SUICIDE PREVENTION IN AUSTRALIA – TOWARDS ZERO

With pandemic lockdowns and uncertainty, growing numbers of Australians experienced mental health problems while, even before the pandemic, youth suicides continued to be a growing concern. Significant reforms have occurred in Australia in the area of suicide prevention and it is agreed that an all-of-government response is required. What can be done? What is being done? Why is there a crisis in mental health at all? The Hon David Coleman MP is the Assistant Minister to the Prime Minister for Mental Health and Suicide Prevention addressed The Sydney Institute in a Zoom meeting on Thursday 9 September 2021 to review what can be done and is being done.

SUICIDE PREVENTION IN AUSTRALIA – TOWARDS ZERO

DAVID COLEMAN

Before I begin, I’d like to acknowledge the Traditional Owners of the lands on which we all meet and pay my respects to Elders past, present and emerging.

It’s great to be back with the Sydney Institute. Although there’s nothing quite like meeting in person, it’s important to maintain some form of connection, in any way we can. So, thank you to the Institute for keeping debate alive during what is an incredibly hard time – but also an incredibly important and historic time for public policy in Australia.

And thank you for helping me draw attention to the critical issue of suicide prevention.  It’s particularly important as tomorrow is World Suicide Prevention Day.

In the past, we haven’t talked about this topic enough And, by the past, I mean over centuries. Our modern discussion of suicide is something that’s really quite new. The same goes for mental health generally – simply talking about it is new. It’s a key point to start with. The historic lack of discussion about suicide and mental health created a negative legacy that we’re still dealing with and will be for some time. Because you can’t address an issue properly if you aren’t willing to talk about it.

Nobody’s ever been ashamed to admit that they have a cold, or a sore tooth.  But with suicide and mental health, silence – or worse – has been history’s default position. There are still differences in the treatment of physical and mental illnesses.  Stigma still exists.  But things are getting better.

Young people, in particular, feel much more comfortable talking about mental health than previous generations. It’s now socially unacceptable to make light of mental illness – a fairly recent phenomenon. And we talk about suicide, too. And in talking about it, we learn so much. Why it happens. And how best to support people whose lives are at risk.

Having said that, suicide is never easy to discuss. In fact, it can be incredibly hard. Especially for those who have been personally affected. So, I would like to make an acknowledgement here at the beginning of my address that should the themes bring on any level of distress …first of all, that’s okay. It’s a normal response. And second of all, if you do need help, please reach out. That could be to Lifeline on 13 11 14, or the Suicide Call Back Service on 1300 659 467, or simply by talking to someone you trust.

My message to Australians throughout the pandemic has been a simple one: “it’s ok not to be ok.” Covid has led to disruption to the lives of millions of Australians. While lockdowns have been necessary, they are very damaging. Extended lockdowns grate against our deepest instincts – as humans, we weren’t born to sit around. People feel isolated, kids miss their friends, relationships are under strain, and financial pressures are very real. And even when lockdowns aren’t in place, Covid has cast a shadow over our communities.

We’ve seen an increase in calls to Lifeline over this period. There’s been an increase in paramedic callouts to people experiencing suicidal thoughts. And an increase in Australians engaging in self-harm. So people ask, what does this mean? What can be done?

While we have seen elevated levels of distress and suicidal crisis in the community during the pandemic, at this stage there is no evidence of an overall increase in suicide. But we do see more people reaching out, all the time. That means a big part of our job is to ensure when those people do come forward, the system they’re met with works. I’ll be going into what this looks like a little later on.

First though, I wanted to look back through our history to see what we can learn from understanding the rate of suicide over time. The Australian Institute of Health and Welfare keeps data on suicide reaching back to 1907, primarily from Coroners reports.  That is a substantial and important data set.

Over that more than a century of data, to me two key points stand out:

• In every single year since 1907, the rate of suicide has been higher among men than women
• The rate of suicide in 2019, at 12.9 per 100,000, was slightly lower than the average rate across the entire period

Across the 114 years for which we have data, the rate of suicide for men was roughly triple that of women.  In 2019, the rate of suicide for men was also roughly triple that of women. Women, however, account for the majority of the estimated 65,000 suicide attempts each year.  Women are more likely to engage in self-harm and attempt suicide than men.

The overall 2019 rate of suicide was lower than the century’s average, but it was higher than in recent years.  In 2006 the rate of suicide was 10.2 per 100,000 population, in 2019 it was 12.9. While it is not straightforward to determine the reasons why the rate of suicide has changed over time, it is notable that the highest ever rate among men was recorded in 1930, at the height of the Great Depression.  Another spike in suicide rates happened in the late 1980s and early 1990s, which, again coincided with a period of high economic uncertainty.

We want to drive the suicide rate down towards zero. With the right public policy settings, we can absolutely save lives. We need to think about suicide prevention policy in the same way we have addressed other major policy interventions in the past.  We know these interventions can work. In 1991, 25 per cent of Australians smoked daily.  Now it’s less than 12 per cent. Another example – and a shining light in focused public policy – is the decades-long effort to bring down the road toll.

All states have made great efforts in this area, but as this is The Sydney Institute let’s talk about New South Wales. In 1970, 1,300 lives were lost on NSW roads.  Half a century later, with a much larger population, 352 lives were lost in 2019. Governments have focused in relentlessly on the highest risk factors on the road From seat belts, to better road design, to random breath testing, to smarter speed limits, to public campaigns on the dangers of fatigue – all of these efforts have zeroed in on one goal: reducing the road toll.

And it’s worked.

Building on this success, New South Wales is now seeking to reduce the road toll right down to zero. We need to be just as focused in our efforts to reduce the rate of suicide to zero.

The truth is that suicide is multi-faceted and complex, and there’s an almost infinite range of factors that can play a part in a person’s decision to take their life. Establishing a direct causal link between specific factors and a suicide isn’t always possible. Because the potential factors are so broad, it can be hard for policy makers to zero in on the best approach to take.

The breadth of factors means that, in a sense, there is no “wrong answer” when it comes to addressing the rate of suicide. But this breadth of potential responses is in itself a risk, because we need to focus to have an impact. As with other sustained policy efforts such as in road safety and smoking, we need to identify the biggest risk factors, and relentlessly focus on addressing them. That’s what we will be doing.

We’re fortunate to have recent, high quality reports on this most important issue. From the Productivity Commission, and the National Suicide Prevention Adviser last year.  And the Victorian Royal Commission earlier this year. And from the Australian Institute of Health and Welfare, which maintains very deep and useful data.

Again, it is important to note – suicide is complex. But there are some things we know for sure.

• We know that men are much more likely than women to take their life, and that this has been the case for more than a century, and women have higher rates of ambulance attendances and hospitalisations for self-harm and suicide attempts
• We know that for both women and men, there are two factors that are most often present in situations where people take their lives. The most commonly identified risk factor for both males and females is a personal history of self-harm. The next highest risk factors, for both males and females, are relationship breakdown, including separation and divorce, and problems in relationships with a spouse or partner.
• And we also know that people in rural, regional and remote Australia have a much higher suicide rate than people in metropolitan Australia.

Australia is divided up into 31 Primary Health Networks (PHNs), which help to deliver local health services. Every single Primary Health Network area outside of metropolitan Australia has a higher share of suicides than its share of population.  Every single one.

These issues must be at the absolute core of our efforts to reduce the rate of suicide. The high level of male suicide – something that we know has continued for more than a century – must be brought down.

We must do a better job of reaching women in distress before a crisis leads to a suicide attempt. We must do everything we can to help people with a history of self-harm, and people going through relationship distress. And we must respond to the specific issues facing rural and regional Australians, to bring down the high rates of suicide that we consistently see outside of our metropolitan centres.

Of course, there are many other important issues that also need to be addressed. We need to ensure we place particular emphasis on helping groups who have higher rates of suicide than the population as whole, such as the LGBTIQ community. We are already taking many steps to address these issues.

As I said earlier, we haven’t seen an overall increase in the rate of suicide since the onset of the COVID-19 pandemic. But we do know that sometimes, traumatic events can bring a delayed effect, so we are very focused on this issue. And we have seen an increase in rate of mental distress in the community. It’s why we’ve prioritised getting immediate help for those most at risk. We’ve set up new pop-up Head to Health clinics in lockdown affected areas of Sydney and across Victoria.

Ever since the pandemic began, we’ve heeded the advice of experts like Christine Morgan, Chief Executive of the National Mental Health Commission, and Dr Ruth Vine, Deputy Chief Medical Officer for Mental Health, and delivered more than half a billion dollars in direct mental health supports.

In the Budget we allocated a record $2.3 billion to new initiatives in mental health, including a major investment in suicide prevention programs. As part of our $2.3 billion investment in the Budget, we committed $159 million towards universal aftercare in Australia. Aftercare is about providing ongoing support in the community to people who have been discharged from hospital after a suicide attempt.

The Productivity Commission found that only about 50 per cent of Australians who are discharged in this situation receive follow up care in the community. It should be 100 per cent, as we know that a history of self-harm is one of the highest risk factors for suicide.

We want to work with the states to make aftercare universal. In addition, we’ve committed substantial funds to national suicide prevention activities. Soon, organisations will be able to apply for funding to run suicide prevention initiatives across the country. A total of $114 million will be available to support suicide prevention programs. We need to ensure that every dollar of this investment is targeted at where it will have the most impact.

Through this grant program, we will be looking for programs that build and increase the capacity of communities to prevent and respond to suicide, and that support targeted responses at the local level. We will also be increasing suicide prevention programs in indigenous communities, and in the Budget we announced a further $79 million in funding for this important priority. Indigenous Australians have high rates of suicide, and this investment aims to drive down that rate. We also announced in the Budget that we will be creating a National Suicide Prevention office, to drive suicide prevention activities across government.

But there’s more to do.  A lot more to do.

Our goal of reducing suicide towards zero is very ambitious.  It will require great clarity of thought, and precision in implementation. Under our federated system, both the Commonwealth and the states and territories have a very important role to play. One of the Commonwealth’s key touchpoints is through Australia’s 31 Primary Health Networks, or PHNs. PHNs are designed to improve coordination of care, with a particular focus on mental health. We need to ensure that PHNs are focused every day on the biggest suicide risk factors in their community, and that they work every day to address those risks. The sharper and more efficient we are in targeting our efforts at the biggest risk areas, the more lives we can save.

Over the past four years, the Commonwealth has overseen 12 Suicide Prevention Trial Sites, run through our PHN networks. In each of these sites, we’ve funded PHNs to deliver locally-informed suicide prevention initiatives.

Earlier this year, the Black Dog Institute published their assessment of the impact of these 12 Trial Sites. And what they found is that this approach has great potential to save lives. Not everything in the Trials has been perfect.  But there is much from which we can learn. With time, and with sustained support from government, these kinds of interventions will save lives.

We know that locally-led, tailored solutions can work. We need to engage all PHNs in this work and make sure they have the tools they need to drive down the suicide rate in their area.  Part of that task is improving the access to real-time data for each PHN. PHNs should be aware of the level of suicide in their communities at all times, so that they can respond in real time to the needs of those communities.

Today, that information is often not available until well after a suicide has occurred.  We need to fix that. We are working more closely than ever before with the states and territories on suicide prevention policy. At present, we are working on a national agreement with the aim of aligning our strategies and pursuing a joint effort on this most critical of issues. It’s the right thing to do, because a more focused, integrated system will be a better system which saves more lives. There is a great deal of goodwill in these discussions, and I am looking forward to continuing to work closely with the States and territories.

Before I leave you, and in acknowledgement of World Suicide Prevention Day tomorrow, I want to pay tribute to Australia’s mental health and suicide prevention workforce. It’s not an easy job. It puts you in situations that can be very distressing. It can be emotionally draining. And it can be frustrating, too, if you feel the system isn’t working as well as it could be.

But it’s an incredibly important job.

What could be more important than working every day to save lives?  Historically, these roles have been under-appreciated.  Because society didn’t talk much about mental health and suicide prevention, we didn’t talk much about the heroic efforts of people who work in the field. But we should. And we will.

So, thank you to everyone who is working right now to help our fellow Australians in this most crucial of areas.

We have discussed some difficult topics tonight, but they need to be discussed.  We have much to do in this area, and historical bias to overcome.  But by doing the hard, focused, practical work that we need to do, I am confident that we can drive the rate of suicide in Australia towards zero.