Suicide In Australia
The annual rate of deaths by suicide in Australia has mostly remained within two standard deviations of the mean of 11.8 per 100,000 for the past 100 years (see Figure 1 calculated from ABS data). This is despite significant attention and investment and multiple national mental health and suicide prevention strategies.
wHAT cAUSES sUICIDE
While suicidality is often purported to be a problem for particular identity groups (e.g., adolescents, older men, middle-aged men, farmers, doctors, construction workers, lawyers, university students, people identifying as LBGTIQA+, veterinarians, people with psychiatric
disorders, FIFO workers, people bereaved after a death by suicide, people who use substances, emergency services personnel), the reality is it is a problem for people; it can happen to anyone who experiences overwhelming distress.
There are seven modifiable domains of health and wellbeing.
Problems in one or more of these biopsychosocial health and wellbeing domains can cause distress. This is universal.
Coping with Distress
Coping is behaviours people use to reduce unpleasant emotions. Coping can be conceptualised as either healthy or unhealthy. Both are likely to reduce acute distress; however, unhealthy coping strategies, negative self-talk, harmful behaviours (emotional eating, alcohol, drugs, aggression, self-harm), social withdrawal, and suicidality are likely to also have adverse consequences. Research has shown that unhealthy coping does not occur in the absence of personal healthy coping strategies (self-soothing, relaxation/distraction), but when personal healthy coping strategies are overwhelmed, hence when people experience overwhelming distress. Increasingly harmful unhealthy coping strategies are used when low harm (e.g., negative self-talk, emotional eating) are ineffective at reducing distress. For some, this requires suicidality and, for some of those, in death by suicide.
Problems with Risk approaches to Suicide Prevention
Health professionals mostly continue to rely on risk assessment to identify people likely to die by suicide without intervention. This approach is problematic because risk and protective factors have been shown to be poor predictors of suicide. This is because they are based on population correlations of biopsychosocial domains of health and wellbeing and coping. When population risk is applied to individuals, there will inevitably be false positives and negatives. While that works in other risk contexts (e.g., insurance, accidents, managing COVID-19), it does not work when the aim is for no Australian to die by suicide. Indeed, Australians die by suicide after asking for help and being assessed as low-risk.
After risk is detected, common responses by health professionals have included observation, pharmacotherapy, or safety planning, including encouraging the person to be hypervigilant for warning signs of suicidality. These responses have focused on the needs of health professionals—stop the person dying by suicide—rather than the needs of the person when they shared how they were feeling, that is, support to feel better. Unsurprisingly, none of these approaches has been shown to prevent suicide, nor has their widespread use of the past 50 years resulted in reductions in deaths by suicide.
There are four stages of suicide prevention.
Suicide prevention involves acute (responding to distress) and long-term biopsychosocial interventions to ensure the health and wellbeing of all Australians.
Innovative acute suicide prevention – meeting the needs of consumers
Care Collaborate Connect was developed in Australia in 2016 as a social intervention to meet the needs of the person who asks for support for distress. It was based on the ethical principles of
a) firstly do no harm,
b) respect the autonomy of the person asking for support, and
c ) if possible, do good.
Using the Coping Continuum coping model, Care Collaborate Connect recognises seeking social and professional support as healthy coping strategies and personal strength, irrespective of unhealthy coping strategies being used. The task for the helper is to be an effective support. Care Collaborate Connect is the world’s first consumer-centred acute suicide prevention intervention. The name was derived from what consumers want when they are for support, and that have been recognised in both Australian mental health and productivity reviews Care about me, Collaborate and work with me, Connect me with more intensive support if I need it. Attending to the needs for support of each person at each interaction ensures that no person falls through the cracks and dies by suicide.
Care Collaborate Connect has numerous benefits over previous approaches to acute suicide
It normalises rather than pathologises distress and help-seeking. Care Collaborate Connect does not pathologise distress as mental illness. It recognises that distress can be caused by problems in one or more biopsychosocial domains of wellbeing.
1. It does not consider overwhelming distress as a weakness. People who experience overwhelming distress are usually the most resilient, bouncing back repeatedly after adverse biological and social adversity.
2. It supports rather than manages. Consumer-centred care does not take over or undermine a person’s autonomy.
3. It is a consistent approach of care at all levels of support. Therefore, it can be used by social supports (e.g., family, friends, acquaintances, colleagues and teachers) and different intensities of professional support (e.g., GPs, psychologists, emergency departments, and inpatient units).
4. Consumer-centred care increases the likelihood of future help-seeking in people who have a history of adverse interpersonal experiences (e.g., abuse, neglect, bullying). Being connected is a buffer against suicide.
Care Collaborate Connect has almost universal support from health professionals. Most importantly, though, it is preferred by people asking for help who appreciate being supported (not managed), being recognised as having strengths (not weaknesses) and being supported to cope.