Postvention

Postvention2019-04-15T07:07:49+00:00

Suicide Story (Alice Springs, NT)

A three-and-a-half-day suicide prevention workshop structured around nine topics incorporated in a DVD specific to community-based helpers.

https://mhaca.org.au/education-and-community-awareness/aboriginal-suicide-prevention

Contact: Mental Health Association of Central Australia
Phone: 08 8950 4600/Email: info@mhaca.org.au

Suicide Story was officially launched on Wednesday, 3 March 2010 at the Alice Springs Town Council, funded by the NT Government Department of Health & Families and the Northern Territory Primary Health Networks (NT PHN) to support Indigenous communities and workers living in remote communities. Suicide Story is a prevention oriented program. It works at the request of communities and is a capacity building approach. Suicide Story was adapted from the Mental Health Association of Central Australia, Life Promotion Program (LPP) which delivers ‘gatekeeper training’ to workers and community members who might encounter people at risk of suicide. A 2-day Living Works ASIST workshop (Applied Suicide Intervention Skills Training) was first adopted by the NT in 2001, and has consistently been in demand among those working in the community sector in Alice Springs. However, it was found that this model did not address some of the core issues central to the needs of Aboriginal people, especially those living in remote regions and town camps. Through extensive consultations with Aboriginal people and discussions with other related services, the LPP team started to further develop the resources and style of training to tailor to the needs of Aboriginal people, creating Suicide Story.

Utilising a community development and action research approach Suicide Story is an Indigenous developed, led and delivered community suicide awareness and prevention training program. It is developed with, and for, central Australian Aboriginal people. The Suicide Story is developed in collaboration with the Mental Health Association of Central Australia and the Suicide Story Aboriginal Advisory Group (SSAAG), the latter consisting of Aboriginal people to ensure the cultural appropriateness of the program. Over the years the content and delivery of the program have been reworked and adjusted through a continuous cycle of participatory action research and quality improvement processes according to the extensive feedback from facilitators and participants. This has ensured the program’s effectiveness and ability to be applied in a number of communities and 20 language groups. The program incorporates the use of a DVD made up of short films that feature the voices of Indigenous people, combined with animation, artwork, music, pictures/posters to generate scenarios, and lots of conversations/discussion. The DVD focuses on 9 topics relevant to suicide, and accompanies 9 modules that are completed over a full 3-day training program that addresses the following questions:

  • Should we talk about suicide?
  • Why is suicide a problem in Aboriginal communities?
  • How big is the problem?
  • How would you know if someone was at risk of suicide?
  • What leads to people thinking about suicide?
  • What can families and communities do to create a suicide safer community?
  • What gets in the way of helping?
  • What are good ways to support people at risk?
  • How might people heal after a death by suicide?
  • How can we keep the helper safe too?

The aim of Suicide Story is to work with communities who recognise and want the tools to make changes in their community by offering customised resources to address the issue of suicide. A pre and post evaluation is conducted with participants to enable them to self-evaluate the impact of the program. This is also incorporated into the program’s evaluation. The participants’ feedback about the workshop informs the structure of future programs by addressing the participants’ comments in the evaluation.

Core elements of the program include:

Listening … sharing … learning
Through listening, sharing and learning from the stories of Aboriginal people to develop a relevant contextual picture of the issue of suicide. Suicide Story contains meaningful training material that is respectful of the people, culture, language and context of people’s lives in Central Australia including Alice Springs, Santa Teresa, Yuendumu, Tennant Creek and Gove Peninsula. It includes drawings, animation and film that have been added to enhance this unique, culturally developed training resource.

Use of local artwork
In 2006, some women from the remote community of Santa Teresa painted two banners for World Suicide Prevention Day, artwork which portrays a local understanding of some of the causes of suicidal behavior and ways to care for people who are displaying suicidal behaviour. This artwork and story feature throughout Suicide Story to give meaning to ‘impersonal’ statistics and data about suicide to remind everyone that this issue is about ‘raw and real’ experiences. It is based on the hope that the ‘best chance of reducing the rates and the pain of suicide for Aboriginal people is to understand their experience of it and bring new learnings to them in a proper way.’

Culturally sensitive approach
The aim of this program is to offer a culturally sensitive approach to the understanding of the issue of suicide, as well as improving skills to work with people at risk, and building a sense of hope and improving the health and wellbeing of the Aboriginal communities for Aboriginal communities of Central Australia.

Suicide Story aims to:

  • Deliver suicide prevention workshops in remote regions in the NT free of charge. Workshops can also be delivered interstate for a fee for service. The program focuses on adults in remote communities to provide them with the tools to identify warning signs of suicide. If members of the community seek extra ongoing resources, they will be referred to the appropriate services;
  • Explore impulsive suicide, suicide as a threat, blame and payback in Aboriginal peoples’ cultural and local context;
  • Recognise the importance of learning through sharing stories from other Aboriginal communities;
  • Share learnings through recognisable symbols, images and language;
  • Explore the history of social injustice and legislated change and the consequent losses that are relevant to the current problem of suicide;
  • Accommodate varying levels of English literacy and different ways of learning among Aboriginal communities;
  • Only deliver Suicide Story in a community that is considered ready for change – and formally requests the program through the Elders of the community.
  • The criterion for an endorsement from the highest authority in a community gives the community the power to decide whether it will benefit from the program;
  • Raise awareness for individuals and community: The interactive workshops are designed to generate conversations and raise awareness by exploring how grief and trauma have become a problem in their communities and how historical and social factors have impacted their communities. They assist people to recognise the seriousness of suicide by debunking the myth among many of the Elders and smaller communities that threats of suicide, especially by young people, is just kids ‘mucking up’.
  • Overcome the lack of experience and understanding among some communities about the pain some people experience – especially in the smaller communities and homelands where there are few people familiar with the prevalence of suicide.
  • Examine issues around traditional language and skin groups and whether upsetting these traditional systems would exacerbate suicide rates and impact the availability of resources for those individuals. The key message to participants is that there are no right or wrong answers and everyone is to feel safe in the program;
  • Implement Train the Trainer: The program facilitators seek to identify and support networks of appropriate people in these traditional communities. The communities identify individuals who would like to undergo training and work in their own regions/communities. This facilitates a more localised approach and ensures the continuity of the program’s mission of targeting suicide by empowering local facilitators;
  • Work through community plans to identify what are the issues, what is required, and how this can be mapped with service providers and existing programs; and,
  • Encourage service providers to attend the program to increase community capacity in identifying warning signs of suicide.
  • The DVD helps communities to see that there are many Aboriginal people who are willing to ‘talk up strong on suicide’ because they have lost too many family members.
  • Communities and individuals are encouraged to work together to map out what is required in their communities to help improve the understanding among their people and the need to learn skills that will help families to stop deaths by suicide.
  • From March 2017 to June 2018 Suicide Story has delivered workshops to 141 participants.
  • Each year, 6 workshops are delivered in the Northern Territory: 2 for Top End and 4 for Central and Barkly regions.
    On average, around 20 people attend each workshop.

Suicide Story drew on a strong theory base of what works in suicide prevention training. The program has been adapted to be culturally responsive. This is a very organised, well-structured and well designed program with a clear set of deliverables and reflexive practices. The program is flexible, dynamic and accommodates different learning styles, languages, traditions, issues, levels of readiness and still progresses through the nine stages. It seeks to empower communities and individuals to identity the issues in their communities and lives and the ways to address them. It establishes a network across the region that ensures the outcomes are sustained. It seeks to work with and support other service providers.

The Suicide Story Program builds strengths and capacity in Aboriginal and Torres Strait Islander communities and resilience in individuals and families. Specifically, it promotes the communities to have the capacity to initiate, plan, lead and sustain strategies to promote community awareness and to develop and implement community suicide prevention plans. It also provides materials and resources appropriate for the needs of Aboriginal and Torres Strait Islander peoples in diverse community settings. They also provide culturally appropriate community activities that engage youth, build cultural strengths, leadership, life skills and social competencies, resulting in life promotion and resilience-building. The activity is also founded on long-term, sustainable prevention strategies that build resilience and promote social and emotional wellbeing. It is specifically adapted from programs for the general public and made appropriate for Aboriginal and Torres Strait Islander families and children.

The Suicide Story Program also offers a coordinated approach through multi-sectoral coordination across levels and sectors of government and supports regional and local coordination of suicide prevention. There are agreements to support collaborative approaches to joint case management to ensure continuity of services and support for higher risk clients. It also has strong partnerships between services, agencies and communities.

The Suicide Story Program demonstrates high standards and quality in suicide prevention. They have a comprehensive plan to develop and support the participation of Aboriginal and Torres Strait Islander peoples in the suicide prevention and wellbeing workforce with a focus on community engagement, culturally awareness in wellbeing services, early intervention and a focus on quality improvement for social and emotional wellbeing and mental health care.
Suicide Story was rated very highly as strong evidence of effectiveness and best practice. Drawing on a strong theory base of what works in suicide prevention training the program has been adapted to be culturally responsive. This is a very organised, well-structured and well-designed program with a clear set of deliverables and reflexive practices. The program is able to be flexible, dynamic and accommodates different learning styles, languages, traditions, issues, levels of readiness and still progress through the 9 stages. It is designed on a program logic and approach that has complete adherence to the need and critical importance of culture, localised approaches, utilisation of local people, and respect for elders, and spiritual and cultural values.

Suicide Story seeks to:

  • empower communities and individuals to identify the issues in their communities and lives and the ways to address them including the service providers and programs already in their communities.
  • establish a network across the region that ensures the outcomes are sustained.
    work with and support other service providers.

Finally the program strongly aligns with the guiding principles of the CBPATSISP Evaluation Framework, emphasising the need to ensure representation of the local communities. The program examines the needs of each community and responds accordingly with an underlying emphasis on the significance of culture, history, and human rights. The program also incorporates an individualised plan for participants to identify the services and stakeholders of the community and ways the Suicide Story Program can coordinate their works with the existing infrastructure of the community. This allows the program to address more pressing concerns that are specific to a community and advocate for any gaps in service that are identified.

In 2017, Suicide Story was the winner of 2017 LiFE Awards for Excellence in Suicide Prevention in the Aboriginal and Torres Strait Islander category. They were recognized for the strong collaboration with SSAAG to develop a curriculum that has been consulted by community leaders and Aboriginal allied health workers. Their focus on local empowerment and effective evaluation measures show 97 per cent of participants gaining skills to identify warning signs of suicide and 98 per cent stated that the workshop ‘strengthened their fire’ to support suicide prevention in their community.

UHELP (Inala, QLD) Action Learning Model

The headspace Inala Service Innovation Project was designed to actively engage Aboriginal and Torres Strait Islander young people in need of mental health intervention into a health care service using established relationships and a culturally safe and appropriate system of care.

Contact:
Phone
(07) 3727 5000/Email: 

headspace Inala (QLD) partnered with the Suicide Prevention and Mental Health Program, Queensland Health and other local community organisations to design and develop a program that tapped into cultural learning styles and strengths. The headspace Inala Service Innovation Project was designed to actively engage Aboriginal and Torres Strait Islander young people in need of mental health intervention into a health care service using established relationships and a culturally safe and appropriate system of care. It sought to engage them into a set of physical, social and emotional wellbeing promotion activities. These aims were actioned through the delivery of an innovative group program that was designed to improve the mental health literacy of the general Aboriginal and Torres Strait Islander youth community, and identify and refer the young people most in need of support. The United Health Education and Learning Program (UHELP) model was developed, named by community and founded on four key components: 1) Awareness; 2) Engagement; 3) Learning/Modelling and 4) Ongoing Support.
headspace Inala is located in a region with a significantly large and culturally strong Aboriginal and Torres Strait Islander community. There is strong local leadership within the community from the Inala Elders Aboriginal and Torres Strait Islander Corporation (“Inala Elders”). Historically, there has been a proportionally high rate of youth suicide among the Aboriginal and Torres Strait Islander people in the region. Aboriginal and Torres Strait Islander young People have struggled to have their mental health needs appropriately managed by mainstream mental health services, and are under-represented in primary mental health care systems. It is significant that almost 70% of UHELP participants reported knowing someone that had died by suicide – a known risk factor for suicidality.

The key objectives of the UHELP program are to:
• Improve the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander young people in the Inala area and surrounding suburbs;
• Develop and refine a new and innovative intervention model that specifically addresses the social and cultural realities of young Aboriginal and Torres Strait Islander people. This includes incorporating cultural governance safeguards;
• Capitalise on the progress made by the Suicide Prevention and Mental Health Program, a community-owned program run by the Inala Aboriginal and Torres Strait Islander Elders;
• Validate the use of Aboriginal and Torres Strait Islander-specific mental health outcome measures within a headspace context;
• Increase the capacity of the Aboriginal and Torres Strait Islander community’s young people to identify and appropriately respond to suicidal behaviour;
• Increase the accessibility and acceptability of individual, culturally appropriate counselling (hereafter referred to as ‘yarning’) for young Aboriginal and Torres Strait Islander people; and
• Foster collaboration between headspace Inala, the local community and relevant organisations to improve the health and wellbeing of the community.

The aim of key component 1 (Awareness) was to improve the health literacy and knowledge of young Indigenous people about social and emotional well-being indicators, strategies and protective mechanisms. The program aspired to deliver positive messages and provide early intervention strategies in relation to mental health and wellbeing.

The aim of key component 2 (Engagement) was to create culturally safe spaces and learning environments and to further develop relationships built on trust and mutual respect. The aim of this component was also to develop strong partnerships and linkages with community and government service providers to strengthen community capacity to improve health and wellbeing of the community.

The aim of key component 3 (Learning/modelling) was to deliver and consistently reinforce messages through diverse mediums and to strengthen the retention and application of learning by participants outside of the group.

The aim of key component 4 (Ongoing Support) was to identify and refer the young people most in need of support and to ensure that services were culturally appropriate to meet those needs.

Program delivery
The program integrated a suite of learning, personal development, team building and mentoring strategies to enhance the social and emotional well-being of participants. The model was founded on the belief that learning is most likely to occur in an environment where there is engagement between knowledgeable, respectful and respected educators and students in a safe, responsive, culturally appropriate and welcoming space. The recruitment of highly skilled and experienced project staff who were able to quickly develop relationships built on mutual respect was critical to the overall success of the project. All project staff identified as Aboriginal, Torres Strait Islander People or both and were well connected, well respected and well established within the region.

The program was designed for delivery over a six week period, with each weekly program running for two to three hours. By the end of the group program, participants would have had between 12 and 18 contact hours over the six week period. The first week focused on orientation: getting to know you and completing assessment measures, and the final week involved completing assessment measures, review, and a celebration of finishing the program.

As is culturally appropriate, male and female participants participated in the program separately. The groups were jointly facilitated by a male and a female project officer, with culturally sensitive material delivered by a same-sex facilitator.

Group topic areas included the following key features:
• Designed as a 30-minute block, with two sessions of content delivered each week over a four week period. Topic areas presented during the same week had thematic ties;
• Incorporated a number of interactive activities to assist participant engagement and retention of information;
• Interactive activities were crafted to tap into cultural learning styles and strengths;
• All activities involved a mixture of yarning, cultural DVD’s, individual and group activities;
• Group processes were designed to be flexible enough that sessions could be delivered in 30 minute blocks (one session per group) or 60 minute blocks (2 sessions per group). This would allow different delivery strategies for different attention spans;
• Activities developed for the groups were interchangeable;
• Each activity the group was engaged in was determined by the lead facilitator, based on participant commitment and interest levels. Where there was high participant enthusiasm, group SEWB content could go for longer than 60 minutes, and additional activities could be introduced;
• Transport was provided to participants to increase accessibility and safety, given the combined factors of afterhours programming, the geographic spread of residency, and independent access regardless of what other family members had planned; and
• A multi layered, reward system for participation and achieving milestones. Participants were provided with a $150 reward for successfully completing the program. This included, for example, gym membership, netball/football fees, sports uniforms/equipment; movie tickets, and pamper packs that promoted self-care.

Governance
High quality cultural governance ensured that the approach the project team took was consistent with Indigenous understanding of social and emotional wellbeing, help seeking, education and appropriate offers of support. Taking a cultural governance approach increased the commitment from the community for the project, and demonstrated the value that headspace Inala placed on the partnership, knowledge and wisdom of the Community, particularly of the Elders.

A Youth Advisory Group (YAG) was established that consisted of local Indigenous young people who were already associated with either headspace Inala, or were Future Leaders with the Inala Elders Suicide Prevention and Mental Health Program. This group participated in and provided feedback into the SEWB group program content, processes and approach to engaging with and supporting project participants.

Clinical governance of the project was provided by the headspace Inala Clinical Governance Advisory Group. Membership of this group includes team leaders from local tertiary mental health and alcohol and other drug services, clinical liaison officers and a local General Practitioner. This group oversaw the development of safeguards for participants, including risk assessment strategies and follow-up mechanisms for group participants identified as requiring extra support.

Service delivery model was based on a partnership approach.
The culture of the UHELP Program is respectful, non-judgemental and supportive. The mutually respectful relationship and positive regard reported between participants and facilitators was identified by both internal and external stakeholders as a critical success factor.

Skilled Facilitators.
Facilitators demonstrate a special skill set which combines respectful management of the participants and the ability to develop relationships with them, many of whom had traditionally had experienced great difficulties engaging with authority and trusting outsiders.

Use of appropriate and effective instruments and tools.
The use of the Westerman Aboriginal Symptom Checklist (WASC) as a psycho-social tool of engagement is regarded by project facilitators as an effective instrument for engaging with Indigenous Youth and for developing relationships between participants and facilitators. Participants also appreciated having this questionnaire (particularly because of its face validity) and headspace staff reported that high subscale scores were meaningful indicators of participants in need of followup assistance.

Provision of culturally appropriate counselling and culturally safe places.
The program provides and promotes the accessibility and acceptability of individual, culturally appropriate counselling for Aboriginal and Torres Strait Islander people at headspace Inala that is considered a culturally safe, appropriate, informed service. The significant increase in referral rates to headspace Inala since the UHELP commenced suggests the program has helped to generate the recognition that yarning at headspace Inala is a safe and culturally appropriate service, particularly as these increases have occurred in the context of client numbers at headspace Inala increasing overall.

Clinical and Cultural Governance.
Taking a Cultural governance approach increased the commitment from the community for the project, and demonstrated the value that headspace Inala placed on the knowledge and wisdom of the Community and in particular the Elders. It also demonstrated headspace Inala recognises that solutions to the challenges in headspace engaging with Aboriginal and Torres Strait Islander young people are best solved in partnership with the Aboriginal and Torres Strait Islander Community. Governance processes were designed to fit with existing community oversight structures, specifically, the Suicide Prevention and Mental Health Program (SPAMHP) community meetings and Inala Elders’ Steering Committee meetings, as well as involvement of appropriate partners such as the Inala Clinical Governance Advisory Group.

Involvement of multiple stakeholders.
UHELP project stakeholders had a shared vision and a similar mandate and worked together to the mutual benefit of Indigenous young people and the community. By sharing knowledge, resources and expertise, the capacity of all partners was strengthened and a new soft entry experience was established for vulnerable young people in the Inala region.

The SPAMHP and Youth Advisory Group informed, guided and provided feedback on all aspects of the program in the establishment, implementation and evaluation phases. These partnerships were built on a two-way flow of information and reported back and enabled UHELP to be quickly established as a credible, culturally effective program for young Aboriginal and Torres Strait Islander people in the Inala region.

An independent internal evaluation identified that the UHELP program successfully improved the knowledge and understanding of SEWB and help-seeking in youth in the community, increased the capacity of youth to respond appropriately to suicidal behaviours, increased the acceptability and accessibility of culturally appropriate counselling (yarning) throughout the community, and fostered fruitful collaboration between headspace Inala, the local community, and other related organisations.

The UHELP program invested in creating a culturally safe and appropriate learning space and offered an intensive six week integrated program of physical, social and emotional wellbeing activities and support to participants. Independent analysis confirmed that the project goals were achieved and participants and other stakeholders provided anecdotal evidence of significant improvements in wellbeing, attitudes, behaviours and personal resilience.

The evaluation found that the UHELP program:
• statistically significant decrease in self-reported suicidal thinking among participants immediately following the group program (as measured by the GHQ-suicide);
• improved the social and emotional wellbeing of program participants.
• enhanced participants understanding of physical, psychological, emotional, preventative and social health
• improved self-confidence, self-management, self-awareness, sense of belonging and a sense of empowerment
• supported a marked increase in the number and effectiveness of coping strategies.
• reduced levels of anxiety, psychological distress, depression and impulsivity and improved levels of self-confidence and self-esteem (confirmed through psychometric testing)
• participants demonstrated skills to manage stress, to take responsibility for their attitudes and behaviours and to respond more constructively to life’s challenge
• significant reduction in stigma associated with acknowledging self-harm behaviours and seeking help
• improved citizenship and engagement of participants in community life, increased social engagement, civic responsibility and reciprocity and supported the emergence of leader skills. Graduates of the Program emerged as new leaders in the community, both in their participation in a Youth Advisory Group (YAG), becoming Suicide Prevention and Mental Health Program (SPAMHP) future leaders, and through the modelling of socially responsible behaviours.

The UHELP Project met its key aims including actively engaging Aboriginal and Torres Strait Islander young People in physical, social and emotional wellbeing activities through a three tiered holistic group program. It also aimed to engage young Aboriginal and Torres Strait Islander People in need of mental health intervention into a health care service using established relationships and a culturally valid and appropriate system of care. In total, seventy five young people aged between 12 and 25 years participated in nine programs which were delivered over a 12 month period from October 2013 to September 2014. Eighty one percent (81%) of participants completed the full six week program.

The UHELP Program rated very highly as strong evidence of effectiveness and practice. It is an important example of a culturally based approach within a mainstream mental health service setting that was able to link vulnerable Aboriginal and Torres Strait Islander young people with each other, with support services and with their communities. By delivering a range of activities and investing in the development of relationships the program addressed cycles of isolation, juvenile offending and dysfunction, and enhanced the social and emotional wellbeing of participants.

UHELP is an example of ways to support more resilient and engaged young people. One of the critical elements of the program is getting young people to be proud of their Aboriginal identity and identifying how they belong to their community. By investing in the development of personal relationships and strengthening connections between young people, their families and their communities, UHELP enhanced the development of feelings of trust, safety, belonging and the sense of connection to community for participants and the Elders involved with the program.

Contact Us

School of Indigenous Studies, University of Western Australia

39 Fairway, Nedlands, WA 6009.

cbp.clearinghouse@uwa.edu.au 

+61 8 6488 1570

Acknowledgement of Country:

We acknowledge and pay our respects to the traditional custodians of the land we live and work on, the Wadjuk people of the Noongar nation, and their Elders past, present and emerging. We also wish to acknowledge and respect the continuing culture, strength, and resilience of all Aboriginal and Torres Strait Islander peoples and communities as well as our Indigenous members from other parts of the world.

Disclaimer:

“The terms ‘Aboriginal’, ‘Aboriginal and Torres Strait Islander’ and ‘Indigenous’ are used interchangeably. It is acknowledged that there are many cultural differences between and within Aboriginal and Torres Strait Islander communities and the use of differing terms does not intend to disregard such differences.” © Copyright 2018