9.2 Barriers and challenges

Barriers and challenges can negatively impact on effectiveness. This section identifies the key barriers and challenges that emerged from the project survey, thematic analysis of project data and documentation (including progress reports), and information submitted as part of the MDS.

9.2.1 Funding
9.2.2 Staffing
9.2.3 Administration
9.2.4 Weak relationships
9.2.5 Target group
9.2.6 Specific challenges for projects focusing on Aboriginal and Torres Strait Islander populations
9.2.7 Data collection
9.2.8 Technology, literacy and language
9.2.9 Rurality and distance
9.2.10 Other factors

9.2.1 Funding

Funding limitations were recognised as a barrier for a number of projects, and the shortage of resources this produced was cited as a reason for difficulties delivering the number, range, intensity or geographic coverage of services needed. Several projects reported a desire to expand their services to other areas or other settings (such as schools or workplaces) but could not do so because of funding limitations.

The short-term nature of funding was also reported to limit the potential for ongoing program development, as well as leading to recruitment difficulties. In some cases, reduction in funding amounts between funding periods placed a strain on the ability to deliver services as planned. In addition, some projects were reluctant or not able to promote their services because they were concerned that a lack of future funding would mean that services could not be delivered.

In some projects, there were concerns related to the small size of the project (in terms of amount of funding and/or number of staff) and the ability to cover absences and continue service delivery and service development. In some cases the small size of the project limited the ability to cover leave, ensure information technology was up to date and operational or ensure that optimal care of workers (related to supervision, etc) could be undertaken.

Key findings

Some projects reported that funding limitations and uncertainties:

• Made it difficult to deliver the number range, intensity or geographical coverage of services needed
• Restricted expansion and/or development of project activities
• Restricted their ability to ensure optimal employee supervision and staff recruitment Top of page

9.2.2 Staffing

Recruitment and retention of adequately trained and skilled staff was a common issue for projects. This is in addition to the expected typical staffing challenges, such as resignations and illness. Specific issues included:

• The specialist skills required for some suicide-prevention roles. Attracting and retaining 'work-ready' staff was a problem, especially for projects requiring staff from particular cultural backgrounds (eg, Aboriginal and Torres Strait Islander people) or who understood the particular needs of the target group (eg, working with older men).
• Difficulties recruiting staff to rural and remote locations.
• Remuneration levels required to attract and retain staff were prohibitive to program sustainability in some areas.
• Long gaps in service delivery whilst recruitment was being undertaken led to loss of confidence in the services and a continual need to rebuild trust with new staff members.
• The short-term nature of NSPP funding led to difficulties recruiting staff to short-term roles because of a perceived lack of job security.
• The often stressful and demanding nature of suicide prevention work (particularly in some community settings) was suggested as a reason for higher levels of staff turnover and position vacancies.

Key findings

Staff recruitment and retention difficulties, which were seen to be largely a function of the short-term NSPP funding, were commonly cited as a barrier to effective program implementation. Top of page

9.2.3 Administration

Barriers and challenges in the administration of projects took several forms. Issues associated with organisational culture, and the skill levels of staff, managers and decision-makers, were cited as difficulties by some projects. The burden of continually applying for funding to deliver services and the pressure of delivering on short-term financial contracts were noted challenges that in some cases stifled change, flexibility and capacity.

9.2.4 Weak relationships

While strong partnerships and relationships were seen as key to project success, challenges to developing partnerships and relationships were also a barrier to success. Difficulties included:

• Relationship building was inevitably time-consuming, and the time required was sometimes underestimated, especially in the project start-up phase.
• Engaging external stakeholders in the project (eg, local schools, health services or other service providers) was challenging due to competing demands on their time, and in some cases, differing perspectives on the importance of suicide prevention.
• Lack of clarity around roles and referrals between service providers (eg, linking hospital patients with GPs) and in some cases, perceived 'territorial behaviour' among partnering organisations. For example, some mental health clinicians were reluctant to accept approaches to suicide prevention that used peer support models if they did not see these approaches as a legitimate model of care.
• Administrative and bureaucratic issues and ‘unsupportive policies’ within organisations were also identified as problems for some projects.

Key findings

The key relationship barriers identified were:

• Time required for relationship building
• Difficulties engaging external stakeholders
• Lack of clarity around roles and referrals between service providers Top of page

9.2.5 Target group

Engaging target groups in suicide prevention activities was challenging for a number of projects. Examples of difficulties included:

• People not turning up to planned workshops or events, in some cases necessitating cancellation of events due to low participant numbers.
• Concerns about the confidentiality of divulged problems or difficult circumstances.
• For some target groups, a reluctance to discuss emotions, or to talk about the issues of suicide because of the fear of stigmatisation.
• Similarly, some target groups were reluctant to engage with health professionals. This was noted particularly for projects targeting older men. Social stigma related to mental illness and suicide was reported as a barrier to help-seeking and engagement by some projects. Projects employed a number of strategies to reach their target groups in a way that was non-threatening.
• For participants of workforce development projects, suicide prevention training necessitated time away from their day-to-day jobs. Time release was often resisted by management.
• Projects that operated in school settings often reported conflicting priorities and demands on the curriculum.

Key findings

Projects experienced difficulties in engaging with target groups due to:

• Poor attendance at events
• Social stigma relating to suicide which resulted in a reluctance to talk about suicide or seek help
• Competing priorities within settings such as schools and workplaces Top of page

9.2.6 Specific challenges for projects focusing on Aboriginal and Torres Strait Islander populations

The complex social and cultural issues faced by Aboriginal and Torres Strait Islander communities created challenges for projects addressing this target group. Key issues included:

• Time required to build trust in Aboriginal and Torres Strait Islander communities, including building positive relationships with elders.
• Importance of ensuring that resources developed or training provided is culturally appropriate and pitched at an accessible literacy level.
• Permission was required to access some Aboriginal and Torres Strait Islander communities and this process was time-consuming.
• Recruitment and retention of Aboriginal and Torres Strait Islander staff was difficult.
• One project reported that events were often cancelled because of funerals, or other sorry business (due to suicide or other reasons), underscoring the magnitude of the health and social problems faced by some Aboriginal and Torres Strait Islander communities.
• Difficulties collecting data due to reluctance or inability to fill out forms or reluctance to be formally followed up.

Key findings

A range of additional challenges exist for projects targeting Aboriginal and Torres Strait Islander populations, which can increase the time and resources required to establish initiatives.

9.2.7 Data collection

There are several areas where data collection and availability was reported to create barriers to the work of projects. Difficulty obtaining data on suicide rates and at-risk groups made it difficult for some projects to understand the specific needs of their target groups and also made it difficult to assess the effectiveness of their interventions. A lack of time and money to collect reliable, consistent data also impacted on the ability of project staff to conduct evaluation activities. The nature of some NSPP-funded activities (such as work with some Aboriginal communities or work through the media) meant it could be difficult to collect reliable statistics on the number of people assisted or reached by the activities. Top of page

9.2.8 Technology, literacy and language

In some cases, lack of computer access and low levels of literacy were reported to influence the usefulness of interventions. In one instance, materials (eg, pamphlets, DVDs etc.) were pitched inappropriately for the audience, hampering the ability to engage the target group. Voice Over Internet Protocol (VOIP) has been a significant issue for one project, with 'line drop outs' making service delivery disjointed. Embedded computer software systems have hampered some projects collecting the MDS data as modifications to existing systems were necessary (taking considerable time and costing considerable amounts of money).

9.2.9 Rurality and distance

Rurality and distance created a number of challenges. The geographic spread of some projects meant that staff needed to travel large distances, and also created logistical problems with coordinating programs from a distance. Attracting staff to rural and remote parts of Australia is generally difficult and attracting workers with specific skills in mental health and/or suicide prevention may be more difficult still. Furthermore, living in rural or remote areas is a risk factor for suicide in its own right (for a number of reasons that include the potential for social isolation and limited access to services), which created additional challenges in terms of engaging this target group.

9.2.10 Other factors

Several projects reported that external factors beyond their control created obstacles. These included natural disasters (floods, cyclones) and limited employment opportunities for people who had undergone training.