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Global concerns, national priorities

Hunter Institute Director, Jaelea Skehan, shares her thoughts ahead of the National Suicide Prevention Conference in Brisbane this week.

Last week, I was at the 29th World Congress on Suicide Prevention in Kuching Malaysia, and today the National Suicide Prevention Conference in Brisbane officially opens.

The conference will include researchers, policy makers, clinicians, politicians, commissioners, leaders from Aboriginal and Torres Strait Islander backgrounds, people representing and working within the LGBTI community, workplaces, technology providers, media, and a large contingent of people with lived experience of suicide who are changing the conversation.

What I will be interested in reflecting on this week is whether the conversations occurring at the international level are reflected in the national priorities being discussed at our Australian conference.

Last week’s world congress started with a keynote on the first day from Dr Saxena from the World Health Organization (WHO) who talked about the importance of suicide been seen as, and addressed as, a public health problem. He highlighted not only the interventions that should be considered and rolled out, but also the leadership, vision and evaluation required for national and global change.

So with this in mind, here are some of my musings, and at times “straight talk” about what I hope can be achieved from the national conference and the work our sector needs to do over the coming months.

Leadership and vision

If leadership and vision are key, then we really need a 5th National Mental Health and Suicide Prevention plan of sound quality that everyone can connect behind. It also needs an action plan with clear roles and responsibilities defined and defined targets we are working towards. We also need our funders (national, state, regional and other) working together to ensure we stay on target and sharpen our focus.

But in waiting for the 5th National Mental Health and Suicide Prevention Plan and with multiple agencies with defined leadership roles in this space, we are at risk of fractured efforts rather than a collective effort in my opinion. What we need to be able to do is rally behind the National Plan as we did in 1997 under the first National Youth Suicide Prevention Strategy and the refined all-ages strategy in the 2000’s. While we must continue to advocate for more and better resources, and we must be open to different or nuanced views, what we don’t need is a sector that is disconnected and setting their own agenda.

Breaking down silos

If we are interested in implementing best practice in suicide prevention and following the recommendations of the WHO, then we need to address current gaps and break down the existing silos that make it hard to bring all relevant players to the table.

In trying to ensure that suicide prevention is seen as a separate and distinct area of work, we have also disconnected suicide prevention planning and action from other health, mental health and public health strategies. For example, the WHO recommends the development of policies to reduce harmful alcohol use as one of three evidence-based general population approaches - along with reducing access to means and encouraging responsible media reporting of suicide (two areas where we have made great progress in Australia).

Even though we have a National Drug and Alcohol Program in Australia, I have never been at a national suicide prevention meeting where that policy or program area has been at the table. We know that reduction of harmful alcohol use is an effective suicide prevention strategy, yet it is rarely, if ever, mentioned in Australia.

Perhaps it is finally time to break down the silos in our policy portfolios and our service systems in this country as it makes little sense when we are thinking about an all-of-government and all-of-community issue like suicide prevention.

Bringing research to our funded programs

We have good or promising evidence for a range of strategies that work in suicide prevention. But we need to continue to build that evidence-base by ensuring that research and development is built into every funded strategy or program. Otherwise, how will we know if it has worked?

It is disappointing to see that many of the organisations and programs funded under the National Suicide Prevention Leadership Program and other nationally funded mental health programs (including programs that my organisation has been tasked to lead) have had minimum requirements placed on them for research and evaluation. This issue was addressed in the National Mental Health Commission’s review of mental health and suicide prevention programs, but little has changed is the recent funding rounds.

It is promising to see the University of Melbourne funded to provide research leadership and the recently announced National Suicide Prevention Research Fund, but we need to ensure that funded programs are, at a minimum, rigorously evaluated. Not just the reach of programs, but the impact of the programs for those they target. I am hopeful that the funding from the National Suicide Prevention Research Fund can be directed towards intervention research and implementation science for this very reason.

Developing the workforce

It is my view that we urgently need a workforce development plan for suicide prevention in Australia that acknowledges the diverse sectors involved. It is generally understood that to make a difference in suicide prevention we need to engage health services, schools, workplaces, the media, governments, families and communities as they all have an important role to play.

This was a key discussion point last week in Malaysia and many countries are grappling with the same issue. We need to invest in good workforce development so all sectors have the knowledge and skills to contribute. This needs to start in undergraduate training, be a focus in early career development and reinforced across a person’s professional career – regardless of whether they are teaching high school mathematics, working as a police officer, or providing psychological therapies and supports to people.

To make suicide prevention everybody’s business, we would benefit from first having a nationally approved core competency framework for suicide prevention and a workforce development plan.

While we have some good training approaches for some professional groups, and an availability of gate-keeper programs, to date we have had a scattergun approach at best and many workforce's are missing out.

Addressing social determinants

The benefits of hosting an international congress within a lower socio-economic country is the sharpening focus it puts back on the social determinants of suicidal behaviour and the importance of thinking more broadly than just offering a better service system.

The reality is, that until we address many of the underlying problems such as social disadvantage, family violence, childhood trauma, loneliness, discrimination and racism, then our national efforts will be less effective. Everyone who cares about health, wellbeing and suicide prevention should care deeply about these issues. An effective national strategy must think broadly about tackling the factors that may increase or decrease risk in individuals and communities. We must have a vision that includes less people getting to the point where they feel life is not worth living, not just investing in crisis and support services (although these will always be a vital part of an effective strategy).

Conferences are a great time to reflect on current practice, learn from others and connect with new partners across diverse sectors. But to be effective, we need to use events like this to come together and implement the changes that are discussed.

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Published: 27 July 2017

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