NSPO National Suicide Prevention Strategy Scoping Paper Consultation Feedback
Thank you for your interest in the National Suicide Prevention Strategy scoping paper consultation.
The feedback has now been reviewed and incorporated with the revised scoping paper documents found to the right of your screen, or by clicking here.
Below you will find feedback provided by members of the community and organisations who indicated they were happy for their feedback to be made publicly available. The right-hand column indicates the response from the NSPO which has been categorised and incorporated into the scoping paper as follows:
- Applied in full: Your feedback has been incorporated into the development of the National Suicide Prevention Strategy.
- Partially applied: Your feedback has been considered and aspects of your feedback have been incorporated into the development of the National Suicide Prevention Strategy.
- Noted: Your feedback has been considered in the development of the National Suicide Prevention Strategy.
There were 35 responses received in total, with 3 of those responses from national member-based organisations who provided response on behalf of their members.
There was some feedback requesting clarification from the team on Groups disproportionately impacted and Timeline for development of the strategy. Please aim to address these below.
Groups disproportionately impacted by suicide
The NSPO recognises that there are populations that experience a higher risk of suicide due to stressors that can be modified to alleviate risk. We also acknowledge that individuals most often identify with more than one community, and when those communities are disproportionately impacted by suicide, even greater risk is experienced. It is for these reasons that the Strategy development will work to identify common risk factors and stressors that can be alleviated across populations to ensure that suicide prevention efforts achieve the greatest reduction in lives lost to suicide. The Strategy will aim to shift the focus beyond the identification of specific communities, towards meaningfully addressing the common issues and unique needs that are disproportionately impacting many communities. The Strategy will work to complement and provide the foundation for the development of suicide prevention strategies that are dedicated to specific populations.
Timeline for the development of the Strategy
In response to public feedback on the original consultation version of the scoping paper, the NSPO consulted with the Lived Experience Partnership Group (LEPG) on the appropriateness of the timeline and consultation processes. The LEPG acknowledged that the timeline is ambitious but still allows for extensive consultation and rigorous content development. The LEPG also highlighted the need to deliver the Strategy as early as possible, to ensure timely progress of suicide prevention reform across Australia. As such, the LEPG determined that the proposed development timeline was appropriate and endorsed the aim of a September/October 2023 launch date.
For more information about the LEPG, click here.
| # | Consultation details | Stakeholder details | Feedback | NSPO response | |
| # | Date feedback received | Stakeholder | Question | Feedback | Public response |
| 1 | 2/11/2022 | Darren Hedley | 1 | The proposed Strategy Structure's inclusion of the statement "addressing specific needs of disproportionately impacted populations" is welcome. However, to date neurodivergent and some other disability groups with high rates of suicide have been repeatedly ignored at the national level with respect to suicide prevention policy and strategy. For example, using Global Burden of Disease data, researchers have clearly demonstrated that autistic people experience significantly higher rates of suicide attempts and death by suicide than the general population, accounting for an estimated excess of 19,000 suicide deaths globally, estimated to be 714,900 excess years of life lost (Santomauro et al., 2022). This echoes the findings from large international, population based studies finding autistic people are up to seven times more likely to die by suicide compared to those who are not autistic (Hirvikoski et al., 2016; Jokiranta-Olkoniemi et al., 2020; Kolves et al., 2021), with 1 in 10 autistic youth attempting suicide (O'Halloran et a;., 2022). Yet despite this wealth of evidence, the autistic population is still largely overlooked and are not considered to be a priority group for suicide prevention strategies. It is hoped that this government, through this process, takes a leading role in rectifying this situation in formally recognizing the autistic population as a priority group for suicide prevention policies and strategies. | Partially applied |
| 2 | 2/11/2022 | Darren Hedley | 2 | The proposed structure appear adequate; however, suicide prevention policy in Australia runs the risk of being dominated by particular self-interest groups and the mental health sector. The National Suicide Prevention Strategy consultation process needs to ensure that no priority risk group is left out, in particular, people with disability, who also experience disproportionately high rates of mental ill-health, are included and their voices heard, instead of being relegated to the disability sector as has traditionally occurred. | Partially applied |
| 3 | 2/11/2022 | Darren Hedley | 3 | Ensure that disability, autistic and otherwise neurodivergent people are represented through lived experience consultation, and formally recognized as a disproportionately impacted population. | Partially applied |
| 4 | 2/11/2022 | Anonymous | 1 | I am not informed enough to answer | Noted |
| 5 | 2/11/2022 | Anonymous | 2 | I am not informed enough to answer | Noted |
| 6 | 2/11/2022 | Anonymous | 3 | I am not informed enough to answer | Noted |
| 7 | 2/11/2022 | Dr Mark Stokes | 1 | The major issues I note with this structure is that there is nothing addressing a large core of the burden of suicide. Neurodivergent (i.e.: autistic, ADHD, etc) people are at considerably elevated risk for suicide. Autistic people are up to 7 times more likely to complete a suicide. Autistic women are at even greater risk. Globally, about 19,000 autistic individuals take their lives (Santomauro et al., 2022) Several large international studies have found similar results. Many autistic youth have attempted suicide; it is estimated that up to 10% of all autistic youth have attempted this (O'Halloran et al., 2022). Nonetheless, this structure does not include or address the neurodivergent population. Such a strategy has set out to fail if this population cannot be incorporated. | Partially applied |
| 8 | 2/11/2022 | Dr Mark Stokes | 2 | A group addressing neurodivergence needs to be included. Other groups of people with disabilities need also to be considered. All these groups experience elevated rates of mental health problems. Additionally, LGBTQIA+ individuals have a seriuosly elevated risk, and should be represented. | Partially applied |
| 9 | 2/11/2022 | Dr Mark Stokes | 3 | Nil | Noted |
| 10 | 5/11/2022 | Trevor Pyman | 1 | Yes, I believe it does. The only thing I would add is that in order to bolster the chances of success in the extraordinarily tricky aspect of cross agency and cross government collaboration is to have a national figure of sufficient power, presence and investment in success publicly champion the Strategy. SBR was only able to survive the petty turf wars because we had Ken Henry (Secretary of the Treasury at the time) taking personal accountability for the success of the project and bringing the public sector agencies to consensus and compromise. You have brilliantly identified the issue with national collaboration as a key to success, but achieving it is tragically difficult, so whatever can be done should be done to get a nationally respected figure with the power and desire to drive success. | Noted |
| 11 | 5/11/2022 | Trevor Pyman | 2 | Yes they do. I completely agree with the wording that lived experience should INFORM (and only inform) the Strategy and its implementation. | Noted |
| 12 | 5/11/2022 | Trevor Pyman | 3 | I am appreciative and heartened by the Strategy as it covers much of what I have experienced as needing improvement and gives me hope that things will get better. Everything my wife and I have advocated for is covered under the very broad descriptions in the papers. The only comment I would make is that the graphics show linear progression and we see it as circular, which is implied in the existing wording anyway. Investment in education of practitioners and researchers feeds in to informed policy and improved service delivery, which creates lived experiences of the system, which are captured by an extensive data collection system, which then feeds into research that informs the design of practitioner education, policy development and service delivery. | Applied in full |
| 13 | 8/11/2022 | Anonymous | 1 | Yes, the structure broadly covers that main areas that need to be addressed by the Strategy, although we would suggest the following refinements. In terms of the principles, we believe that it is important to recognise that suicide prevention requires a two pronged mental health promotion and mental healthcare response, rather than just a mental healthcare driven response. The former focuses on identifying and addressing the underlying drivers of suicide (i.e. interpersonal, psychological, social, cultural and economic risk and protective factors) through preventive programs and social policies, while the latter focuses on supporting people who are experiencing suicidal ideation, or who are at risk of suicide because of an underlying mental health condition. We therefore believe another key principle is: Adopt an integrated mental health promotion/mental healthcare approach to suicide prevention. That way it will be clear that we will need to combine public health informed approaches that happen within the 'community' (e.g. schools, workplaces, local neighbourhoods, online, etc), as well as medical/psychological approaches that happen within the 'clinic' (primary/secondary/tertiary care, digital mental health, etc) to reduce the suicide rate. Moreover, we also believe that there needs to be a recognition that a major part of the way forward to prevent suicide is to prevent the psychological distress and mental health conditions that are linked to suicidal distress and behaviours and suicide, and there needs to be an explicit recognition that initiatives that aim to promote mental wellbeing and prevent the onset of mental health conditions are a core component of effective suicide prevention. Another approach to this issue would therefore be develop a combined Mental Ill-Health Prevention and Suicide Prevention Strategy. | Noted |
| 14 | 8/11/2022 | Anonymous | 2 | Yes, we broadly support the approach to consultation and development, however, we would suggest the following refinements. Rather than three working groups, we suggest four, and we also suggest a re-naming of the groups The mental health promotion working group would include people with lived and living experience, as well as those with expertise in public health, health promotion, mental health promotion, social work, psychology and suicide prevention to look at the component of the Strategy that will focus on tackling the underlying psychological, interpersonal, social, economic and cultural drivers of suicide. The service systems working group would remain as outlined The enablers group would be split in two and include a governance/lived experience/workforce working group and a data, research and evaluation working group. Given the need for a whole of government approach, particularly for the mental health promotion/preventive mental health aspects of the Strategy, we propose that the governance/lived experience/workforce group include senior public servants from a cross-section of government departments to provide advice on how exactly a robust whole-of-government approach can be implemented. Public servants know better than anyone else how the machinery of government works, and how it can be leveraged/change to support a more preventive approach to mental ill-health and suicide. The data, research and evaluation group would be able to provide advice on data and monitoring to track implementation and success, and research to strengthen the evidence base. Once drafted, the Strategy should be open for broad public and sector consultation, with specific input sought from community sector peak bodies (e.g. Relationships Australia, ACOSS, Council to Homeless Persons, etc) and public health sector bodies (e.g. PHAA, and AHPA) not just mental health sector organisations. | Partially applied |
| 15 | 8/11/2022 | Anonymous | 3 | We encourage the National Suicide Prevention Office to ensure a strong balance between community based prevention approaches and clinical mental health service approaches to suicide prevention. Moreover, given the considerable overlap between public health informed approaches to the prevention of mental health conditions and the prevention of suicide in terms of risk and protective factors that are targeted, we encourage the NSPO to look for ways to create a combined Preventive Mental Health/Suicide Prevention Strategy that allows us to reduce the incidence of mental health conditions, as well as the incidence of suicide, using a two-pronged and integrated mental health promotion/mental healthcare approach. | Noted |
| 16 | 8/11/2022 | John Cranfield | 1 | We need a simple plan Teach the youth about endorphins and how to boost them you will reduce mental health. There is to much research and we know if you boost your endorphins you stay well and don’t get suicidal thoughts | Noted |
| 17 | 8/11/2022 | John Cranfield | 2 | Get the best salesman in Australia to devise a positive plan to stop suicide. Boost your endorphins reduces mental health so advertise it. | Noted |
| 18 | 8/11/2022 | John Cranfield | 3 | People can’t get into services and people don’t want the stigma of being labelled mentally I’ll so we need a campaign to prevent suicide. Laurie Lawrence has do the 5 stay alive for swimming sun cancer has slip slip slap We need choose live Excercise start a new routine start a new hobby boost those endorphins create your life A marketing plan is required! Everything about suicide is negative creating stigma Excercise and lifestyle reduces suicidal thoughts So tell people and sell it to them! | Noted |
| 19 | 8/11/2022 | Anonymous | 1 | Yes | Noted |
| 20 | 8/11/2022 | Anonymous | 2 | The structure of advisory groups, working groups and consultation plan is fine, however the process of consultation will need to be facilitated by appropriately qualified people to provide adequate opportunity for input from a variety of perspectives. In my view, facilitators need to have training and experience in facilitating engagement with diverse personality types and backgrounds; in mapping user journeys; and in design thinking to ensure that groups are focused on defining the problems they are trying to solve and ideating freely without constraint. | Noted |
| 21 | 8/11/2022 | Anonymous | 3 | No | Noted |
| 22 | 9/11/2022 | Anonymous | 1 | Yes | Noted |
| 23 | 9/11/2022 | Anonymous | 2 | Yes | Noted |
| 24 | 9/11/2022 | Anonymous | 3 | Nil | Noted |
| 25 | 9/11/2022 | Health Justice Australia | 1 | The structure of the strategy is generally appropriate, and we especially welcome the recognition of the need for compassionate and collaborative care and the principle of addressing the needs of disproportionately impacted populations. We also welcome the inclusion of intersections with the justice system and the recognition of legal need. We also welcome the recognition of the importance of lived experience, and note that 'lived experience' extends beyond the critical expertise of people about their own lives and experience accessing services, and also includes the lived experience and insights of practitioners and systems leaders working in systems. All of these types of lived experience are all important in a strategy, and these diverse insights can play a key role in identifying levers for systems changes. We also welcome the recognition of workforce and community capability as a key enabler. In our experience, this is a critical piece of the puzzle and needs to be thought through carefully to ensure it is effective. Training needs to be ongoing, especially in recognition of the high turnover of workforces, and it needs to be relevant to people's work, flexible and properly resourced. In health justice partnerships, a key benefit is also in enabling practitioners to build a relationship of trust with other service providers that also enables them to be supported during their day, through secondary consultations, as well as in formal training. This also enables them to be part of a more holistic response to the complex problems in people's lives. We acknowledge the work that many services and practitioners have done to develop trauma-informed approaches in their work, including in the legal assistance sector. We suggest that the phrasing 'services must take a compassionate and collaborative approach' (p. 3) requires some nuance, as this can suggest that services are failing to be compassionate and collaborative, rather than that systemic barriers are making this difficult or challenging. We suggest services should be 'supported and enabled' to take a compassionate and collaborative approach is a more accurate expression of the intention. This would include through funding and commissioning models that incentivise not only value but are also flexible enough to enable innovation and/or partnership, and for this investment to deliver broader social and wellbeing outcomes beyond health outcomes. | Applied in full |
| 26 | 9/11/2022 | Health Justice Australia | 2 | In general, we support the proposed engagement and consultation plan, but have some specific comments. First, we welcome the inclusion of people with lived experience as part of the Working Groups, rather than in a separate silo. However, there will need to be careful thought about how to convene those groups effectively to ensure that intersectional lived experience is given voice and space, and that the expertise of others is also effectively marshalled. Second, we welcome the openness of the expression of interest process, but find it hard to comment on the representativeness of the proposed Working Groups, given that we do not yet know those who will be sitting on them, although we note that the suggested number of 10 members may be too restrictive to do justice to the diversity of perspectives and the breadth of the topics, especially if members can withdraw at any time with notice. Third, the enabler of governance and collaboration across government is key, but it is unclear how this is linked to the development of the Strategy or its implementation. It may be that the Strategy will, like so many others, include a cross-government implementation structure, but it would also be useful to link in relevant portfolios during the development of the Strategy, especially where those portfolios are also doing similar work in related areas under different strategies. The proposed consultation plan is ambitious, as noted, and we are unclear whether the timeline for development (Fig 3) reflects an intention to limit the consultation on particular focus areas to specific months in the proposed timeline. We note, in particular, that focus areas 1 and 4 would fall during the summer holidays, which would be a difficult time of year for most community organisations and individuals to provide input. | Applied in full |
| 27 | 9/11/2022 | Health Justice Australia | 3 | We note that the scoping paper indicates that the Strategy will connect with other suicide prevention strategies, but think it would also be helpful to articulate how this strategy sits alongside other related whole-of-government strategies with similar aims and principles, such as the National Preventive Health Strategy, the National Plan to End Violence against Women and Girls, and Closing the Gap. While those strategies are broader in scope, all of them also focus on collaborative strategies and similar enablers. We also think the strategy will need to articulate the relationship and intersections between suicide prevention and mental health more broadly, and why and how the strategy focuses on suicide prevention, given the breadth of the scope of the strategy. | Applied in full |
| 28 | 10/11/2022 | Prue Gregory | 1 | I like the proposed structure of principles, focus areas and enablers. The division is logical and will make it easier for the working groups to think through ideas under each of the headings. In relation to the Principles set out in the scoping paper, I think highlighting 'specific needs of populations disproportionately impacted by suicide..' risks a subjective assessment of population groups. Would it be possible to identify groups under more objective headings eg Aboriginal & Torres Strait Islander people, people experiencing homelessness, newly arrived migrants. In relation to Focus Areas - the inclusion here of the concept of 'mitigation of known drivers of distress' is excellent. So often social determinants are ignored or not even explored. In relation to Enablers - my only comment would be to ensure under each of these headings the NGO and community sector be included. I believe it is important that the consistent approach is not just seen within government but across the entire sector. Many community organisations and NGOs almost unknowingly do extremely valuable work in addressing issues causing mental distress in peoples' lives. Ensuring the principles and work practices being followed by these organisations are consistent with government services, is very important. Bringing in the NGOs and community organisations would also mean their data (in all of its diversity) would be collected as well. | Partially applied |
| 29 | 10/11/2022 | Prue Gregory | 2 | I like the structure of the working groups. It will be important to establish a strong sense of collaboration between all of the proposed groups. Maybe plenary sessions through the year could be held could build collaboration and enable the sharing of ideas and learnings? | Noted |
| 30 | 10/11/2022 | Prue Gregory | 3 | I don't have anything further to add. | Noted |
| 31 | 10/11/2022 | yourtown | 1 | Principles yourtown supports the principles outlined in the proposed Strategy structure; however, these should be underpinned by a human rights-based approach to suicide prevention. Evidence shows that suicide is linked to societal level issues, such as economic inequities and need; isolation; lack of social inclusion; barriers to accessing healthcare and social support; and exposure to trauma, whether through interpersonal violence and abuse affecting families and communities. Given this evidence, the principle of ‘Compassionate & collaborative’ should be extended to ‘Informed by human rights, compassionate & collaborative’. Having a human rights-based foundation gives greater credence to and recognition of the complexity of issues that can impact suicide. A human rights approach will enable the focus of prevention and early intervention strategies to go beyond focusing on mental health and suicide ideation concerns and expand to understand the drivers of inequity, homelessness, child abuse, domestic and family violence, poverty, and discrimination as critical issues to be addressed systemically, and individually. There is also no mention of evidence. While lived experience and tailored services and supports are essential, the principles should also include the need for ‘evidence informed’ approaches and identifying evidence and good practice of what works to prevent suicide. There is also a need for innovative practices to develop and inform key indicators in order to further support and build a robust evidence base. Enablers The Strategy should also recognise the critical role of virtual mental health services as an enabler of the focus area ‘Supporting long-term mental health and wellbeing’ and as part of a broad continuum of support. Young people under 25 are digital natives and want choice of service delivery both online and face to face, especially young people in rural and remote areas where virtual/online support may be the only accessible option. The following gaps in the workforce need to be addressed within the Strategy so that the continuum of support is available for young people across the virtual and physical service delivery spectrum: •specific skills and capabilities required for virtual service delivery •education programs to build virtual health capability in frontline workforces and other social and health services workforces to equip them with the right skills and knowledge to use digital technology tools and platforms effectively •development of virtual counselling skills within courses related to Psychology, Social Work and Social Sciences, Human Services, Mental Health, Drug and Alcohol and Counselling •capability to quickly upskill and engage a digital workforce to respond to surges in demand associated with unexpected crises such as natural disasters and pandemics and •mechanisms to enhance integration between the mainstream and digital workforce to increase competency and agility across the digital and mainstream frontline workforce sector to deliver blended service delivery models where digital services are used in conjunction with face-to-face services. yourtown strongly supports embedding lived experience in decision-making and leadership as a foundational area of system reform required to drive the effective implementation of the Strategy. However, the Strategy should go further and include human-centred design, where key stakeholders including those with lived experience participate in all stages of the design process. This will ensure the Strategy meets the needs of key stakeholders and achieves greater buy-in/impact. Further, given suicidality affects groups of children and young people in significantly different ways, children and young people from varied backgrounds and experiences should be part of any human-centred design that guides the development and implementation of the Strategy. This is particularly important given the statistics highlighted at the beginning of page three. Additionally, there should be targeted engagement with specific groups such as Aboriginal and Torres Strait Islander and LGBTQIA+ groups to ensure that their specific needs and issues are addressed within the Strategy. | Partially applied |
| 32 | 10/11/2022 | yourtown | 2 | While yourtown recognises the range of groups (including from government, service provider, academic, and lived experience of suicide perspectives) to provide expertise and feedback through the two Working Groups to be established, suicidality affects groups of children and young people in significantly different ways. Therefore, yourtown recommends that youth suicide prevention intervention approaches under the Strategy be informed by, and tailored to, different groups of children and young people. This includes seeking input from a range of children and young people to ensure the strategy meets their specific needs and preferences. Furthermore, evidence shows the following specific groups of young people are at higher risk of suicide [1]: •Young women •Young men •Young people who have experienced mental health issues (including comorbidity with substance misuse increasing in the risk) •Young people with a history of self-harm •Aboriginal and/or Torres Strait Islander children and young people •LGBTQIA+ young people •Young people recently in contact with the justice system •Young people living in rural and remote areas •Young people who are in or have recently left statutory care •Young people who have been exposed to suicide-related behaviour. Engaging in a process of meaningful consultation and co-design with these groups would further strengthen the final strategy by placing the dignity of children, young people, and vulnerable groups at the centre of the development process and enhancing trust through open engagement. [1]Robinson, J., Bailey, E., Browne, V., Cox, G., & Hooper, C. (2016). Raising the bar for youth suicide prevention. Melbourne: Orygen, The National Centre of Excellence in Youth Mental Health (www.orygen.org.au). | Partially applied |
| 33 | 10/11/2022 | yourtown | 3 | yourtown welcomes the opportunity to provide feedback to the National Suicide Prevention Office on their draft scoping paper to guide the process for the creation of a National Suicide Prevention Strategy. Developing a national strategy will be a significant step in the right direction to ensuring a holistic Australian approach to suicide prevention, and the drivers contributing to suicide. It is well known that suicide is the leading cause of death for people in Australia aged between 15-24 [1]. With higher rates of suicide experienced by Aboriginal and Torres Strait Islander youth than non-indigenous youth, and disproportionately high rates of suicide experienced by young people who identify as LGBTQIA+, or who live in rural and remote areas. [2] Every day at yourtown we work directly with young people contemplating suicide, or at high risk of suicide. In 2021, the top six issues raised during nearly 100,000 counselling sessions through Kids Helpline were (in the following order): mental health and emotional wellbeing; suicide related concerns; family relationships; friend/peer relationships; and child abuse. We undertook 5,823 emergency responses nationally, where we sought the assistance of ambulance, police or child protection services to respond to an emergency for a young person. Of these, 33% involved issues related to suicide. [3] We also find that many young people we support across all our service including our employment programs raise issues related to suicidal ideation or are at high risk of suicide. This can be due to a variety of factors facing them as unemployed young people, whether due to financial hardship, cost of living challenges, family or caring issues, educational concerns, mental health, or their unemployment status and sense of worth. We strongly support the National Suicide Prevention Office’s approach of embedding the contributions of those with lived experience. In 2021, over 3,500 young people (aged 15 to 25) from around Australia participated in yourtown’s Your Voice project telling us about their issues and what mattered to them most. Two of the top issues that they told us about included the multiple barriers they face in accessing appropriate and timely mental health support, and the lack of youth-appropriate services with staff who have the expertise and skills to engage and provide support to young people. These findings align with Suicide Prevention Australia’s 2022 report ‘In Their Words: How to support young people in suicidal distress’, particularly regarding young people’s negative experiences with services after attempting suicide, or self-harm, or when at a point of suicidal distress.[4] Concerted action needs to be taken to ensure access to help and support for young people is available not only in a crisis, but long beforehand, by addressing the social and economic factors that lead a young person being at risk of suicide in the first place. Young people in regional and remote areas are highly disadvantaged when it comes to access to supports/available services, any action plan should consider how to better support this cohort. Approaches that meet the needs, experiences, and preferences of young people Evidence suggests that the way young people seek help is vastly different to that of adults. Young people (and young males in particular)[5] are less likely to go to a GP, and far more likely to reach out first to their peers, or a family member for support [6]. Support in-the-moment and at any time Digital services should be a key component of a suicide prevention strategy, especially for supporting young people. Not only are young people digital natives, but they are more likely to reach out to find help, supports and resources online. Digital services can support young people’s preference to engage in the-moment and at any time. They can aid non-stigmatised responses to help-seeking, given that a person reaching out for help may wish to stay anonymous, and can remain anonymous while reaching out for support via phone, webchat, email, or text. Social media can also be valuable in learning about young people’s knowledge and attitudes regarding mental health and suicide prevention and their help-seeking preferences. Trends from public social media content can be analysed and used to inform messages that will best facilitate help-seeking behaviour, and service responses. Resources and supports need to be directed towards where young people seek help. To appropriately support young people, face-to-face and digital resources and supports need to be co-designed with young people. This will facilitate the development of services that young people will see as relevant and accessible. Furthermore, these supports should be designed for the eco-system that young people live in, ensuring young people can access various supports and be supported to navigate the complex service landscape. Anonymity and confidentiality Young people (particularly young males) often ‘try before they buy’ when seeking help, testing out whether a service is ‘safe’ to engage with. Over 31 years, our Kids Helpline staff have observed how children and young people who first reach out for help will often only do so if they have first done so privately or anonymously. Anonymity and confidentiality help them to test whether a service is reliable. It also helps them overcome fears of being judged when they reach out for help, particularly if stigma is attached (e.g., mental health or suicidal thoughts). Often it is only once the trust is built with our service that a child or young person will feel comfortable and confident enough to start talking to a counsellor. Facilitating anonymous help-seeking behaviour in the virtual context is key to creating a safe space where a young person wants to share what is really happening to them. Further, children and young people experiencing suicidality need a variety of mechanisms to seek help. They should be able to choose from a range of care options that are appropriate for them, their needs, and circumstances. This ranges from self-help to personalised counselling support as and when needed. Access to non-stigmatising, timely, and affordable youth specific suicide support Young people need access to services and supports at the time when they need it most. Being available 24/7 means that Kids Helpline is always open for business and available to provide services when other services close for the day, or weekend. In 2021, 55% (almost 153,000) of all phone and webchat contacts received across Australia were made between the hours of 5pm and 9am, with over 72,000 of these contacts received on a Saturday and/or Sunday. [7] More needs to be done to address barriers to access, including promotion and funding of these critical digital services that bridge the service gaps of face-to-face care, as well as more affordable (bulk-billed) walk-in face-to-face services, particularly in rural and remote locations. We would welcome the opportunity to explore these ideas with you in further detail. Should you require further information about any issues raised in the submission, please do not hesitate to contact Kathryn Mandla, Head of Advocacy and Research at yourtown via email at kmandla@yourtown.com.au. [1] Australian Institute for Health and Welfare (2021). Deaths by suicide among young people. [2] See Department of Health (2013) Aboriginal and Torres Strait Islander suicide: origins, trends and incidence. [3] yourtown. (2022), Kids Helpline Insights Report 2021, (https://www.yourtown.com.au/insights/annual-overviews). [4] Suicide Prevention Australia. (2022). ‘In their words: How to support young people in suicidal distress’ (https://www.suicidepreventionaust.org/wp-content/uploads/2022/08/SPA_Youth-Report_In-your-words_12-August-2022.pdf). [5] yourtown (2021) Research in Action: Boys’ Help Seeking Behaviour. Boys help seeking behaviour report (https://www.yourtown.com.au/sites/default/files/document/Boys%20help%20seeking%20behaviour%20-%20Summary%20Snapshot.pdf). [6] Robinson, J., Bailey, E., Browne, V., Cox, G., & Hooper, C. (2016). Raising the bar for youth suicide prevention. Melbourne: Orygen, The National Centre of Excellence in Youth Mental Health (www.orygen.org.au). [7] yourtown. (2022), Internal data set. | Partially applied |
| 34 | 11/11/2022 | Alcohol and Drug Foundation | 1 | The Alcohol and Drug Foundation (ADF) thanks the National Suicide Prevention Office (NSPO) for the opportunity to contribute to this scoping paper. We would like to acknowledge that while our expertise is focused on the prevention of harms related to alcohol and other drug (AOD) use in the community, there is a strong link between suicide, suicidality, and AOD use. Additionally, the ADF has experience with and is committed to advocating and working towards preventative health measures which are cost effective and save lives. Finally, the ADF’s experiences with AOD use in communities has demonstrated how stigma can impact on individual and social health outcomes. It is the ADF’s position that suicide and suicidality must be addressed through primary prevention measures in addition to acute intervention and postvention. While there is critical work to be done with people who are experiencing heightened distress and suicidality, there are significant opportunities to build protective factors and minimise contributing factors before an individual develops more serious needs. Prevention of suicide and suicidality through the strengthening of factors including community engagement, access to general services, and early-intervention programs can be highly effective at reducing the burden of disease and saving costs in treatment. The ADF has extensive experience working with communities to prevent individual and community harms associated with AOD use. These evidence-based approaches have demonstrated that early-intervention and prevention can be highly effective at preventing the development of substance use disorders, which are a known and significant contributing factor for suicide and suicidality. Additionally, the importance of highly targeted prevention programs with priority populations has been shown to be effective. Prevention programs and resources should be targeted towards these cohorts. The ADF commends the NSPO on its strong inclusion of early-intervention and prevention in its key areas of focus for the Strategy. Finally, the ADF advocates for health conditions such as substance use disorders, and suicidality and suicide to be treated without stigma. There is extensive evidence showing the negative impacts of stigma on health outcomes. Leadership from government and stakeholders is required to work to reduce stigma in the community. Responses to selected elements of the structure are below: Principles Addressing specific needs of disproportionately impacted populations: As discussed above, it is understood that suicide affects certain populations disproportionately. While suicide prevention and response are a community-wide issue, it is the ADF’s opinion that targeted interventions are the most effective method for priority populations where specific contributing and protective factors can be focused on. There is a significant history of public health campaigns in Australia being targeted at specific populations (e.g., people engaging in problematic gambling). Local and systems-based responses are an appropriate avenue for targeted interventions to priority populations, as this ensures that interventions are culturally relevant and effective. Additionally, a focus on place and community-lead response ensures greater equity in the provision of resources. This is in line with recommendation 7 of the Suicide Prevention Adviser’s Final Advice. Compassionate & collaborative: Evidence shows that alcohol and other drugs are two of the main risk factors contributing to suicide and suicidality(1), with research suggesting that AOD use was present in 65.8% of ambulance callouts for suicide attempts in Victoria in 2019(2). One-third of individuals entering into AOD treatment in Australia will have attempted suicide over their lifetime, and one in ten well have done with within the previous twelve months3. Additionally, there are strong links between diagnosed mental health conditions and substance use disorders, as well as between factors predicting suicidality and substance dependence(3, 4). Research from the National Drug and Alcohol Research Centre (NDARC) suggests that only 26.8% to 56.4% of those needing AOD treatment access it. This may be driven factors including a lack of understanding of the harms resulting from AOD use, difficulty finding services, or difficulty in service access. Given the interrelation between suicidality and AOD use, unmet demand for services likely contributes to higher risks of suicidality requiring acute intervention. The AOD sector has significant experience with people experiencing suicidal distress as well as understanding risk and protective factors for suicide and suicidality. The ADF therefore strongly advocates for the Strategy to include specific actions ensuring consultation and collaboration with both prevention and treatment organisations within the AOD sector. Recognising & responding to the diverse drivers of distress: The ADF supports recommendation 6.5 of the Suicide Prevention Adviser’s Final Advice, that the Strategy implement priority actions to connect alcohol and other drug prevention and treatment services within the Strategy. The evidence outlined above demonstrates the clear links between AOD use and suicidality, and the ADF believes that the strategy should include concrete actions that reflect this. Focus Areas Strengthening protective factors and wellbeing and Empowering earlier intervention: There is a strong and growing body of evidence around prevention measures in mental health and AOD that can be effective and cost-efficient in preventing the development of mental health and substance use disorders. Economic analysis of prevention measures for mental health have found that prevention is a very cost-effective method for addressing the cumulative harms associated with mental ill health and suicide(5). Evidence suggests that investment in prevention and early-intervention can reduce the impacts of mental ill health and substance use later in life, which may in turn reduce the demand placed on acute mental health settings where costs are high and individuals are more likely to be facing co-occurring challenges(6). It is the ADF’s position that investment in initiatives that build individual and community resilience are an important and effective approach for addressing suicide and suicidality in the community. Additional evidence suggests that targeting multiple risk factors simultaneously through evidence-based approaches may be an effective method for suicide prevention(7). This aligns with the evidence and the ADF’s experience in reducing AOD-related harms through place-based approaches that target contributing and protective factors in the community. Contributing and protective factors that are associated with suicide and suicidality including social isolation, low self-esteem, and depressive symptoms, occur on a local level and can be targeted by local systems-based responses. Enablers Data & Evaluation: Interventions and actions implemented as a part of the Strategy must be both evidence-based and contain mechanisms for review and evaluation. The importance of evidence-based responses to suicide prevention and responses was highlighted by recommendation 3 of the Suicide Prevention Adviser’s Final Advice. Primary prevention strategies as discussed in this submission are an effective and evidence-based approach. The ADF supports that the strategy include robust and reliable data and evaluation measures as a key enabler of the Strategy. 1.Australian Institute of Health and Welfare. Suicide & self-harm monitoring, Behavioural risk factor burden for suicide and self-inflicted injuries: Australian Government; 2022 [Available from: https://www.aihw.gov.au/suicide-self-harm-monitoring/data/behaviours-risk-factors/burden-of-disease-studies-suicide-self-inflicted. 2.Turning Point. Beyond the Emergency: A national study of ambulance responses to men's mental health. Richmond, Victoria: Turning Point; 2019. 3.Darke S. Suicide: The hidden issue. Drug Use and Mental Health Melbourne: IP Communications; 2009. p. 143-9. 4.Hall W, Degenhardt L, Teesson M. Understanding comorbidity between substance use, anxiety and affective disorders: Broadening the research base. 2009;34. 5.Mihalopoulos C, Vos T, Pirkis J, Carter R. The economic analysis of prevention in mental health programs. Annual Review of Clinical Psychology. 2011;7:169-201. 6.Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, et al. Preventive strategies for mental health. The Lancet Psychiatry. 2018;5(7):591-604. 7.Baker ST, Nicholas J, Shand F, Green R, Christensen H. A comparison of multi-component systems approaches to suicide prevention. Australasian Psychiatry. 2018;26(2):128-31. | Applied in full |
| 35 | 11/11/2022 | Alcohol and Drug Foundation | 2 | The ADF recommends that both working groups include membership from both the prevention and treatment arms of the AOD sector. This will ensure that the key relationship between these two health issues is addressed at a fundamental level in the strategy. Additionally, working group membership should, as a matter of priority, include persons with lived and living experience that represent the diverse causal factors associated with suicide and suicidality. In this regard, people with lived and living experience of drug and alcohol harms should be actively included in both working groups. There are significant and multi-factorial interrelations between suicide, suicidality, and drug and alcohol harms. The ADF therefore strongly recommends that if relevant lived and living experience of drug and alcohol related harms are not represented, that the NSPO proactively seeks this membership by consulting with appropriate organisations and individuals. Further, it is important that working groups ensure lived and living experience of the causal factors of suicide and suicidality, including drug and alcohol harms, are explicitly considered. Individuals with lived experience both of suicide and suicidality, and of drug and alcohol harms, should be proactively encouraged to share experiences concerning the role of substance use and associated harms. Working groups should develop mechanisms to ensure that these vital experiences are considered in addition to individuals’ lived and living experience of suicide and suicidality. | Applied in full |
| 36 | 11/11/2022 | Alcohol and Drug Foundation | 3 | The ADF reiterates the need for concerns relating to drug and alcohol use and suicidality and suicide to be key elements of the plan. Additionally, while stigma around mental health challenges and suicide has been decreasing, there is still a significant amount of stigma around suicide8, with research suggesting that suicide and stigma have a two-way relationship9. Additionally, the World Health Organisation has rank dependence on illicit substances the most stigmatised health condition globally, and alcohol as the fourth most stigmatised10. A significant body of evidence has shown the impacts of stigma on health outcomes, with stigma often negatively influencing social connection, access to services, and engagement in treatment11-13. Interventions that target priority populations are able to help reduce stigma, particularly in targeting populations where stigma is more prevalent14. The ADF therefore advocates for stigma to be included as a key focus area of the Strategy. 8.Pitman AL, Osborn DP, Rantell K, King MB. The stigma perceived by people bereaved by suicide and other sudden deaths: A cross-sectional UK study of 3432 bereaved adults. J Psychosom Res. 2016;87:22-9. 9.Kučukalić S, Kučukalić A. Stigma and Suicide. Psychiatr Danub. 2017;29(Suppl 5):895-9. 10.Room R RJ, Trotter RT, Paglia A, Ustun TB,. Cross-cultural views on stigma, valuation, parity, and societal attitudes towards disability. Seattle, WA; 2001. 11.Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453. 12.Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a Fundamental Cause of Population Health Inequalities. American Journal of Public Health. 2013;103(5):813-21. 13.Allen H, Wright BJ, Harding K, Broffman L. The role of stigma in access to health care for the poor. The Milbank Quarterly. 2014;92(2):289-318. 14.New Zealand Drug Foundation. Scoping of a destigmatisation programme on drug use and drug dependence.; 2015. | Partially applied |
| 37 | 11/11/2022 | Anonymous | 1 | I certainly agree with a whole-of-government approach and equal focus on protective and risk factors. Overall, though, people bereaved by suicide receive relatively little attention, although they are a risk group for suicide and have first-hand information about suicide. | Applied in full |
| 38 | 11/11/2022 | Anonymous | 2 | Overall, a variety of groups should be able to provide their input. I have the impression that, especially over the last years, the voice of a few - selected - people with lived experience of suicide, from a particular group, have been given a very loud voice in the field. This was polarising rather than constructive at times. Suicide prevention should be based on research and evaluation, and informed by service providers, and users and lived experience. There should be a balance between the different perspectives. | Partially applied |
| 39 | 11/11/2022 | Anonymous | 3 | Please invest in research and evaluation, otherwise it will be impossible to asses any success of the strategy or its components. | Noted |
| 43 | 11/11/2022 | Anonymous | 1 | The National Suicide Prevention Strategy (NSPS) Scoping Paper is aligned with the priority areas, principles and enablers in Tasmania’s Draft Suicide Prevention Strategy. Primary Health Tasmania (PHT) supports the proposed structure detailed in the NSPS Scoping Paper with the following additions/revisions suggested: oThe principles, focus areas and enablers are thorough but PHT suggests the proposed structure includes reference to the requirements at the individual, organisational and systems levels across the strategy, which could be incorporated into Figure 1 (for example, service providers / industries / businesses etc could be represented). oAnother significant influencing enabler for consideration could be advancing technology, including the known and unknown factors around digitisation of health service provision. o‘Addressing specific needs of disproportionately impacted populations’ is named as a principle but it is not yet named up which priority population groups will be a focus under this strategy. | Partially applied |
| 44 | 11/11/2022 | Anonymous | 2 | Primary Health Tasmania (PHT) supports the proposed advisory and working groups and consultation plan with the following queries for consideration: oOne of four principles is to address the specific needs of disproportionally impacted populations (as above, these groups are not specifically named in the scoping paper). The Consultation Plan does not appear to include any scope to reach out to stakeholders or representatives of these specific population groups for feedback on the strategy areas being developed expressly for them. This may be captured within the “NSPO Lived Experience Partnership Group”. This group will provide advice on the Strategy, however PHT couldn’t find any more detailed information about this group and their Terms of Reference or membership / recruitment strategy. Ideally the membership of this group would include representatives from the identified populations and PHT suggests the Consultation Plan could be improved by specifying consultation with these key groups. oPHT would value the opportunity to participate in the Service Systems Working Group as this will support our organisation to drive reform and improvement in Tasmania as well as providing local and state perspectives at the national level. PHT has submitted a separate request to seek membership into this working group. oRegardless of outcome of membership to the working groups, PHT would value ongoing visibility and opportunity to provide feedback throughout the development of the NSPS. | Applied in full |
| 45 | 11/11/2022 | Anonymous | 3 | There does not appear to be any reference to development of this Strategy in relation to the Fifth Mental Health and Suicide Prevention Plan, some additional context about the development of this Strategy in relation to previous strategies and reform work would be useful. | Applied in full |
| 46 | 11/11/2022 | Jen Waltmon | 1 | No, there are missing bits in relation to the inclusion of people with lived/living experience (LE). In terms of the principle: "Informed by lived experience", the principles of lived/living experience should not only be informed by people with LE, but should co-designed, co-produced, co-planned, co-evaluated and co-delivered. If the expertise of people with LE is to be fully understood, valued and implemented so that outcomes are relevant, useful, equitable, sustainable and scable, LE principles must align by following the iAP2 Model of Engagement: Inform, Consult, Involve, Collaborate, Empower. Also, under the principles areas, the principle: "Addressing specific needs of disproportionately impacted populations" outlines the idea that specific needs will only be addressed for underrepresented populations, and shouldn't. Reports show who the disproportionately affected groups are, but we must provide services and supports to everyone in Australia, but with a person-centred approach. Under focus areas, the focus area: "Providing accessible, coordinated & comprehensive care should" build in more work around affordability. Governments should be coordinating with service providers alternative ways to provide support to those in need, rather than people being turned away and either ending up in the ED, or taking their own lives. More funding should focus on actual, usable outcomes like more safe spaces/houses, peer workers and supervisors and beds, rather than on creating more policies and red-tape. Also in the focus areas, "Governance and collaboration across governments and portfolios" doesn't mention the inclusion of people with LE. With one of the enablers being "Embedding lived experience decision-making & leadership", why is LE not mentioned in the "Governannce & collaboration across governments & portfolios" enabler? People with LE should be sitting at the table using their leadership skills and decision-making to inform broader health reforms and models of support. This inclusion further stregthens the importance of the iAP2 Model of Engagement. "Data and evaluation" is also an important enabler, but without the inclusion of LE consulting from the earliest statge, how can we be sure the right data is being collected? The "Workforce and community capability" enables also doesn't mention embedding lived/living experience roles and leaders within organisations, so that they can provide expertise from the beginning of the national approach (embeddment), and remain a source of knowledge for ongoing, sustainable and scable capabilities. | Partially applied |
| 47 | 11/11/2022 | Jen Waltmon | 2 | All advisory groups and working groups must again include the voice of people from lived/living experience, but also be equitable across groups and demographics like age, gender, sexuality, digital competency and exposure, veteran status, and CALD, as well as experiences with and without MH services and suicide prevention support programs. LE is individualistic, but can also evolve and change according to community exposure and connection (or a lack thereof). | Applied in full |
| 48 | 11/11/2022 | Jen Waltmon | 3 | The strategy outlines the idea that we need more policies, which we don't. As someone that works in the MH sector as a lived experience engagement manager, what I hear from our community the most often, but is rarely addressed is the lack of immediate/crisis support and services. When someone requires a spot or a bed because they are in suicidal crisis, time is not on their side, nor is money. Immediate action must be taken to protect these vulnerable people, which doesn't include wait lists, complex forms, policies to adhere to, and incompassionate workers, clinicians and ED staff. | Partially applied |
| 55 | 14/11/2022 | TrackSAFE Foundation, Heather Neil Executive Director | 1 | The TrackSAFE Foundation recommends: 1.Funding for implementation of the strategy be added as a strategy enabler; 2.An additional focus area: Prevention through restriction of access to means. There will likely always be a group of people who experience suicidal ideation. This means that restriction of access to means is essential, and it is known to prevent suicides. In public places such as the railways, access to new funding to enable priority risk locations to be fenced (key locations along the rail corridor and bridges over the rail corridor) will reduce the number of deaths. The type and efficacy of fencing should be evidence based; 3.The strategy encourage and support the piloting of new community, health and hospital based services to support people in crisis as well as those with long term mental illness that come frequently to the rail environment creating risks to themselves, passengers and rail staff. | Noted |
| 56 | 14/11/2022 | TrackSAFE Foundation, Heather Neil Executive Director | 2 | The TrackSAFE Foundation recommends: 1.A change to the terminology to replace ‘disproportionately impacted populations’ with ‘priority populations’; 2.A compression of the consultation and strategy development process. The Final Advice together with State/Territory Government strategies have all included consultative processes so this should allow a reduction in time for the national strategy. The Government must rapidly move its focus from planning to action if it is to impact the number of suicides and attempted suicides in Australia; 3.Consultation should be expanded to non-health sectors including rail operators who experience an average of 74 suicide deaths and a similar number of attempted suicides each year. A suicide or attempted suicide on the rail network directly impacts the train driver and other rail staff, public witnesses, train crew involved in moving and cleaning the train, as well as causing around 3 hour network disruptions and train delays for each event. More information about suicides and attempted suicides on the rail network is available here. | Noted |
| 57 | 14/11/2022 | TrackSAFE Foundation, Heather Neil Executive Director | 3 | The TrackSAFE Foundation recommends: 1.Additional investment to better understand motivations and behaviours associated with attempted suicides in public places. This should include Psychological Autopsies or similar investigations of suicide deaths on the rail network over the last few years. This will help target intervention measures; 2.Assessment of suicide and attempted suicide ‘hot spots’ (multiple suicides in a public place in a 3 year period), and the local factors that may contribute to attempted suicides in these places; 3.Identifying and trialling different ways to shift the public discourse about particular ‘hot spots’ so they become less known as a place to attempt suicide; 4.Gatekeeper and public bystander awareness campaigns and training is encouraged and easily accessible, including free short online courses; 5.Ongoing funding support for R U OK? as an evidence-based approach to strengthening protective factors and wellbeing and empowering earlier intervention; 6.Ongoing funding support for Lifeline Australia to provide crisis counselling service, including the expansion of text-based counselling. | Noted |
| 58 | 14/11/2022 | Mental Health Australia | 1 | Mental Health Australia welcomes the strategy structure as proposed in the Scoping Paper, including the principles, focus areas and enablers. This structure reflects the Final Advice and supports development of actions for the National Suicide Prevention Strategy. Mental Health Australia welcomes all principles outlined in the Scoping Paper. In relation to the principle 'Informed by lived experience'; this is a critical success factor for the strategy’s development. Given there is a significant proportion of people who experience suicidal thoughts who also experience mental ill-health, it will be important for this lived experience representation to also include lived experience of mental ill-health. Mental Health Australia welcomes the principle addressing the specific needs of disproportionately affected groups. Aboriginal and Torres Strait Islander people, the LGBTIQ+ community and the culturally and linguistically diverse (CALD) community all also experience disproportionately high prevalence of mental ill-health and greater barriers to service access compared to the general population. Mental Health Australia has specific expertise in relation to CALD mental health through its administration of the Embrace Multicultural Mental Health project. This expertise should be drawn upon in development of the strategy. Mental Health Australia also welcomes the focus on 'compassionate and collaborative approaches' by services and supports. This is in line with best practice approaches in mental health including recovery-oriented and trauma-informed approaches. Mental Health Australia welcomes all focus areas outlined in the scoping paper. These accurately reflect the Suicide Prevention Advisers Final Advice and offer appropriate categories from which to develop tangible actions through the Strategy. Mental Health Australia also welcomes all enablers outlined in the scoping paper. In relation to 'governance and collaboration across governments and portfolios'; it will be important for the Strategy to consider how the National Mental Health and Suicide Prevention Agreement can best be leveraged to increase collaboration and drive action across governments for suicide prevention. In relation to 'embedding lived experience decision-making & leadership', Mental Health Australia is a strong supporter of embedding lived experience in decision making and leadership. As noted above, given the strong correlation between mental ill-health and suicide, it will be important for the lived experience chosen to participate to include people with lived experience of mental ill-health and caring. In relation to 'data and evaluation', there are many gaps in data collection and transparency within the mental health sector which, if rectified would also assist analysis of and planning for the suicide prevention sector. For example, the Productivity Commission Inquiry into Mental Health recommended that “Australian, State and Territory Governments should enhance and make all parts of the [National Mental Health Service Planning Framework] NMHSPF publicly available, including the Planning Support Tool and all supporting documentation”. The Productivity Commission Inquiry into Mental Health also recommended that “Australian, State and Territory Governments should ensure a nationally consistent dataset is established in all States and Territories of non-government organisations that deliver mental health services.” In addition, the Primary Mental Health Care Minimum Data Set is also yet to be made publicly available. In relation to workforce and community capability, it will be important for the development of the strategy to take into account multiple workforces including the mental health and wellbeing workforce, medical workforce, social services and others. | Applied in full |
| 59 | 14/11/2022 | Mental Health Australia | 2 | Mental Health Australia welcomes the proposed development and consultation process. Subject matter experts engaged through the two working groups on Governance and Social Determinants and Service Systems, will provide valuable input to the development of the Strategy. The Jurisdictional Working Group should also ensure collaboration across the country through the strategy. As acknowledged in the Scoping Paper, the timeframes are ambitious. The timeframe should allow significant time for public consultation throughout the development of the Strategy to ensure the most vulnerable people with lived experience are enabled to provide input to this important piece of work. | Applied in full |
| 60 | 14/11/2022 | Mental Health Australia | 3 | Mental illness is one of many factors that can contribute to a person’s decision to take their own life but is rarely the only reason. We know that mental illnesses such as depression, psychosis and substance use are associated with an increased risk of suicide. But we also know that experiencing such risk factors doesn’t necessarily mean a person will think about or attempt to take their own life. The mental health system has an important part to play in early identification and treatment of people with suicidal ideation and support after an attempted suicide While the mental health and suicide prevention sectors are unique and distinct, there are also many shared challenges and opportunities. Many organisations and individuals interact with both sectors. Significant growth in service demand, challenges to grow workforces and the need for more timely, reliable data are common issues across these sectors. These should be considered through the Strategy’s development as a priority and in an integrated way. | Applied in full |
| 61 | 14/11/2022 | Anonymous | 1 | It does and it is very comprehensive however I do feel that there needs to be something more obvious and deliberate with provision of tailored services to suit individual communities in regional, rural and remote Queensland. Possibly by adding something more overt in the structure. | Partially applied |
| 62 | 14/11/2022 | Anonymous | 2 | Again I believe they do as long as there is representation from regional, rural and remote Queensland. | Partially applied |
| 63 | 14/11/2022 | Anonymous | 3 | Nil to report | Noted |
| 64 | 14/11/2022 | Thomas Jessup and Charles Chu, Thorne Harbour Health | 1 | Firstly, there must be a core overarching policy objective that provides further nuance of influencing and informing any and all prospective principles, focus areas or enablers of the strategy. For example, as espoused in the Final Advice and mirroring the Victorian Government’s update of its Suicide Strategy, the concept of ‘[t]owards zero suicides’ should be expressly included in any prospective strategy structure as an as it represents the essence of what the Strategy, and what the Commission seeks to address. Importantly, to lay readers, such an overarching theme would further be beneficial as it provides an additional layer of context to the strategy and the Commission’s work. Although it is noted that this strategy is perhaps addressed via the statement “..in which no person feels driven to take their own life” on the first page of the scoping paper, a succinct, condensed, direct, and express goal would be preferable, especially for lay persons not involved in mental health reform or adjacent areas. Secondly, mirroring expert commentary to the right to health, the fourth pillar of the ‘Focus Areas’ should include the words ‘available’, ‘appropriate’/’inclusive’ and ‘acceptable’. The word ‘available’ connotes that services are actually manifestly provided; in essence, services cannot be accessible without being made available first. For example, this term is particularly germane to those living rurally who struggle to access appropriate mental healthcare. ‘Appropriate’/’inclusive’ relates to service providers; it should be included to as to ensure that all individuals involved or associated with service delivery to diverse populations provide care go to all reasonable efforts so as to ensure that consumers feel culturally safe and comfortable in a setting void of discrimination, vilification, hate speech or any associated behaviours that could effectively deter or all together negate future help-seeking behaviours. Likewise ‘appropriate’ connotes the provision of services that are provided by competent, knowledgeable, and understanding clinicians. ‘Acceptable’ relates to the consumer; it should be included so as to ensure that diverse communities receive care they subjectively perceive as culturally safe. Additionally, consideration should be paid to the term ‘affordability’. Not only serving as an apt alliterative pairing to the suggestions above, but affordability of healthcare, especially secondary and tertiary mental healthcare, is becoming an increasing problem for many Australians, not just those in priority populations, who are electing to forego healthcare to finance other life’s necessities. Importantly, all these terms act interrelatedly and are mutually reinforcing. | Noted |
| 65 | 14/11/2022 | Thomas Jessup and Charles Chu, Thorne Harbour Health | 2 | In theory, yes, however there is a noticeable absence of any express commitments of the hiring of individuals from diverse backgrounds that are from priority populations to sit in these groups so as to ensure diverse voices form an integral part of any and all reform processes. Despite the Terms of Reference stating the selection panel will consider all applications to ‘ensure a diversity of critical expertise and perspectives’, there is only an inference that any advisory groups will be comprised of members with diverse lived experience. Albeit noting the existence of the Lived Experience Partnership Group, both currently advertised advisory groups must provide firm commitments to represent those with diverse lived experience. In this regard, given the significantly disproportionate poor mental health outcomes suffered by LGBTIQ+ communities across Australia has been so comprehensively documented, from Thorne Harbour Health’s perspective, as the largest LGBTIQ+ community-controlled healthcare provider in Australia, an individual or individuals of the following backgrounds must be part of these advisory groups: a) LGBTIQ+ persons with lived experience, ideally from CALD backgrounds; and/or b) Service providers or staff from LGBTIQ+ community-controlled service providers; and/or c) A carer with lived experience of caring for an LGBTIQ+ with poor mental health. | Partially applied |
| 66 | 14/11/2022 | Thomas Jessup and Charles Chu, Thorne Harbour Health | 3 | Both the recognition of intersectionalities and people living with intersecting needs and the related effects of discrimination and marginalisation have on poorer mental health outcomes on priority populations must receive significant recognition in any prospective strategy. The Victorian Government’s Suicide Strategy Dicussion Paper and assorted academic literature has informed current practice that people with intersecting needs are at greater risk of experiencing poorer mental health outcomes compared to their peers due to the fact service systems often work in silo and cannot provide integrated care, a lack of appropriate services, and/or difficulties to associated with accessibility. Therefore, recognition of intersectionalities needs to be embedded from a strategic level down to service provision. Ideally, targeted services that serve those from priority backgrounds and people with intersecting needs will be led by, or will have employed strategies, policies, and procedures previously curated and approved by, their respective community after active consultation by clinical providers. This would manifest in examples such as, including, culturally safe and appropriate services for those who are Aboriginal or Torres Strait islander led by the same community these services are targeted to assist. Additionally, intersectionality is inextricably tied with ‘cultural safety’, to which the Australian Human Rights Commission has defined as; ‘an environment that is safe for people: where there is no assault, challenge or denial of identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience of learning, living and working together with dignity and true listening.’ Despite ‘safety’ being mentioned multiple times within the Final Advice, there is an absence as to cultural safety forming part of the strategy. In this regard, if an environment is not perceived as culturally safe, individuals from priority populations may be disinclined to disclose medically pertinent information, or even avail themselves to appropriate mental health treatment or consultation. Thus, situations like these can result in suboptimal mental health outcomes and impair successful long-term treatment outcomes of priority populations, and therefore the concept of cultural safety and what it means to priority populations deserves recognition within any prospective strategy. | Partially applied |
| 67 | 14/11/2022 | Anonymous | 1 | •The overall direction of the Strategy could benefit from a clearly stated goal or vision and purpose. What is the strategy trying to achieve? Is it coordinated action to achieve suicide prevention reform or to decrease suicide rates in Australia? •Objectives: The “specific objectives” are not SMART. The development of a project logic model could help to guide and summarise the Strategy. •Principles: There is potentially not enough emphasis on evidence-informed approaches alongside insight from people with lived experience as the first principle. For example: Evidence-informed, integrated, cross-sectoral approaches are needed. It is preferable for activities to be developed and implemented on the basis of evidence and of what does and does not work. Where evidence is unavailable, programs informed by evidence and best practice methods in similar fields can be implemented. The insights of people with lived experience of suicide; traditional forms of knowledge, such as from Aboriginal people; and unique cultural perspectives can form part of the evidence base for effective suicide prevention. Continual development, implementation and evaluation of existing and future initiatives is crucial. However, it is also important that any evaluations of suicide prevention programs or activities are open to trialling new, innovative and non-traditional initiatives (page 20, Western Australian Suicide Prevention Framework 2021-2025. •Principles: include a principle that aligns appropriately to primary prevention (wellbeing and protective factors) which support a ‘whole of population’ approach and prevents people from becoming suicidal eg “community wellbeing and resilience are fundamental/everyone has a role in suicide”. •Focus areas: these could be better explained/articulated similar to the WA Suicide Prevention Continuum (page 16, Western Australian Suicide Prevention Framework 2021-2025.) This is not clearly defined and is somewhat confusing. •Focus area: Mitigate the impact of the known drivers of distress; Social determinants sits better in the ‘strengthening protective factors and wellbeing’ as a coordinated national approach is required for this. Perhaps talk to risk factors as well as ‘known drivers of distress’. Are we trying to reduce the impact or the occurrence of the distress happening in the first place? •Focus area: Empowering earlier intervention; it feels like ‘transitions and points of disconnection’ are also known drivers of distress. I am not sure if the heading and the description fully align. I would also include financial instability. •Focus area: “Supporting long-term mental health and wellbeing” does suicidal crisis include supporting those who have taken their life and their family/friends/broader community? This may need to be defined. •Enablers: Governance and collaboration across governments and portfolios. This should also include a sentence around many of the factors that can influence suicide prevention. •Enablers: data and evaluation to include emphasis on collection of data to be improved, eg. LGBTIQA+ data collection could be improved. | Partially applied |
| 68 | 14/11/2022 | Anonymous | 2 | •Governance and Social Determinants Working Group MUST include skills-sets of population-based prevention external to the mental health sectors, it could also include the lived-experience of the ‘well population’. •The enabler to the Advisory and working groups that is important is clear leadership and approval from Government to embed and prioritise suicide across sectors and broaden it from having a health focus only. •Consider the inclusion of the word ‘compassionate’ when describing provision of care in the advisory and working groups table, given this is a key principle. It may need to be threaded appropriately throughout the scoping document also. | Partially applied |
| 69 | 14/11/2022 | Anonymous | 3 | •If the aim of the Strategy is to operationalise the vision (which is not clearly stated) it perhaps should consider stating who is responsible for each action (or is this omission deliberate?) enablers, governance and collaboration: these settings needs to occur, and provide examples of these sectors, for example transport, housing or employment. •Are there specific advisory groups that will represent priority populations; Aboriginal people, LGBTIQA+, CALD, who will be involved in the consultation phase? | Noted |
| 70 | 14/11/2022 | ACON | 1 | Thank you for the opportunity to provide feedback on the National Suicide Prevention Strategy Scoping Paper. It is a great opportunity to ensure that the experiences of LGBTQ+ people, who experience suicidality at rates far higher than the general population are reflected in the forthcoming Strategy. Around 1 in 20 LGBTQ+ people will have attempted suicide in the past 12 months, and around 1 in 3 LGBTQ+ people will have attempted suicide in their lifetime. It is critical that the actions of the Strategy address these deeply shocking statistics. The Strategy structure does reflect the Final Advice, and our comments provided today focus on how specific actions could be better developed in the National Suicide Prevention Strategy in order to adequately reflect the needs of our communities. Principles We are pleased that the Principles indicate that the needs of populations disproportionately impacted by suicide will be considered in every domain of suicide prevention. It is extremely important that the actions of the Strategy contain tailored responses for LGBTQ+ communities. It is well documented that our communities need tailored interventions that do not rely on emergency departments or other hospital models. We would like for the Principles (and Focus areas) to recognise the unique drivers of suicidal distress experienced by priority populations, including LGBTQ+ people, including barriers to healthcare, stigma, lack of community connection, structural and systemic discrimination, and situational distress. Focus areas The Focus areas also outline a clear plan for action. We believe it is necessary for the focus areas around strengthening protective factors and mitigating drivers of distress specifically acknowledge the unique circumstances for priority populations including LGBTQ+ people. It is therefore important that the protective factors focus area acknowledges LGBTQ+ protective factors including community and cultural connection, access to inclusive and affirming health care, recognition of who we are, living free and equal as our true selves, pride, gender euphoria, and broadly, equitable, inclusive, and affirming societies. Enablers The Enablers offer many opportunities for service and system improvement to reduce suicidality. It is our belief that the enablers must acknowledge the importance of reducing service wait times to increase service access. Embedding lived experience is essential, and it may be necessary to explicitly clarify what is meant by lived experience, and what kind of lived experience will be embedded. Data and evaluation offer an opportunity for enabling better services and outcomes. However, it is well established that many data systems do not adequately capture or reflect LGBTQ+ people, in life, and in death. Health systems, death records, and Census data need to be able to reflect the diversity of our communities, in order for us to be properly counted, and the true impact of suicidality felt by LGBTQ+ communities is measured, understood, and subsequently addressed. Finally, workforce and community capability must emphasise the important role of the peer workforce in suicide prevention, including the role of peers from priority populations in service provision. LGBTQ+ communities have a long history of caring for each other, both in formal peer roles, and in informal capacities. This work is rewarding, invaluable, and exhausting. In order to best enable effective suicide prevention, the suicide prevention workforce must employ, develop, and support the work of peers in all facets of the sector. | Applied in full |
| 71 | 14/11/2022 | ACON | 2 | It is our view that the two working groups allow for robust consultation across the Strategy’s focus areas and enablers. It will be essential that representatives from LGBTQ+ community organisations, as well as LGBTQ+ people with lived experience of suicide are included in these working groups, to ensure that our subject matter expertise is reflected, and that any tailored actions produced by the Strategy have been co-designed with members of our communities. LGBTQ+ community organisations should also be involved in the Strategic advisory groups, given the role of community wellbeing in suicide prevention, and the importance of community care in early intervention. We note that the timing from final consultation to launch is short, and while it is important to finalise this Strategy and commence the work it provides for, it is also necessary that the Strategy is effective. Responding thoughtfully to consultation and feedback is a critical component of an effective Strategy, so we note that more time may be needed to meaningfully incorporate feedback on the final draft. | Partially applied |
| 72 | 14/11/2022 | ACON | 3 | Nil | Noted |
| 76 | 14/11/2022 | Tandem Carers | 1 | Tandem is the peak body in Victoria representing family carers and supporters in mental health. Tandem welcomes the delivery of recommendation 1.2 of the ‘Final Advice’, to establish a National Suicide Prevention Strategy (NSPS). To progress a national reform agenda for suicide prevention, lived experience knowledge must be at the forefront of research, policy and practice. Tandem values the opportunity to respond to the proposed structure of this important national strategy. We support the shifts and enablers required for reform, outlined in the ‘Final Advice’ report, and welcome the use of this framework to underpin the NSPS. Tandem’s members include family and friends, carer networks, support groups, organisations with a significant mental health focus, including carer networks and services and other key stakeholders in the sector. Located in metropolitan, rural and regional areas across Victoria, the expertise of our network is varied and diverse. In this submission we draw on their collective knowledge and experiences. A note about language - Few of our members identify with the word “carer”. They define themselves in a relational context as a family member or friend. When we refer to ‘family’ it is broadly defined and includes anyone the consumer chooses to identify as family, such as friends, partners, kinship connections, biological relatives and/or significant others. Please find below our response to the proposed structure of the NSPS. Principles We support the prioritisation of lived experience as one of the central guiding principles of the NSPS. We recognise that, when describing ‘people with lived and living experience of suicide’, the intention is to include family and carers alongside consumers. We also recognise that there are some exemplary models of compassionate family-inclusive service delivery throughout Australia. We have found, however, that the practice of involving family, carers and their supporters across Australian Mental Health services is far from universal. Through consultation, and through our support and referral line, our members have told us they often feel invisible in the mental health system. They are often locked out, denied basic information and excluded from important decisions around treatment, management and care. They also express frustration that their important role in prevention and recovery often goes unrecognised. Research also suggests the intensity, stressful and all-consuming nature of mental health caring makes family carers and supporters vulnerable to adverse physical and psychological outcomes, including burnout, fatigue, trauma, and reduced health status. This can also extend to suicide risk. Despite these impacts, family carers and supporters tell us that services rarely acknowledge or respond to their health and wellbeing needs. Given this lack of support and recognition, it is important that family carers and supporters are visible in the lived experience definition in the NSPS. We recommend the further strengthening of this principle, through the explicit identification of family carers and supporters under the broad definition of lived and living experience of suicide. Recommendation: •Expand the lived experience definition to ‘people with lived experience of suicide, including family carers and supporters’ Focus areas After a suicide attempt, family carers and supporters generally have the most contact with the person. If they are properly informed and resourced, they can play a major role in suicide prevention. Provision of information, education and support to family carers and supporters has the potential to be a major suicide prevention strategy. That’s why, accessible, coordinated and comprehensive support services for family carers and supporters should also be included in the ‘Providing accessible, coordinated and comprehensive care’ focus area. Recommendation 31 of the Victorian Royal Commission into Mental Health is an example of a state government initiative that recognises family carers and supporters as partners in delivering effective, ongoing support that leads to recovery. The focus of this key reform is the establishment of new family and carer led centres in eight settings across Victoria. Tandem is leading the project development that will provide family and carers with locally based support that includes: •tailored and localised information, education and supports •access to hardship funds for immediate practical needs including short-term respite •locally based peer support groups and networks Recommendation 31 also included a new state-wide peer call-back service designed to support family, carers and supporters caring for people experiencing suicidal behaviour. Tandem also recognises the importance of data and evidence to the development of an impactful and successful prevention framework. Research, surveys and framework development also need to ensure that family carers and supporters are included, and their experiences, voices and needs are captured. Recommendation: •Expand the ‘Providing accessible, coordinated and comprehensive care’ focus area to include family carer and supporters alongside people experiencing suicidal distress or a suicidal crisis. •Expand the data and evaluation enabler to ensure family carers and supporters are explicitly named and their experiences, voices and needs are captured. Enablers We welcome the identification of lived experience decision making and leadership as foundational to system reform. We also recognise that designing and delivering a compassionate and therapeutic suicide prevention system, in partnership with consumers and their family carers and supporters, requires a workforce ready to support the delivery of the NSPS. That’s why, we suggest the ‘workforce and community enabler’ specifically mentions building and maintaining Australia’s lived experience workforce. Empowering these workers to co-design and lead system reform will require investment in education, supervision, peer support and career pathways. Recommendation: •Update the scope of the workforce and community enabler to specifically mention the need to support the growth and build the capability of the lived experience workforce. | Partially applied |
| 77 | 14/11/2022 | Tandem Carers | 2 | We agree in principle with the structure of the advisory groups, working groups and consultation plan. The Terms of Reference for both working groups clearly outline the member’s roles and responsibilities and required expertise. We support the NSPO seeking expertise from government representatives, service providers, academics, and people with lived experience of suicide perspectives. It is important to ensure that the definition of people with lived experience explicitly includes family carers and supporters. The voices, expertise and lived experiences of family carers and supporters will be essential to inform a Strategy that is inclusive, relational and holistic. We are concerned that the expression of interest process does not call for applicants with expertise to explore considerations that lie at the intersection of cultural diversity and mental health. We recommend that future EOI processes include a diversity statement. We also suggest the diversity statement includes a clear articulation of supports available to increase participation, specifically participation by family carers and supporters from diverse backgrounds. We also request the inclusion of more information regarding the consultation process scheduled for June 2023. Will the process extend beyond written submissions to increase participation and ensure a diversity of responses? We would recommend that the consultation process includes: •Public forums in remote, regional and metropolitan areas •Group meeting and roundtable discussions •One-on-one meetings or interviews with sector leaders. •Questionnaires and simple online forms. •Ensuring that family carers and supporters are actively invited to participate as lived and living experience participants | Partially applied |
| 78 | 14/11/2022 | Tandem Carers | 3 | Family carers and supporters are often the first responders to people at risk of suicide. Through consultations and via our support line, we hear about their experiences, intervening, calling for emergency help, transporting their friends and families to emergency departments and taking a caring role in the weeks and months after an acute event. Family carer and supporters are experts by experience, yet they are noticeably absent from much of the existing literature, policy/policy development and practice, related to suicide prevention. If family, carers and supporters are properly informed and resourced, they can play a major role in suicide prevention. Provision of information, education and support, across all government and community touchpoints, will provide opportunities for family carers and supporters to proactively engage in early intervention. They need to be consulted about and recognised for their critical role in suicide prevention. Further to family carers and supporters being essential to prevention and recovery, it is important to note the growing body of evidence that suggests this group are also a high-risk group for suicide, yet this is not addressed at a policy or service development level. Recognition of the role of first responders and the consequences of exposure to trauma is addressed in the Final Advice (Compassion First: Opportunity 6) however, explicit prevention, support and recognition of the unique needs for family carer and supporters is noticeably absent in the Principles or Focus Areas of the Strategy. The NSPS must identify family carer and supporters as crucial e in prevention and recovery and ensure their specific needs are adequately supported. Recommendation •Family carers and supporters are explicitly recognised not only as key to prevention and recovery but also given adequate support for their own mental health and wellbeing to prevent increased risk to themselves. | Applied in full |
| 85 | 14/11/2022 | Lifeline Australia | 1 | Lifeline Australia endorses the approach of implementing the Final Advice via the structure proposed by the National Suicide Prevention Office (NSPO). Noting that the four identified enablers broadly correspond to those proposed by the National Suicide Prevention Taskforce, and that the Principles and Focus Areas capture (and add to) the four identified ‘Shifts we need’, Lifeline Australia’s position is that the structure in principle will support an effective approach to implementing the Final Advice. Lifeline Australia in particular endorses the inclusion of the focus area of accessible, coordinated and comprehensive care, as well as community services, within the workforce and community capability enabler. We note and endorse the inclusion of non-clinical services towards the objective of ‘providing proactive options that support people in a coordinated and compassionate manner’ and identify as a key enabler for viable delivery of non-clinical (and clinical) services the provision of long-term funding opportunities. Lifeline Australia further endorses the inclusion as a principle of Lived Experience advice. Within that context we note the importance of including representation of different types of lived/living experience. We also note the benefits of including multiple levels of consultation at all levels including planning, implementation, and evaluation of suicide prevention activities. We note that one of the risks associated with working-group based Lived Experience consultation activities is that a relatively small and potentially unrepresentative number of people exert power and influence over outcomes. To mitigate this risk Lifeline Australia suggests a multi-method consultation approach be considered to amplify the diversity of input, including community consultations with individuals who might not otherwise be involved in advocacy. | Applied in full |
| 86 | 14/11/2022 | Lifeline Australia | 2 | Lifeline Australia welcomes the ambitious timeline for delivery, noting the need for follow through on the comprehensive work of the National Suicide Prevention Taskforce in delivering the Final Advice. In particular, Lifeline Australia endorses inclusion of the Jurisdictional Working Group in developing the strategy. Mechanisms for cross-jurisdictional coordination in suicide prevention have so far been illusive and, we submit, are key to national delivery of effective suicide prevention. Per our response to Question 1, Lifeline Australia endorses the layered approach to capturing lived/living experience advice. We submit that ensuring the representation of diverse lived experience voices will require multiple levels and methods of lived experience consultation. We submit that those should include opportunities for input beyond Working Groups which may exclude many individuals. Building in multiple levels of lived experience consultation to ensure that there is sufficient opportunity for sound and rigorous input to support the Strategy achieving the objectives identified. | Applied in full |
| 87 | 14/11/2022 | Lifeline Australia | 3 | Lifeline Australia highlights the significance and complexity of delivering against the focus area of delivering accessible, comprehensive and - in particular - coordinated care. As the nation’s largest suicide prevention service provider we welcome the opportunity to play our part in creating a ‘joined up’ support system, one that underpins a truly coordinated national approach to suicide prevention. | Applied in full |
| 91 | 14/11/2022 | Settlement Services International | 1 | Settlement Services International (SSI) is pleased to see that the National Suicide Prevention Strategy (the Strategy) will be informed by lived experience and the needs of disproportionately impacted populations. We recommend the Strategy is informed by people with lived experience from a range of backgrounds, including race, ethnicity, age, gender, religion, sexual and gender diversity, disability, socio-economic status and other diverse backgrounds. People with lived experience should include those who have considered or survived suicide, as well as those who have been affected by suicide, including family members, carers, peers and school communities. Refugees and people seeking asylum are a significantly impacted, but often overlooked, group who deserve tailored mental health support services. Refugees settling in Australia often experience high levels of psychological distress and trauma from escaping persecution and conflict in their countries of origin. Post-migration stressors of adapting to a new country place added pressure on their mental health. Refugees and people seeking asylum often experience discrimination and disconnection, as well as other drivers of distress (housing insecurity, underemployment, and family separation) upon their arrival in Australia. Research led by the University of South Australia’s Mental Health and Suicide Prevention Research Group in partnership with the Australian Red Cross found that male asylum seekers have significantly higher rates of suicide (33 per 100,000) than males in the general Australian population (19.2 per 100,000). Over the last three weeks alone, SSI has identified three cases of suspected suicide among refugee clients. SSI recommends that refugees and asylum seekers be intentionally considered and prioritised as a ‘disproportionately impacted population’ in the Strategy. More broadly, Culturally and Linguistically Diverse (CALD) communities face barriers to accessing mental health services. In SSI’s service delivery to refugees, migrants and people from multicultural backgrounds, we see first-hand the pivotal role of culture and language in understanding and treating mental ill-health. Considering this, SSI recommends the addition of a new focus area on ‘breaking down barriers to access mental health services’. This could include addressing location barriers, language barriers and cultural barriers to accessing mental health and psychosocial support. SSI welcomes the Strategy’s proposed focus on strengthening protective factors (including increasing cultural connections and social cohesion) and providing accessible, coordinated and comprehensive care. But the significance of barriers to accessing mental health services warrants a dedicated focus, especially for marginalised populations which have the highest burdens of psychological distress. When identifying priority groups, it is also important to consider intersectionality. People cannot be explained by single categories (such as age, gender, race, ethnicity, sexual orientation, ability, etc) and their mental health is often not the result of a single risk factor but a combination of risk factors (social isolation, historical trauma, family history, discrimination, etc). Refugees, new migrants and people from CALD backgrounds, especially youth, experience an intersection of risk factors which make them a disproportionately impacted group. SSI supports the Strategy’s proposed focus on building workforce and community capability to deliver suicide prevention services. We recommend a workforce stream be specifically established for multicultural communities to ensure mental health support is tailored, culturally-responsive, and trauma-informed, especially for refugees and other people who have escaped persecution and conflict and for those who face language barriers when accessing mainstream mental health services. Community engagement will be critical to building awareness and capability, especially for CALD communities which tend to lean on peers and social networks for support in times of crisis rather than formal services. SSI supports the person-centred approach to suicide prevention identified in the objectives of the Strategy, and recommends this include a focus on the individual’s cultural context. SSI also supports the proposed integrated approach to suicide prevention beyond health, and suggests embedding early intervention in other settings including, for example, settlement services for refugees, foster care provision and disability support services. The Strategy’s focus on prevention could be complemented by ‘postvention’ support – that is, helping people bereaved by suicide to support their mental health and reduce ‘suicide contagion.’ Lastly, the enabler of ‘embedding lived experience decision-making and leadership’ is a critical one, but it needs to be supported by practical mechanisms to ensure a place at the decision-making table. | Partially applied |
| 92 | 14/11/2022 | Settlement Services International | 2 | In addition to the Governance and Social Determinants Working Group and the Service Systems Working Group, SSI recommends the establishment of an Access and Responsiveness Working Group. This Working Group would be responsible for identifying barriers for different communities and groups to access (existing and new) mental health services, and it would recommend ways to address those barriers. This group would also be responsible for advising on how to make mental health services culturally responsive and appropriate, including for Aboriginal and Torres Strait Islander communities and culturally and linguistically diverse communities. An alternative (but less preferred model) is to broaden the scope of the Service Systems Working Group to address barriers to accessing mental health services. The scope and complexity of the National Suicide Prevention Strategy warrants a third working group, in our view. | Noted |
| 93 | 14/11/2022 | Settlement Services International | 3 | SSI recommends the National Suicide Prevention Strategy be developed in conjunction with the National Stigma and Discrimination Reduction Strategy given the intersections and interdependencies between the two strategies. Reducing stigma and discrimination is a critical step to preventing suicide. We recommend that both strategies consider ways to support local non-government and community-based organisations to reduce stigma associated with mental health (including changing social and cultural norms and attitudes) to provide safe spaces for people to discuss mental health and to encourage uptake of mental health services when they are needed. | Partially applied |
| 94 | 14/11/2022 | Lived Experience Australia | 1 | I think the 'Mitigating the impact of known drivers of distress' section needs to be more detailed and recognise a broader set of ideas. 'Addressing social determinants of health' is very generic and has potential to be a catch all phrase that is then overlooked or assumed. I note that racism and discrimination are not mentioned there and they probably should be. In the 'Provide assessible, coordinated and comprehensive care' section, it is also important to include something about how services need to act towards the person and how they talk to, respect and regard each other in the communication of information and support provided to the person. In the 'Workforce and community capability' section, I think 'community organisations' needs to be clearer what is meant here, especially given contact with people who are never known to any services or mental health services. | Applied in full |
| 95 | 14/11/2022 | Lived Experience Australia | 2 | They seem reasonable. The challenge is to reach the many people who simply haven't had prior contact with services. | Applied in full |
| 96 | 14/11/2022 | Lived Experience Australia | 3 | Thanks for the opportunity. | Noted |
| 97 | 15/11/2022 | Suicide Prevention Australia | 1 | Suicide Prevention Australia strongly supports he overall structure set out in this scoping paper. Based on consultation with our members and those with lived experience, we have the following suggestions to further enhance this structure: Accountability: The key point raised by the sector has been the need for increased mechanisms to ensure accountability. There should be specific reference to the need for accountability and transparency mechanisms in the discussion of enablers. We suggest, in the discussion on governance and collaboration across governments and portfolios, that specific mention is made of the need to establish mechanism to ensure that all parts of government are considering the impacts on suicide of their decisions and activities. Community-wide strategies: The need for community-wide strategies should be made more prominent in the focus areas. Building the resilience of communities, both generally and in the wake of a suicide to prevent further suicides, is a key aspect of intervening early. We suggest that the third focus area in figure 1 should be rephrased as “Empowering earlier intervention and community-wide strategies” Priority populations: The use of the phrase “disproportionately impacted populations” can be seen to be reflecting an overly statistical-based approach and potentially be seen to exclude certain populations who should be considered. The phrase might be seen to exclude populations where there is a lack of definitive statistical evidence that this population is disproportionately impacted, but the insights of front-line service providers and those with lived experience indicate that this group should be a priority for suicide prevention support. As well as potential gaps in knowledge around disproportionate impacts, there are certain groups, such as some CALD communities, where there is not a higher rate of suicide deaths or attempts, but support access barriers (such as language) mean that targeted and tailored approaches will still be needed. We would suggest using the phrase “priority populations” as more inclusive and accurate. | Partially applied |
| 98 | 15/11/2022 | Suicide Prevention Australia | 2 | Suicide Prevention Australia supports the proposed mechanisms to include insights and input. Based on consultation with our members and those with lived experience, we have the following suggestions of further aspects of consultation that may help ensure thar the broadest possible range of perspectives are included: Broad government representation: To ensure a whole of government focus representation from government departments outside health need to be included. This could be done by having, in addition to the Jurisdictional working group, a broader government reference group made up of relevant representatives of all major government departments (e.g. Education, Social Services, Justice) in all jurisdictions. This group would be too large to meet, but could be consulted via email and the nomination of representatives would provide linkages into the various departments. Multi-method consultation approach: It is important that there is not over-reliance on advisory groups in the development of the strategy. No matter how well set up advisory groups are, limits on numbers mean that they can never fully represent all views. In addition, some people and organisations are excluded from working-group based advocacy, including those without an advocacy background, those who struggle with group-based speaking activities, and those who do not currently have the time, resources or ability to engage in such groups. The stages of the strategy development should explicitly include that there will be public consultations conducted using a varieties of modes, with strategies to ensure that there is active targeting of groups who may be excluded, face barriers, or struggle to participate. This should occur during the content development process addressing specific topics, as well as for the finalisation of the strategy. In addition, timeframes for responses to consultations must be long enough to allow for input from smaller suicide prevention organisations and individuals with lived experience, who may be delayed in becoming aware of consultations and/or in having the resources to respond. | Partially applied |
| 99 | 15/11/2022 | Suicide Prevention Australia | 3 | No further comments. | Noted |
| 103 | 11/11/2022 | Michael Struth, Western Victoria PHN | 1 | Western Victoria Primary Health Network (WVPHN) is grateful for the opportunity to participate in this process and strongly endorses this National approach to suicide prevention and supports the proposed structure. WVPHN believes that preventing suicide is ‘everybody’s business’ and requires the collective effort of community in all of its social structures to successfully reduce deaths by suicide. This submission is focused only on points where we identify an opportunity to comment constructively and contribute to the discussion about a national strategy. We offer the following comments for the National Suicide Prevention Office to consider Overall WVPHN agrees with the structure but makes the following comments regarding some of the key principles and focus area. Reflections and Observations WVPHN see merit in a national strategy that leverages off what is known to be effective and challenges what has not been effective in preventing suicide. Some of our observations may appear critical or provocative, which is not our intent. However suicide is such a complex social issue that we have not yet mastered a successful response for. Therefore we have looked at this paper with critical intent in the hope that the critical conversations that need to be had, will be had as we collectively work towards a national strategy for a better result. Outcomes Framework WVPHN learnt through the Place Based Suicide Prevention Trials that establishing an outcomes framework is essential to focus the development of a strategy. The outcomes framework guides a logic that align objectives with actions towards the desired outcomes. Without establishing the outcomes framework, stakeholders will not necessarily share an understanding that aligns the strategy with desired outcomes. This was clear feedback from Trial leadership groups in western Victoria. We suggest the structure of the strategy puts the outcomes framework at the front of the process Principles Lived Experience. WVPHN unequivocally endorses that suicide prevention efforts must be informed by people with a lived experience of suicide. However, the complex diverse and deeply personal impact experienced is not the same experience for all and cannot be ‘grouped’, Therefore WVPHN advocates for an intentional and authoritative role for people with a lived experience through well facilitated processes. Participants must feel heard, safe and valued so that it is a constructive experience and mitigates the risk of triggering personal trauma for people that participate. Most importantly, they must observe action and improvements relevant to their experiences that promote hope and prevent the sense of helplessness that many have experienced in their journey. Specific needs of populations WVPHN agrees that in principle specific needs of populations disproportionately impacted by suicide must be considered for the reasons described. However, the strategy should be informed by best evidenced actions and interventions at universal transitional stages of life (as they correlate with suicide) and pre-emptive interventions relevant to the known knowns (objective indicators of suicide). The strategy must enable a better analysis of these transitional life stage factors and correlating suicidality factors and the combination of fatality factors in each of these life stages in order to target those populations disproportionately impacted by suicide. Service Responses WVPHN acknowledges the need for services to take a more compassionate and collaborative approach for the reasons specified. However, this is a much more complex challenge than it looks as a statement and WVPHN suggest a systems approach needs to include the following; Organisational Governance and Risk Tolerance The escalation and operationalisation of corporate and clinical governance and authentic leadership that enables learning and high performing environments are keys to enabling compassionate and collaborative approaches by the workforce of services. However, risks to the costs of insurance, legal suit and defence, reputation and workplace injury are a curious amalgam of the current context that complicate pure service responses from an evidence based, compassionate and collaborative ideal. Governance (both clinical and corporate) led and operationalised poorly undermines the capacity and confidence of workforces to exercise their judgments purely. Defensive practice based around medico-legal accountabilities in poorly led services undermines this principle and objective. Additionally, competitive tendering practices can disrupt service collaborations. Workforce, exposure to risk, systematic de-sensitisation and vicarious trauma Frontline workforces that are constantly exposed to assessing and responding to people at risk (accidental and deliberate self harm, harm to others such as violence and abuse) are known to be at risk of compassion fatigue. Issues of workplace violence and injury of health, emergency services, teaching and aged care, General Practice etc workers are well documented. This strategy must incorporate a national approach to the health and wellbeing of the workforce that respond to people at risk of suicide and seeking help. Community standards and tolerances related to the Dignity of Risk and the Duty of Care Community standards and expectations are enshrined through the laws of the relevant State and the Nation. The challenge is to reach the right balance that enables workforces to respond in more compassionate and collaborative ways which is directly influenced by the laws that create the environment for services to respond, the standards and protocols that operationalise them and the consequences of failure or negligence. The lived experience context raises paradoxical expectations in the way they relate to suicide which can be a compelling barrier for the workforce. To illustrate this point, WVPHN participated in a Community of Practice event at the commencement of the Victorian Place Based Suicide Prevention Trials. Two people with a lived experience of suicidality presented at the forum as well as a panel of experts. One person with an experience as a service user said ‘when I asked you for help, YOU sent the police, they took me to hospital against my will and YOU LOCKED ME IN A ROOM BY MYSELF! Why would I ask you for help again? The second person with a parental experience of a son with a completed suicide said ‘I brought my sone to you. YOU sent him away. I pleaded with you to take him because he would kill himself. YOU did not listen to me’ This highlights the challenge service workers face in formulating their conclusions at the end of an assessment and in exercising their judgements within the policies of their organisations that reflect the law; the standards of our community today. A national suicide prevention strategy must include the balance between the compassionate dignity of risk and the professional’s duty of care mixed within the complexities outlined above. WVPHN delved into more contemporary theories on suicide such as the Thomas Joiner theory and the like during the Place Based Suicide Prevention Trails in Victoria. When considering the Joiner type theories, we wondered if more could be learnt by a retrospective analysis of the decisions services made to intervene restrictively or not with suicide risk being imminent against the combination of factors like the joiner theory. This could then correlate with those where interventions were active (at times restrictive) as opposed to those that were not where people were lost to suicide. WVPHN hypothesise that it is not the number of risk factors that result in suicide; it is the combination of factors and context. This type of work would enhance a national strategy in a more informed way and may help to inform future laws and practices in how services respond to a person at risk of suicide Focus Areas Strengthening protective factors and wellbeing: WVPHN agree that requires genuine prevention requires comprehensive policy and system responses that strengthen protective factors and wellbeing at a population level. WVPHN emphasises that any strategy developed relating to protective factors and wellbeing must be evidenced based and knowledge driven following deep analysis. WVPHN agree that nationally coordinated policies and programs that enhance the population level factors known to protect against suicidality and suicide, including increasing interpersonal and cultural connection, family and social cohesion, health, education, socioeconomic opportunity, and resilience are required. However, we challenge that that these factors are known to protect against suicidality. That is a consensus of minds to build upon, not yet an evidence base | Partially applied |
| 104 | 21/11/2022 | Dr Zena Burgess, CEO, Australian Psychological Society (APS) | 1 | The APS generally supports the proposed structure of the Strategy and believes that it is well-aligned with the Final Advice. We recognise and affirm the emphasis placed in the Scoping Paper on lived experience as a guiding principle. We would also suggest that a further guiding principle is that the development of the Strategy is evidence-based. Such an approach would complement, not detract from, the emphasis on lived experience. A properly evidence-based approach to suicide prevention encompasses not only the extensive and ever-evolving psychological and interdisciplinary scientific research about suicide and its drivers and prevention, but also includes an intentional and systematic framework for hearing, synthesising, and learning from people and communities affected by or with a lived experience of suicide. As we have said in our recent APS Position Statement on Evidence-Based Practice and Practice-Based Evidence in Psychology (2022), the role of practice-based evidence (PBE) is essential for an inclusive and transformative application of science to the community. Recognising the role of PBE in the suicide prevention context is particularly important for populations (including First Nations people and communities) where traditional scientific research and methodologies have been underapplied or are not culturally appropriate. In addition, we would recommend that the development of the Strategy be guided by a theory or model of change. The ambitious scope of the Strategy for suicide prevention in Australia needs to be underpinned by a realistic and testable model which is informed by the psychology of behaviour and culture change at the level of individuals, communities, and institutions. Such a model would also allow for the prioritisation of actions in the Strategy according to a system-based understanding of how to effect change in the most effective and efficient way. Psychologists are uniquely placed to contribute to the development of a theory of change which maximises the translation of the Strategy into successful and sustainable action. | Partially applied |
| 105 | 21/11/2022 | Dr Zena Burgess, CEO, Australian Psychological Society (APS) | 2 | The APS welcomes the intention to consult with people and organisations beyond those traditionally involved in suicide prevention, including through the advisory groups, and working groups. We would caution that this widened scope of consultation should not be at the detriment of the critical role that mental health professionals, researchers and advocates continue to have in suicide prevention. As psychologists, we are not seeking a privileged voice in the consultation process, but at the same time, the disciplinary maturity, expertise, and insight of those in the health and mental health community – including psychologists – should not be sidelined. The development and implementation of the Strategy should be an opportunity for dialogue and learning, not the basis of creating new silos or for risks of failure to be unintentionally created by not drawing on the body of knowledge, experience and wisdom that already exists. As part of this, the Strategy development process should create institutionally safe spaces to share and learn from policy and program failures in ‘traditional’ suicide prevention approaches, and thus to innovate together for the benefit of the Australian community. In particular, the APS notes that the role of psychology and psychologists in suicide prevention includes and goes beyond clinical service delivery, particularly at the acute or postvention stages. The Scoping Paper rightly recognises that suicide is more than a mental health issue. Similarly, psychology’s contribution to suicide prevention extends beyond mental health to other domains which are critical to the success of the development and implementation of the Strategy. As noted above, psychologists bring unique expertise in understanding and shaping behavioural and culture change. Psychologists also work not only with individuals across the lifespan but can harness the power of groups and communities. Psychologists work within organisations, institutions and regulatory structures to promote wellbeing and prevent distress using evidence-based interventions and strategies. Psychologists understand the inextricable connection between physical and mental health. All of this is relevant to effective suicide prevention. Moreover, psychologists are attuned to the often unspoken but profound influences on suicidality which lie between individual clinical factors and broader societal phenomena, including the role of shame, anger, disconnection, and the loss of meaning in life. As such, we would hope that the development of the Strategy is psychologically-informed in the fullest sense of the term. | Applied in full |
| 106 | 21/11/2022 | Dr Zena Burgess, CEO, Australian Psychological Society (APS) | 3 | The APS would like to see maximal interoperability and minimal duplication between the Strategy and the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and state and territory suicide prevention strategies. | Applied in full |
| 107 | 17/11/2022 | LGBTIQ+ Health Australia | 1 | •The Strategy does reflect the high-level principles, focus areas and enablers addressed in the Final Advice and its reports. •However, it does not pick-up on the specific areas and risk-factors that are uniquely experienced by priority populations (as acknowledged in the Final Advice). Having a ‘compassionate’ and ‘lived experience’ approach that is ‘embedded in decision making’ needs to recognise that there is a huge diversity in such lived and living experiences. (This also needs to be picked up in the consultation process). oFor example: risk factors, enablers and drivers for suicide and suicidality in the LGBTIQA+ community are diverse and nuanced. Stigma and discrimination, often leading to hindered access to health and social services, is an ongoing risk factor. There are also multiple risk factors that can be present, such as drug and alcohol use, isolation, and trauma and mental illness. It can also be cross-cultural, with people from Aboriginal communities who are LGBTIQA+ are also at higher risk of suicide. •Given the high rates of suicide and suicidality in the LGBTIQ+ Community, that has been identified in all the national strategies to date, it is recommended that a dedicated section of the Strategy needs to be included. This would also identify the paucity and needs for LGBTIQ+ health data as well as mental health and suicide, and subsequently the broad scope of risk factors within the communities. •When we talk about ‘lived experience’ it should also be transparently recognised as ‘living experience’. People who are impacted by suicide, or who are survivors of suicidal behaviours and attempts, have active experiences. This needs to be understood as it will directly contribute to the type of information sought in the consultation process. •In reference to governance, the scoping paper indicates that there needs to be a cross-government and cross-portfolio approach. However, what level of government is this? State is the State and territory governments that provide health services. Local Governments also have an active role, with many councils adopting health and well-being Strategies, and implementing programs like drop-in centres. | Partially applied |
| 108 | 17/11/2022 | LGBTIQ+ Health Australia | 2 | •Participation of a diverse range of people with lived and living experience needs to be embedded in the consultation process. A dedicated lived and living experience working group should be considered, given the diversity of experiences, as well as to capture information without any agenda that might influence feedback. For example, there may be some power dynamics at play. •It is the NGOs that are predominantly funded to provide suicide prevention services and aftercare, as well as other community and social supports. How will they be included in the consultation? | Partially applied |
| 109 | 17/11/2022 | LGBTIQ+ Health Australia | 3 | •There must be focus on the need for systemic changes in health and well being for LGBTIQ+ community, including access to primary health care, and address of complex needs, and stigma and discrimination. •The impacts the lack of funding provided for targeted services for the LGBTIQ+ community (and other priority populations) to specifically address the health and well being of the communities, to support any recommendations for change. •There needs to be a balance between looking at a broad national approach to providing prevention, early intervention, postvention and long-term care for people with lived and living experience of suicide and suicidality in the LGBTIQ+ community (universally identified as a priority population), and implementing activities to provide immediate, effectual, person-centred care in real time that can leverage off existing systems. | Applied in full |
Page last updated: 06 Nov 2023, 12:38 PM
Documents
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REVISED - National Suicide Prevention Strategy Scoping Paper - Incorporating Consultation Feedback.docx (481 KB) (docx)
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FINAL_-_National_Suicide_Prevention_Strategy_Scoping_Paper_-_Incorporating_Consultation_Feedback.pdf (408 KB) (pdf)
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National Suicide Prevention Strategy Public Consultation Feedback.xlsx (69 KB) (xlsx)