Learning lessons on suicide prevention

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In most developed countries, more people aged 15 to 44 years old die by suicide than by any other means, despite most suicides being preventable.

This tragic conundrum has led to a growing role for research(ers) to provide breakthrough insights and evidence of what ‘works’ in reducing suicide rates.

There was a step change in Australia around 2013-14, for a number of reasons. Many advocates were becoming stronger voices and forming alliances with researchers. The Suicide Prevention Australia (SPA) body was led by CEO Sue Murray, who now heads the new Zero Suicide Institute of Australasia. A National Coalition for Suicide Prevention was formed, with key stakeholders coming together in a ‘collective impact’ approach.

Research had a higher profile, with more emphasis on impact. Increasingly, research was being published, showing which groups were most at risk – Aboriginal and LGBT people, and farmers.

Some research shocked. Public health data showed that one in four of those who died by suicide each year had accessed ‘the health system’ in the 90 days before their death. This led to more calls to improve ‘the system’ and better support people – including after discharge from hospital – to keep them alive.

Each year, 50-60% of those who die by suicide are known to health professionals, mainly because of a history of mental ill health. The most ‘at risk’ group are those who have made a suicide attempt; they need intensive support around them. But others questioned what happened to the 40-50% of people who take their own lives with no previous history of mental ill health and no prior contact with the health system?

These people are often fine one day, in crisis the next. It can happen to anyone. The data can read like a random distribution. People lose their jobs, their relationships break down, they lose access to their children, they have financial crises, pressure at work, a crisis of identity… and they see suicide as ‘the only way out’.

It was agreed that additional work was needed here, with more innovative ways of identifying and supporting those who suddenly reach crisis point.

A particularly influential piece of research was carried out in 2006 by Griffith University for Mates in Construction that has now won many awards for its pioneering suicide prevention work. This research showed that construction workers are six times more likely to die by suicide than in accidents at work, and apprentices nine times more likely – but almost all policy, funding, regulation and workplace training is focused on physical health and safety, not mental health and safety.

Another key driver focused on workplaces was insurance companies realising that 50% of their workplace compensation claims were now mental health related.

What focuses the mind more than anything, however, is when the numbers go up. When the figure for deaths by suicide are stable or appear to be declining, interest wanes – but a rising suicide rate grabs attention.

Much has been achieved in Australia since 2013-14. I facilitated the stakeholder engagement process that led to the National Suicide Prevention Research Fund being established, with seed funding of $12m from the Department of Health. This has now flowed through to Australia’s first National Strategy for Suicide Prevention for 2020-25.

So, there’s been great success, but concerns, too: clinicians’ predictive risk-assessment tools proving to be harmful not helpful; the growing ‘suicide prevention sector’ becoming more focused on activity than outcomes; and institutionalised thinking settling for low ambition – for example, a 10% reduction rather than a zero-suicide goal.

Most significantly, suicide numbers have only fallen 2.5% according to the latest figures for 2017-18, despite more funding and activity than ever. That’s better than the 12% increase in the UK for 2017-18, however. So, what lessons can be learned from the Australian experience?

• Make sure there’s accurate data on deaths by suicides, suicide attempts and risk groups (for example, consistent reporting of deaths, regular surveys to measure incidence of attempts) so policy and action can be targeted and have impact
  
• Scrutinise this data, along with qualitative research, to understand it fully – for example, engaging with people who have ‘lived experience’ of suicide to guide policy and action
  
• Develop evidence-based policy, but seek innovation too, to have more of what is known to ‘work’ in reducing suicide rates and to look for breakthrough ideas for more substantial reductions in the numbers
  
• Find ways to share what ‘works’, both established and breakthroughs, and continue to monitor and evaluate
  
• Undertake population-level research, which can have impact by identifying risk groups, but also find ways to communicate at an individual level, as saving lives requires individuals to be identified and supported
  
• Develop top-down, whole-government, policy solutions and systems-based approaches across healthcare, education and employment that have the potential to reduce suicide rates significantly
  
• Develop bottom-up, community-based, solutions, with appropriate and effective community and stakeholder engagement, which have the potential to reduce suicide rates substantially, and move us towards the zero-suicide goal
  
• Avoid being ‘captured by the system’ – becoming an institutionalised player in the system; focusing on (your own) activity rather than prevention (of deaths by suicide); being driven by funding streams; thinking that ‘more money’ is the answer; ‘settling’ for 10% reduction.

Paul Vittles is a fellow of the Market Research Society, who has returned to the UK after almost 15 years in Australia

If you have been affected by the issues raised in this article, please seek help. Samaritans: 116 123

This article was first published in the January 2020 issue of Impact.