National Aboriginal and Torres Strait Islander Suicide Prevention Strategy

Action area 3: Targeted suicide prevention services

Page last updated: 2013

Targeted services are provided to individuals and families at a higher level of risk. Individuals at higher risk include those with mental illness, particularly those with a prior history of attempted self-harm; people in, or discharged from, custody; those with histories of alcohol and drug abuse or of domestic violence; and some people with histories of neglect and abuse. It is important that the mental health and suicide risk status of individuals are properly assessed in settings such as hospital emergency departments where presentations for mental illness, trauma and substance abuse issues are common. Police responses to antisocial behaviour, alcohol and violence requiring arrest and detention may need to be followed by assessment of risk of self-harm. It is critically important that targeted services are well-coordinated and culturally appropriate and have access to or are followed up by culturally competent community-based preventive services.

Outcome 3.1 There is access to effective targeted and specialist services by all Aboriginal and Torres Strait Islander peoples who are at risk of suicide or self-harm

  • Issue: There are significant gaps in access to after-hours and emergency mental health services at hospitals and different factors influencing access to services in urban, rural and remote communities. Assessment and triage teams at hospitals often lack capacity to make mental health assessments, and referrals through networks and crisis assessment teams lack Aboriginal and Torres Strait Islander-specific capacity and the capacity to support follow-up care after discharge.

Outcome 3.2 Integrated services, including targeted and indicated services for families and individuals, are available in Aboriginal and Torres Strait Islander healing centres or other community centres

  • Issue: Community health services, community justice centres and counselling services increasingly offer a range of integrated services that may include general health care and/or family support services, combined with more specialised counselling, treatment or rehabilitation services. This approach has potential to improve continuity of care and support for families and individuals.

Outcome 3.3 Targeted and indicated services, including emergency services, are culturally appropriate. They are delivered by Aboriginal and Torres Strait Islander personnel and engage Aboriginal and Torres Strait Islander clients and families

  • Issue: Key services lack any specific protocol for identifying Aboriginal and Torres Strait Islander peoples or specifically responding to their needs. Hospitals may lack Aboriginal and Torres Strait Islander liaison or other Aboriginal and Torres Strait Islander wellbeing workers as part of the response and Aboriginal and Torres Strait Islander families may avoid services, abscond from treatment or not make use of follow-up that is available.

Outcome 3.4 There are links and partnerships between mainstream specialist mental health and wellbeing services and Aboriginal and Torres Strait Islander wellbeing services and community organisations

  • Issue: Community-controlled services and organisations need to build capacity to provide specialist therapeutic services through innovative partnerships with other specialist services. Some mainstream services do not have specific resources or capacity to work with Aboriginal and Torres Strait Islander clients and could achieve this through partnership with Aboriginal and Torres Strait Islander organisations.

Outcome 3.5 There are integrated and collaborative approaches across sectors responding to Aboriginal and Torres Strait Islander peoples who are at high risk, such as people experiencing mental illness, substance misuse, incarceration, domestic violence, etc.

  • Issue: A range of problems, including mental illness and substance misuse, share a range of common risk factors; early prevention approaches that target outcomes across these problems are needed. These may include strengths-based early intervention initiatives and counselling for youth, or community-based programs targeting those with established problems after discharge from treatment, custody or in other identifiable situations of risk.

Outcome 3.6 There is capacity to identify children with early or emerging risk of conduct, behavioural and developmental problems and options for referral of children and families at moderate and high risk, including families with complex multiple needs, to culturally adapted therapeutic programs.

  • Issue: Early behavioural and conduct problems may be a sign of later antisocial tendencies and mental health problems, including vulnerability to suicide and self-harm. Early intervention to address emerging antisocial behaviour and conduct problems has been shown to significantly modify suicide risk factors. There is a need to trial and implement culturally adapted therapeutic early intervention strategies targeting Aboriginal and Torres Strait Islander parents and children with culturally informed assessment and referral options. Developmental impairments caused by foetal alcohol syndrome disorder are associated with suicide risk.
    OutcomesStrategies
    Outcome 3.1 There is access to effective targeted and specialist services by all Aboriginal and Torres Strait Islander peoples who are at risk of suicide or self-harmi. Map service utilisation and barriers for Aboriginal and Torres Strait Islander peoples seeking to access targeted and indicated services in regions and communities
    ii. Identify barriers to access and utilisation and develop strategies to improve access to referral networks, Aboriginal and Torres Strait Islander-specific information, liaison, flexibility and responsiveness
    iii. Develop strategies to improve Aboriginal and Torres Strait Islander identification, assessment of suicide risk, psychosocial assessment and culturally informed discharge protocols for hospital emergency departments
    Outcome 3.2 Integrated services, including targeted and indicated services for families and individuals, are available in Aboriginal and Torres Strait Islander healing centres or other community centresi. Develop and disseminate models for services that combine specific targeted and indicated services in centres providing integrated wellbeing services
    ii. Strengthen the focus on early intervention and suicide prevention within integrated services
    iii. Build inter-sectoral and professional links to support integrated services
    iv. Develop and evaluate models for interdisciplinary practice in mental health and early intervention
    v. Investigate innovative models for partnerships between specialist mental health and wellbeing services (eg headspace) and Aboriginal and Torres Strait Islander wellbeing services and community organisations
    Outcome 3.3 Targeted and indicated services, including emergency services, are culturally appropriate. They are delivered by Aboriginal and Torres Strait Islander personnel and engage Aboriginal and Torres Strait Islander clients and familiesi. Develop Aboriginal and Torres Strait Islander-specific protocols and training for targeted and indicated services
    ii. Employ Aboriginal and Torres Strait Islander personnel in outreach, follow-up and engagement roles
    iii. Expand availability of appropriate cultural awareness training for mainstream services
    Outcome 3.4 There are links and partnerships between mainstream specialist mental health and wellbeing services and Aboriginal and Torres Strait Islander wellbeing services and community organisationsi. Identify opportunities for complementary service provision arrangements and referral linkages between mainstream services and Aboriginal and Torres Strait Islander community services to coordinate the provision of targeted preventive services
    ii. Develop local partnerships between existing services such as headspace centres and Aboriginal and Torres Strait Islander community social and emotional wellbeing services
    Outcome 3.5 There are integrated and collaborative approaches across sectors responding to Aboriginal and Torres Strait Islander peoples who are at high risk, such as people experiencing mental illness, substance misuse, incarceration, domestic violence etci. Develop partnership programs to build links between residential/custodial settings and community support (such as transition from prison to community or from alcohol rehabilitation to community reintegration)
    ii. Provide specific suicide prevention and assessment training for staff in high risk settings who work with Aboriginal and Torres Strait Islander clients
    iii. Identify alternatives to community reintegration where return to community is not desirable
    Outcome 3.6 There is capacity to identify children with early or emerging risk of conduct, behavioural and developmental problems and options for referral of children and families at moderate and high risk, including families with complex multiple needs, to culturally adapted therapeutic programs.i. Provide training for child health and early education staff to assist them in effectively identifying and responding to behavioural and early mental health problems at childcare, preschool and school
    ii. Engage at-risk parents to provide parenting and family support via access to health, early education and childcare services as well as child protection services
    iii. Trial and implement culturally adapted therapeutic family interventions for Aboriginal and Torres Strait Islander parents and children
    iv. Develop strategies to identify and reduce risk associated with child protection interventions, including child removal, foster care and kinship care and practices of child placement
    v. Improve identification of foetal alcohol syndrome disorder and other developmental impairments in children
    vi. Develop information and resources to assist health and social and emotional wellbeing practitioners to respond to family suicidal behaviour and family mental illness