IDENTITY, VOICE, PLACE SUICIDE PREVENTION FOR INDIGENOUS

AUSTRALIANS ‐ A SOCIAL AND EMOTIONAL WELLBEING APPROACH

Krysinska, K., Martin, G. and Sheehan, N.

The University of Queensland “The Mental Health of a Nation is judged by the care with which those most in need are assisted to regain control of

their own lives”

Personal Journey Pitjantjatjara child ACH 1975 CAMHS Ngarrindjerri Riverland position 1996 to date Elcho Island visit (Terry Yumbulal) (NYSPS Liaison),

1996 Auseinet position 1997-2006 Masters & Grad Cert program 1998 to date (Sharon

Cruse) Yunggorendi First Nation Centre, Flinders Uni and

Nunkuwarrin Yunti 2nd Year Medical student patient 1998 Spirituality and Suicide Conference, Brisbane 2004 Mount Isa child 2008 Mornington Island service planning, 2009

From Nanna, Christmas 1955

Identity, Voice, Place

Our literature review was based on 9 Key Principles consistent with existing Australian and International declarations, frameworks, policy, plans and strategies

Our recommendations derive from the best available evidence (both national and international) in promotion of social and emotional wellbeing, and prevention of suicide through early intervention in social, family, personal and biological determinants along the trajectory to suicide.

The Key Principles Direct Involvement of Community Members and

Development of Local Workforce Ensuring Program Sustainability and

Organization Capacity Evidence‐ or Theory‐Base for Programs Appropriate Program Evaluation “Researching Ourselves Back to Life” Community Empowerment Recognition of Human Rights, Transgenerational

Trauma, Loss and Grief Development of Individual, Family and

Community Social and Emotional, and Spiritual Wellbeing

Acknowledgement and Recognition of Aboriginal and Torres Strait Islander Diversity and Importance of the Local Context

The Personal Journey

Mackay 2008

Children’s Commission Report 2008 2 cases

“Suicide Prevention for Indigenous Australians: A Social and Emotional Wellbeing Approach”

pdf from <www.SuicidePreventionStudies.com.au>

The First Direction:Services and Programs

Suicide is increasing worldwide

Nearly 1 millionpeoplein 2007

Strategies work: Finland 1992

(a) Males

0

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54 51 48 45 42 39 36 33 30 27 24 21 18 15 12 9 6 3 0 3 6 9 12 15 18 21

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All ages 15-24 years

(b) Females

0

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54 51 48 45 42 39 36 33 30 27 24 21 18 15 12 9 6 3 0 3 6 9 12 15 18 21

No. of years pre-strategy No. of years post-strategyNo. of years pre-strategy No. of years post-strategy

Strategies work: Australia 1995

(a) Males

0

10

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60

54 51 48 45 42 39 36 33 30 27 24 21 18 15 12 9 6 3 0 3 6 9 12 15 18 21

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All ages 15-24 years

(b) Females

0

10

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54 51 48 45 42 39 36 33 30 27 24 21 18 15 12 9 6 3 0 3 6 9 12 15 18 21

No. of years pre-strategy No. of years post-strategyNo. of years pre-strategy No. of years post-strategy

Mann et al, 2005 (consensus)

“National suicide prevention strategies have been proposed despite knowledge deficits about the effectiveness of some common key components

the most promising interventions are physician education, means restriction, and gatekeeper education. Many universal or targeted educational interventions are multifaceted, and it is not known which components produce the desired outcome”

Despite this we concluded…

National Strategies are successful if they provide… communication program to the whole population education for relevant groups (‘gatekeepers’) reduced access to means (bridges, firearms, etc) a strategy on drugs and alcohol a critical mass of clinical services with relevant

and sufficient highly trained professionals improved services managing suicidal people, as

well as improved linkages with the community proper evaluation with a formative approach a strategy for Indigenous peoples

Fact

The estimated resident number of Indigenous Australians (June 2006) is 517,200 including 463,900 Aboriginal Australians, 33,100 Torres Strait Islander Australians and 20,200 people identifying as both Aboriginal and Torres Strait Islander, altogether comprising 2.5% of the total population (ABS&AIHW, 2008).

Fact

Best available data indicate that overall mortality rates among Indigenous males and females are almost three times higher than for non‐Indigenous Australians, and there is a 17‐year gap between life expectancy at birth for Indigenous and non‐Indigenous males and females (59 v 77 yrs and 65 v 82 yrs respectively) (ABS&AIHW, 2008).

Facts: Suicide

Among Indigenous Australian males, overall suicide rates are almost three times higher than suicide rates for non‐Indigenous Australian males, with biggest differences in younger ages (ABS&AIHW, 2008).

Suicide rates among Indigenous Australian females aged 10‐24 are five times the rate of other Australian females, although in age groups 45‐54 and over, suicide rates are similar or lower compared to rates for non‐Indigenous Australian females.

Fact

The situation of Indigenous Australians looks grim even by comparison to other Indigenous populations (Freemantle et al., 2007), and not much has changed since 1995 when Ring observed that “expectations for life for Indian populations in Canada and the United States, and for the Maoris in New Zealand are at least 10 years more than for Australian Aborigines, an enormous difference” (Ring, 1995; p. 228).

Indigenous Deaths 2008 (ABS, 2010)

Male Female Total Rank % All deaths OR

Suicide (X60-X84)

Indig Aust 74 29 103 5 4.22.8

Non-indig 1,588 444 2,032 14 1.5

Accidental Poison. (X40-X49)

Indig Aust 24 13 37 14 1.53.75

Non-indig 408 156 564 39 0.4

Assault (X85-Y09)

Indig Aust 22 15 37 14 1.515

Non-indig 100 62 162 51 0.1

Self-Injury Prevalence Last 4 wks

129/12,0061.1%

Aboriginal Australians Key Findings

Interpret with caution

183 (1.94%) respondents identifying as Aboriginal or Torres Strait Islander compared to 2.29% in the population (Χ2=0.63, p=0.426).

4 week prevalence 2.4% (1.1% NI) Females 4.2%, (n=4) Males 0% (none)

Lifetime prevalence 15.7% (n=29) (8.1% NI) Higher for women (17.8%, n=19) Males 13% (n=10)

Proposed Outcomes

Sufficient Indigenous professional capacity to sustain development and implementation of programs toward Social and Emotional Wellbeing at the local level;

Coordinated local training in Mental Health First Aid, ASIST, Drop the Rock and other relevant programs where evaluation shows them to be effective;

Provision of relevant crisis management at the local level for suicidal people.

Sufficient local awareness of mental health systems and how these are accessed.

Existing programs Suicide Awareness for Aboriginal Communities

manual and workshop King, Appleby, & Brown, 1995

Yarrabah Men’s Health GroupMitchell, 2005; Patterson, 2000

Family Wellbeing Empowerment Program Mitchell, 2005; Tsey et al. 2004a, 2004b, 2005, 2007

Healing Our Way self-help resource Mitchell, 2005

Indigenous community suicide intervention forums Indigenous Psychological Services

Toughin’ it out. Survival skills for dealing with suicidal thoughts pamphlet

Bridge, Hanssens, & Santhanam, 2007 Health Interactive Technology Network (HITnet)

Hunter, Travers, Gibson, & Campion, 2007

Existing programs

Applied Suicide Intervention Skills Training (ASIST) LivingWorks

Increasing the Capacity of Local Counsellors “Drop the Rock”

Royal Flying Doctor Service of Australia (Qld) Learning from the experts: Building bridges to

implement successful life promotion and suicide prevention expertise across Aboriginal communities

Centre for Rural and Remote Mental Health Queensland et al. Something Better

Queensland Police-Citizens Youth Welfare Association Napranum Life Promotion

Queensland Police-Citizens Youth Welfare Association

Far North Queensland TaskforceDr. Edward Koch Foundation (Dulcie Bird)

Issues Lack of co-ordinated service response

to self-harming behaviour Lack of follow-up services Inappropriateness of psychological

testing tools Interdisciplinary training (eg Wesley

Mission Lifeforce program) Issue of stigmatisation of 'Mental

Health’ Appropriate referrals Better data on suicide and deliberate

self harm patterns Better data required on help-seeking

behaviours Lack of accommodation for young

people exhibiting high risk behaviour