Recent trends in communitybased suicide prevention

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Recent trends in community-based suicide
prevention

• Michael Dudley, Chair, Suicide Prevention
  Australia
• Martin Harris, School of Rural Health, University
  of Tasmania, and SPA Tasmanian delegate

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Who/what is Suicide Prevention Australia (SPA)?

• A member organisation founded 1992
• Approx. 300 individual and corporate members
• Charter is to prevent suicide in Australia, using
  community-based education and training,
  advocacy, and networking of governments,
  organisations and individuals to achieve this
  goal
• Annual conference provides premier opportunities
  for these activities

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Rural vs metropolitan suicide

• 1964-1968 male 15-24 year rates, metro. 9.8,
  rural towns lt 4,000 4.9/100,000
• 1994-1998 male 15-24 year rates, metro. 24.9,
  rural towns lt 4,000 53.7/100,000
• Reasons for high rural suicide rates
• 1) economic downturn, scarcer resources
• 2) more health problems, less services
• 3) male identity problems? (lack of valued social
  roles, disrupted personal histories)
• 4) access to firearms

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Male 15-24 year suicides in remote areas,
1994-1998
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CommunityLIFE Project

• Funded by the Federal Department of Health and
  Ageing
• Aims to build community capacity for suicide
  prevention
• Based on the LIFE Framework, the national
  framework for suicide prevention in Australia.
• Has a mainstream and an Indigenous component.

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CommunityLIFE Project (2)

• Project managed by a consortium.
• Members are the Centre for Developmental Health
  (CDH) based in Perth, Auseinet based in Adelaide,
  Suicide Prevention Australia (SPA) based in
  Sydney, and the National Aboriginal Community
  Controlled Health Organisation (NACCHO), based in
  Canberra.

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CommunityLIFE Project (3)

• LIFE Framework document
• Promote a collaborative approach, involving
  government and non-government services, community
  groups, and individuals,
• reduce the incidence of suicide and enhance
  resilience and resourcefulness,
• Increase support available to individuals,
  families and communities affected by suicide or
  suicidal behaviours and
• Provide a whole of community approach to suicide
  prevention and to extend and enhance public
  understanding of suicide and its causes.

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• Specific CommunityLIFE project objectives
  include
• Help meet community need for suicide prevention
  programs consistent with the National Suicide
  Prevention Strategy LIFE Framework
• Build partnerships with key non Indigenous and
  Indigenous groups to influence the diffusion of
  good practice suicide prevention activities
• Enhance community participation, capacity
  building and skills in planning, implementing and
  evaluating safe, effective and sustainable
  community suicide prevention programs
• Support knowledge development to inform the
  Commonwealth and the nation

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Community

• Usually refers to
• A group of people living in a geographical area,
  or
• People who share an ethnic, cultural or religious
  affiliation, or
• People who are linked through a particular
  interest or circumstance e.g. as members of
  community organisations.

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Community development

• Community development supports the development of
  strong communities . It is a community building
  its capacity to protect and enhance the health
  and well being of its members.

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Community ownership

• Communities are more committed to change that is
  driven from within.
• This involves community groups
• 1) becoming aware of a problem
• 2) developing a shared understanding that it
  needs to be addressed
• 3) making a commitment to address the problem and
  begin to work together to seek solutions.
• 4) approaching outsiders after that?

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Community ownership (2)

• In contrast, some community programs assume that
  particular issues are under-recognised and need
  active promotion.
• It is often difficult to create commitment when
  the community has not previously priorised the
  issue.
• Moral go with issues that communities have
  identified as priorities.

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Community development activities should (1)

• Empower communities to address and solve the
  problems they themselves have identified
• Build democratic organisations or structures that
  represent a wide cross section of the
  populationparticularly those who find it
  difficult to gain access or a voice.

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Community development activities should (2)

• Support young peoples participation
• Build formal links between local communities and
  existing local, regional, state/territory and
  national planners, funders and governments
• Provide professionals and community members with
  training in skills relevant to community
  development.

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Involving young people

• Providing a space where young people can gather,
  spend time and feel they belong is important for
  engaging marginalised young people.
• Genuine consultation and ongoing power-sharing is
  vital

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Community capacity

• Characteristics of communities that affect their
  ability to identify, mobilise and address social
  and public health problems and the cultivation
  and use of transferable knowledge, skills,
  systems and resources that affect community and
  individual-level changes consistent with public
  health-related goals and objectives (Goodman et
  al, 1998).
• Capacity operates at the individual, group,
  organisational, community and policy levels. It
  is both process and outcome.

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Community capacity key components (Goodman et
al,98)

• participation and leadership
• skills
• resources
• social and inter-agency networks
• sense of community
• community history
• community power
• community values
• critical thinking

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Leadership that contributes to capacity

• diverse
• includes formal and informal leaders
• encourages participation from a diverse range of
  players
• ensures democratic decision-making and effective
  planning
• nurtures and supports new leaders
• Leadership and participation go hand in hand.

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Skills

• conduct a needs assessment and plan
• collect and analyse data about problems,
  opportunities, barriers and resources
• solve problems
• resolve conflict
• advocate

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Community power

• Power is often unequally distributed across
  neighbourhoods and groups within communities.
• Those with access to most resources usually
  exercise it, but it may be exercised in many
  forms.
• It may be reflected in how much social capital is
  present in the community and how this is used to
  create or resist change that matters to people.

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Community values/spirituality

• Key values include
• promoting and protecting good health
• relieving suffering and doing good
• having democratic processes to reach agreement
  about values and visions
• shared belief/tradition/purpose/meaning.

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Social capital

• Social capital is the fabric that binds society
  together networks, trust and reciprocity that
  exist between individuals and/or groups within a
  community.
• Cohesion, cooperation, values, ability,
  motivation physical social structures
• Local and general
• Has a key relationship to the health and well
  being of individuals and community

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Social capital rural communities (mental)
health

• Geography and environment
• History and cultural traditions
• Local, national international economies
• Gender
• Information technology
• Indigenous peoples communities

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• Suicide prevention is about preventing suicide
  and promoting mental health and resilience among
  people in our community.

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• Suicide is complex, resulting from a wide range
  of biological, psychological and social risk
  factors.
• Effective suicide prevention should encompass a
  wide range of activities across programs and
  sectors.
• It requires the effort of the whole Australian
  community including community groups, families
  and young people, all levels of government,
  business and non-government and professional
  organisations.

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• There is some evidence that such national
  whole-of-community programs can be effective,
  as the Finnish and Australian experiences show.

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Principles of effective suicide prevention

• Shared responsibility across the community,
  professional groups, government and
  non-government agencies
• A diverse approach is needed targeting the whole
  population, specific population subgroups and
  people at risk
• Evidence-based programs, focussing on results,
  with evaluation as an integral part

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Principles of effective suicide prevention (2)

• It must incorporate input from the community,
  carers and experts
• It must be sustainable to ensure a continuous and
  consistent service

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It is crucial that activities do no harm.

• Some well-meaning activities that aim to prevent
  suicide can increase risk of suicide among
  vulnerable groups.
• Keep this in mind in programs involving schools,
  the media or raising awareness of suicide.
• All approaches need to be pilot tested and
  carefully evaluated for negative as well as
  positive outcomes.

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When planning activities for your
community,consider (1)

• What do you want to achieve? Ranging from
  community-wide prevention to crisis response or
  risk management
• Target groupwhole population, high-risk group or
  individuals?
• Is there evidence this activity works? Even
  where evidence is limited, activities should be
  able to show they reduce the level of risk

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When planning activities for your
community,consider (2)

• The likely costs and benefits of the strategy
• The place and role of the activities in the
  overall field of suicide preventionincluding its
  nature, potential scope, boundaries and
  limitations
• A collaborative approach including relating to
  others to provide a more integrated and effective
  approach.

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• In selecting an approach you should consider not
  only how strong a risk factor is in a particular
  group in the community but also how common it is.
  Activities that focus on a risk factor that
  places an individual at high risk may have a
  smaller effect on overall suicide rates than a
  program that focuses on a lower-risk but
  relatively common risk factor.