Postvention

Postvention2019-06-20T15:47:30+08:00

Suicide Story (Alice Springs, NT)

Suicide Story is a three-and-a-half-day suicide prevention program created for use in Aboriginal and Torres Strait Islander (hereon Aboriginal) communities by Aboriginal people who live and work in remote communities. The workshop is structured around nine topics which are covered in an accompanying DVD and target community-based helpers.

Link to Suicide Story web page

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

Suicide Story was developed by the Mental Health Association of Central Australia (MHACA) in partnership with a Suicide Story Aboriginal Advisory Group. The latter consisted of Aboriginal people from remote communities in the central Northern Territory (NT) who ensured the cultural appropriateness of the program. Under the Suicide Story umbrella, workshops are delivered by trained local Aboriginal facilitators. A local and culturally specific approach is used to guide participants through the process of understanding suicide and reducing the associated stigma so that they can effectively identify and respond to the signs of an impending suicide attempt in a family member or friend. This approach respects the unique needs and issues within each community.

Suicide Story was launched in March 2010 and funded by the NT Department of Health and Families and the NT Primary Health Networks to support healthcare workers and Aboriginal people living in remote communities. Suicide Story is a prevention-oriented program and responds to requests from communities using a capacity building approach. Suicide Story was adapted from the MHACA, Life Promotion Program (LPP) which delivered ‘gatekeeper training’ to healthcare workers and Aboriginal people who might encounter people at high risk of suicide. A two-day Applied Suicide Intervention Skills Training (ASIST) workshop was used in the NT in 2001 and was consistently in demand among those working in the community healthcare 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 related service providers, the LPP team began to further develop this resource and the style of training to tailor to the needs of Aboriginal people. Suicide Story was created.

Utilising a community development and action research approach, Suicide Story is a community suicide awareness and prevention training program which is developed, led and delivered by and for central Australian Aboriginal people. 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 extensive feedback from facilitators and participants.  A Suicide Story Aboriginal Advisory Group has been maintained to ensure ongoing cultural safety and the integrity of storytelling throughout the Program. This has optimised its effectiveness and ability to be applied in multiple communities and to multiple language groups. A key message to participants is that there are no right or wrong answers.

The program incorporates a DVD composed of short films that feature the voices of Aboriginal people, combined with animation, artwork, music, pictures and posters to generate scenarios, conversations and discussions. The DVD focuses on nine topics relevant to suicide, and accompanies nine modules that are completed over the three-and-a-half-day program to address the following questions:

  • Should we talk about suicide?
  • Why is suicide a problem in Aboriginal communities and how big is the problem?
  • What leads people to think about suicide?
  • How do I recognize a person at high risk of suicide?
  • What can families and community members do to help protect their community from suicide?
  • What gets in the way of helping?
  • What are good ways to support people at high risk of suicide?
  • How might people heal after the death of a loved one by suicide?
  • How can we keep the helper safe?

Core elements of the program are:

Listening … sharing … learning
By listening, sharing and learning from the stories of Aboriginal people, a relevant contextual picture of suicide is developed. 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.

Local artwork
In 2006, women from the remote community of Santa Teresa painted two banners for World Suicide Prevention Day which portrayed a local understanding of some of the causes of suicidal behaviour and some of the ways to care for people who display suicidal behaviour. This artwork and the associated story remind participants that Suicide Story is about ‘raw and real’ experiences. It is based on the premise that the best way of reducing the rates and pain of suicide for Aboriginal people is to guide them to understand their own experience and to bring to them new learnings in the best possible way.

A culturally sensitive approach
Suicide Story provides a culturally sensitive approach to understanding the issues surrounding suicide. It recognises the importance of learning through sharing stories and sharing knowledge through recognisable symbols, images and language in Aboriginal communities. The program uses a collaborative approach that allows community members to work with service providers in a culturally safe space.

The program’s mission is to target suicide by empowering local facilitators. This can be achieved by increasing the skills, knowledge and confidence of participants to work with at-risk people. In turn, local facilitators can work to improve the health and wellbeing of Aboriginal people in remote communities of Central Australia and restore their hope for the future.

The objectives of Suicide Story are to:

  • Deliver Suicide Story only within communities where Elders have formally requested the program and then, only if the community is considered ready for change
  • Deliver suicide prevention workshops in remote regions of the NT free of charge and to interstate workshops for a service fee
  • Accommodate varying levels of English literacy and different ways of learning among program participants
  • Empower adults in remote Aboriginal communities with the tools to identify the warning signs of suicide
  • Increase participant awareness of the problem of grief and trauma in their communities and to understand how this has been impacted by historical and social factors
  • Debunk the myth (especially among some Elders and smaller communities) that suicide threats, especially by young people, are ‘just kids mucking up’
  • Refer members of the community who seek extra and/or ongoing resources to the relevant provider(s)
  • Overcome the lack of understanding of some communities about the pain some people experience, especially in the smaller communities and homelands where fewer people have experienced suicide first-hand
  • Identify and support networks of appropriate people within traditional communities who would like to undergo training and work in their own regions/communities
  • Work with the community to identify the issues, the requirements and how this can be achieved within the context of service providers and existing programs
  • Encourage service providers to attend workshops to increase their capacity to identify the warning signs of suicide
  • Explore impulsive suicide, suicide as a threat, along with blame and payback in Aboriginal people within a cultural and local context
  • Explore the history of social injustice and legislated change and the consequent losses which pertain to current suicide issues in Aboriginal communities
  • Examine issues around traditional language and skin groups and whether transgressing traditional systems exacerbates suicide rates and impacts the availability of resources for the transgressors.

The DVD helps participants to realise that there are many Aboriginal people who are willing to ‘talk up strong on suicide’ because of family members lost to suicide. From March 2017 to June 2018, Suicide Story delivered workshops to 141 participants. Each year, six workshops are delivered in the NT: two in the Top End and four for Central and Barkly regions. On average, around 20 people attend each workshop.

Pre- and post-evaluation of workshops are conducted with participants to enable them to self-evaluate its impact. The participants’ feedback about the workshop informs the structure of future workshops. This feedback is also incorporated into the wider evaluation of the program.

In 2017, Suicide Story was the winner of a LiFE Award for Excellence in Suicide Prevention in the Aboriginal and Torres Strait Islander category1. The program was recognized for the strong collaboration of developers with the Suicide Story Aboriginal Advisory Group to develop a curriculum. The program evaluation stated that 97% of participants gained skills to identify the warning signs of suicide and 98% stated that the workshop ‘strengthened their fire’ to support suicide prevention in their community1.

In a review of mental health and suicide prevention services, the Northern Territory Mental Health Coalition described Suicide Story as an example of an invaluable prevention resource which required long-term and secure funding2. Reviewers expanded with an explanation of how Suicide Story aimed to reduce the need to remove people at risk of suicide from their community by providing local people with the skills, confidence and ability to deal with attempted suicides or suicide ideation2.

An evaluation3 published in 2012, used a qualitative methodology with a triangulated approach, with direct observations of two workshops, along with focus groups and semi–structured interviews to provide feedback from participants. Results suggested that Suicide Story increased participants’ knowledge and confidence to respond pro-actively to a person contemplating suicide. This success was attributed to a strong and strategic approach to implementation, which included delivering the DVD within a suicide prevention workshop and employing local cultural consultants and Aboriginal people to implement the program3.  In another evaluation4, Suicide Story was described as improving the evidence base and understanding of suicide prevention, building individual resilience and the capacity for self-help, improving community resilience and capacity in suicide prevention and implementing a high standard in suicide prevention.

As a case study in an meta-evaluation5, Suicide Story was rated very highly with an overall score of 90%. Comments included the outcomes of increasing participants’ knowledge and understanding of suicide, its employing of local consultants and Aboriginal staff and the embedding of the DVD within a three-and-a-half-day program5.

Suicide Story builds strength and capacity in Aboriginal communities and resilience in individuals and families. Specifically, it promotes participant capacity to initiate, plan, lead and sustain strategies to promote the awareness of suicide risk and subsequent prevention plans within a community.

Suicide Story also provides materials and resources which address the needs of Aboriginal peoples in diverse community settings. This program also provides culturally appropriate community activities that engage youth, build cultural strengths, leadership, life skills and social competencies, resulting in life promotion and resilience-building. Suicide Story also builds 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 families and children. Suicide Story also offers a coordinated approach through multi-sectoral co-ordination across levels and sectors of government and supports regional and local co-ordination 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. There are also strong partnerships between services, agencies and communities.

Suicide Story demonstrates high standards in suicide prevention. There is a comprehensive plan to develop and support the participation of Aboriginal people in the suicide prevention and wellbeing workforce with a focus on community engagement, cultural 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 reflective practices. The program is able to be flexible, dynamic and accommodates different learning styles, languages, traditions, issues and levels of readiness. It is designed using logic and an approach that adheres to culture, a local approach by local people, and a respect for Elders and Aboriginal spiritual and cultural values.

Finally, the program strongly aligns with the guiding principles of the CBPATSISP Evaluation Framework. It emphasises the need to ensure the representation of 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 and the ways in which the Suicide Story team can co-ordinate their work with the existing infrastructure within their community. This allows the program to address more pressing concerns that are specific to a community and advocate for any identified gaps in service.

  1. Suicide Prevention Australia. 2017 LiFE Award Winners for Excellence in Suicide Prevention Brisbane, Australia2017 [Available from: https://www.medianet.com.au/releases/139369/ accessed 2019 June 6.
  2. Northern Territory Mental Health Coalition. Mental Health & Suicide Prevention Service Review, 2017.
  3. Lopes J, Lindeman M, Taylor K, et al. Cross cultural education in suicide prevention: Development of a training resource for use in Central Australian Indigenous communities. Advances in Mental Health 2012;10(3):224-34. doi: 10.5172/jamh.2012.10.3.224
  4. Evaluation of suicide prevention activities: Suicide Story Train the Trainer 2014 [Available from: https://www.health.gov.au/internet/publications/publishing.nsf/Content/suicide-prevention-activities-evaluation~Appendices~appendixa~project43 accessed 2019 June 6.
  5. Healthcare Management Advisors. Suicide Prevention in Aboriginal and Torres Strait Islander Communities: Learnings from a meta-evaluation of community-led Aboriginal and Torres Strait Islander suicide prevention programs. 2016. https://www.atsispep.sis.uwa.edu.au/resources.

United Health Education and Learning Program – UHELP (Inala, QLD) 

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.
• 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.
• 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

Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention

School of Indigenous Studies, University of Western Australia

cbp.clearinghouse@uwa.edu.au 

+61 8 6488 6926

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