For every death by #suicide, as many as 30 others attempt to end their life. Australia has a #suicide problem — it seems we can all agree on that — but when it comes to solutions, the verdict isn’t so clear.
By Bridget Judd
The gentle croons of James Blunt echoed through Graeme Holdsworth’s stereo as he penned his parting words: “I’m so hollow, baby. I’m so hollow.”
As a former project manager, he’d spent his life transforming banal blueprints into architectural narratives.
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
If you or anyone you know needs help:
Melbourne was his canvas; his legacy irrevocably embedded in the city’s skyline.
He was methodical. Fastidious. A man whose life had become synonymous with planning.
And today was no different. He’d crossed his T’s and dotted his I’s.
“It became all enveloping. I played it over and over in my head,” he muses.
“The attempt is to kill yourself, yes, but it’s not to die — it’s to get rid of the pain when you’ve tried every other way.”
In an unassuming town in Victoria’s south-west dairy belt, Graeme woke up in a police station.
The 73-year-old would come to be a part of what he calls the “silent” statistics — a demographic of Australians often spoken about, but seldom spoken to.
Those who have survived a #suicide attempt, only to be left to run the gauntlet of the nation’s broken #mentalhealthsystem.
Our national shame is bigger than first thought
It is a national tragedy.
That was the consensus in the headlines when the “lucky country” marked a harrowing milestone in 2015: for the first time in Australian history, #suicide deaths had eclipsed 3,000 in a single year.
In 2018, the most recent available data, that figure rose once more.
This insidious national picture, however, only paints part of the story.
For every death by #suicide, it is estimated that as many as 30 people attempt to end their lives — some 65,000 each year.
But it is just that — an estimate. And perhaps most alarmingly, one that is considered conservative among some within the #mentalhealth sector due to gaps in critical data and the lack of a universal definition for suicidal behaviour.
“There is good evidence that even low lethality ‘self-harm’ still has considerable morbidity and risk of subsequent #suicide,” says Robert Goldney, an emeritus professor at Adelaide University and an international expert on #suicide.
“Some academics have made a career of developing complicated descriptions of varying complexity, but the reality is that all should be taken seriously.”
And for good reason.
In Graeme’s case, after being picked up by police some eight years ago, he received a visit from a “lovely woman” from the health department.
But despite her best efforts, they simply “didn’t know what to do” with him.
“The local hospital didn’t want me because they didn’t have any psychiatric help there, so they locked me up in a police station,” he said.
“And the finally, out of the blue, they brought family and friends to bring me back to Melbourne.
“And that was it, I was sort of left alone at home.”
#Suicide doesn’t occur in a vacuum
As the former president of both the International Association for #SuicidePrevention and the International Academy for #Suicide Research, Professor Goldney doesn’t mince words: “People get lost between the cracks.”
There are, of course, the obvious and well-publicised problems around access to acute #mentalhealthservices.
An analysis of #mentalhealth presentations to Australian emergency departments, conducted by the Australasian College for Emergency Medicine (ACEM) in 2018, found that those with #mentalhealth conditions waited significantly longer to be admitted than those with physical injuries.
Concerningly, patients presenting for #mentalhealth concerns were also twice as likely to leave before their treatment was completed.
But experts say the problem is far broader than the substantial shortfalls in #mentalhealthservices.
#Suicide doesn’t occur in a vacuum, nor is it merely a health condition looking for a medical solution.
It is a corollary of a range of circumstances, including psychiatric illness, social factors and sudden loss, like the breakdown of a relationship or loss of employment.
It begs the questions: What are we doing to reach people before they hit this tipping point? And why isn’t it working?
‘You get put in the too-hard basket’
Fifteen rows from the front, four seats across, Matt Runnalls sat staring at the broken faces around him.
It was his best friend’s funeral. By that point, the seventh loved one he had lost to #suicide.
His first introduction to the black dog would come when he was just 12 years old, when his childhood friend ended his own life.
It has, irrevocably, come to define the course of his 29 years.
For most of his life, the mongrel has gnawed at his heels — often out of sight, but never out of mind.
But in that auditorium of some 800 people, all struggling to make sense of the incomprehensible, something changed.
“It was in that moment that I sat there and realised that I’m one of the lucky ones who is still here,” he says.
It was the “kick up as the ass” that he needed, but only the beginning of his battle.
After seeking help to address his own struggles with #mentalillness, he recalls being shipped around to more than a dozen psychiatrists.
“It took every bit of me vulnerability wise to say the things I said… to spill your guts to a stranger, your trauma, while you’re sitting there shaking… for them to tell you, ‘Okay, I don’t think I’m suitable for you’,” he says.
“You get put in the too-hard basket… and those too-hard baskets were three six-month periods in between me getting another appointment, and so I just found myself slipping through the cracks every single time.”
Matt believes the system caught him “at the bottom of the cliff”.
Early interventions, he says, were few and far between, and it was only through his own perseverance after his #suicide attempts that he was able to develop a more holistic approach to his #mentalhealth.
He’s pragmatic about the situation, with a remarkable sense of self-examination.
What works for him won’t necessarily work for others, he says, and it would be spurious to suggest that there is any single solution to the crisis.
But as he lists off the names of those he has lost to the darkness, there is one thing he knows for sure: we need to ask where we’re going wrong.
The problem of ‘lobbyist-led reform’
For more than a decade, Anthony Jorm, an emeritus professor at the Centre for #MentalHealth at Melbourne University, has been plagued by one seemingly innocuous word: solutions.
He has been tracking Australia’s #suicide rate since the late 1990s — and while it initially appeared the nation was making headway, it quickly became apparent any perceived progress was short-lived.
“We had about a decade where the #suicide rate was going down. And I thought, ‘Great, we’re doing everything right here’, but then it started creeping back up,” he remarks.
The argument that greater funding for #mentalhealthservices will reduce the #suicide rate is inherently flawed, Professor Jorm maintains — simply because, we have and it hasn’t.
Rather, he points to what he calls “lobbyist-led reform”.
“Too often ministers for health are persuaded by someone who’s a good lobbyist to go and implement something without any real evaluation, and I think that is a major barrier to evidence-based reform,” he says.
“Every budget, every election, I see all these promises and I think, ‘Is this really going to make any difference?’ It might, but we just don’t have any evidence.
“I think we need to say we haven’t done a good job in the sector at reducing #suicide. And there are people who are going to be professionally threatened [by that], but we’re not here to benefit them.”
‘It’s turned into an industry’
Left to navigate the gamut of Australia’s #mentalhealth sector after his own #suicide attempt, Graeme concurs: the root of the problem does not lie with funding.
“They’re throwing money at it like you wouldn’t believe, but it’s turned into an industry,” he says.
“It’s driven by politics. Everyone is fighting each other for the research or the government dollar.”
The missing link, he argues, lies with lived experiences — those at the centre of the conversation, who, paradoxically, are often left without a voice.
“All of these large groups keep taking the money and it’s controlled by bureaucrats, academics and clinicians,” offers Graeme, who is himself a lived experience ambassador with #SuicidePrevention Australia.
“They don’t listen to the people who’ve been there. They treat them as a patient still, like we’re not well and shouldn’t be listened to.
“We see it sometimes sticking out at us, when they talk about something you think, ‘How is that going to prevent a #suicide?’”
‘I think people have to ask these hard questions’
Evidence. It’s a contentious word in the multi-million-dollar #mentalhealth industry, marred by internal politics and competing interests.
Professor Goldney likens it to “attacking motherhood” — everyone within the sector agrees that funding prevention projects is the right thing to do.
But when it comes to questioning their effectiveness? Less so.
“People are pussyfooting around, trying to make out that really it’s all very simple and something that can be helped by a bit of a kiss and a cuddle,” he remarks.
“I think people have to ask these hard questions — you’re promoting yourself as a #suicideprevention organisation, but do you have the evidence to show that that’s what you do? And they don’t.”
It’s a blunt assessment, but one not without merit.
Evidence — and the need for more of it — has been a consistent theme in evaluations of Australia’s #suicideprevention measures.On the frontline with a #mentalhealth emergency teamThe ABC gains unprecedented access to join social worker Anne-Marie Skegg and psychiatric nurse Chris Ward on the job, as they respond to acute #mentalhealth emergencies.
In its 2019 report into #suicideprevention reform, the National #MentalHealth Commission recommended the Federal Government consider the role of an independent statutory body to monitor and evaluate #mentalhealth policy outcomes, and to commit to longer-term funding for suicide prevention evaluations to “better assess outcomes over a longer period of time”.
Organisations like #SuicidePrevention Australia have similarly flagged concerns around the “lack of information about the outcomes achieved” for National #SuicidePrevention Trial Sites, while pushing more broadly for investment grounded on a “strong evidence base that proves their efficacy”.
That’s not to say evaluations have never been conducted.
But given the statistically small number of #suicide deaths each year, mounting a large enough study can be difficult.
“And so what usually happens is that it ends up being process report and analysis, rather than outcome analysis,” Professor Goldney says.
“And by that I mean, yeah the patients might be asked if they feel good about it, but if it’s set up as a #suicideprevention program, is it actually preventing #suicide?”
‘I do think we’re making progress’
It’s a quandary of which Helen Christensen, the director of the Black Dog Institute, is acutely aware.
The nation’s approach to #suicideprevention was “scattergun” in years past, she says, and it’s imperative these shortfalls are acknowledged so the community understands “it is a complex issue and one people are trying to tackle”.
But she rejects suggestions prevention projects are being implemented without any basis, pointing to their proven effectiveness in overseas trials.
“Only in the last five years have we been starting to collect the data that we need to evaluate whether what we’ve been doing is effective,” Professor Christensen says.
“So you can either do nothing, you can do something that’s scattergun if you like, or you can do something that’s evidence-based and after you get the result of trials, you can presumably offer a systematic and scalable response to #suicide.
“I really do think we’re making progress, even though you could make the claim that we don’t know whether the particular action that we’re putting into place will work in Australia.”
#Suicideprevention is a complex beast, echoes #mentalhealthorganisation Beyond Blue, and no single intervention can make a difference in #isolation.
It says any program’s inability to clearly reduce rates of intentional self-harm doesn’t mean interventions have had no impact.
It points to an independent evaluation of its Way Back Support Service — a prevention project designed to support those who have attempted #suicide or experienced a suicidal crisis.
While there was no “significant reduction in hospital re-admissions for deliberate self-harm” at its Hunter New England trial, the evaluation found the psychological distress scores of those who participated in the program dropped, on average, from severe to mild following discharge from hospital.
Likewise, participants reported overall less concern about the major life stresses that contributed to their #suicide attempt.
“Apart from all else, the evaluation demonstrates the complexity of #suicideprevention – that no one intervention can make a difference in #isolation – but that The Way Back is able to be integrated and is making a difference to people and their families,” a Beyond Blue spokesperson said.
Health Minister Greg Hunt’s office stopped short of directly addressing claims prevention projects are being funded and expanded without scrutiny.
But it noted increased support for the National #SuicidePrevention Leadership and Support Program, which provides funding to leading organisations to “build the evidence base on #suicideprevention initiatives”.
‘We need to be proactive’
While there are valid questions to be asked about the outcomes of #suicideprevention projects, the onus to combat Australia’s silent statistics does not rest solely on the shoulders of the #mentalhealth sector.
Any real progress requires a whole-of-government approach, Matt argues, starting from an early age to build resilience and develop coping strategies to address some of the peripheral factors that play into #suicide.
Using his lived experience, Matt founded Mindfull Aus, a non-profit #mentalhealth and well being foundation, focused on early intervention.
He now hosts workshops in schools, covering basics like understanding and acknowledging the spectrum of human emotions, and the relationship between physical and #mentalhealth.
It’s not a one-size-fits-all strategy, nor does it negate the need for other services — something he’s quick to point out.
But he believes there are gaps to be filled in the nation’s current approach to #suicideprevention — namely, reaching children before they grow up to come into contact with the #mentalhealth system.
“People say to me, they’re too young to learn about this… but [about half] of all lifelong #mentalhealthchallenges begin by the age of 14,” he says.
“So, at what time do we decide it’s too young to talk about what really matters?”
‘#Healthprofessionals can’t be there all the time’
The need for a whole-of-government approach is hardly a novel concept.
In its 2019 report, the National Mental Health Commission found that the relationship between #mentalillness and other social, economic and health factors presented opportunities for reform and investment “outside the health sector, and vice versa”.
“In acknowledgment of their shared responsibility for preventing #suicide, [it is recommended that] any future national #suicideprevention strategies be co-designed and co-governed by all relevant portfolios under the Australian Government, including health, education, justice, social services and employment,” it said.
Deaths in 2018
There were 3,046 registered #suicide deaths, including:
- 2,320 men (18.6 deaths per 100,000 people)
- 726 women (5.7 deaths per 100,000 people)
- 169 Aboriginal and Torres Strait Islander people (24.1 deaths per 100,000 people)
On this point, Professor Christensen and Professor Jorm both agree.
#Mentalhealthservices are unlikely to have any major impact on other social factors like education, housing or unemployment, they say, which require a broader response.
Suicidal feelings can also be sudden and impulsive, adds Professor Jorm, and #healthprofessionals simply can’t be there all the time — nor can the onus be placed solely on the health sector more broadly.
Rather, he believes #mentalhealth first aid — an initiative he helped pioneer, which involves equipping people with first aid skills to support those with #mentalhealthproblems — could help bridge the gap for those dealing with an immediate crisis.
“You’re dealing with things like relationship breakdown, legal crises and so on,” Professor Jorm says.
“A large percentage of the population needs the confidence and skills to intervene, and they can take action to protect the person until the suicidal crisis reduces.”
Nothing lasts forever
Concealed beneath Graeme’s watch on his left wrist is a single word: Annica.
Sanskrit for “impermanence”, it is a fitting testament to a man who has looked death in the eye.
He knows better than anyone that the darkness that had once enveloped him still lurks in the background.
“Things are still hard… but I’m pretty good at looking after it,” he muses.
“I’ve come to accept that I’m allowed to be sad, and I let that emotion run.”
With a combination of therapy and exercise, Graeme has forged a new sense of normality.
He is candid about his struggles.
The road to recovery is seldom straight, narrow or flat, and the supports in place to help those at risk are, by all accounts, far from perfect.
But it is these very experiences that he hopes will help inform future prevention policies and allow others in his situation to see that there is a light at the end of the tunnel.
Because while the tattoo on his wrist may be permanent, adversity is not.