Several years ago, while visiting Estonia in Eastern Europe, I was told by the Estonians that during the 50 years or so that their country was incorporated into the former Union of Soviet Socialist Republics, there was no data released on deaths by suicide. Why? Because the Soviet governments could not accept that anyone in such a socialist paradise would want to end their life. Suicide was simply not acknowledged, or was regarded as the unreality of someone who was profoundly mentally unwell.
I relayed this story at a recent conference attended mainly by mental health professionals, highlighting that, too often, Australia's response to suicidal persons has been to prescribe mental health treatments as the solution to their intentions to end their lives. So, when suicide rates go up, calls for greater funding of mental health services or different mental health services arise.
We need to be careful in Australia not to apply a Soviet view of suicide. While Australia has many features of a paradise -- and was a remarkably 'lucky country' through the Global Financial Crisis in 2007-08, its own economic restructuring and a sizeable immigration program -- this should not excuse us for making over-simplistic generalisations about anyone who becomes suicidal.
Regardless of what mental health issues surround a suicidal person, it is likely that the crisis state that they are experiencing is fuelled by specific negative life events such as relationship breakdown, or life-changing impacts such as a lack of employment, continuing discrimination, or background trauma.
We should go further than offering only one way of interpreting and responding to suicidal behaviour. While mental ill health is often a factor in suicidal ideation, (the latest ABS National Survey of Mental Health and Wellbeing, now more than five years old, found that 72 percent of those respondents who had serious thoughts about suicide also had a mental health issue) it is also the case that mental health issues are not always the presenting issue when a suicidal person puts out a call for help.
Some years ago, this was highlighted by those working in mental health when the Federal Government embarked on a homelessness strategy without any reference to the relationship between having nowhere to live and experiencing significant mental health issues. Yet, more than 80 percent of homeless people also had mental ill health.
What comes first, housing issues, or the mental health issues?
Lifeline has perspectives in this regard. About one third of calls to our national telephone crisis line are from people who are suicidal at the time of contact; for the Lifeline Online Chat service, about half are suicidal when they reach out to Lifeline.
The main crisis issues -- the focus issues of our brief interaction with these people -- are as follows: family and relationship difficulties (about 25 percent); personal hardships including loneliness, a lack of purpose in life and struggles 'fitting in' to society (20 percent), employment, addictions, bereavement, finance and social exclusion (about 20 percent) and mental health (20 percent).
Domestic violence features in about 20 percent of the contacts made to Lifeline where a safety issue is identified. A higher proportion of young women contacting Lifeline reveal personal distress surrounding sexual assault and trauma.
Moreover, survey research directly asking callers why they have called has found that almost two thirds of those surveyed nominate two main reasons: to talk about their [intense] feelings at that time, and because they have no one else to confide in about the issues in their lives.
Such findings directly relate to other research and theory on suicidal behaviour, such as Ed Shniedman's revelations of 'psych-ache', the profound emotional distress a suicidal person experiences, in his book The Suicidal Mind, and 'thwarted belongingness' and aloneness as identified in Thomas Joiner's Interpersonal Theory of Suicide.
This all suggests that, regardless of what mental health issues surround a suicidal person, it is likely that the crisis state that they are experiencing is fuelled by specific negative life events such as relationship breakdown, or life-changing impacts such as a lack of employment, continuing discrimination, or background trauma.
My point to the aforementioned conference delegates was to suggest that too much accountability for the national suicide rate has been placed at the feet of mental health professionals and services. This is not fair because they are only ever going to deal with certain aspects of a suicidal person's life. And they may not even come into contact with the suicidal person before an attempt to die occurs: survey research by the Black Dog Institute found that of more than 100 persons who had attempted suicide, only half had any contact with a health service in the period after the attempt.
A broader approach is necessary to ensure more individuals, groups and services -- not just those focused on mental health -- are available to support someone struggling with what life has thrown at them.
It is likely that many other non-mental health services and individuals will, perhaps unwittingly, come into contact with suicidal persons -- and possibly will have this contact well before the suicidal crisis state becomes so elevated as to critically place the person at risk of death. Therefore, a broader approach is necessary to ensure more individuals, groups and services -- not just those focused on mental health -- are available to support someone struggling with what life has thrown at them. These include, but are not limited to: family relationship services, employment services, drug and alcohol services, housing services, life insurance companies, employer HR departments, lawyers, accountants, work mates, sporting team members, family members and friends.
This kind of support is offered by Lifeline's Crisis Supporters in about 2200 interactions every day. Therefore, crisis support must be regarded as one of the key strategies in the COAG Health Council's recently announced National Suicide Prevention Plan.
Reaching out to people who are struggling to cope with life is a necessary and obvious technique to engage with those who are vulnerable to suicide. The timing and context also matters: when 'negative life events' occur, that is when the offer of help and support is most needed.
In Australia, we have been good at recognising this in our provision of practical support for those affected by bushfires, flood and drought, but we have not been as good at promoting crisis support when emotional and psychological struggles affect those around us.
The #StopSuicide Summit, hosted by Lifeline Australia and supported by various private companies on May 1, is a way to bring a different set of eyes and experiences to the problem of suicide prevention. Not because the valuable work of the mental health sector is being undermined, but because we need to do more, with more people and in more varied ways.
Let's spread the responsibility for suicide prevention widely in the hope that we can reach, support and foster recovery for people who need our support during a time of personal crisis.
Lifeline is exploring Australia's suicide crisis with business and community leaders at the #StopSuicide Summit on May 1, in partnership with HuffPost Australia and Twitter Australia.
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