As outlined in Section 5.5, projects reported that activities occurred across all six LIFE Action Areas. Multiple LIFE Action Areas were being addressed by most projects.
Overall, self-reported achievement scores differed little across the 19 components of the LIFE Action Areas, with average scores per component ranging from 3.41 and 4.06 (see Figure 5-3). This suggests that project staff consider that they are effectively targeting their suicide prevention work to the LIFE Action Areas.
The data suggests that LIFE Action Area 5.2 (Systematic, long-term, structural interventions), which achieved an average score of 3.06, may be an area requiring more attention. This finding may be partially explained by the short-term nature of NSPP funding and the limitations this imposes on achieving long-term or structural change.
Drawing on the project documentation/data, the following provides illustrative examples of the self-reported achievement of objectives for each of the six LIFE Action Areas.
- LIFE Action Area 1: Improving the evidence base and understanding of suicide prevention
- LIFE Action Area 2: Building individual resilience and the capacity for self-help
- LIFE Action Area 3: Improving community strength, resilience and capacity in suicide prevention
- LIFE Action Area 4: Taking a coordinated approach to suicide prevention
- LIFE Action Area 5: Providing targeted suicide prevention activities
- LIFE Action Area 6: Implementing standards and quality in suicide prevention
LIFE Action Area 1: Improving the evidence base and understanding of suicide prevention
Understanding of imminent risk and how best to interveneThis outcome was primarily addressed through 'gatekeeper training' including training aimed at first responders such as police and other emergency services personnel. Some school-based training interventions also addressed these issues.
Understanding of whole-of-community risk and protective factors, and how best to build resilience of communities and individualsMost projects with a community focus reported some achievement in this regard. Some projects demonstrated considerable effort to understand the unique needs of the population they served (eg, understanding the particular areas of vulnerability/distress for young people from refugee backgrounds or Indigenous people). This was achieved through extensive stakeholder involvement in the development of strategies to ensure appropriate interventions.
Other projects improved understanding of risk and protective factors through community capacity-building and training activities which meant that that the community as a whole was better equipped to respond to risk of suicide.
The extent to which projects contributed to the evidence base, particularly in relation to how best to build community and individual resilience, is difficult to ascertain due to the variable availability and quality of existing project evaluations. Communications with project stakeholders highlighted the need for greater opportunities for information sharing among projects about what strategies they have found to be effective. A number of project representatives noted that the opportunity to meet representatives from other projects during the August 2012 workshops held to develop the MDS was very beneficial, as it provided an opportunity to interact with their peers and share information. Top of page
Application and continued development of the evidence base for suicide prevention among high-risk populationsBased on the current literature on suicide prevention, a strong evidence base does not exist for many of the interventions that are currently funded under the NSPP. This is not to say that these interventions are not effective. As discussed in Section 4.10, lack of evidence is one of the key evaluability issues that apply to suicide prevention activities generally. It would therefore be erroneous to equate lack of strong evidence with ineffectiveness.
Many of the projects reported that they were responding to perceived community need or working with a model that had been evaluated as effective in another setting. Others described a process of continual review and evaluation which enabled activities to be refined.
Improved access to suicide prevention resources and informationProvision of suicide prevention resources and information formed part of the activities of most projects. This was achieved through training, workshops, other promotional activities (eg, talks to community groups), development of websites, or provision of print resources. Other ways that projects achieved this outcome included dissemination of research on suicide prevention, and by encouraging/reminding journalists of the need to include helpline numbers when publishing media articles relating to suicide or mental health.
- 'Gatekeeper training' including training aimed at first responders such as police and other emergency services personnel and school-based training interventions, were the main strategies used to develop understanding of imminent risk and how best to intervene.
- Most projects reported they were responding to perceived community need or working with a model that had been evaluated as effective in another setting.
- Provision of suicide prevention resources and information was part of the activities of most projects. This was achieved through training, workshops, other promotional activities (eg, talks to community groups), development of websites, provision of print resources, research dissemination and encouraging publication of helplines in media articles. Top of page
LIFE Action Area 2: Building individual resilience and the capacity for self-helpSection 5.5 shows that LIFE Action Area 2 represented the LIFE Action Area that projects considered they were making the greatest progress. Self-reported achievements for Action Area 2 are described below.
Improved individual resilience and wellbeingImproved individual resilience and wellbeing was demonstrated by a number of projects, particularly those with an individual or community focus. Several projects demonstrated improvements in:
- Interpersonal and school functioning
- Self esteem
- Health and wellbeing
- Personal behaviour strengths
- Talking to a family member or friend about mental health and/or suicide
- Visiting websites of services or contacting services/helplines directly
- Raising issues/concerns with health professionals
An environment that encourages and supports help-seekingThe extent to which the NSPP-funded projects promoted an environment that encourages and supports help-seeking was mixed. A number of projects facilitated help-seeking by promoting services (eg, formal counselling services or informal support groups) and improving referrals to services. There is also evidence that population-wide social marketing approaches have been effective in promoting help-seeking. For example, a key message of RUOK? Day (2010 campaign) was 'It's OK to admit that you are not coping', and this reportedly resulted in a spike in referrals to SANE Australia.
Nevertheless, encouraging help-seeking is a challenging goal that hinges on broader socio-cultural factors including stigma and social norms. It may also be affected by the extent to which services are perceived to be appropriate or helpful (eg, LGBTI, Aboriginal cultural appropriateness), and for some groups in particular, cultural norms around stoicism and independence (eg, men, and rural men in particular).
- Improved individual resilience and wellbeing was demonstrated by a number of projects, particularly those with an individual or community focus.
- The extent to which the NSPP-funded projects promoted an environment that encourages and supports help-seeking was mixed.Top of page
LIFE Action Area 3: Improving community strength, resilience and capacity in suicide prevention
Improved community strength and resilienceIt is difficult to determine the extent to which the funded projects improved community strength and resilience. Improved cohesion and resilience was reported in some well-defined target populations, eg, certain projects targeting Aboriginal and Torres Strait Islander people in rural/remote Australia. While many of the projects undertook training, education, workshops and others focused on improving community networks (through support groups, camps and a range of recreational activities), the extent to which these resulted in meaningful changes in community strength and resilience cannot be measured based on the existing documentation or data sources.
Increased community awareness of what is needed to prevent suicideMany of the projects achieved improved community awareness of what is needed to prevent suicide. Strategies used to do so included training (particularly gatekeeper training) workshops/conferences, provision of information through a range of media and strengthening referral pathways. As previously suggested, more support for information sharing between organisations delivering suicide prevention programs is likely to assist with achieving increased community awareness.
Improved capability to respond at potential tipping points and points of imminent riskA range of projects improved capabilities to respond at points of imminent risk through providing access to counsellors/support (notably to high-risk groups, such as people who had been recently bereaved) and through gatekeeper training and improvements to referral pathways. Several projects that undertook training of frontline workers reported that participants had improved their skills and confidence in interacting with people at imminent risk of suicide.
- Improved cohesion and resilience was reported in some well-defined target populations (eg, certain projects targeting Aboriginal and Torres Strait Islander people in rural/remote Australia)
- Many of the projects improved community awareness of what is needed to prevent suicide
- Limited opportunities existed for projects to share strategies/best practice
- A range of projects improved capabilities to respond at points of imminent risk through providing access to counsellors/support. Top of page
LIFE Action Area 4: Taking a coordinated approach to suicide prevention
Local services linking effectively so that people experience a seamless serviceThe development of partnerships and linkages was an important component of almost all projects. In the survey, 92% of projects reported that they collaborated with other organisations (Section 5.10) while the MDS data revealed extensive referral networks (Section 6.4.12). From the pre-existing project documentation/data, it was evident that this was also one of the most challenging tasks for many projects. In some cases partnerships were formalised through Memoranda of Understanding while in other cases they were less formal in nature. Examples of cross-sector collaborations included partnerships between police and mental health services, and between ambulance services and bereavement services.
The extent to which the linking of services led to provision of a seamless service cannot be measured based on existing project documentation or available data. While examples of improved referral pathways as a result of partnerships and linkages were described, cases in which services did not work together effectively were also recounted. The reasons for ineffective partnerships and collaborations included lack of shared vision, competing priorities, or perceived competition for clients or funding (these are described in more detail in Section 9.2.4). In cases where these barriers occurred, the client journey may have been impeded.
Program and policy coordination and cooperation, through partnerships between governments, peak and professional bodies and non-government organisationsThere is evidence of a shared vision and cooperation between policy stakeholders in relation to suicide prevention. This has been demonstrated through the efforts to align the NSPS with other Australian government initiatives as well as state/territory suicide prevention strategies (although, as outlined in Chapter 11, there is room for improvement in this regard).
However, at the project level, many project representatives indicated that they lacked knowledge about other suicide prevention projects. Others reported feeling isolated and expressed a desire for support and advice from other services grappling with similar problems (particularly in relation to community engagement and evaluation).
Regionally integrated approachesAlthough data was not specifically collected about the extent to which regional integration occurs, there was little evidence that there were regionally integrated approaches operating.
- While high levels of partnerships and linkages were reported in the survey, this was an area of challenge for many projects.
- Policy stakeholders had significant shared vision and cooperation in relation to suicide prevention. However, many project staff reported a lack of knowledge about other suicide prevention initiatives.
- There was little evidence that there were regionally integrated approaches operating.Top of page
LIFE Action Area 5: Providing targeted suicide prevention activities
Improved access to a range of support and care for people feeling suicidalThe majority of funded projects undertook activities to improve access to support and care for people feeling suicidal. These activities addressed the needs of a range of high-risk groups and demonstrated that a wide range of services were available (although not for all risk groups in all areas). A wide range of approaches were used to promote these services, which increased the likelihood of uptake. While it is not possible or practical to quantify how many of the recipients of these services were feeling suicidal, most projects had an appropriate focus on the groups known to be at higher risk. Of note are several projects that have developed partnerships to increase access to referral to services through innovative pathways – for example through linkages between agricultural sector organisations and mental health services.
Systemic, long term, structural interventions in areas of greatest needAs discussed in Chapter 5, the body of NSPP-funded projects covered the majority of target groups and geographical areas of need. The extent to which the interventions can be described as systemic, long-term or structural is variable. Projects which focused on collaboration, partnerships and linkages (eg, improving referral practices from the hospital to community sector, or partnerships between the funded organisation and Youth Diversion programs) have potential to be sustained beyond the life of the funding period.
Similarly, projects that focused on training and upskilling (eg, through train the trainer approaches) are more likely to have long-term effects compared with, for example, approaches relying on passive dissemination of information (provided that those trained are able to enter or remain in the workforce). A number of projects, while addressing areas of need, acknowledged that systemic, long-term change was beyond their scope given the short-term nature of the NSPP funding.
Reduced incidence of suicide and suicidal behaviour in the groups at highest riskBased on the information available for this review, it is not possible to evaluate the extent to which the projects reduced the incidence of suicide or suicidal behaviour in the groups at highest risk. While several projects reported improvements in knowledge, attitude and behaviours relating to suicide prevention, and others showed decreased levels of suicidal ideation, distress, anxiety and depression (in some cases assessed with validated tools such as the K10+), data on the incidence of suicide and suicidal behaviour before or after the interventions was not collected.
Project reports included comments from project participants that suggested that involvement in the project may have deterred them from attempting suicide. For example 'I could not have made it through without your support'; 'I didn't realise how close I was to committing suicide before receiving counselling'. See Section 8.2 for a discussion of challenges relating to measuring the impact of programs on the suicide rate.
Improved understanding, skills and capacity of front-line workers, families and carersA number of projects addressed the aim of improving the understanding, skills and capacity of a range of workers including teachers, health professionals, police, community workers and Aboriginal Health Workers. In many cases the training programs used were established and well-researched programs (such as ASIST and SafeTALK). Other projects have targeted community groups, people bereaved by suicide and other high-risk groups. A number of projects reported high levels of satisfaction with training or workshops, as well as positive changes in knowledge and attitudes.
- The majority of funded projects undertook activities to improve access to support and care.
- The ability to achieve long-term, structural change was beyond the scope of many projects. Many projects reported that this was partly due to the short-term nature of NSPP funding.
- Several projects demonstrated improvements in knowledge, attitudes and behaviours of groups at high risk, but the extent to which this translated into reduced incidence of suicide or suicidal behaviour is not known.
- A number of projects undertook activities that improved the understanding, skills and capacity of front-line workers, families and carers.Top of page
LIFE Action Area 6: Implementing standards and quality in suicide prevention
Improved practice, national standards and shared learningThe LIFE Framework emphasises that suicide prevention programs need to reflect the evidence of what does and does not work, and to communicate this effectively to the point of need. A number of examples of improved practice at a project level have been identified in this final report. In some cases, projects reported that activities have been refined in light of evaluation or review. Processes have also been undertaken to document best practice, for example by capturing the insights of senior workers and formalising processes in manuals or policy documents.
Several projects demonstrated commitment to shared learning. This was achieved through development of partnerships and networks, presentations at meetings and conferences and development of resources.
In addition, there is evidence of stakeholders in suicide prevention sharing knowledge via the physical and online communication channels provided through the LIFE Communications program, however, there is arguably scope for this to improve, given that many project representatives reported limited awareness of other suicide prevention activities underway.
Improved capabilities and promotion of sound practice in evaluationEvaluation reports for 37 projects were supplied for this evaluation (see Section 4.2); however the quality of the reports was variable with many being largely descriptive in nature. In addition, inadequate project evaluation was listed as a shortcoming for a number of projects, with staff often indicating that they felt they would benefit from more evaluation advice and expertise through the NSPP (see Section 9.3.3). These findings suggest that there is scope to better support project staff to improve evaluation capabilities.
Systemic improvements in the quality, quantity, access and response to information about suicide prevention programs and servicesTo date, information about suicide prevention programs and services generated at a project level has been channelled centrally to DoHA as part of projects' regular reporting requirements under funding agreements. Analysis of this aggregate data has not been made available in the public domain or to funded projects (although there is potential for this with the MDS). While several projects focused on disseminating information about suicide prevention programs and emerging research, there is arguably scope to improve the consistency and systemic nature of information provision.
- A number of projects demonstrated a commitment to shared learning and several projects were funded to either conduct or disseminate research. However there is scope to improve communication between projects.
- Evaluations were not a requirement under all project funding agreements. This has implications for the level of systemic improvements that could be achieved.
- Many project representatives expressed a desire for greater support to evaluate their activities.
- Analysis of aggregate data generated through the NSPP has not as yet been made available in the public domain or to projects funded.