LIFE News issue 13: education and awareness

Welcome to LIFE News - January 2011. In this edition LIFE focuses on suicide prevention education and awareness, with a sector comment that provides an overview of education and awareness raising about suicide prevention, project profiles of Community Radio Suicide Prevention Project and Community Response to Eliminating Suicide (CORES), a review of both the literature on education and awareness and recent personal accounts of suicide, comments on media guidelines and what's new to the LIFE website. LIFE warmly encourages feedback on LIFE News - please contact us with your comments or suggestions.

Comment: education, training and awareness and suicide prevention

By Susan Beaton

Susan Beaton is a psychologist and has been working for Lifeline at the National Office in Canberra for six years as National Advisor on Suicide Prevention. Susan has been involved in suicide prevention for 25 years both in Australia and the US, working mostly for NGO’s in project management, training and education, Board representation, service development and delivery. Susan is currently the International Representative on the Board of the American Association of Suicidology.

Education, training and awareness have been highlighted as an essential component of successful suicide prevention programs by most National Strategies across the world.  Australia’s LIFE Framework (Action Area 3) is no exception articulating that “Improving individual, family and community awareness and understanding of suicide and suicide prevention will increase the capacity of communities to prevent and respond to suicide”. These universal initiatives improve the ability of a broad range of services and support networks to assist those at risk through recognition, response and prevention.

Five of the recommendations from the recent Senate Inquiry’s Hidden Toll – Suicide in Australia report proposed support for training, either accredited suicide prevention training for ‘front line’ and professional staff or general community ‘gatekeeper’ awareness and training especially in regional, rural and remote areas.

Hard evidence about the effectiveness of suicide prevention activities is rather limited. However, there is research that suggests that gatekeeper training is one of three promising approaches that may have an impact on suicide rates (Beautrais et al. 2007; Lester, 1997; Mann et al. 2005); the other two being GP education in the recognition and treatment of depression, and restricting access to lethal means of suicide (LIFE: Research & Evidence in Suicide Prevention 2007, p 42).

Australia’s suicide rates and lack of general awareness and understanding of the topic suggest a crucial need for training in the area of suicide prevention among health and human service workers as well as non-specialist workers and caregivers alike. This commentary will mostly focus on what is termed “Gatekeeper Training”. Gatekeepers are those who regularly come into contact with individuals or families in distress.

Gatekeeper training generally refers to programs that seek to develop individuals' "...knowledge, attitudes and skills to identify (those) at risk, determine levels of risk, and make referrals when necessary” (Gould et al., 2003). Gatekeepers could be either ‘designated’ or ‘emergent’ (Isaac et al. 2009). Those designated and trained as helping professionals (e.g. nurses, GPs, psychologists, social workers, etc) would be an identified group of gatekeepers. The emergent group consists of community members who are naturally positioned in everyone’s existing personal and/or professional relationships (e.g. clergy, police, coaches, teachers, friends, family, work colleagues, etc). Having suicide intervention skills, means that gatekeepers can notice risk, respond appropriately and get people to suitable help when required and keep them safe. Since suicide happens in families, among friends, in workplaces and so on, it is wise for suicide prevention gatekeeper training to follow public health philosophy and include universal dissemination of awareness raising and skills training.

There is an underlying assumption that supports gatekeeper training. If a broad cross-section of people are trained to: 

• recognise the signs of suicide
• intervene with people at risk
• refer those at risk for help

then:

• support and treatment of those at-risk will increase
• the number of suicide attempts and deaths will decrease
  

This is vital because those who are at risk of suicide may not communicate their suicidality in overt ways, or even recognise or acknowledge that they need help and if they do, they are more likely to seek help from family and friends than from medical or mental health professionals (Barnes et al. 2001; Goldsmith et al. 2002).

Gatekeeper training has been utilised widely among: veterans, the military, indigenous peoples, secondary schools, universities, GPs, and workplaces to name but a few. Studies with these populations have shown positive affects on trainees’ skills, attitudes and knowledge (Isaac et al. 2009). Though research is limited in demonstrating the impact of these changes into actual identification, referral and treatment of those at risk and ultimately on decreased suicide rates, it is seen as a very promising initiative as part of a multifaceted strategy to address suicide.

Ongoing challenges

Suicide has an unfortunate history as a crime and a sin and the vestiges of these continue to encase this behaviour with stigma and discrimination. Discomfort, fear and ignorance make the topic of suicide a challenging one to promote to the general public. Many people do not perceive the need to know anything about suicide until it confronts their personal life with perhaps a family member, friend or colleague who attempts or completes suicide. It is often only then that people ask “Why didn’t I know the signs, what should I have done? What could I have done?”
 
Given this phenomenon, taking a settings approach may increase the likelihood that communities seek training and are prepared to identify and respond to warning signs, tipping points and imminent risk factors associated with suicide (see LIFE Fact sheet 21: Suicide warning signs and tipping points).

The workplace is a viable site to train community gatekeepers where employee in-service trainings are a standard component of workforce infrastructure to enhance workplace safety (e.g. legislation mandates fire warden and First Aid training in most workplaces).

The most successful example of a settings approach is the US Air Force suicide prevention initiative (Knox et al. 2003). The initiative contained 11 different tactics one of which was gatekeeper training. Two years after the program commenced, 90% of personnel had received some form of suicide prevention training. Research into this military population initiative found that there was a 33% relative risk reduction after the intervention.

Successful examples of a workplace settings approach in Australia include Ozhelp and Mates in Construction, which are aimed at improving mental health and wellbeing for workers in the construction industry.As previously mentioned, training of GPs has proven to be very effective in addressing depression and suicide. There has been much research reporting the large number of patients who suicide having consulted their GP prior to doing so – up to 66% within 30 days before their death (Andersen et al. 2000). Also research showing that people experiencing suicidality and mental health problems are more likely to contact their GP than a specialised mental health professional. It is therefore essential that GPs receive suicide prevention training and that all medical schools are supported with a standardised suicide prevention curriculum (Hawgood et al. 2008) as well as ongoing professional development opportunities.

Relevant to schools setting is the recent Australian research (Crawford & Caltabino, 2009) that found that the majority of teachers in their random sample had not received youth suicide prevention training, yet nearly half had a student attempt or die by suicide. The lack of training was recognised as a key risk for young people and informed the recommendation that teacher training include detailed, regular suicide prevention training (Crawford & Caltabino 2009; Scouller & Smith, 2002).

Thanks to the Garret Lee Smith Memorial Act in the US (2004) much federal funding has been directed to the provision of suicide prevention training in schools and universities in the US over the past few years (Goldston et al. 2010). Robust infrastructure supporting these grants (managed by SAMHSA) is providing standardised and comparable reporting and cross-site evaluations (e.g. Wyman et al. 2008). There is much useful learning that can be accessed and utilised from these programs and Australian education systems would be wise to pay attention to these research outcomes.

Training is only one component of a successful suicide prevention strategy however. Researchers Miller et al. (2009) and Wyman et al. (2008) state that training for those involved with young people needs to be accompanied by interventions that modify help seeking and help negation behaviours (Wilson & Deane 2010) and teaching problem solving techniques.

Recommendations

Suicide prevention education and awareness programs should provide evidence-based content and deliver appropriate best-practice approaches to suicide prevention, intervention and postvention.

There are many education, training and awareness programs available across Australia. However, there is no centralised place where detailed information, research and evaluations of these programs can be accessed.

Australia needs a Best Practices Registry (BPR) providing communities with a centralised authoritative location to source information on training, education and awareness programs. Such a registry would be guided by evidence-based best-practice and provide accessible and standardised presentation of material. Training programs would need to comply with certain uniform accreditation processes and standards to be accepted onto the registry. A community organisation would therefore have access to evaluation results where available and valuable information about a program in order to be able to decide which suits their needs best. The comparative matrix provided by the US Suicide Prevention Resource Center (SPRC)  BPR is an example of the kind of useful tool that could guide communities (e.g. the Comparison Table of Suicide Prevention Gatekeeper Training Programs).

We need a bridge between research and practice, so that the research evidence that is available can be interpreted and readily accessible to the community in order to better prepare them to identify and provide support for people at risk. As the Suicide Prevention Australia (SPA) Senate enquiry submission states, we need to:

“[E]stablish an independent national suicide prevention accreditation and standards agency, drawing on international ‘best practice’ standards, to manage the accreditation and evaluation of suicide prevention service delivery, training and programs.” (p 51)

We might well be guided by the work already done by the SPRC/AFSP BPR  in the US whose purpose is to identify, review, and disseminate information about best practices that address specific objectives of the National Strategy for Suicide Prevention.

An example of training available in Australia is LivingWorks, auspiced by Lifeline, which has provided suicide prevention training for nearly 15 years and trained over 70,000 people in its 2 day ASIST  program (Applied Suicide Intervention Skills Training). It is internationally developed and recognised and can be accredited under the AQTF when delivered by an RTO. ASIST  and safeTAL K both appear on the SPRC/AFSP BPR. ASIST has recently received a comprehensive review and evaluation . The evaluation results from this study found that ASIST trainees demonstrated greater relevant knowledge and positive attitudes, increased intervention skills, and increased interventions.

In conclusion

It is broadly accepted in the field that by and large suicide is a preventable cause of death. One of the key strategies to actualise that opportunity is through education, training and awareness. However we do need to also recognise that suicide is a complex behaviour that requires a multifaceted comprehensive approach to effectively reduce suicide deaths.

Visit the LIFE training page for information on education and training on suicide prevention across Australia.

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Using national community radio networks to raise awareness of suicide prevention and mental health

By The Community Broadcasting Association of Australia

The Community Broadcasting Association of Australia’s (CBAA) National Suicide Prevention Project has been using the unique medium of community radio to provide help-seeking and well-being messages to a wide and diverse network of communities around Australia.

Each month, the CBAA project team develops a series of 20 short radio segments designed to promote help-seeking behaviour and positive lifestyle choices. These segments use interviews with service providers, as well as profiles of people who have successfully dealt with tough times in their lives and include:

• information on mental health, depression and anxiety
• information on support services available to people going through difficult times in their lives
• aspirational messages from well-known community members
• messages from ‘grass-roots’ community members about how they have coped with difficult periods of their lives, and the support they have accessed to help them to do this

These interviews are then broadcast around the country to community radio stations via satellite, as well as being provided to all community radio stations each month along with a project newsletter. This informative and practical newsletter contains feature stories on individuals who have overcome difficult times in their lives, information on mental health issues, profiles of services, and contact details of service providers nationally and around Australia.

The project has been highly successful in reaching a large and diverse national audience, with regular local and satellite broadcasting giving the project an estimated national listening audience of over 9 million Australians each month (McNair Ingenuity research, 2010). Importantly, the project has been successful in targeting ‘hard-to-reach’ sections of the Australian population, including youth audiences, rural and remote audiences, people form culturally and linguistically diverse backgrounds (CALD), and Aboriginal and Torres Strait Islander people.

A highlight of the project in recent months has been the development of a series of messages about mental health and suicide prevention in Indigenous and CALD community languages. The CBAA has been working with key suicide prevention and mental health services to develop these messages, with input from headspace, Lifeline Australia, Multicultural Mental Health Australia, SANE Australia and beyondblue. These messages are being translated by the Ethnic Broadcasting Association of Queensland, the Central Australian Aboriginal Media Association, and the Queensland Remote Aboriginal Media Association. They will provide diverse CALD and Indigenous audiences around the country with appropriate messages about mental health and suicide prevention in their own language on their own local radio station.

In the coming months, the project team will be developing a range of new approaches to reaching important audiences around the country, including working with:

• Multicultural Mental Health Australia to explore new ways to provide culturally-appropriate information on suicide prevention to new and emerging migrant communities
• Indigenous radio stations in remote areas such as Cape York to build links between health and well-being services and local broadcasters
• headspace to provide information on help-seeking to young people who are same sex attracted or gender questioning, as well as to young people concerned with body image or affected by eating disorders

For more information on this project, and to obtain copies of the monthly newsletter and audio CD, please contact the Community Broadcasting Association of Australia on (02) 9310 2999, or email: iwatson@cbaa.org.au  

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Community Response to Eliminating Suicide (CORES)  

By Kentish Regional Clinic Inc

 

Aims

The CORES Package aims to develop the skills and confidence of community members to intervene in suicide and hence assist in the development of a community’s capacity to eliminate suicide. More specifically, the package covers how to:

• recognise the warning signs of suicide
• intervene before a crisis occurs
• support the person at risk to access the appropriate services

The philosophy

“The more people from within a community who complete the training, the less likelihood there is of someone at risk not receiving help. It empowers communities to watch out for each other.”

Background

The CORES program was developed and implemented in the North West Tasmanian Kentish Community in 2003.  The program was developed to address the issues of suicide in the community after 10 people completed suicide over a three year period. Through the Tandara Lodge Kentish Regional Clinic 24 hour counselling service we recorded a large number of calls from people who either had suicidal tendencies themselves or family and friends who were concerned for someone who might be suicidal.

The model

The program works on a model of education and awareness for the whole community, and seeks to provide people with a pathway to involvement in suicide prevention, and skills which can be shared across the community. It makes no assumptions about prior knowledge of suicide and suicide prevention, and so the materials that are delivered via training are presented in a simple format via comprehensive training, mentoring and support. Training and team support materials are presented in an easy to follow format.

There are two components to CORES, these are the one day course and team leader training. The program now operates nationally within 18 communities (12 in Tasmania, three in Queensland, two in Victoria and one in South Australia) using our ‘community package’ The package includes training six community people as team leaders free training for 200 community people, five support visits from KRC and all material, a community launch and setting up a community team over a 12 month period (this is negotiable).  Many communities have also taken up the chance to participate in the CORES one day course. In the past seven years, 2497 people have completed the CORES one-day course and 112 people have completed the Team Leader Training.

The one-day CORES course

Participants are guided through a professionally developed handbook that covers the following topics:

• community attitudes towards suicide
• suicide statistics
• river of risk
• funnel vision
• signs and indicators of suicide
• wallet card
• assessing the level of risk
• interventions
• agreements
• accessing and listing community resources and services

The CORES team leader training

The four-day CORES team leader training covers the material from the one-day course as well as communication and listening skills that are required to successfully deliver the one day course to their community.

We have found the CORES program to be successful for a number of reasons:

•  it is a community based ‘train the trainer’ program which allows the local community to take charge of presenting the training to their own community and therefore a greater sense of ownership by the community
• twelve months of ongoing support after the initial training appears to be an optimal period which gives sufficient time for the local community to both understand and take full advantage of the program
• the program does not impinge upon the practices of local specialised services but seeks to raise awareness about these services within the community

The future

• CORES continues to receive great interest across Australia, with large numbers of people reporting that they continue to use the training and the number of new communities requesting our service 
• However like many organisations, we continually struggle to find funding for core staff and communities that would like our program.  During the next 12 months the biggest task will be to explore either securing a large corporate sponsor or government funding

The program has been evaluated externally and this is available upon request or you can view the evaluation completed in 2008 on the website. For further information or to find out how to start a CORES in your local community you can:

• visit www.cores.org.au
• call Coralanne Walker on 1300 079 596 or 03 64 911 552
• email  Admin@Kentishrc.com.au 
   
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Suicide prevention, education and awareness mini-literature review

By LIFE Communications

A major part of suicide prevention is education and awareness raising. The most commonly applied within this subset is ‘gatekeeper training’, where a variety of populations might be taught about the warning signs and how to assist individuals at risk of suicide. Professionals (e.g. teachers, GPs, mental health workers) who are working with identified at risk populations as well as peers (either of the same age or in the same community) are the usual audience of gatekeeper programs. Other programs that fall under the ‘education and awareness’ approach generally do not contain all components of information that could be used to support individuals at risk.

A review of published data from suicide prevention programs in the Western Pacific region (World Health Organisation, 2010), which includes Australia, indicates that 45 percent of these programs (or 14 out of a total 31) focused on awareness raising and most commonly via gatekeeper training (six of the 14, or 43 percent of education and awareness programs). Ten of these programs were targeted at particular populations, such as professionals who might be working with clients who could be at risk including young persons, Indigenous people and those people who could be experiencing a mental illness. The remaining four programs that aimed to educate and raise awareness were aimed at the general population. Two of these programs sought to improve the media reporting and portrayal of mental illness and suicide by producing guidelines and offering education programs or campaigns. One of these programs is Mindframe, the other a project that has been conducted in Hong Kong. The Hong Kong campaign involved holding a press conference, providing free copies of information about contagion and recommendations for media reporting. Prior to the campaign, a high percentage of newspaper articles on suicide were not following the World Health Organization’s (2008) recommendations such as not including pictorial representations and including the word suicide in the headlines.

Returning to gatekeeper training, the school-based model developed by Gibbons and Studer (2008) will be briefly reviewed as an example. This model was developed by the authors as they had noted that while a number of evaluation studies had identified these programs as worthwhile they were not often implemented within schools. Based on their own literature review, Gibbons and Studer recommend that as a minimum the training program ought to contain the following:

• Demographics of attempters and completers
• Risk factors
• Referral information
• Clear conceptual basis for suicide prevention
• Proven instructional strategies

The authors recommend that the program also draw attention to particular demographics and risk factors that are considered relevant on the basis of the school population.

Gatekeeper training programs have been found to be effective in raising awareness as they have increased the degree of confidence and knowledge regarding suicide and suicide prevention in a wide range of professionals and peers (e.g. Bartlett, Travers & Cartwright, 2008; Isaac, Elias, Katz, Belik, Deane, Enns, Sareen et. al., 2009; Reis, Cornell, 2008; World Health Organization, 2010; Walker, Ashby, Hoskins, Greene, 2009; Wyman, Brown, LoMurray, Schmeek-Cone, Petrova, Walsh, Wang, 2010). Additionally, Isaac and colleagues noted that there were significant reductions in suicidal and homicidal behaviours, family violence and accidental deaths in the five years leading up to and the 5 years after the implementation of a gatekeeper program (Knox, Litts, Talcott, et. al., 2003). The peer gatekeeper programs not only raised awareness about suicide prevention but also increased the sense of social connectedness for those at risk (Wyman et. al. 2010).

Another means of educating and raising awareness that is on the increase is the provision of information on websites. Szumilas and Kutcher (2009) undertook a review of the quality of information available on youth suicide prevention. They found that a little under half of the information provided on the top 20 youth suicide prevention websites was actually based on evidence and research. The study reported that on the whole the information provided by the non-profit sector was most likely to provide evidence-based information.

It is heartening to see that the education and awareness raising approach of suicide prevention has received reasonably strong support in evaluation, and as a consequence is being put into practice; particularly with regards to gatekeeper training. Anyone wanting to know more about evidence-based suicide prevention programs is encouraged to read the Pacific Region of the World Health Organization’s (2010) review. 

References

Bartlett H, Travers C, Cartwright C (2008). Evaluation of a project to raise community awareness of suicide risk among older men. Journal of Mental Health, 17, 1-10.
Gibbons MM, Studer JR (2008). Suicide Awareness Training for Faculty and Staff: A Training Model for School Counselors. Professional School Counseling, 11, 272-276.
Isaac M, Elias B, Katz LY, Belik SL, Deane FP, Enns MW, Sareen J (2009). Gatekeeper training as a preventative intervention for suicide: a systematic review. Canadian Journal of Psychiatry, 54, 260-268.
Reis C, Cornell D (2008). An evaluation of suicide gatekeeper training for school counselors and teachers. Professional School Counselling, 11, 386-394.
Szumilas M, Kutcher S  (2009). Teen suicide information on the internet: a systematic analysis of quality. Canadian Journal of Psychiatry, 54, 596-604.
Walker RL, Ashby J, Hoskins OD, Greene FN (2009). Peer-support suicide prevention in a non-metropolitan U.S. community, Adolescence, 44, 335-346.
World Health Organization (2008). Preventing suicide: a resource for media professionals. World Health Organization: Geneva.
World Health Organization (2010). Towards evidence-based suicide prevention programmes. World Health Organization: Geneva. 

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Raising awareness and educating: personal accounts of suicide experiences

By LIFE Communications

Much of the research and information available to professionals working in the area of suicide prevention draws upon quantitative or aggregated data. Whilst this is highly important for understanding the bigger picture of variables that may increase risk or protect people from attempting suicide, this data, on its own, may miss the finer details of individual experiences of suicide. Some argue (e.g. Suicide Prevention Australia, 2010, Position statement on supporting suicide attempt survivors) that the voices of the individuals affected can be lost. Insights into what it is like to have experiences with suicide (either the person struggling with the thoughts or those whose lives have been touched by another’s suicidality) on an individual level may assist both practitioners and members of the public to gain deeper understandings of the issues. In short, the ‘human’ component needs to be understood and remembered in suicide prevention.

Australian-based researchers David Webb and Diego De Leo have provided the opportunity to gain a deeper understanding at the personal level. Webb with his interviews (e.g. 2010a & 2010b) and public talks that that cover both personal and professional accounts of suicide, provide a different personal and professional opinion, challenging the medical model of suicide. De Leo has contributed by producing an edited collection (2010) of personal accounts of those who have either attempted or been bereaved by suicide.

The main focus of this article is the collection of personal accounts edited by De Leo, titled Turning points: an extraordinary journey into the suicidal mind. De Leo starts the collection of lived experiences with his own experience of losing a colleague and friend to suicide, which set him on the path of researching suicide. This includes his own surprise on learning the news of the death and how his colleagues appeared to expect him to have anticipated this outcome along with the ostracization he felt due to this expectation. De Leo’s story is followed on with 10 accounts by people who survived suicide attempts and two people who were left behind after a family member who took their own life. While each account is relatively brief, they each offer potentially valuable information that can’t be gleaned from quantitative research in this area alone.

For instance there is Cynthia’s story. Cynthia grew up in a violent home, and was sexually abused by both her father and her regular babysitter when growing up. She had felt intermittently suicidal for as long as she could recall, making her first attempt at the age of four. Cynthia’s story, like a number of the others in this book, takes the reader on the journey of recovery. There’s also Lucia, whose father took his own life over 20 years prior to her own attempt. These two accounts add a deeper understanding to the known risk factors of sexual abuse and suicide bereavement (Department of Health and Ageing, 2007). Diane’s mother took her own life when Diane was a young child, an event that impacted heavily on Diane as she describes in sharp and painful detail.

De Leo concludes each personal account with his own comments which relate the stories back to his professional understanding of suicide specific to the account. This includes referring to research and other similar stories that he’s heard about, in a way that remains accessible and useful for creating insight for a variety of readers.

It may be difficult or even painful for some people to read such personal accounts of suicide. In addition, it is important to remember that personal accounts will vary from individual to individual. However, it is one way in which to personalise the research evidence and theory around suicide and suicide prevention. It is also a way to supplement quantitative data about risk and protective factors, providing a personal voice that may assist in understanding the phenomenon. 

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Comment: media, suicide prevention, education and raising awareness

There has been increased public discussion about media reporting on suicide, which includes the Hidden Toll – Suicide in Australia and the government’s response to the report. Given this discussion, we decided to put the following question to two of Australia’s leading voices in media reporting of mental illness and suicide:

“Do you believe that the current media practices require review and that we need to change our approach to the way that media informs the public about suicide and suicide prevention?”

The replies to this question given by Barbara Hocking (SANE Australia) and Jaelea Skehan (Mindframe National Media Intitiative) follow.

By Barbara Hocking

Barbara Hocking has held the position of Executive Director at SANE Australia since 1995. Hocking also represents community perspectives on a number of committees and advisory groups, including the Australian Suicide Prevention Advisory Council (ASPAC).

I welcome the recommendation from the Senate Enquiry, supported by the Department of Health and Ageing, for review of the Mindframe Media Guidelines.

Suicide prevention is an important issue for everyone. Every death by suicide is a tragedy for the person involved and for family and friends who love them. We know that much can and must be done to reduce the numbers of people who feel so bereft that they believe taking their life is their only option.

The media is an important ally in this task. Media can help to raise community awareness about the issue, to help people understand:

• the impact of suicide on people left behind
• that help is available
• that it is OK to ask for help
• that good services and social supports can reduce the risk

However, on occasions media can also be an opponent in this task. There is growing evidence that irresponsible media reporting can be harmful. For example, the inclusion of unnecessary details such as method or location , or sensationalising or glorifying the issue.

The Mindframe National Media Initiative was developed by the Australian government to assess current evidence and provide information and guidance on reporting suicide and mental illness to ensure that these issues are portrayed responsibly and safely. Mindframe strategies include the Media Guidelines, resource kits and websites, undergraduate and professional education as well as support to build the evidence base for this work. The SANE Media Centre is supported by Mindframe to provide day-to-day education and support to media, mental health and suicide prevention workers. The Media Centre also incorporates the StigmaWatch program, which takes media to task when they report irresponsibly and commends them for good reports.

A review is particularly welcome at this time given that during the past 12 months there has been public criticism of the Guidelines from both mental health experts and sections of the media; thus it is important that these criticisms be addressed openly and clearly. Additionally, as some of the criticism has demonstrated an apparent lack of understanding about the wording of the Guidelines and/or their implementation, this review will provide an opportunity to clarify exactly what the Guidelines do and don’t say, to take stock on how much media reporting of suicide is currently happening and to make an assessment of its quality. Some commentators have claimed for example that suicide is not reported in Australia. Yet we know from the Media Monitoring Project that, when compared to reporting of suicide by the Australian news media in the 2000-2001 period, reporting in 2006-2007 showed considerable improvement. Across all media, both suicide and mental health/illness items increased in volume, with approximately a two-and-a-half-fold increase. And an analysis of the quality of reporting suicide increased from 57% to 75%.

I can also attest that SANE Media Centre staff increasingly field calls from media professionals who are well aware of potential problems; researching their stories about suicide, looking for up to date statistics, seeking expert spokespeople and personal stories; and those who wish to better understand and interpret the Guidelines so they report safely and do no harm. Media Centre staff also support mental health and suicide prevention workers who would like to work with media to get their prevention messages out to the community.

My sense is that a review is also very timely, particularly a review which focuses on collecting evidence about the merits of responsible reporting, so we can better advise media on what they can safely and responsibly do, rather than on what not to do. This will be an important step to reinforce that the Mindframe guidelines are not designed to be obstructive, and that we wish to work with and support media professionals to promote effective suicide prevention messages.

By Jaelea Skehan

Jaelea Skehan has been with the Hunter Institute, which manages several projects under the Mindframe National Media Initiative, since 2001 and is the Project Manager of Mindframe She also holds a Conjoint Teaching Fellowship at the University of Newcastle and is a registered psychologist. 

The issue of suicide and the media is a complex one with various opinions existing within the media, the suicide prevention sector and the community.  Many people (in both the media and the suicide prevention sector) have recently called for more media coverage of suicide. However, there has been a lack of clarity about what exactly people are asking for, which has led to some confusion across sectors.

Nobody would argue that we need to find ways of increasing community discussion of suicide and suicide prevention – in families, among friends, in health services, in workplaces. However, there is a real difference between raising community awareness, changing attitudes and behaviours towards suicide, and media reporting of suicide. 

In general, having a discussion with someone about suicide or their suicide risk will not increase suicidal behaviour. However, we need to remember that the mass media is mostly one way communication, not a discussion, where the evidence for potential risk is very different from evidence about having conversations. 

A recent critical review of the evidence (see Pirkis and Blood, 2010) confirms that there remains a strong association between media presentations of suicide and increases in actual suicidal behaviour (including suicide deaths, attempts and thoughts about suicide). 

Stories about suicide appear to have the greatest impact on people in the community who are already vulnerable.  The risk is increased where someone identifies with the person in the report, where the story is prominent, is about a celebrity, details method and/or location or glorifies the death in some way. Evidence also suggests things that can be done to mitigate the potential harm – such as removing references to method or location, seeking comment on the impact of the death on others, including information on where to seek help, and minimising the prominence of the report. 

The media have historically shied away from covering suicide, even before the introduction of formal codes of practice or informal guidelines. During the 1990s, all peak media bodies in Australia developed codes of practices that guide the way suicide is reported. These codes of practice are now supported by resources developed under the Mindframe National Media Initiative that provide further guidelines and advice for media, mental health, suicide prevention, law-enforcement and justice sectors.

These resources, or guidelines, are not about censorship or restricting media coverage, rather they are designed to practically explain the international research evidence and provide some guidance about how best to cover suicide and mental illness. These are supplemented by face to face training and ongoing engagement with the media to understand and apply the evidence to their practice, while not shying away from issues that are in the public interest or newsworthy to cover. 

Rather than restricting media coverage of suicide Australian research Media Monitoring Project 2000/2001 – 2006/2007 has indicated that there has been a two-fold increase in the reporting of suicide since the dissemination of the Mindframe resources. Importantly, the study also indicates that media have integrated the guidelines into their reports, with an overall improvement in quality from 57% in 2001 to 75% in 2007, with an improvement across seven of the nine suggestions in the resources.
Many have talked recently about the benefits of more reporting – whether this be about deaths, the numbers of deaths or the issues more broadly. While, in fact, there may be benefits from certain types of coverage, the research evidence does not support this claim at this time. There is a definite gap in the research evidence about what constitutes “good news” or “positive” stories. A promising recent study in Europe (Niederkrothenthaler et al., 2010) has indicated a reduction in suicide rates following stories about an individual’s suicide risk, but only where the person has not attempted or died by suicide. Interestingly, the research also found that stories about suicide deaths, suicide attempts and experts talking about suicide were all associated with increased suicide rates.  Indeed it appears to be a tricky and fine line to walk.

There is no doubt that increasing media reporting about suicide and suicide deaths will increase community awareness of the problem and will probably put pressure on governments to increase funding for suicide prevention...but at what cost? At this point in time, there is limited evidence for any benefits of increased reporting of suicide on actual suicidal behaviour and a lack of evidence to support mass media or social marketing campaigns addressing suicide. 

Having said that, suicide is an issue of public interest that should be covered by the media. Given the weight of evidence, however, I would be advocating for continued caution with reporting suicide deaths. What I would like to see is more coordination of the suicide prevention sector, thoughtful planning about media messages at national, state and local level and more formal support and training for both experts and people with personal stories who are vital to any media story about suicide.  While the media have formed good relationships with mental health organisations and are generally aware of how to access personal stories about mental illness, the same does not occur with regards to the issue of suicide. Often media organisations and journalists are relying on only a few organisations, individual experts or people bereaved by suicide (who are often unsupported by the suicide prevention sector).

If we really want to make a change to media coverage of suicide, then the first step may be to focus on our own sector as partners in the process. At the same time, we need to invest in building the evidence about potential positive benefits of using media in suicide prevention to ensure we continue to do no further harm. 

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National suicide prevention – the current picture

 

By Department of Health and Ageing, Mental Health and Suicide Prevention Programs Branch

Since the 'Best of' issue of LIFE News (July 2010), the suicide prevention landscape has moved ahead significantly from an Australian Government perspective. Work continues to build on existing efforts under the National Suicide Prevention Strategy.

The Minister for Mental Health and Ageing, Mark Butler, released the Government’s response to the Senate Inquiry into Suicide in Australia – The hidden toll: suicide in Australia on 24 November 2010. The Response highlights that the Government has already made significant progress in implementing many of the recommendations made in the Senate report.

The response develops further a holistic approach to suicide prevention and commits the Commonwealth to further developing initiatives to:

• Support at risk groups
  
• Provide front line training
  
• Improve access to mental health services
  
• Reduce access to means of suicide

The Response, however has also acknowledged more needs to be done.

The Commonwealth Government identified mental health as an important second-term agenda and committed an additional $274 million over four years for the Taking action to tackle suicide package.

This package will provide more services to those at greatest risk of suicide, fund more direct suicide prevention and crisis intervention, provide more services and support to men who are at greatest risk of suicide, and promote good mental health and resilience in young people.

One of the key elements of the package is $6.1 million to train front line community workers such as financial, legal professionals and relationship counsellors, and healthcare workers, to better identify and respond to the needs of people at risk of suicide or who have attempted suicide. This initiative will provide funding for front line training in around 40 regions around Australia.

The Government is also working closely with the States and Territories through the Mental Health Standing Committee (MHSC) to progress actions identified under the Fourth National Mental Health Plan. At the November meeting, the Mental Health Standing Committee endorsed the adoption of the LIFE Framework as the agreed national suicide prevention framework, and agreed to seek formal endorsement by Australian Health Ministers Advisory Council and Australian Health Ministers Council.

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What's new at livingisforeveryone.com.au

The LIFE team are always updating the LIFE website. Below are some highlights worth browsing.

New brochure Suicide: worried about someone?

Hot off the press! LIFE has updated our brochure for people who are concerned about someone at risk of suicide. Now called Suicide: worried about someone?, print-friendly versions of the brochure can be downloaded from the website and print copies can be ordered by contacting us.

Live chats

Since our last issue, LIFE Communications hosted two very successful live chats. In November 2010, Associate Professor Abd Malak (multicultural mental health specialist) responded to questions on suicide prevention in culturally and linguistically diverse communities. During January 2011 Belinda Clark (National Coordinator: LivingWorks) on education and raising awareness. The edited transcript of these are now available here.

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