The path to suicide prevention
Care of people who may be suicidal can literally make the difference between life and death. Taylor Fry’s recent review for the NSW Agency for Clinical Innovation looked at the evidence for several aspects of suicide prevention care, and will help inform government towards setting standards of care for people at risk.
Nine Australians die every day by suicide – that’s more than 3,000 people a year. For each death by suicide, it’s estimated more than 30 suicide attempts are made. Suicides and suicide attempts have long-lasting impacts on families, friends, colleagues, communities and societies.
Suicide is preventable but complex
It’s now recognised that suicides are preventable and there are measures organisations, society and individuals can take to prevent suicides and suicide attempts. Yet despite all we know, suicide prevention remains complicated, partly because the factors leading to suicide are complex and varied. A recent initiative by the UK charity Campaign Against Living Miserably, for example, shares the last photos ever taken of people who took their own lives, smiling for the camera as if nothing is wrong.
In Taylor Fry’s rapid review for the NSW Agency for Clinical Innovation, we looked at a range of research and evaluation evidence on suicide prevention programs in Australia and around the world. This will assist the government in making decisions on policy standards that support the identification, assessment and management of people who may be suicidal in all care settings in NSW.
What the evidence tells us
While the review found robust research and evaluations on some practices, we found a critical need for more rigorous sources of evidence in certain areas of suicide prevention.
Shift towards universal suicide care
One key finding is a paradigm shift towards universal suicide care within the Australian health system. Historically, approaches to suicide prevention have focused on the treatment of mental illness. Universal approaches involve responding to whole populations – including those who are suicidal but not presenting with mental illness. These people may be experiencing distress or crisis from issues such as alcohol or other drug problems, unemployment or loss of a loved one.
“… aftercare is key to reducing future attempts and deaths”
This shift towards universal suicide care has led to clinicians and other staff caring for a broader range of people and in greater numbers, particularly given recent spikes in presentations of people with a mental health crisis linked to natural disasters and COVID.
As a result, some are arguing for more resources to deliver universal evidence-based suicide care.
Emphasis on person-centred aftercare
A prior suicide attempt is the single largest risk factor for subsequent death by suicide. The risk of a reattempt remains very high for at least the days, weeks and months following a suicide. That’s why aftercare is key to reducing future attempts and deaths. Many people – including the chair of Beyond Blue and former prime minister Julia Gillard – are advocating for increased access to suicide aftercare.
But not all aftercare services are effective. For example, brief contact by text or letters is not effective alone. Person-centred, clinically integrated care consistently appears as an element of successful care after self-harm or a suicide attempt. Person-centred care emphasises treating people with dignity, compassion, and respect, and providing coordinated care and support. Establishing trust and connection is also important.
The evidence suggests providers could aim to follow up and connect people to aftercare as soon as reasonably possible following discharge, and to consider how to prioritise those who require more assertive follow-up. To understand specifically what works best – for example, the most effective timing and method of aftercare – more research and evaluations are needed to ensure services are effective.
Need for tailored care for the most at-risk groups
There is a stark gap in evidence of best practice care for priority groups. This gap points to a need for more rigorous evaluations of suicide care pathways and how they can be adapted for different priority populations. The review offers several considerations for tailoring care for people who may be suicidal, especially young people, older people, LGBTIQ+ people, and Aboriginal and Torres Strait Island people. Many people belong to one or more groups, which adds extra layers of need for bespoke care.
Navigating the challenges
Our review identifies a need for robust evidence in critical areas of suicide prevention care. Highlighting these gaps and exploring broad patterns of consistency in care treatments and outcomes are a first step towards building a strong evidence base. Suicide is preventable and this evidence will help improve understanding of the best way to care for someone who may be suicidal, moving the dial closer towards zero suicides.
“The review offers several considerations for tailoring care for … young people, older people, LGBTIQ+ people, and Aboriginal and Torres Strait Island people”
The Care of people who may be suicidal rapid review is part of our broader focus on mental health. This includes contributing to evaluations of suicide prevention initiatives in NSW and Victoria, and using linked data to understand the pathways of people who may be suicidal through Australia’s health system.
Here’s a selection of other articles you may like to read on our work across the social sector:
If you need someone to talk to, call:
- Lifeline on 13 11 14
- Kids Helpline on 1800 551 800
- MensLine Australia on 1300 789 978
- Suicide Call Back Service on 1300 659 467
- Beyond Blue on 1300 22 46 36
Related articlesMore articles
Disability report reveals major inequality, need for collective action
The Actuaries Institute releases new research by Laura Dixie and Hugh Miller, examining systemic inequality for people with disabilityRead Article