REVISED DRAFT PRIORITIES FOR THE 5 TH NATIONAL MENTAL HEALTH AND SUICIDE PREVENTION PLAN
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1 REVISED DRAFT PRIORITIES FOR THE 5 TH NATIONAL MENTAL HEALTH AND SUICIDE PREVENTION PLAN DEVELOPED BY THE WORKING GROUP FOR THE NATIONAL COALITION FOR SUICIDE PREVENTION MARCH 2016
2 NCSP working group membership Mr Alan Woodward Ms Bella Burns Ms Jaelea Skehan Mr Christopher John Ms Anne Kingston Mr David Meldrum Ms Sue Murray Ms Nikki Kelso Lifeline Australia beyond blue Hunter Institute for Mental Health United Synergies On The Line Mental Illness Fellowship Australia Suicide Prevention Australia Suicide Prevention Australia
3 Overview In 2014 the World Health Organization (WHO) released its first global report Preventing Suicide: a global imperative in which it calls on member nations to develop a national suicide prevention strategy. It presents the best available international evidence and provides a ten-point framework on which a national strategy should be developed. The placement of Suicide Prevention as a discrete section of the 5 th National Mental Health and Suicide Prevention Plan is appropriate and provides an opportunity to lay down a framework for a more effective and comprehensive approach to suicide prevention in Australia. The Goerets respose to the Natioal Metal Health eie for suicide preetio has idicated the following will be prioritised: national infrastructure and leadership; a systematic and planned regional approach to community based suicide prevention; refocusing efforts to prevent Indigenous suicide; working with states and territories to ensure effective post discharge follow up; and measuring progress on reducing suicide, including a KPI on active follow up support for people who have attempted suicide. Suicide Prevention Australia consulted with the members of the National Coalition for suicide Prevention and there is strong support for the direction and leadership taken by the Government. The need for reform to achieve meaningful outcomes in reducing the incidence of suicide in Australia is long overdue. As a membership organisation and peak body the challenges the Government needs to undertake to make change are well understood. We also respectfully hold a position that advocates a need to highlight areas we believe the Government needs to take stock and consider, based on feedback from members. While mental health promotion, prevention and improved treatment will at a population level contribute to a reduction in suicidal behaviours and suicides, the behavioral aspects of suicide are more complicated than can be addressed through attention to mental health disorders and recovery alone. Contextual factors surrounding the suicidal person, pre existing vulnerabilities and the potential for impulsivity in reaction to these factors must also be addressed through specific suicide prevention strategies. Effective suicide prevention involves more focus than solely mental health issues. Accordingly, the 5 th National Mental Health and Suicide Prevention Plan should explicitly include those strategies for suicide prevention that will complement the broader mental health components. In particular, a shift towards crisis intervention and ensuring immediate, appropriate and effective responses are in place so that priority is given in a systematic manner to preventing death and maximizing opportunities for the provision of services and support for individuals, families and carers. Attention should also be given to identification of suicidal behaviors including suicidal thoughts, feelings and motivations with the objective of earlier intervention and less reactive prevention of suicides. The strategies for suicide prevention must be person-centred with systems, with stakeholders and communities working around and with the individual and their family and carers. Engagement and collaboration with suicidal persons and those surround or care for them is essential for safety, effective
4 crisis intervention recovery support and future help-seeking. i.e. Clinical and non-clinical responses are needed. To successfully deliver this requires a multi-sectoral, multi-level approach that empowers communities with evidence of what can be done to help reduce suicide. This in turn requires a commitment to building capacity within communities and the relevant workforces (i.e. first responders to gatekeepers and health staff) to recognise and identify vulnerable individuals and to have the knowledge, skills and confidence to provide the necessary direction to support relevant to the individual. Importantly, appropriate referral optios eed to eist for the cotiuu of care to be maintained and prevent people falling through a gap. In delivering a multi-sectoral, multi-level collaboration approach leadership from Government, NGOs, community and business leaders will be required. This leadership in the coordination of these efforts we believe needs to be initiated at a national level, with clear indicators, responsibilities and engagement with all stakeholders. This is where we believe where the national leadership component of the Goerets respose needs to be strengthened. National Leadership The 5 th National Mental Health and Suicide Prevention Plan provides a unique opportunity to define national leadership for the Governments of Australia and in particular the Health portfolio contributions to these areas of public health priority. This needs to be addressed at the COAG level to ensure the Governments focus on regional leadership through the Primary Health Networks is effectively coordiated ith State Goerets efforts for effectie ad coordiated suicide prevention specific investment. This National leadership needs to provide: 1. Commitment: the articulation and policy priority given to suicide prevention so that the attention of all levels of Government and their agencies, along with PHN resources are directed towards meaningful results and improvements. The WHO Report calls for countries to set targets for the reduction of suicides. Suicide Prevention Australia and the NMHC have advocated a target of 50% reduction in deaths by suicide in 10 years as an appropriate measure to aspire to gie Australias potetial ith a highl deeloped health sste, epertise i suicide prevention and capability for implementation through government programs and sectoral organisations. Recommendation: The Commonwealth Government commit to a 50% reduction in the number of suicides in Australia over 10 years and partner with SPA and its members to guide and support the appropriate allocation of resources. 2. Priority Setting: the identification of those areas of strategy in suicide prevention that will, at this point in time, produce the greatest benefit in reducing deaths and preventing suicidal behavior in Australia. This should guide the work of Governments and their resource allocations, but also inform the work of the wider hospital and health services, the Primary Health Networks, non-government organisations, professionals and clinicians and local communities.
5 3. Governance: Strong governance arrangements, across the Commonwealth, State and Territory governments, and Primary Health Networks, will need to be developed and implemented. These should enable and support local leadership and control, clear decision-making processes and lines of accountability to achieve; a. Transparency in the funding for suicide prevention by Federal and State/Territory Governments within common definitions of what funds are regarded as 'specific suicide prevention' in addition to broad mental health, and for these funding allocations to be reported in annual reports; i. Guidelines for PHNs to indicate the minimum proportionate allocation of their funds for suicide prevention, in contrast to other health and mental health priorities, and that these Guidelines require PHNs to relate their regional plans for suicide prevention to the 10 actions recommended by the World Health Organisation to form a coordinated approach to suicide prevention; ii. Establishment of an Office for Suicide Prevention within the National Mental Health Commission, to support the governance and accountability framework in the following ways: 1. Monitoring and verifying funding levels and strategic action plans for Suicide Prevention in all jurisdictions, and for ensuring their alignment with the WHO Action Plan for Suicide Prevention; 2. Soliciting and disseminating expert advice and guidance on the implementation of action plans for suicide prevention, including on specific priority issues in Australian society 3. Facilitating engagement and coordination across all portfolio areas of government, so that a 'whole of government' approach is adopted to suicide prevention. 4. Monitoring workforce development issues related to the implementation of suicide prevention action plans. Recommendation: The Federal Government, through COAG, establish an Office for Suicide Prevention to lead a prioritisation of strategic investment between the National & PHN investment and the arious States suicide preetio iestet strategies, promote workforce development, report on progress against priorities set and report on evaluation of program effectiveness. 4. Quality Improvement: continual improvement should be reinforced through the National Suicide Prevention Plan, in recognition that knowledge gaps remain and that the application of evidence based programs and services in one context may need to be tested in their operations for different geographic or demographic audiences. PHNs should be supported and assisted to commission evidence based suicide prevention programs and services. Research priorities should be oriented towards translational knowledge that improves the effectiveness of suicide prevention strategies. Collaboration across tiers of government and stakeholders in the provision of information, data and feedback to support continual improvement processes will be vital for effective implementation of the Plan.
6 5. Monitoring and Evaluation: the monitoring of the National Suicide Prevention Plan for results should be undertaken against a sound evaluation framework that maps intended impacts and outcoes to actiit ad resource allocatio; specific easures for oitorig the Plas ipact should be established and universally adopted by all Governments and non-government contributors to the actions contained in the Plan. Recommendation: 1. Build an evaluation framework and data collection and analysis to gather high-level data measures outlined in the Plan. The WHO 2014 document Preventing Suicide a resource for non fatal suicidal behavior case registration could provide guidance relating to suicidal behavior 2. Commit to supporting an analysis of the economic impact of suicide and suicidal behavior to better understand specific areas where enhanced investment would both influence the design of programs and attract alternative funding sources as per the Recommendation 1 of the senate inquiry into Suicide Infrastructure Support: national provision of the following supports will enable implementation of a strategically oriented, multi-sectoral and person-centred National Suicide Prevention Plan. As part of the National Leadership component of the plan. It is recommended that: - Utilizing Suicide Prevention Australia as the peak body to: o Gather and provide advice to the Department responsible for the National Suicide Prevention Strategy o Support PHNs with direct input into the quality of the design and delivery of programs in suicide prevention o Act as an agent for quality improvement and advise on commissioning activities through its links to its membership, PHNs, State governments and community networks. - Endorsement of national services for o Crisis Intervention Services utilizing the Digital Gateway and national crisis line/online crisis support services for help seekers, together with hospital, emergency services and health services, so that all parts of Australia have immediate, accessible and effective responses for suicidal persons, and enhanced follow-up to suicidal behavior; o Information Resources access to evidence based knowledge, guidelines, training and tools for organisations, industry sectors, government agencies, health professionals, community services and supports to be well-informed on appropriate action for suicide prevention, especially with regard to communications and media guidelines. This should also include a clearly defined strategy for engaging the wider community in understanding they have a role to play in providing early identification, support and referral to additional appropriate services and supports; supported through infrastructure a centralized nationally accredited evidence based
7 quality assured, competency based training system for both community and health based settings. - Increase in the Quantum of Funding for National Suicide Prevention strategies streamlined, long term and clear funding mechanisms for suicide prevention programs so that government funding is efficiently utilized, properly coordinated and targeted towards areas of greatest impact. The focus of regional delivery and coordination with the Primary Health Networks operating as key commissioning agents and holders of public funds for community based activities is fully supported. However, more needs to be done in the national leadership role for specialized groups of vulnerable populations and national guidance on policy and practice issues. Ultimately we believe $18M will be insufficient to achieve objectives around the following: o In setting priorities for the delivery to communities, the understanding of special population groups who are vulnerable to suicide needs to be addressed. This includes Aboriginal and Torres Strait Islanders, people with severe and persistent mental illness, people of LGBTI experience, those suffering abuse, bereavement intervention and trauma during childhood, those suffering from severe eating disorders and emergency services workers. o Policy and practice guidance on means reduction and media guidance need to be available to guide organisations and PHNs in assessing their capability to address the needs of these and other vulnerable population groups (as outlined in WHO objectives outlined below). World Health Organisation Framework for Suicide Prevention On World Suicide Prevention Day 2014, the World Health Organization released the first-ever global report detailing the extent of suicide, Preventing Suicide: A global imperative. The report calls on all Member Nations, to implement a national suicide prevention strategy. As a Member Nation, Australia is expected to report on its planning, implementation and evaluation of a national suicide prevention strategy. It is in this context that the national Coalition for Suicide Prevention (NCSP) Working Group strongly recommends that Australias 5 th National Mental Health and Suicide Prevention Plan adopt the 10 strategic areas identified in the WHO Report as the national framework for suicide prevention and therefore promote these 10 areas as essential components to be addressed in all state/territory and PHN suicide prevention plans. 1. WHO Key Messages most relevant to Australia The WHO Report identifies key messaging for suicide prevention strategies. Of the global messages the following are considered appropriate for Australia. 1. Suicides are preventable. For the national response to be effective a comprehensive multi-sectoral long-term suicide prevention strategy is needed.
8 Suicide is a public health issue and must be regarded as a priority in public health for Australia and therefore given similar attention by Governments to other major health issues such as cancer and accident related health issues such as road deaths. Leadership by Governments in advancing suicide prevention as a national priority will be essential for the engagement of stakeholders in the Australian Suicide Prevention Plan. For a comprehensive effort to be successful, collaboration must feature in the implementation and monitoring of the Australian Suicide Prevention Plan. Integral to planning and implementation is the need for the collection of accurate and consistent quality data to enable a clear understanding about what works and what is making a difference. 2. Healthcare services need to incorporate suicide prevention as a core component. Mental disorders, bereavement by suicide and harmful use of alcohol contribute to many suicides around the world. Early identification and effective management are key to ensuring that people receive the care they need. The linkages between hospital and health services and community based crisis support services should be strengthened to create an effective system of crisis intervention for suicide prevention including appropriate and timely care following a suicide attempt. 3. Communities play a critical role in suicide prevention. Within communities, families, organizations, social networks and local supports are well placed to recognize and respond to suicidal persons and initiate offers of help and support or referral to the health system. Moreover, communities play an important role in fostering protective factors for suicide prevention through the provision of social support to vulnerable individuals including follow-up support, stigma reduction on help seeking and timely support for those bereaved by suicide. Connection between government activity on suicide prevention and community action is essential for a fully effective suicide prevention plan. Primary Health Networks will perform a major role in ensuring these connections are made. 2. WHO Strategic Action Areas The WHO report identifies 10 strategic actions for suicide prevention. 1. Data surveillance and quality - both suicides and attempts given greater influence can be achieved for attempts. 2. Means restriction 3. Engage the media 4. Access to services 5. Training and education to have a National focus on quality assured accredited training standards. 6. Treatment 7. Crisis intervention 8. Postvention 9. Awareness and stigma reduction to change attitudes and beliefs 10. Oversight and coordination of comprehensive national suicide prevention strategy.
9 Recommended priority areas for suicide prevention The following diagram represents the priority action areas for inclusion in the draft 5 th National Mental Health and Suicide Prevention Plan. It outlines risk related to intervention areas identifying where greatest effort will yield the most benefit for the Australian community; areas of focus for activity in each intervention group and suggested strategies to assess effectiveness.
10 Figure 1:
11 A regional approach to community based suicide prevention Implementation should foster continuous improvement and collaboration across all tiers of government such that it: Enhances crisis intervention responses: e.g. o States through hospitals; emergency services o Commonwealth through GP networks and PHNs Encourages multi-level collaboration Contributes to data and research through State-based suicide registers Supports implementation of the Aboriginal and Torres Strait Islander suicide prevention strategy. The approach to implementation could draw on proven disaster recovery approaches bringing together Primary Health Networks; State/Territory Governments and the Commonwealth Government. Table 1. For example (Note: red text includes the strategies identified by WHO) RECOVERY ELEMENTS PHN STATE GOVERNMENT COMMONWEALTH GOVERNMENT PREPARATION Engage media in help seeking messaging and stigma reduction Local mapping of services Needs analysis Training and education of gatekeepers Quality assured evidence based training & education for at those working with risk populations, including industry groups Means restriction Hotspots (physical) National coordination Review of LiFE Framework Stigma reduction Standards on; - Media Engagement - Training and education (GP training) - best practice (evidence and innovation based) Capability framework for workforce MOBILISATION Access to services Coordination of services Planning pathways: Drug & alcohol services NGO/private providers Local coordination of Target at risk group interventions Postvention intervention Treatment Safety planning at discharge Hospitals and Emergency Services Crisis intervention Crisis lines and online crisis support (Link to Digital Gateway) Contagion management Target at-risk groups - ATSI - Bereaved - High risk industries (construction, resources, farming) - LGBTI - Eating Disorders
12 RECOVERY ELEMENTS PHN STATE GOVERNMENT COMMONWEALTH GOVERNMENT RECOVERY Engage media in recovery and help seeking messaging ATAPS and other psychosocial supports Community awareness and engagement activities Treatment Mental Health Services National coordination Lived experience Carers etork National leadership in community awareness Postvention follow-up EVALUATION Data surveillance Data quality Data surveillance Community councils State registers Research agenda Data collection Local intelligence Community leadership is important in creating an environment whereby cross-sector participation is both accepted and embraced. To foster this implementation should encompass evidenced based training and development for workplaces and social groups. Mechanisms for measurement In line with the PHN Performance Framework the 5 th Plan needs to identify specific indicators to measure effectiveness of suicide prevention strategies at the national and local levels. Conclusion Suicide is a significant public health issue for Australia. Our efforts to address the rate and number of suicides in Australia need to be increased and diversified to make a significant change. These include strong national leadership and well-coordinated regional efforts particularly for those with high levels of need, in crisis and at risk. It should also be noted that whilst initial efforts are focused on those most at risk and in crisis, our efforts to reduce factors leading to crisis also need ongoing focus monitoring and evaluation.
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