Part 3: Responding to Selected Situations and Groups

Situations associated with suicide risk

Life ‘transition points’

Policy document Reference Description
Townsville SP Plan (2017–20) Strategy 10
  • One of the biggest challenges, and corresponding gaps, identified during the consultation process for this CAP is the lack of support provided to people at times of transition in their life: when the natural course of life changes and identity is reshaped. This could be transitioning from school, leaving the workforce, becoming a parent, going through a divorce, becoming injured and no longer able to play professional sport, losing a farm or business, grief and trauma, chronic illness and/or disability, a broken relationship, moving to a location, sexuality transition, and so on. At one end, there is recognition and support; on the other side there can be isolation, fear and ‘the great unknown’. These pivotal moments can put people at high risk of suicide. [See plan for a range of actions]

Exiting hospitals, EDs

Policy document Reference Description
NATSISPS (2013) Outcome 3.1, p.35
  • (iii) Develop strategies to improve Aboriginal and Torres Strait Islander identification, assessment of suicide risk, psychosocial assessment and culturally informed discharge protocols for hospital emergency departments
Living Well (2014–24) p.38, Action 3.4.8
  • Assess and improve the identification and response to suicidal people in hospital and community services, and at points of care or service transition, such as discharge from hospital.

Contact with criminal justice system/justice issues

Policy document Reference Description
NSW SP Plan (2018–23)
  • Building capacity to reduce suicide among people in contact with the justice system
  • Online training is being delivered to Corrective Services NSW staff in Suicide Awareness and Managing At-Risk Inmates.
  • Corrective Services NSW is working with Victims Services to increase the availability of counselling for inmates who have been victims of crime. If a Victims Services Approved Counsellor identifies that an inmate receiving counselling may be suicidal, they will alert custodial staff to facilitate a safety intervention by Corrective Services NSW Psychology Services.
NATSISPS (2013) Outcome 3.5, p.36
  • There are integrated and collaborative approaches across sectors responding to Aboriginal and Torres Strait Islander who are at high risk, such as people experiencing mental illness, substance misuse, incarceration, domestic violence, etc.
  • Develop partnership programs to build links between residential/custodial settings and community support (such as transition from prison to community or from alcohol rehabilitation to community reintegration)
  • Provide specific SP and assessment training for staff in high risk settings who work with Aboriginal and Torres Strait Islander clients
  • Identify alternatives to community reintegration where return to community is not desirable
Qld SP Action Plan (2015–17) Priority 3, p.21
  • DCS will continue to develop and implement the Reducing Risk of Prisoner Self-Harm 2017 Action Plan.
VIC SP Plan (2016–25) Obj 2, p.18
  • The government will continue to implement the Correctional Suicide Prevention Framework: working to prevent prisoner and offender suicides in Victorian correctional settings.
Qld SP Action Plan (2015–17) Priority 2, Action 15, p.28; Actions 18 19 and 24, p.29
  • Improve the identification and assessment of people at risk of suicide at the point of admission into custody in Queensland’s Correctional Centres.
  • Implement a suicide prevention and resilience model across Queensland’s Correctional Centres to provide person-centred assessment, support, treatment and care for those at risk.
  • Enhance personal resilience of prisoners and strengthen protective factors through the delivery of the Strong Not Tough Adult Resilience program- this will be rolled out in 2015–16 to assist prisoners build emotional and social skills, and resilience strategies that are both practical and useful for coping with stressful circumstances. The initial target group will include prisoners with a history of suicidal ideation or experiencing adjustment difficulties within the correctional environment.
  • Continue to expand safer cell measures in Queensland’s correctional centres.
Action 22, p.29
  • Implement updated Operational Practice Guidelines for Probation and Parole for managing offenders under community-based orders identified as at increased risk of suicide.
Action 21, p.29
  • Continue to ensure that young people in youth detention centres are in a safe environment where risk of, and opportunity for, suicide and self-harm is minimised.

Youth detention

Policy document Reference Description
NSW SP Plan (2018–23)
  • Juvenile Justice NSW is working closely with the Justice Health and Forensic Mental Health Network to prevent suicidal behaviour and self-harm among Juvenile Justice clients. Services include early screening for young people at risk of self-harm, trauma counselling for detainees who have been victims of crime, specialist assessment and referral, therapeutic care for clients with mental health issues and monitoring as required.
Qld Aboriginal and Torres Strait Islander SEWB Action Plan (2016–18) Action 8, p.18
  • Establish Murri Courts in 13 locations across Queensland. Murri Courts provide an opportunity for members of the Aboriginal and Torres Strait Islander community (including Elders and victims) to participate in a court process which requires defendants to take responsibility for their offending behaviour but which also respects and acknowledges Aboriginal and Torres Strait Islander culture (Department of Justice and Attorney-General).
Action 10, p.18
  • 0. Continue to support the Youth Justice First Nations Action Board. The cultural diversity and distinct cultural views of Aboriginal and Torres Strait Islander people should not be ignored and for this reason the Youth Justice First Nations Action Board (YJFNAB) was developed. This group is made up of Aboriginal and/or Torres Strait Islander staff members that are considered strong advocates and leaders for Aboriginal and Torres Strait Islander issues in their local areas. The YJFNAB has been established to guide the organisation’s priority focus on reducing over representation in the youth justice system and to ensure that youth justice policy, programs and interventions are designed and delivered appropriately for Aboriginal and Torres Strait Islander young people, their families and communities. The YJFNAB will ensure there is a cultural lens embedded in the way Youth Justice does its business to enhance a stronger workforce to address the overrepresentation of Aboriginal and Torres Strait Islander young people in the justice system (Department of Justice and Attorney-General).
Action 11, p.18
  • Embed Aboriginal and Torres Strait Islander perspectives into Restorative Justice practice. Key Queensland communities will be engaged to raise the perspectives of Aboriginal and Torres Strait Islander young people, families and communities about how Youth Justice might increase Aboriginal and Torres Strait Islander participation in diversionary justice processes. This work is in response to the proposed Restorative Justice Reform and aimed at maximising the impact of the new reform to address the over-representation of this cohort within the Youth Justice system. Through the development of specific client-led responses the project proposes to make justice responses more culturally attuned and supportive of raising Aboriginal and Torres Strait Islander communities’ ownership of responses to young people’s offending behaviour. Such a response is in line with the intended outcomes of the restorative justice project plan and upholds the Youth Justice First Nations Action Board’s key priority of embedding First Nations People’s perspectives in restorative justice reform (Department of Justice and Attorney-General).
NT RC (2017) Rec 24.1, p.40
  • An integrated, evidence-based through care service be established for children and young people in detention to deliver: adequate planning for release including, as appropriate, safe and stable accommodation, access to physical and MH support, access to substance abuse programs, assistance with education and/or employment

Workplace-related stress

Policy document Reference Description
NSW SP Plan (2018–23) Priority 1, p.22
  • Supporting mentally healthy workplaces. — SafeWork NSW is leading the implementation of the Mentally Healthy Workplaces in NSW Strategy 2018–2022, which is aimed at improving workplace mental health.
WA SP 2020 (2015) Action 4, p.39
  • Suicide Prevention 2020 will build on the previous agency coordination program with a strengthened workplace suicide prevention program that shares guidelines, protocols, training programs, planning tools and best practice. This action area will be achieved through:
    • Assisting organisations to fulfil their responsibilities and legal obligations for the mental wellbeing and safety of their employees.
    • Developing implementation, monitoring and accreditation systems for workplace mental health and suicide prevention initiatives.
    • Setting minimum requirements for mentally healthy workplaces, including training to identify and support people at risk.
    • Acknowledging and disseminating best practice approaches to creating a mentally healthy workplace.
    • Encouraging large government and corporate organisations to have mental health and suicide prevention as a key outcome measure with adequate resources and monitoring. [See policy for greater detail.]
Tas SP Plan (2016–20) Actions 2.1/ 2.2 p.23
  • Develop a best-practice framework for workplaces in Tasmania that integrates mental health promotion, prevention of mental ill-health, suicide prevention and suicide postvention plans, which link to state and national work to support workplaces.
  • Identify workforces in Tasmania that may be at increased risk of suicidal behaviour – either because of their workforce demographics (for example construction, mining) or the nature of their work (for example emergency workers, defence personnel) and work with them to implement integrated mental health, suicide prevention and suicide postvention plans and programs.

Rural adversity (drought, etc.)

Policy document Reference Description
NSW SP Plan (2018–23) Priority 1, p.22
  • The Rural Adversity Mental Health Program (RAMHP) is a state-wide program delivered by the Centre for Rural and Remote Mental Health based in Orange. RAMHP workers are spread across rural and remote parts of NSW where they help communities respond to rural adversity such as natural disasters and economic change, train people to respond to mental health problems and connect people to health services when necessary.
VIC SP Plan (2016–25) Objective 2, p17
  • The Victorian Government will ensure that the National Centre for Farmer Health can continue to improve the health and wellbeing of Victorian farmers and their families. The government will work in partnership with the centre to identify further training and program opportunities, such as brief intervention programs to reduce emotional distress and the risk of suicide.
  • The government has provided a $1.5 million mental health wellbeing package for dairy farmers. This included extra counselling services, mental health first aid training, support for community events and a $100,000 boost towards the Look Over the Farm Gate program. This forms part of an $11.4 million support package for dairy farmers affected by the global fall in milk prices and decisions by some processors to cut the prices paid to their suppliers. The support package, which was developed in consultation with the Dairy Industry Taskforce, will ensure dairy farmers and their families experiencing financial and emotional stress get the support they need. The package also includes financial counselling, and a flexible fund of $4.5 million to support affected farming communities.

Homelessness

Policy document Reference Description
NSW SP Plan (2018–23) Priority 1, p.23
  • Led by the NSW Department of Family and Community Services, the NSW Homelessness Strategy 2018–2023 aims to intervene early to prevent homelessness and break disadvantage, increase access to supports that prevent homelessness and re-entry to homelessness and create an integrated, person-centred service system. The Strategy includes new initiatives to support tenancies, provide transitional accommodation, expand domestic violence services and provide outreach to support rough sleepers.
  • NSW Health, in collaboration with the Department of Family and Community Services, provides intensive coordinated clinical, psychosocial and housing support to people who have complex mental illness and would be otherwise at risk of homelessness through the Housing and Accommodation Support Initiative (HASI).
  • NSW Health is funding Compass Housing Services through the Suicide Prevention Fund to deliver mental health first aid training and an awareness campaign to better identify and respond to mental health issues among social housing tenants and staff across the Central Coast, Hunter, Dubbo and Broken Hill regions of NSW.
Korin Korin Balit-Djak (2017–27) Priority focus 4.1, p.44
  • See under Aboriginal Victorians have stable, secure and appropriate housing
  • Strategic direction 4.1.1: Advance self-determination in Aboriginal housing and homelessness
  • Strategic direction 4.1.2: Improve access to suitable stable and supported housing

Financial stress

Policy document Reference Description
NSW SP Plan (2018–23) Priority 1, p.23
  • The NSW Government’s Work and Development Order Scheme reduces financial stress for the most disadvantaged people — Work and Development Orders are made by Revenue NSW to allow eligible people who have a mental illness, intellectual disability or cognitive impairment, are homeless, are experiencing acute economic hardship, or have a serious addiction to alcohol, drugs or other substances, to satisfy their fine debt through unpaid work with an approved organisation or by undertaking certain courses or treatment.

Gambling

Policy document Reference Description
SA SP Plan (2017–21) Action 6, p.13
  • The Office of Problem Gambling will promote that, where appropriate, gambling help services will provide a Suicide Assessment Screening and either respond or refer clients to an appropriate clinician.

Mental health facilities

Policy document Reference Description
MH&SEWB Fr (2017–23) Outcome 5.1, p.42
  • That the human rights of Aboriginal and Torres Strait Islander people living with severe mental illness are respected
  • Aboriginal and Torres strait Islander people living with severe mental illness are entitled to protections as people with mental illness as provided by the 1991 United Nations’ Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care; the 2006 United Nations Convention on the Rights of Persons with Disabilities; and equal protection under the 2012 Mental Health Statement of Rights and Responsibilities of Australia’s National Mental Health Strategy.
  • Ensure access to culturally and clinically appropriate treatments, including with Elders, traditional healers, cultural healers and interpreters.
  • Ensure the SEWB of Aboriginal and Torres Strait Islander people with severe mental illness is supported, including within psychiatric hospitals and in supported accommodation facilities.
  • Develop culturally adapted assessment and treatment information options for those with severe mental illness and their families and carers.
Nat Standards – MH Services (2013) Standard 1, p.7
  • The rights and responsibilities of people affected by mental health problems and / or mental illness are upheld by the MHS and are documented, prominently displayed, applied and promoted throughout all phases of care.
Criterion 10.3.1, p. 54
  • Implementation Guidelines– Public Mental Health Services and Private Hospitals, p.54 The entry process to the MHS meets the needs of its community and facilitates timeliness of entry and ongoing assessment… The MHS should have a documented entry policy and procedure which includes but is not limited to: ensuring the needs of Aboriginal and Torres Strait Islander persons… are addressed in the entry process & the use of interpreters
Standard 10.5, p.26
  • The MHS provides access to a range of evidence based treatments and facilitates access to rehabilitation and support programs which address the specific needs of consumers and promotes their recovery
Criterion 10.5.2, p.26
  • Treatment and services provided by the MHS are responsive to the changing needs of consumers during their episodes of care that address acute needs, promote rehabilitation and support recovery.
  • Implementation Guidelines– Public Mental Health Services and Private Hospitals, p.61. Treatment options need to address Aboriginal and Torres Strait Islander persons… In rural and remote settings practitioners must ensure processes for frequent monitoring (through primary care or wellbeing services) to identify and respond to Aboriginal and Torres Strait Islander consumer needs.
  • Implementation guidelines for Non-Government Community Services, p.79. Service options need to address Aboriginal and Torres Strait Islander persons, Evidence that this criterion is met could include: having specialist positions in the organisation, for example… Aboriginal and Torres Strait Islander liaison staff
Criterion 10.5.16
  • Implementation Guidelines– Public Mental Health Services and Private Hospitals, p.66. MH services operating in areas with significant Aboriginal and Torres Strait Islander populations should ensure that supported and transitional accommodation options appropriate to Indigenous consumers are available. This includes flexible options in regional centres close to specialist and tertiary services, which are connected with in-community options.
Criterion 10.5.9
  • Implementation Guidelines– Public Mental Health Services and Private Hospitals, p64. Because of the burden of social adversity and comorbidity in some Aboriginal and Torres Strait Islander communities, diverse agencies and organisations are involved in ongoing care. The MHS should ensure coordination and communication across the services and sectors.
Criterion 2.11
  • Implementation Guidelines– Public Mental Health Services and Private Hospitals, p.12. There should be a regular risk assessment of consumers… Consumers are at greatest risk in times of transition between settings or transfer of care…  Joint risk assessments between the MHS, non-government organisations, local communities and primary health services or Aboriginal and Torres Strait Islander medical services are often appropriate when responsibility for care is being transferred or jointly managed.
Criterion 10.6
  • Implementation Guidelines– Public Mental Health Services and Private Hospitals, p.68. The intent of this criterion is to ensure that mental health services (MHS) have policy and procedures on how to assist consumers when they exit the service and that consumers are provided with sufficient information on how to re-enter the service if / and / or when required… The consumer’s exit from, follow-up and re-entry to the service is the joint responsibility of the private mental health service, the private psychiatrist and the general practitioner… In rural and remote settings this responsibility demands involvement of the mental health service, the primary care service or Aboriginal and Torres Strait Islander community controlled organisation, and other relevant providers. This may include general practitioners.
Vulnerable groups / intersectionality with Indigenous

In general

Policy document Reference Description
Qld SP Action Plan (2015–17) Priority 3, p.21
  • Our actions will focus on strategies that aim to:
    • Improve the effectiveness of mainstream services to better understand and respond to the needs and circumstances of vulnerable groups.
    • In partnership with at-risk groups, customise approaches to meet their unique needs and circumstances ensuring they are included in the planning, implementation and evaluation of such initiatives.
SA SP Plan (2017–21) Action 6, p.13
  • We will continue to work at identifying people and groups who are at greater risk and work in collaboration with these communities to develop specific approaches for reducing suicide.
  • We will partner with Aboriginal and Torres Strait Islander peoples to find safe ways of working with people at risk in a culturally competent manner that will maximise the chances of them recovering.
  • We will identify ways in which we can reduce the risk of suicide for LGBTIQ people, including the introduction of support programs.
  • We will promote initiatives that encourage help-seeking from all high risk and vulnerable groups.
NT SP Framework (2018–23) Goal 3, p.21
  • Focused and evidence informed support for the most vulnerable groups of people: Children, young people, men, Aboriginal people, people with mental health issues, people who have recently harmed themselves, those who are bereaved by suicide, ex-service personnel, members of the LGBTQI community
  • Targeted training for health and social care staff in supporting vulnerable people, especially those in primary health care services;
  • Provision of selected and indicated programs for all groups of people
WA SP 2020 (2015) Action Area 3, p.8
  • Coordinated and targeted services for high-risk groups. This action area will be achieved through:
    • Facilitating effective interagency coordination to address social determinants for suicide prevention across the lifespan.
    • Co-producing new programs with the at-risk groups themselves, including people with lived experience, family members and carers.
    • Delivering responsive, high quality treatment and support for those with mental illness, aligned with the Mental Health and Alcohol and Other Drug Services Plan 2015-2025.
    • Improving policies, protocols, discharge planning and continuing care for people who have self-harmed and/ or attempted suicide.
    • Strengthening early intervention services and family counselling to prevent and address cumulative trauma in children and young people.
    • Supporting interagency postvention responses for individuals and communities who have lost someone to suicide.

Males

Policy document Reference Description
NATSISPS (2013) Outcome 2.2, p.31
  • Life promotion and resilience-building strategies are developed; access to wellbeing services among Aboriginal and Torres Strait Islander males is improved
  • Develop strategies, including information and mental health promotion strategies, to promote use of general health and wellbeing services and specialist services by men
  • Identify and disseminate good practices for men’s self-help groups
  • Develop strategies to promote the strengths of elders, fathers and other men as positive role models able to contribute to the wellbeing of community, families and youth

Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people

Policy document Reference Description
National LGBTI Health Alliance National LGBTI Suicide Prevention Strategy (2017)
  • The National LGBTI Mental Health and Suicide Prevention Strategy is a plan for strategic action to prevent mental ill-health and suicide, and promote good mental health and wellbeing for lesbian, gay, bisexual, transgender, and intersex (LGBTI) people and communities across Australia. This strategy includes recommendations across the breadth of approaches in Australian mental health work including promotion, prevention, intervention, treatment and maintenance. The purpose of the strategy is to respond to LGBTI people in current need, to provide interventions to those who are at risk, and to interrupt the structural factors that contribute to overrepresentation of LGBTI people in mental health and suicide statistics. See: https://lgbtihealth.org.au/resources/national-lgbti-mental-health-suicide-prevention-strategy/
Vic SP Plan (2016–25) Objective 2, p.16
  • The government will partner with lesbian, gay, bisexual, trans and gender diverse and intersex (LGBTI) people and community groups to tackle discrimination and to improve inclusiveness of health and social services. These partnerships will help build the evidence base on patterns of self-harm and suicidal behaviour in LGBTI.
  • Services will be encouraged to support LGBTI people to develop full and healthy identities and provide culturally appropriate and accessible services across all ages and in both metropolitan and regional settings. These services include the Victorian AIDS Council, community health services, alcohol and drug treatment services, and both clinical and community mental health services.
  • For young LGBTI people, the government and the Youth Affairs Council of Victoria continue to fund the Health Equal Youth (HEY) Project and HEY grants. The grants support organisations to undertake mental health promotion and community engagement activities focusing on same-sex attracted and sex and gender diverse young people up to the age of 25, and their families.
  • The government is also supporting the development of a Pride Centre for Victorian LGBTI community organisations, associations and groups, and delivering an education and training program to combat homophobia across Victoria.
  • In May 2016 the Victorian Parliament apologised for laws criminalising homosexuality and the harms caused. The apology is a powerful statement, especially for older members of the Victorian LGBTI community
Korin Korin Balit-Djak (2017–27) Strategic direction 5.2.5, p.60
  • Improve outcomes for Aboriginal LGBTI people
  • Over the next three years the department will:
    • Develop a statewide Aboriginal LGBTI wellbeing plan across the spectrum of needs including primary healthcare, sexual health, mental health and health promotion.
    • Build on the Rainbow eQuality guide to acknowledge the diversity within Aboriginal communities.
    • Continue to provide support for gatherings of the Aboriginal LGBTI communities, using models of good practice such as the Kunghah Retreat held in 2016.
    • Promote inclusive safe spaces, both physical and online, for Aboriginal LGBTI, brotherboy and sistergirl Victorians to gather, and encourage community engagement, community advocacy and cultural identity for the unique and diverse Aboriginal LGBTI community.
    • Develop better pathways for Aboriginal LGBTI people in regional and rural communities to access tailored health and wellbeing services.
    • Promote LGBTI quality assurance sector accreditation, including the rainbow tick, for mainstream and Aboriginal-specific health and human services.
    • Support Aboriginal organisations and the blood-borne viruses and sexually transmitted infections sector to develop culturally responsive sexual health prevention and tertiary services for Aboriginal LGBTI Victorians.
    • Support the capacity of Aboriginal LGBTI networks and organisations to provide peer support, health promotion, advocacy and community development services.
    • Liaise with the Victorian Pride Centre board to advocate for strong Aboriginal recognition and representation within the new Victorian Pride Centre.
  • In 10 years, success will look like:
    • Aboriginal LGBTI people are supported in the LGBTI community and within Aboriginal communities.
    • Aboriginal LGBTI people have access to the culturally safe services and supports they require to live healthy, self-determined lives.
    • Aboriginal LGBTI people have access to their own networks and organisations that deliver peer support, health promotion, advocacy and community development services.

Older people

Policy document Reference Description
NSW SP Plan (2018–23) Priority 1, p.22
  • Older Persons Mental Health First Aid training is being rolled out across NSW, providing approximately 32 new instructors and delivering training to over 1,000 older people and people working with older people across the state. This initiative will mean problems can be detected early and help provided so that older people with a mental health issue can participate fully in their communities and live fulfilling lives.

People living with disability

Policy document Reference Description
Korin Korin Balit-Djak (2017–27) Strategic direction 5.2.6
  • Improve outcomes for Aboriginal people with a disability
  • Over the next three years the department will:
    • Work with the National Disability Insurance Agency to implement strategies to support Victorian Aboriginal communities during the transition to the NDIS by supporting self-determined, place-based Aboriginal disability coordination and planning networks and strengthening the capacity of Aboriginal communities to navigate disability services.
    • Build the voice of Aboriginal people with a disability through advocating for culturally safe Aboriginal and broader network groups.
    • Explore options for expanding the Balit Narrum model.
    • Work with the Commonwealth Government to increase supports and resources for Aboriginal organisations to respond to the NDIS.
    • Advocate for the Commonwealth Government to build and promote cultural safety of the Victorian disability sector through the NDIS.
    • Ensure all Aboriginal children with a disability in out-of-home care are appropriately identified and provided with relevant supports.
    • Ensure all departmental policy and programs are adopting ‘designing for diversity’ principles, creating and sustaining a health and human services system that is inclusive, non-discriminatory and accessible for everyone.
    • Undertake activities targeted at ensuring mainstream services interface with the NDIS and provide broader disability supports in ways that are responsive to the needs of Aboriginal Victorians.
  • In 10 years, success will look like:
    • All Aboriginal people with a disability have access to the culturally safe supports they require to live healthy self-determined lives.