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The ‘silent’ statistics... Suicide prevention programs are a cornerstone of the mental health system, but how well do they work? - ABC News


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இந்த கட்டுரையை வாசித்தபொழுது, எனக்கு தோன்றியது என்னவென்றால், சாதாரணமாக இங்கே பிறந்தவர்கள், மொழிபிரச்சனை இல்லாதவர்களே கஷ்டப்படும் பொழுது ஆங்கிலமொழி அல்லது அந்தந்த நாடுகளின் மொழி அதிகம் பரீட்சயமில்லாதவர்கள் உளவியல்ரீதியான பிரச்சனைகள் வரும்போது எவ்வளவு கஷ்டப்படுவார்கள் என்பதே. எங்களது சமூகத்தில் கூட இந்த உளவியல்சம்பந்தமான தொழிசார்நிபுணர்களும் அதிகம் இல்லை என்பதும் கவலையான விடயம். 
 

Suicide prevention programs are a cornerstone of the mental health system, but how well do they work? - ABC News

By Bridget Judd   Posted 6 days ago

For every death by suicide, as many as 30 others attempt to end their life. Australia has a suicide problem — it seems we can all agree on that — but when it comes to solutions, the verdict isn't so clear.

An illustration of four men in silhouette and one in the light In 2015, for the first time in Australian history, suicide deaths eclipsed 3,000 in a single year.(ABC News: Emma Machan)

The gentle croons of James Blunt echoed through Graeme Holdsworth's stereo as he penned his parting words: "I'm so hollow, baby. I'm so hollow."

As a former project manager, he'd spent his life transforming banal blueprints into architectural narratives.

If you or anyone you know needs help:

Melbourne was his canvas; his legacy irrevocably embedded in the city's skyline.

He was methodical. Fastidious. A man whose life had become synonymous with planning.

And today was no different. He'd crossed his T's and dotted his I's.

It wasn't that he wanted to die. He just wanted the pain to stop.

Graeme, dressed in a black jumper and glasses, looks at the camera. Eight years ago, Graeme found himself at crisis point.(ABC News: Peter Healy)

"It became all enveloping. I played it over and over in my head," he muses.

"The attempt is to kill yourself, yes, but it's not to die — it's to get rid of the pain when you've tried every other way."

In an unassuming town in Victoria's south-west dairy belt, Graeme woke up in a police station.

The 73-year-old would come to be a part of what he calls the "silent" statistics — a demographic of Australians often spoken about, but seldom spoken to.

Those who have survived a suicide attempt, only to be left to run the gauntlet of the nation's broken mental health system.

Our national shame is bigger than first thought

It is a national tragedy.

That was the consensus in the headlines when the "lucky country" marked a harrowing milestone in 2015: for the first time in Australian history, suicide deaths had eclipsed 3,000 in a single year.

In 2018, the most recent available data, that figure rose once more.

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This insidious national picture, however, only paints part of the story.

For every death by suicide, it is estimated that as many as 30 people attempt to end their lives — some 65,000 each year.

But it is just that — an estimate. And perhaps most alarmingly, one that is considered conservative among some within the mental health sector due to gaps in critical data and the lack of a universal definition for suicidal behaviour. 

"There is good evidence that even low lethality 'self-harm' still has considerable morbidity and risk of subsequent suicide," says Robert Goldney, an emeritus professor at Adelaide University and an international expert on suicide.

"Some academics have made a career of developing complicated descriptions of varying complexity, but the reality is that all should be taken seriously."

And for good reason.

Attempted suicide remains the single biggest risk factor for death by suicide, with evidence showing that risk is at its greatestimmediately following discharge from an inpatient unit.

That is, assuming you can get a bed.

The 73-year-old would come to be a part of what he calls the "silent" statistics.(ABC News: Peter Healy)

In Graeme's case, after being picked up by police some eight years ago, he received a visit from a "lovely woman" from the health department.

But despite her best efforts, they simply "didn't know what to do" with him.

"The local hospital didn't want me because they didn't have any psychiatric help there, so they locked me up in a police station," he said.

"And the finally, out of the blue, they brought family and friends to bring me back to Melbourne.

"And that was it, I was sort of left alone at home."

Suicide doesn't occur in a vacuum

As the former president of both the International Association for Suicide Prevention and the International Academy for Suicide Research, Professor Goldney doesn't mince words: "People get lost between the cracks."

There are, of course, the obvious and well-publicised problems around access to acute mental health services.

An analysis of mental health presentationsto Australian emergency departments, conducted by the Australasian College for Emergency Medicine (ACEM) in 2018, found that those with mental health conditions waited significantly longer to be admitted than those with physical injuries.

Concerningly, patients presenting for mental health concerns were also twice as likely to leave before their treatment was completed.

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But experts say the problem is far broader than the substantial shortfalls in mental health services.

Suicide doesn't occur in a vacuum, nor is it merely a health condition looking for a medical solution.

It is a corollary of a range of circumstances, including psychiatric illness, social factors and sudden loss, like the breakdown of a relationship or loss of employment.

It begs the questions: What are we doing to reach people before they hit this tipping point? And why isn't it working?

'You get put in the too-hard basket'

Matt Runnalls has lost more than half a dozen loved ones to suicide.(ABC News: Peter Healy)

Fifteen rows from the front, four seats across, Matt Runnalls sat staring at the broken faces around him.

It was his best friend's funeral. By that point, the seventh loved one he had lost to suicide.

His first introduction to the black dog would come when he was just 12 years old, when his childhood friend ended his own life.

"Too young to even spell suicide," Matt says softly.

His first introduction to the black dog would come when he was just 12 years old.(Supplied) From an early age, Matt has been exposed to suicide.(Supplied)

It has, irrevocably, come to define the course of his 29 years.

For most of his life, the mongrel has gnawed at his heels — often out of sight, but never out of mind.

But in that auditorium of some 800 people, all struggling to make sense of the incomprehensible, something changed.

"It was in that moment that I sat there and realised that I'm one of the lucky ones who is still here," he says.

It was the "kick up as the ass" that he needed, but only the beginning of his battle.

After seeking help to address his own struggles with mental illness, he recalls being shipped around to more than a dozen psychiatrists.

Matt believes the system caught him "at the bottom of the cliff".(ABC News: Peter Healy)

"It took every bit of me vulnerability wise to say the things I said… to spill your guts to a stranger, your trauma, while you're sitting there shaking… for them to tell you, 'Okay, I don't think I'm suitable for you'," he says.

"You get put in the too-hard basket… and those too-hard baskets were three six-month periods in between me getting another appointment, and so I just found myself slipping through the cracks every single time."

Matt believes the system caught him "at the bottom of the cliff". 

Early interventions, he says, were few and far between, and it was only through his own perseverance after his suicide attempts that he was able to develop a more holistic approach to his mental health.

He's pragmatic about the situation, with a remarkable sense of self-examination.

What works for him won't necessarily work for others, he says, and it would be spurious to suggest that there is any single solution to the crisis.

But as he lists off the names of those he has lost to the darkness, there is one thing he knows for sure: we need to ask where we're going wrong.

The problem of 'lobbyist-led reform'

For more than a decade, Anthony Jorm, an emeritus professor at the Centre for Mental Health at Melbourne University, has been plagued by one seemingly innocuous word: solutions.

He has been tracking Australia's suicide rate since the late 1990s — and while it initially appeared the nation was making headway, it quickly became apparent any perceived progress was short-lived.

"We had about a decade where the suicide rate was going down. And I thought, 'Great, we're doing everything right here', but then it started creeping back up," he remarks.

"I thought, 'What is going on? Why?'"

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Historical changes in the suicide rate in Australia, showing the points at which various interventions and plans were introduced.(Supplied: Anthony Jorm)

The argument that greater funding for mental health services will reduce the suicide rate is inherently flawed, Professor Jorm maintains — simply because, we have and it hasn't.

Rather, he points to what he calls "lobbyist-led reform".

"Too often ministers for health are persuaded by someone who's a good lobbyist to go and implement something without any real evaluation, and I think that is a major barrier to evidence-based reform," he says.

"Every budget, every election, I see all these promises and I think, 'Is this really going to make any difference?' It might, but we just don't have any evidence.

"I think we need to say we haven't done a good job in the sector at reducing suicide. And there are people who are going to be professionally threatened [by that], but we're not here to benefit them."

'It's turned into an industry'

Left to navigate the gamut of Australia's mental health sector after his own suicide attempt, Graeme concurs: the root of the problem does not lie with funding.

Left to navigate the gamut of Australia's mental health sector after his own suicide attempt, Graeme does not believe funding is the problem.(ABC News: Peter Healy)

"They're throwing money at it like you wouldn't believe, but it's turned into an industry," he says.

"It's driven by politics. Everyone is fighting each other for the research or the government dollar."

The missing link, he argues, lies with lived experiences — those at the centre of the conversation, who, paradoxically, are often left without a voice.

"All of these large groups keep taking the money and it's controlled by bureaucrats, academics and clinicians," offers Graeme, who is himself a lived experience ambassador with Suicide Prevention Australia.

"They don't listen to the people who've been there. They treat them as a patient still, like we're not well and shouldn't be listened to.

"We see it sometimes sticking out at us, when they talk about something you think, 'How is that going to prevent a suicide?'" 

'I think people have to ask these hard questions'

Evidence. It's a contentious word in the multi-million-dollar mental health industry, marred by internal politics and competing interests.

Professor Goldney likens it to "attacking motherhood" — everyone within the sector agrees that funding prevention projects is the right thing to do. 

But when it comes to questioning their effectiveness? Less so. 

"People are pussyfooting around, trying to make out that really it's all very simple and something that can be helped by a bit of a kiss and a cuddle," he remarks.

"I think people have to ask these hard questions — you're promoting yourself as a suicide prevention organisation, but do you have the evidence to show that that's what you do? And they don't."

It's a blunt assessment, but one not without merit.

Evidence — and the need for more of it — has been a consistent theme in evaluations of Australia's suicide prevention measures.

In its 2019 report into suicide prevention reform, the National Mental Health Commission recommended the Federal Government consider the role of an independent statutory body to monitor and evaluate mental health policy outcomes, and to commit to longer-term funding for suicide prevention evaluations to "better assess outcomes over a longer period of time".

Organisations like Suicide Prevention Australia have similarly flagged concernsaround the "lack of information about the outcomes achieved" for National Suicide Prevention Trial Sites, while pushing more broadly for investment grounded on a "strong evidence base that proves their efficacy".

That's not to say evaluations have never been conducted.

But given the statistically small number of suicide deaths each year, mounting a large enough study can be difficult.

"And so what usually happens is that it ends up being process report and analysis, rather than outcome analysis," Professor Goldney says.

"And by that I mean, yeah the patients might be asked if they feel good about it, but if it's set up as a suicide prevention program, is it actually preventing suicide?"

'I do think we're making progress'

It's a quandary of which Helen Christensen, the director of the Black Dog Institute, is acutely aware.

Affable and pragmatic about the state of play, she doesn't shy away from criticisms of the sector.

Helen Christensen points to overseas trials, which have had effectiveness proven.(Supplied: Black Dog Institute)

The nation's approach to suicide prevention was "scattergun" in years past, she says, and it's imperative these shortfalls are acknowledged so the community understands "it is a complex issue and one people are trying to tackle".

But she rejects suggestions prevention projects are being implemented without any basis, pointing to their proven effectiveness in overseas trials.

"Only in the last five years have we been starting to collect the data that we need to evaluate whether what we've been doing is effective," Professor Christensen says.

"So you can either do nothing, you can do something that's scattergun if you like, or you can do something that's evidence-based and after you get the result of trials, you can presumably offer a systematic and scalable response to suicide.

"I really do think we're making progress, even though you could make the claim that we don’t know whether the particular action that we're putting into place will work in Australia."

Suicide prevention is a complex beast, echoes mental health organisation Beyond Blue, and no single intervention can make a difference in isolation.

It says any program's inability to clearly reduce rates of intentional self-harm doesn't mean interventions have had no impact.

It points to an independent evaluation of its Way Back Support Service — a prevention project designed to support those who have attempted suicide or experienced a suicidal crisis.

While there was no "significant reduction in hospital readmissions for deliberate self-harm" at its Hunter New England trial, the evaluation found the psychological distress scores of those who participated in the program dropped, on average, from severe to mild following discharge from hospital.

Loading videoYoutube Beyond Blue's The Way Back program

Likewise, participants reported overall less concern about the major life stresses that contributed to their suicide attempt.

"Apart from all else, the evaluation demonstrates the complexity of suicide prevention – that no one intervention can make a difference in isolation – but that The Way Back is able to be integrated and is making a difference to people and their families," a Beyond Blue spokesperson said.

Health Minister Greg Hunt's office stopped short of directly addressing claims prevention projects are being funded and expanded without scrutiny.

But it noted increased support for the National Suicide Prevention Leadership and Support Program, which provides funding to leading organisations to "build the evidence base on suicide prevention initiatives".

'We need to be proactive'

While there are valid questions to be asked about the outcomes of suicide prevention projects, the onus to combat Australia's silent statistics does not rest solely on the shoulders of the mental health sector.

Any real progress requires a whole-of-government approach, Matt argues, starting from an early age to build resilience and develop coping strategies to address some of the peripheral factors that play into suicide.

"We need things in the system to support people who are unwell right now, but we also need to be proactive," he says.

Any real progress requires a whole-of-government approach, Matt argues.(ABC News: Peter Healy)

Using his lived experience, Matt founded Mindfull Aus, a non-profit mental health and wellbeing foundation, focused on early intervention.

He now hosts workshops in schools, covering basics like understanding and acknowledging the spectrum of human emotions, and the relationship between physical and mental health.

It's not a one-size-fits-all strategy, nor does it negate the need for other services — something he's quick to point out. 

But he believes there are gaps to be filled in the nation's current approach to suicide prevention — namely, reaching children before they grow up to come into contact with the mental health system.

Matt believes there are gaps to be filled in the nation's current approach to suicide prevention.(ABC News: Peter Healy)

"People say to me, they're too young to learn about this… but [about half] of all lifelong mental health challenges begin by the age of 14," he says.

"So, at what time do we decide it's too young to talk about what really matters?"

'Health professionals can't be there all the time'

The need for a whole-of-government approach is hardly a novel concept.

In its 2019 report, the National Mental Health Commission found that the relationship between mental illness and other social, economic and health factors presented opportunities for reform and investment "outside the health sector, and vice versa".

"In acknowledgment of their shared responsibility for preventing suicide, [it is recommended that] any future national suicide prevention strategies be co-designed and co-governed by all relevant portfolios under the Australian Government, including health, education, justice, social services and employment," it said.

Deaths in 2018

There were 3,046 registered suicide deaths, including:

  • 2,320 men (18.6 deaths per 100,000 people)
  • 726 women (5.7 deaths per 100,000 people)
  • 169 Aboriginal and Torres Strait Islander people (24.1 deaths per 100,000 people)

On this point, Professor Christensen and Professor Jorm both agree.

Mental health services are unlikely to have any major impact on other social factors like education, housing or unemployment, they say, which require a broader response.

Suicidal feelings can also be sudden and impulsive, adds Professor Jorm, and health professionals simply can't be there all the time — nor can the onus be placed solely on the health sector more broadly.

Rather, he believes mental health first aid — an initiative he helped pioneer, which involves equipping people with first aid skills to support those with mental health problems — could help bridge the gap for those dealing with an immediate crisis.

"You're dealing with things like relationship breakdown, legal crises and so on," Professor Jorm says.

"A large percentage of the population needs the confidence and skills to intervene, and they can take action to protect the person until the suicidal crisis reduces."

Nothing lasts forever

Concealed beneath Graeme's watch on his left wrist is a single word: Annica.

Sanskrit for "impermanence", it is a fitting testament to a man who has looked death in the eye.

He knows better than anyone that the darkness that had once enveloped him still lurks in the background.

But the tattoo serves as an enduring reminder that no feeling is final.

Graeme, with his dog Bruiser, has forged a new sense of normality.(ABC News: Peter Healy)

"Things are still hard... but I'm pretty good at looking after it," he muses.

"I've come to accept that I'm allowed to be sad, and I let that emotion run."

With a combination of therapy and exercise, Graeme has forged a new sense of normality.

He is candid about his struggles.

The road to recovery is seldom straight, narrow or flat, and the supports in place to help those at risk are, by all accounts, far from perfect.

But it is these very experiences that he hopes will help inform future prevention policies and allow others in his situation to see that there is a light at the end of the tunnel.

Because while the tattoo on his wrist may be permanent, adversity is not.

More stories from Your Mental Health week

Credits:

Words: Bridget Judd

Photographs: Peter Healy

Illustration: Emma Machan

Editor: Leigh Tonkin

This article contains content that is only available in the web version.

https://www.google.com.au/amp/amp.abc.net.au/article/12416882

https://apple.news/AT9fEj-H6SA6Ld-ZlpQVgDA

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