Suicide Prevention

Suicide Prevention broadly covers all work across the continuum of activities in Prevention and Early Intervention, SEWB/Healing, Postvention, Crisis Response, Training, and Clinical Services. The articles include studies undertaken Internationally and Nationally.

Dudgeon, P., & McPhee, R. (2019). Drawing Connections. Medicus Journal of Australian Medical Association, October 2019, V59, Issue 9.
This article highlights how community leadership, self-determination and collaboration are key to Aboriginal and Torres Strait Islander Suicide Prevention.

Journeys to Healing and Strong Wellbeing  A project 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.

National Suicide Prevention Symposium Report (August, 2019). In May 2019, the Black Dog Institute hosted a two day Suicide Prevention Symposium in Canberra. The symposium sought to bring together for the first time the interim learnings from 29 suicide prevention trials that are currently in progress across Australia – 12 national suicide prevention trials, 12 Victorian place-based trials, four NSW LifeSpan research trials and one ACT LifeSpan research trial.

Ryder, A., & Mascall, C. (2019) Cultural social and emotional wellbeing of Aboriginal people. Relationships Australia.  (Forthcoming)
Aboriginal and Torres Strait Islander Peoples understanding of Cultural, Social and Emotional Wellbeing (CSEWB) has been further explored in consultation with Aboriginal people who completed the National Empowerment Project (NEP), CSEWB Program in metropolitan Perth in 2018.

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).

Peer Reviewed Publications

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).

Dudgeon, P., Milroy, H., & Walker, R. (Ed.). (2014). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.,). Canberra: Department of The Prime Minister and Cabinet.
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.

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.

Lopez-Carmen, V., McCalman, J., Benveniste, T., Askew, D., Spurling, J., Langham, E., & Bainbridge, R. (2019) Working together to improve the mental health of indigenous children: A systematic review. Children and Youth Services Review.

This systematic review analyses research measuring or evaluating primary health care interventions that focused on improving the mental health of Indigenous children via intersectoral service integration processes and tools.  Of the eleven studies included five were conducted with Indigenous children (aged 4 to 17 years) in Australia, the remaining studies included New Zealand, Canada, Norway and/or the United States. Among the nine key strategies adopted by service integration interventions of note were: Engaging the members of the Indigenous community; Empowerment of families; Adapting interventions and care to the specific socio-cultural circumstances; and Cultural strengthening and empowerment of Indigenous children’s identity.  Six factors enabling effective implementation of service integration included: Including and involving the community and stakeholders, Sensitivity to culture, including to historical background and inter-generational trauma, Multi-disciplinary and collaborative health services and Resourcing factors (e.g. funding, costs, time availability, staff/organisation capacity).

The authors conclude that while the research evidence for interventions focused on improving the mental health of Indigenous children via intersectoral service integration is preliminary the findings hold potential. Importantly, the main outcomes where strategies focused on intersectoral integration were: Improvements in children’s psychosocial functioning, stress management, and individual empowerment; Improvements in health service access and use; Empowerment of both families and communities; and Increased links and collaboration between the community and health services. The authors identify the need for further research, particularly to incorporate Indigenous voices in evaluation, help clarify impact, and to evaluate costs.

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.”

Rawlings, L., O’Shaughnessy,P., & Robson, SJ. (2019). Potentially Preventable Mortality in Young Australian Women. The Economic Society of Australia.
We examined mortality rates in Australian women aged twenty to fifty years during 2001–2016, demonstrating continued disparity by socioeconomic status. Mortality has declined but the reduction occurred in the first decade with no evidence of improved rates since 2010. There have been steady improvements in death rates from causes not considered preventable, while potentially preventable deaths increased in all but the highest socioeconomic quintiles. These rises are particularly alarming in what have been termed “deaths of despair.” As well as the obvious compassionate responses to death in prime aged women, there are important economic considerations that should prompt further research and a policy response.

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.”

Salmon, M., Doery, K., Dance, P., Chapman, J., Gilbert, R., Williams, R. & Lovett, R. (2019). Defining the Indefinable: Descriptors of Aboriginal and Torres Strait Islander Peoples’ Cultures and Their Links to Health and Wellbeing, Aboriginal and Torres Strait Islander Health Team, Research School of Population Health, The Australian National University, Canberra.
Introduction: In Australia, limited data establish or define the relationship between health, wellbeing and culture and the mechanisms through which Aboriginal and Torres Strait Islander cultural determinants impact health and wellbeing. There is increasing attention on the relationship between culture, health and wellbeing in this population. We conducted this literature review as preliminary work for the Mayi Kuwayu Study—Mayi Kuwayu broadly means “to follow Aboriginal people over a long time” in Ngiyampaa language (language of the Wongaibon people of New South Wales, Australia)’ (Jones et al. 2018:2).

Skerrett, D., Gibson, M., Darwin, L., Lewis, S., Rallah, R., & Diego, D. (2017). Closing the Gap in Aboriginal and Torres Strait Islander Youth Suicide : A Social–Emotional Wellbeing Service Innovation Project. APS.
The suicide rate for Queensland’s Aboriginal and Torres Strait Islander young people is over four times that of their non-Indigenous counterparts, with Aboriginal and Torres Strait Islander children (under 15) dying by suicide at 12 times the non-Indigenous rate.There is a need for interventions that are culturally validated and community-endorsed. The aim of this article is to describe the design and implementation of a group-based intervention, as well to report the results of the various qualitative and quantitative measures.

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.

Special Editions

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.”

Journal Articles

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.”

Huria, T., Palmer, SC., Pitama, S., Beckert, L., & Lacey, C. (2019) Consolidated criteria for strengthening reporting of health research involving Indigenous peoples: the CONSIDER statement. BMC Medical Research Methodology.
Research reporting guidelines are increasingly commonplace and shown to improve the quality of published health research and health outcomes. Despite severe health inequities among Indigenous Peoples and the potential for research to address the causes, there is an extended legacy of health research exploiting Indigenous Peoples. This paper describes the development of the CONSolIDated critERtia for strengthening the reporting of health research involving Indigenous Peoples (CONSIDER) statement.

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.”