In 2015, 3,027 Australians died by suicide, representing a steady increase over the preceding decade.1 This upward trajectory has caused considerable community concern, and efforts to identify effective suicide prevention interventions have received increasing attention. A significant proportion of people who die by suicide are not in contact with mental health or general health services. 2-4 Rather, research evidence suggests that people at risk of suicide often communicate their suicidal thoughts and intentions to family members and friends before they make a suicide attempt. 4-7 Therefore, there may be an important role for family members and friends in identifying and intervening in response to suicide risk. However, because family members and friends are frequently uncertain about how best to interpret and respond to this communication, they may be unsure about whether, or how, to address this suicide risk, and their responses may be unintentionally unhelpful or dismissive. 5,8,9 A suicide prevention campaign aimed at promoting identification of people at risk of suicide and positive helping responses among family members and friends could therefore have significant positive effects for both those at risk and those wanting to offer support who are unclear about how to do so.
In 2016, beyondblue funded the University of Melbourne’s Centre for Mental Health and Whereto Research-Based Consulting to conduct research with the primary aims of understanding what evidence-informed and socially acceptable advice beyondblue could give the general public to increase the likelihood that they will ask about and support someone who may be at risk of suicide to stay safe and get the help they need; and to develop a communications framework for a future multi-media awareness campaign using the above formative research findings and recommendations. The research consisted of five components: (1) three literature reviews;10-12 (2) an expert consensus study;13 (3) a qualitative research component involving focus groups and interviews;14 (4) an online questionnaire study;15 and (5) a nationally representative computerassisted telephone survey.16
Our research findings suggest that Australian adults generally have positive attitudes to suicide prevention and are confident to support someone they know well who is in severe distress or at risk of suicide. Most commonly, they offer assistance that those at risk find helpful by listening and talking to them, offering them support, and encouraging them to seek professional help. Most of our research participants who had experienced suicide risk were able to identify someone who had been helpful to them when they were at risk. These results are encouraging, suggesting a widespread willingness to help family members and friends in distress or at risk of suicide, and that they are taking appropriate steps to do so. However, our research also showed actions to assess level of suicide risk and help ensure the safety of the person at risk were far less common than general supportive behaviours. These actions include asking questions about suicidal thoughts, plans and means, and removing means. Men were less likely than women to ask direct questions about suicide risk and to take steps to ensure the safety of a person at risk. People aged 60 or older were also less likely than younger people to ask whether someone was thinking about killing themselves. Only about half of participants in the national telephone survey intended to take steps like asking questions about suicidal thoughts, plans and means, and removing means, even when the person verbally expressed suicidal intentions. Since the results of our online questionnaire study, and other previous research studies have shown that only a minority of people express their suicide risk verbally and directly to others, it is important that community members are able to identify non- iv verbal signs of suicide and assess suicide risk. Qualitative study participants expressed doubt in their own ability to identify when someone was at risk of suicide, and particularly how the signs might differ from someone experiencing sadness in response to life events. Qualitative study participants also expressed a desire for clear guidance on how to approach a person they were concerned about, how to ask direct questions about suicide, and the steps to take to help them.
Our national survey showed that attitudes to suicide prevention were generally positive and that helping intentions and behaviours toward someone in severe distress or at risk of suicide were generally appropriate. However, we did identify some areas for which knowledge and attitudes could be improved; for example, almost 50% of participants believed that helping a person at risk of suicide requires the skill of a professional, about 40% of respondents believed that suicide happens without warning, and about 30% believed that most suicides occur without any sign, that asking someone about suicide could make them start thinking about it, or trying to help someone at risk could make the situation worse. These attitudes have the potential to reduce confidence and inhibit potentially helpful behaviours towards a person at risk. Both the national telephone survey and the online questionnaire study also explored the frequency of non-recommended actions, including reminding people who are considering suicide ‘what they’ve got going for them’, telling them how much their suicide would hurt their friends and family, and trying to convince them that suicide is wrong. These actions were commonly reported by respondents who had experience suicidal ideation and who had a close friend or family member at risk of suicide. In addition, participants from the two survey studies who had been at risk of suicide identified helper responses that minimised their thoughts and feelings or indicated that the helper did not consider their mental health difficulties to be ‘real’ as the most unhelpful types of response. Our expert consensus study also showed that experts believed that promotion of the message ‘take all talk of suicide seriously and do not dismiss it as attention seeking or a ‘cry for help’ to be imperative to a suicide prevention campaign.