113 Suicide prevention in Australia

Australia is among countries with a medium rate of suicide: 10.3 per 100,000, with the male:female suicide ratio of approximately 4 to 1, and suicide rates 16.4 per 100,000 and 4.3 per 100,000, respectively (ABS 2007). Young males in the age group of 25–34 are at the highest risk 25.1 per 100,000 (ABS 2007). Similarly to other countries with an Anglo-Saxon sociocultural background (De Leo 1999), the rates for males decrease with advancing age only to rise again among elderly males over the age of 75, to 21.6 per 100,000 (ABS 2007).

Australia was one of the first countries to introduce a national strategy for the prevention of suicide. The initial programme, the National Youth Suicide Prevention Strategy, was implemented from 1995–1999, and was followed by the National Suicide Prevention Strategy which targeted all age groups. The strategy was based upon the Living is For Everyone (LIFE) Framework, which provided the overall structure and conceptual guidance for national and local initiatives and programmes (Commonwealth Department of Health and Aged Care 2000). The framework's aims were to prevent suicide and to promote resilience and mental health in the Australian population across all age groups, with a special focus on the youth and young adults. Specifically, six action areas were identified within the LIFE Framework:

Over a period of seven years, 22 national and 156 state/territory projects were funded under the strategy, the majority of them being universal and selective suicide-prevention initiatives implemented in community-based settings (Headey et al. 2006; Robinson et al. 2006). The national initiatives included the development of the Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet) and the Mindframe National Media Initiative, the introduction of the National Youth Participation Strategy, a range of activities for individuals bereaved by suicide, and publication of culturally appropriate information leaflets for the indigenous populations. Following the six areas of action, a wide range of at-risk groups was targeted by the strategy; however, at the local, state and territory levels, the three major target groups for interventions were the youth, Aboriginal and Torres Strait Islander populations and people in rural and remote areas (Headey et al. 2006).

Although the decrease in the overall suicide rate in Australia (from 14.7 per 100,00 in 1997 to 10.3 per 100,000 in 2005), especially among the young males aged 15–24 (from 31.0 per 100,000 in 1997 to 16.2 per 100,000 in 2005), has been attributed to the effectiveness of the National Suicide Prevention Strategy (Goldney 2006; ABS 2007; Morrell et al. 2007), problems related to the accuracy of national suicide mortality data call for caution in considering the strategy's impact (De Leo 2007).

Following extensive consultations with key suicide prevention stakeholders at the national and local levels, in August 2005, the Commonwealth Government Department of Health and Ageing recommended a review of the effectiveness, relevance and appropriateness of the LIFE Framework. The review acknowledged its importance and impact; however, it indicated the need to revise the framework in order to clarify its purpose and to ensure that the framework is reflective of a diverse Australia. Also, the need for greater integration of information presented in the framework documents and publications, as well as adding practical content with an implementation focus and presenting the material in a more visual and concise manner, was recommended. Consequently, the Redevelopment of the LIFE Framework Project commenced and a new framework—Life is for Living—has been developed with the implementation starting in 2008.

The Life is for Living Framework is based upon a vision ‘that suicide prevention activities will reduce loss of life’ and its purpose is that ‘individuals, families and communities will have the support necessary to ensure that no one sees suicide as their only option’ (Commonwealth of Australia 2007). Three fundamental principles, i.e. doing no harm, client-centred service delivery and community ownership and responsibility for action, apply to six action areas of the framework:

These action areas were adapted through the process of stakeholders consultations from the original areas of action delineated in the LIFE framework, and each of them has a specific objective and expected implementation outcomes. The high-risk target groups under the new strategy are people who engage in self-injurious behaviours and/or have a history of suicide attempts, men, indigenous people, individuals living in rural and remote parts of Australia, and individuals from culturally and linguistically diverse backgrounds.

While the LIFE framework activities were based upon the spectrum of mental illness interventions model (adapted from Mrazek and Hagerty 1994)—i.e. prevention, treatment and continuing care—the new framework is founded upon the model of Pathways to Care for Suicide Prevention. This model, although also based upon the concepts of universal, selective and indicated prevention, includes a wider range of interventions, stresses more the role of clinicians, service providers, community and individuals in prevention of suicide, as well as the need to ensure that there are community-based ‘safety nets’ at the points of intervention handovers.

Reduction in suicide mortality is one of the effectiveness measures for the framework. Other suggested measures include increased awareness, interest and understanding of issues related to suicide and its prevention, increased application and understanding of effective suicide-prevention initiatives, higher capacity of communities and families to respond to individuals at risk of suicide, as well as improved resilience and well-being in people from high suicide risk populations.

The new framework is presented in a practical and user-friendly format on a website (http://www.lifeisforliving.net) and in a set of documents (including twenty-five fact sheets), which will be distributed among major stakeholders and individuals in the general community.