Suicide and self-harm are significant public health concerns and a reason for premature mortality amongst Aboriginal and Torres Strait Islander people in Australia. Indigenous suicide was almost unheard of prior to the 1960s . However, there is growing concern over the high and increasing rates of suicide and suicide attempts among young Aboriginal and Torres Strait Islander people. This is a problem of national significance. The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) is an important Australian Government funded initiative to identify what programs and services are most effective in helping reduce high rates of Aboriginal and Torres Strait Islander suicide. The project is led by the School of Indigenous Studies (SIS) and the Poche Centre at the University of Western Australia (UWA), in collaboration with the Telethon Kids Institute and with support from The Healing Foundation. ATSISPEP is a renewed attempt to find enhanced ways of dealing with the problem of suicide in Aboriginal and Torres Strait Islander communities. This literature review was prepared by Healthcare Management Advisors, in conjunction with the Telethon Kids Institute. It informed the companion report, Suicide Prevention in Aboriginal and Torres Strait Islander Communities: Learnings from a meta-evaluation of community-led Aboriginal and Torres Strait Islander suicide prevention programs This literature review uses many of the processes and principles of a systematic literature review, but has restrictions on the breadth or depth of the research to suit a shorter timeframe. Our literature review methodology placed a number of limitations on the search criteria and how the evidence was assessed. Also, while the strength of the evidence was assessed in a rigorous and defensible way, it is not necessarily as exhaustive as a systematic review and meta-analysis. A major strength, however, is that a literature review can inform policy and decision makers more efficiently by synthesising and ranking the evidence in a particular area within a relatively short space of time. Research question The research question used in this literature review consisted of two parts: What evidence is there on effective interventions to promote suicide prevention and provide postvention support amongst Indigenous people, including Aboriginal and Torres Strait Islander people? and trial
What evidence is there to assess the effectiveness of evaluation frameworks developed for these programs? Search strategy Relevant literature was sourced through systematic searches of databases, including MedLine (PubMed), PsychINFO, Cochrane library and Google Scholar, as well as pertinent journals including Internet Interventions and the Journal of Medical Internet Research. Search terms Search terms using the Title/s, Abstract/s and Keywords lists included: Suicide OR self-harm OR depression OR anxiety OR trauma OR stigma OR alcohol OR “alcohol abuse” OR drug OR “drug abuse” OR “self-harm” OR wellbeing OR social AND Indigenous OR Aboriginal and Torres Strait Islander OR Maori OR First Nations OR Aboriginal OR Inuit OR American Indian OR Native American OR Alaskan Native OR adults OR youth OR adolescents OR colonization OR colonisation OR racism AND prevention OR postvention OR promotion OR program OR policy OR intervention OR education OR strategy OR resource OR support OR social media OR “mobile applications” OR “mobile health” AND Evaluation OR “Evaluation Framework” OR efficacy OR effectiveness OR engagement OR outcome OR monitoring OR implementation OR acceptability Paper selection After conducting searches, studies identified by a screen of title and abstract were evaluated against inclusion and exclusion criteria listed in Table 2.1. Table 2.1: Inclusion and exclusion criteria Included: Excluded: Internationally and locally published research studies Research papers that were published from 1995 to 2015 Published book chapters, government reports and government websites Trials with outcome data that assessed research outcome (e.g., depression, health seeking behaviour) English language papers Non-English papers Papers where full text was not readily available Validation studies Animal studies Grey literature (e.g.,Media: websites, newspapers, magazines, television, conference abstracts, theses) Literature which did not include “Suicide” OR “Aboriginal Torres Strait Islander people / Indigenous Australians” Information management A screening process was adopted to code the eligibility of papers acquired through the literature search. All records that were identified through the literature search were screened for relevance against the inclusion criteria, and then processed using Microsoft Excel. Initial screening for inclusion was performed by one reviewer, and was based on the information contained in the title and abstract. Full text versions of all studies which satisfied this initial screening were obtained. In screening the full text paper, the reviewer made the decision on whether the paper should be included or excluded, based on the pre-defined inclusion and exclusion criteria.
LIFE New South Wales The NSW Suicide Prevention Strategy 2010–2015 (the Strategy) follows on from NSW’s first suicide prevention strategy, Suicide: we can all make a difference and is aligned with the strategic directions set out in the LiFE Framework . The Strategy recognises Aboriginal people – particularly Aboriginal men – as a high-risk group. The directions set out in the Strategy focus on sharing the responsibility of suicide prevention among all levels of government as well as between individuals, families, schools, workplaces and communities. Victoria In 2015, the Victorian Government released Victoria’s 10-Year Mental Health Plan which stipulates that a suicide prevention strategy will be published that provides direction for all levels and departments of Victorian government . The Victorian Aboriginal Suicide and Self-Harm Prevention and Response Action Plan 2010–2015 (the Action Plan) was released in 2010 to provide strategic directions to reduce the incidence and impact of suicide in Aboriginal populations and communities across Victoria . The Action Plan sets out four priority areas which include: Prevention through building resilience in individuals, families and communities; Improving access to care and support for at risk; Improving the crisis response and providing support to communities after suicide; and Building the evidence base and improving data collection and analysis. The Action Plan and Victorian suicide prevention policies are aligned with the strategic directions set out in the LiFE Framework. Queensland The Queensland Suicide Prevention Action Plan 2015–2017 (the Action Plan) is the first step towards Queensland Mental Health Commission’s broader goal of reducing suicide in the state by 50% within a decade . The Action Plan recognises Aboriginal and Torres Strait Islander people as at greater risk of suicide. The Action Plan sets out four priority areas including: Stronger community awareness and capacity to enable families, workplaces and communities to recognise suicide risk and act appropriately; Improved service system responses and capacity to ensure appropriate and timely access to support and care for those at risk; Focused support for vulnerable groups; and A stronger, more accessible evidence base to drive improvement in research, policy and service delivery. The Action Plan acknowledges that the LiFE Framework sets out current best practice in suicide prevention suicide and incorporates the Framework’s continuum of care across eight domains into its strategic directions.
Primary prevention through providing prevention and training activities at the primary health level; Secondary prevention including postvention activities; Tertiary prevention to support people transitioning from, and between care; and Evaluation and quality improvement to build the evidence base around suicide prevention activities. Australian Capital Territory The latest strategy released by ACT Health is Managing the Risk of Suicide: A Suicide Prevention Strategy for the ACT 2009–2014 (the Strategy) has a on suicide prevention across the lifespan in the ACT . The Strategy is the product of local consultations and informed by the LiFE Framework. The Strategy recognises Aboriginal and Torres Strait Islander people as a high-risk group and aims to facilitate suicide prevention initiatives that reflect how Aboriginal and Torres Strait Islander people view health and wellbeing. The action areas set out in the Strategy reflect those established in the LiFE Framework, described previously. Northern Territory The Northern Territory Suicide Prevention Strategic Action Plan 2015–2018 (the Action Plan) sets out directions to reduce the incidence and impact of suicide on people in the Northern Territory . One-third of the actions set out in the Action Plan specifically target Aboriginal and Torres Strait Islander individuals and communities. The action areas set out in the document align with those in the LiFE Framework and include: Provision of targeted suicide prevention activities in the NT that are accessible to those in greatest need (e.g., children and young people, Aboriginal and Torres Strait Islander people); Building strength and resilience in individuals and families at risk in the NT with a key focus on culturally appropriate activities to engage youth and build cultural strengths and leadership; Improving wellbeing and resilience of communities across the NT with a key focus on community controlled prevention activities; Coordinating approaches to suicide prevention in the NT at the policy, program coordination and service provision levels; Improving the evidence base and disseminating information with an emphasis on knowledge and creating research partnerships; and Implementing high standards and quality in suicide prevention to improve practice.