1 Introduction and background

1.1 Evaluation of the National Suicide Prevention Program – literature review
1.2 An overarching framework for suicide prevention strategies
1.3 Australia's approach

1.1 Evaluation of the National Suicide Prevention Program – literature review

The evaluation of the National Suicide Prevention Program (NSPP) has been informed by an in-depth literature review with two distinct stages. Stage one of the literature review sought to inform the development of a robust Evaluation Framework to be employed by the evaluation. To achieve this, all published articles relating to the evaluation of suicide prevention programs both in Australia and internationally were identified. The key aims of the Stage 1 Review were to:

1. Examine each of the evaluation frameworks and methodologies employed, in order to determine whether or not they could help to inform the development of a framework to be employed by the current evaluation
2. Identify the various quantitative and qualitative performance indicators that have been used to evaluate the effectiveness of programs, and could potentially be applied in the Australian context
3. Identify appropriate quantitative and qualitative tools that have been used to define and measure the impacts of suicide prevention activities that could be used in Australia
4. Identify key (Australian) stakeholders who may be able to contribute to the stakeholder consultation.

The conclusions from this component of the review highlighted that while the majority of national suicide prevention strategies identified set out a series of goals and/or objectives for action, for the most part they did not outline a clear framework for evaluation. A minority of strategies (or supporting action plans) included performance indicators or targets; some included specific sources of data for monitoring success against these indicators; some nominated the agency responsible for implementing each goal; and some included specified timelines for action. Only one included an economic evaluation. For some countries either independent evaluations or documents reporting on the progress of a strategy were available. However, the application of clear evaluation frameworks was rare.

The purpose of the second stage of the literature review was to enable conclusions to be drawn about the effectiveness of Australia’s suicide prevention efforts to date, compared with other local and international efforts. Building on the information obtained in stage one, the stage two literature review was conducted to assist the evaluators in:

• Determining whether or not the approach taken in Australia reflects international best practice
• Examining how outcomes achieved in Australia compare to those reported elsewhere
• Identifying any gaps in systems of delivery and evaluation
• Highlighting possible improvements in the way suicide prevention activities are delivered and evaluated in Australia.

In particular, it examined and synthesised the evidence with regard to those groups at elevated risk of suicide and the effectiveness of specific suicide prevention interventions. Top of page

1.2 An overarching framework for suicide prevention strategies

In response to high suicide rates around the world, the United Nations (UN) published guidelines in 1996 that aimed to encourage and assist countries in developing national suicide prevention strategies.¹ Acknowledging that the pathways to suicide are often complex and multifaceted, the guidelines recommended that strategies should adopt a range of approaches and activities, target their activities towards a range of at-risk groups, and that they should be based upon the best available evidence.

Many countries have since developed national approaches to suicide prevention based on these recommendations. The complexity of such multifaceted approaches and specific targeting of high risk groups can be conceptualised under the framework originally developed by Mrazek and Haggerty,² and later adapted by Silverman and Maris,³ which classifies suicide prevention activities into 'universal', 'selective' and 'indicated' approaches.

Universal approaches target whole populations, with the aim of favourably shifting proximal and distal risk and protective factors across the entire population. Selective interventions target subgroups whose members are not yet manifesting suicidal behaviours, but exhibit risk factors that predispose them to do so in the future. Indicated interventions are designed for people who are identified as already beginning to exhibit suicidal thoughts or behaviours.

1.3 Australia's approach

Australia was one of the first countries to develop a national suicide prevention strategy.⁴ This is operationalised through the LIFE Framework and supported by a national program of funded activity (the NSPP). Drawing upon the priorities set out in the LIFE Framework, and in line with the UN recommendations described above, this funding program is dedicated to both population wide (i.e. universal) and targeted (i.e. selective or indicated) suicide prevention activities, i.e. supporting broad population health approaches where proven effective, as well as targeted interventions directed towards groups identified as being at increased risk of suicide. In addition, the LIFE Framework highlights the importance of ongoing evaluation in order to ensure that the program of work is (as far as possible) evidence-based.