The weekend before Greg Hunt got his fellow health ministers from the states and territories to agree to a national plan to reduce suicide, I watched people with paper butterflies in Bendigo trying to heal the sorrowful hurt of our national suicide emergency.
At a community event there, I saw affected family members and friends queue up — young and old, townies with tattoos and country conservatives in Akubras — to pin their homemade personal tributes onto a net that symbolised holding hope.
I counted some 50 butterflies and some 800 participants.
I listened to a local GP who regularly deals with people with suicidality say: “People aren’t dying to die. People are dying from the pain of not being heard.”
Now, as governments and stakeholders consider what a national suicide prevention plan should include, and we finally join the other 28 countries who currently have one, we would be wise to listen and learn from the hard-earned and heartfelt lessons of those of ‘lived experience’. Those who directly deal with suicidal people, those impacted on by suicide death, and those who have overcome suicidality.
The vast majority of those who experience suicidality do not die.
For the 3027 deaths by suicide in the past statistical year — a 10-year high at a time of 25 straight years of economic growth — there were likely more than 100,000 attempts. The vast majority of those who experience suicidality do not die.
Let’s start our listening there, where hope lives. We know from overseas successes that suicide is practically preventable. For many, suicidality is an experience of being overwhelmed by pain at a point in time. This ‘psych-ache’ is contributed to by isolating factors such as loss of work, lack of access to services, relationship breakdown, addiction, and, in some but certainly not all cases, mental illness.
If we can hear people in that critical period and respectfully support them through what’s happening for them, many go on to live positive and prosperous lives. Therefore, the infrastructure for crisis support is vital to recognise in a national plan. We believe we contribute to saving some 1100 lives per week by being unconditionally there for people in intense pain and confusion.
Part of our contribution needs to be about matching our tradition of empathy with greater effectiveness. This year, to compliment the near 1 million phone and Internet interactions we fielded from around 300,000 Australians in crisis, we will seek to introduce crisis text and messaging.
A large portion of Australian communications activity is by SMS or some form of messaging, and that’s where we need to be to help. That’s especially true of men (about 75 percent of all suicides), and younger people (where rates are rising again), who may be more likely to use text or messaging in the first instance to seek help. Plus, it may make crisis support more accessible to rural and regional communities with weaker signals for mobile coverage, which typically have the most frightening suicide rates in Australia. We have at least enough money from the Feds and some very dedicated corporates to trial this year.
People across our society need the confidence and skills to speak openly about suicide, to remove the barriers such as shame and blame, and to encourage help-seeking.
Another key message from people with ‘lived experience’, especially those who have sadly seen loved ones die, is the need for greater skills in the community to address suicide among our family, friends, workmates and neighbours. Organisations such as Mates in Construction are currently doing a great job of training people in the high-susceptibility industry that is construction.
But we need to do more to destigmatise suicide and empower more people to have suicide-related conversations. That includes more involvement by the broader business community, especially where suicide risk is higher. Focus should be on male-dominated professions, and ‘gatekeeper’ sectors such as education, social welfare, employment organisations and the judiciary. People across our society need the confidence and skills to speak openly about suicide, to remove the barriers such as shame and blame, and to encourage help-seeking.
On the other hand, ‘spotting the signs’ of suicide is a difficult proposition that often eludes trained professionals, and there’s limited return in training people in this method of prevention. It’s likely to be more effective to empower the community to ask the critical question, “Are you suicidal?”, that Lifeline asks an average of 2500 times per day.
We need to use what we know about speaking about suicide from our 54 years of experience and share it with a community that has come to trust us to a truly humbling extent. We need more support for school and university programs, and businesses are literally crying out for help for their employees, contractors, suppliers and stakeholders.
Another ‘lived experience’ voice that is vital to hear is the one that consistently says this to Lifeline crisis supporters: “I’ve just left the hospital after a suicide attempt and don’t know what to do.” There is a massive gap in services and support for the group that is much more likely to be suicidal: those who have already made an initial attempt. As overseas evidence suggests, many of the deaths of this group of people are preventable through better ‘post-vention’ and recovery, including improved discharge procedures, after-care facilities, follow-up services, and peer-to-peer support.
This we can do and it’s an area Hunt is very focussed on. It’s a group of people who number in their hundreds and we literally know them by name. They have been to hospital; we can deliver hope directly to them by breaking down the barriers between hospital systems and charities, and by using the best of what modern technology offers us, such as e-health.
A national strategy can’t be up to the mental health and emotional wellbeing sectors alone, because it will fail.
Whether it’s ‘lived experience’ or others, a key aspect is co-ownership. A society wide problem needs a society wide solution. A national strategy can’t be up to the mental health and emotional wellbeing sectors alone, because it will fail.
As an alternative approach, The Huffington Post Australia, Twitter, Accor, and Lifeline will soon hold a #stopsuicide summit with 50 CEO-level executives and leaders from multiple sectors such as financial services, public administration, media, transport, tourism, agriculture, the law, resources and ICT to discuss their ideas for innovation and problem solving around suicide.
Ultimately, it’s this continuum of compassion and innovation that we need to have a go at, or as the World Health Organisation recommends, from ‘universal’ strategies to fight stigma to ‘selective’ strategies to reduce risks in vulnerable communities to ‘indicated’ strategies for specific people who need immediate support. As a colleague describes it: more of what works and more of what we need to try. And, in that respect, the principle of co-design, the use of evidence, the inclusion of measurement and evaluation, and the identification of accountability structures are simply non-negotiables in good policy and practice.
While a national plan is a good and necessary thing, the truth is much suicide will be prevented not by change in public policy but change in personal perspective. The disconnectedness and toxic loneliness that drives much suicide is given space to exist when we don’t go out of our way to look after each other and connect.
When the pervasive narcissism of our times negates our niceness to each other. When vanity blocks our values. When our practice of empathy goes without everyday practice. When our compassion is doled out in convenient clicks rather than acts of kindness. When we don’t speak plainly about the very real social disadvantages that at least compound suicidality in many people.
In the months ahead, we have the chance to make a real plan to save Australian lives. But, in this very moment, we have the chance to make a real promise to ourselves to care and connect with those who most need it. One bereaved mother in Bendigo told me that’s what she now devotes her life too; we should look at our own actions too.
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