Many Aboriginal and Torres Strait Islander communities across Australia face high levels of suicide and self-harm, some of which occur in marked clusters. In such circumstances, steps need to be taken to mobilise community and organisations to respond to the immediate risk through training and support for community providers, peers and other natural helpers (family members, elders, traditional healers); through the provision of effective and sensitive postvention and bereavement support for people in peer and family networks; through coordinated action to work with and to follow up with individuals in high risk settings; and to build the capacity of community-based services to maintain targeted preventive activity. There is limited evidence for the effectiveness of postvention responses for the reduction of suicide (Szumilas and Kutcher, 2011). Suicide awareness and postvention training, if well integrated into community services and adapted for the needs of communities and families, are important forms of treatment and follow-up care. However, it is likely that on their own they are not sufficient to prevent suicide at either community or population levels.
There is growing evidence that, in order to reduce rates of suicidal behaviour and suicide over the longer term, measures should also be put in place to address the developmental precursors of suicide and suicidal behaviour. These measures should be targeted to reduce the impact of adversities over the lifespan and to support healthy social and emotional development from early childhood through to young adulthood. It is especially important that there is intervention to support children and young people growing up in adverse family environments, to reduce early emotional and behavioural problems.
Preventive responses should include parenting programs and therapeutic interventions for high risk families and children, and a mix of therapeutic, supportive and competency-building or "life skills" interventions for youth in schools or in post-secondary training, as well as for those who are unemployed or entering the workforce. In many contexts, young people leaving school struggle to undertake further training or to stay in work and are in need of counselling and support.
For young people and adults who have been arrested, incarcerated or placed under residential supervision, including mandated residential treatments for drugs and alcohol, the transition back to their communities is often poorly supported. Given that substance misuse, mental health issues and problem behaviours leading to arrest or incarceration commonly co-exist, it is increasingly important that prevention policies focus on their common precursors in human development. There needs to be a shift towards collaborative, cross-sectoral approaches to treatment and prevention to treat both current risk and its developmental precursors.
Figure 8 suggests that in community settings with high multiple risks, action to respond to the vulnerabilities of high risk groups, such as adolescents and adult males and their families, should be accompanied by long-term prevention strategies targeting the developmental precursors of these sources of difficulty.
Figure 8: Long-term and short-term prevention and early intervention activities in high risk communities
Text version of figure 8This diagram identifies risk factors for communities and individuals, prevention and intervention activities, and the result of such intervention.
Community high risk factors include:
- suicide threats/ attempts
- antisocial behaviour
- alcohol and drug use
- school-drop out
- low youth engagement
- community violence
- low social and cultural capital
- homelessness or overcrowding
Developmental precursors include:
- neglect, abuse, foster care
- impaired parenting
- family violence
- substance abuse
- family and community suicidal behaviour
- deviant peer relationships
- local, community, family contexts