518
Results from a pilot randomised controlled trial’ suggest that apps for suicide prevention reduce distress and depression but do not result in significant reductions in suicidal ideation or impulsivity.
Dudgeon, P., Watson, M., & Holland, C., (2017) Trauma in the Aboriginal and Torres Strait Islander Population Australian Clinical Psychologist, Volume 3, Issue 1, Article no. 001.
Abstract: The prevalence of trauma is beginning to be recognised as an Aboriginal and Torres Strait Islander population health issue. Trauma in this context needs to be understood in a way that accounts for the experience of Aboriginal and Torres Strait Islander peoples. Furthermore, the impact and contribution of trauma to many other problems in Aboriginal and Torres Strait Islander communities is only starting to be acknowledged. Relevant types of trauma are those related to historical events with intergenerational and transgenerational impacts, trauma resulting from repeated exposure to life stressors, trauma resulting from specific, intense life experiences and trauma arising from adverse childhood experiences including complex and developmental trauma.In clinical settings, this layering of trauma can present unique challenges to health and mental health professionals and workers. Community-level healing responses are also important. Trauma should be addressed as a significant Aboriginal and Torres Strait Islander population health issue.