Every eight minutes someone in Australia attempts suicide.
It’s a stark and confronting fact that each year 65,000 people in Australia will try to take their own life; 35,000 of them will be hospitalised for suicide-related injuries.
2,500 will die.
Suicide is the most common cause of death in Australians aged 15-44. Young Australians are more likely to take their own life then die from motor vehicle accidents.
The personal toll on loved ones, friends, work colleagues is incalculable.
While there are no widely accepted, reliable estimates of the financial cost of suicide nationally, the Australian Bureau of Statistics and Australian Institute of Health and Welfare have calculated the economic cost of suicide and suicidal behaviour on the Australian community is $17.5 billion a year.
Despite these terrible statistics, funding for suicide research from traditional sources such as the National Health and Medical Research Council is low.
A 2011 report by Helen Christensen, who heads Wells Haslem
client the Black Dog Institute, and others, established that suicide and self-harm research funding per disability-adjusted life-year1 had not increased between 2001 and 2009, and it received the lowest level of investment compared to other mental health categories.
Australia is not alone.
A recent report from the science journal, Nature, reported that “government should invest as much in suicide prevention as they do in reducing fatal road accidents. In 2008-2009, UK spending on road-safety awareness, including television advertisements, topped £19 million; by contrast, £1.5 million was invested over three years in suicide research. Fatal road accidents have declined steadily over the past decades, whereas suicide rates have levelled or even increased.”2
Wells Haslem is helping the Black Dog Institute advocate a new approach to suicide prevention to the Federal Government.
The Black Dog Institute, based at the University of NSW, was founded in 2002 and is a world-leader in the diagnosis, treatment, and prevention of depression, bipolar disorder, and suicide.
It focuses on the rapid translation of quality research into improved clinical practice, increased accessibility for consumers, and delivery of long-term public health solutions.
The Institute argues that in addition to the lack of funding into suicide research, there are three other major reasons Australia is failing to reduce suicide rates.
First, and most importantly, the major stumbling block to reducing suicide is the lack of an agreed program of action to reduce suicide rates. At present, there is no evidence-based rationale for distributing funding. A range of initiatives is funded, with little consideration or concerted effort.
Second, the approach taken by the Australian Government to lower suicide rates, while laudable, is not optimal.
This year an Australian Healthcare Associates review of the 49 activities funded under the National Suicide Prevention Program and selected elements of the Taking Action to Tackle Suicide package, found that many of the suicide prevention activities were not sustainable.
The report called for a stronger role for the Australian government in “setting and disseminating the policy agenda” and “improved coordination, facilitation and funding of strategic, translational research that addresses the key evidence gaps in suicide prevention”.
Third, Black Dog argues, there is “very little investment in suicide prevention for the size of the problem, and certainly not when compared to costs of reducing other forms of injury”.
There is an alternative approach.
International experience demonstrates that the best suicide-prevention response may be gained from a multi-level, multifactorial, systems-based approach.
This recognises that suicide prevention involves both healthcare systems and community approaches.
It also involves buy-in from Industry and people who have been directly or indirectly affected by the suicide of someone they know.
A systems approach requires that each system involved must move in concert with other systems to put all evidenced-based interventions into action simultaneously.
This includes both public health and health care systems.
Taken together, these changes reflect a revolution in policy and practice. They suggest that suicide can be prevented, and that suicide prevention is an achievable goal.
Black Dog argues that this “is a case of the whole is greater than the sum of the parts, and implementation of all strategies simultaneously has not been tried in Australia”.
Examples of strategies in the hospital setting include keeping accurate health records that can be data mined to better predict suicide; specialist medical teams able to assess suicide attempts; assessments of patients by qualified specialist practitioners; brief treatments or interventions before people are discharged from Emergency Departments; inpatient Cognitive Behavioural Therapy for people admitted to hospital; hospital building design to reduce access to means to commit suicide; and suicide literacy and materials addressing stigma for hospital staff about developing positive attitudes towards people who attempt suicide or self-harm.
Community mental health services could include 24/7 call out emergency teams experienced in child/adolescent suicide prevention, while at Medicare Locals GPs could be better trained in the detection of suicide complemented with training in Cognitive Behavioural Therapy and Dialectical Behaviour Therapy from psychologists and psychiatrists.
The NGO sector also has a major role to play in a systems approach via crisis call lines and chat services for emergency callers; e health internet-based programs; and community education around the nature of suicide stigma.
At schools, teachers and other staff would receive gatekeeper training, which equips them with skills to identify people at high risk for suicide and then to refer those people for treatment.
Local Councils can reduce suicide risk through better planning such as building fences to prevent people jumping off bridges and promoting awareness of programs to assist people at risk of suicide.
The Black Dog Institute acknowledges that many of these strategies are used in Australia. However, no attempt has been made to combine these strategies through communities and health systems in local areas, simultaneously.
The Institute has asked the Federal Government for funding to run four pilot studies (one in each of inner city Sydney and Melbourne and one in each of regional NSW and regional Victoria) to demonstrate that the systems approach can be successful in lowering suicide rates in Australia.
The studies would test the hypothesis that a systems-based approach will lower suicide rates and attempts 20 per cent in 24-48 months.
Suicide is a complex behaviour, with a range of causes and triggers, which vary between individuals and communities.
The Black Dog Institute argues that if Australia continues a fragmented approach, funding diverse projects, many of which are not specifically aimed at suicide prevention, fail to prioritise interventions with proven effectiveness, and ignore the opportunity now to integrate across community and health systems, suicide rates will continue to rise.
1 The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the cumulative number of years lost due to ill-health, disability or early death
2 Aleman & Denys (2014). Mental health: A road map for suicide research and prevention. Nature
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