This document is a companion guide to the Centre for Evidence and Implementation and Black Dog Institute’s LifeSpan Implementation Framework – Implementing Integrated Suicide Prevention. It is intended to support Primary Health Networks (PHNs) as they work to implement integrated approaches to suicide prevention in Aboriginal and Torres Strait Islander (Indigenous) communities.
This companion guide recognises that Indigenous suicide deaths are associated with different historical, political and social factors than those of the non-Indigenous population; therefore, different approaches to prevention may be required. Secondly, Indigenous rights to self-determination, cultural differences and recognised good practice require a non-negotiable approach to engagement, process and governance that empowers and respects community self-determination and culture.
It is recommended to appoint local Indigenous PHN board members who work with Indigenous communities within the region to provide overarching technical and adaptive leadership. In many cases, Aboriginal Community Controlled Health Services CEOs will be ideally placed for such a role.
Be proactive – reach out to Indigenous communities rather than waiting to be contacted. Early and frequent engagement and time should be allowed for the development of trusting and open relationships at both the interpersonal and organisational level.
Present-day Indigenous suicide rate is about double that of the non-Indigenous population and likely to be increasing, suggesting the urgent need for effective action.
Younger age groups affected by suicide in Indigenous communities suggest the need for a particular focus on young Indigenous people.
There is a need for community-wide approaches and activities that builds on community strengths as an important element of Indigenous suicide prevention activity.
Stakeholders working in Indigenous suicide prevention must have the capacity to inform and support or contribute to the implementation of an integrated suicide prevention approach in a community setting.
Be flexible about what constitutes ‘data’ that will drive data-driven decision making. In an Indigenous community context, a focus on deaths deemed as suicide by coronial inquest that excludes anecdotal reports and community identification of suicide deaths may be counterproductive. Some commentators believe that suicide is significantly unreported in Indigenous communities. This underscores the need for suicide audits to also occur under community leadership if an accurate foundation picture for suicide prevention activity is to be established.
Indeed, much of the evidence informing this report remains untested in Indigenous settings, and is likely to require cultural adaptation and a strong commitment to ongoing evaluation and refinement during the initial implementation stage to ensure it responds effectively to community need. Further, additional elements and/or recommended interventions may be required to meet the different suicide prevention needs of particular Indigenous communities; in this context, the Guide is informed by Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project’s (ATSISPEP) Solutions That Work report.
This guide has been commissioned by the Black Dog Institute, funded by the Australian Government Department of Health, and developed in partnership between the LifeSpan Program in the Black Dog Institute and the CBPATSISP at the University of Western Australia. This ongoing partnership will produce numerous other resources, including a guide to implementing cultural governance to support integrated approaches to suicide prevention in Indigenous communities, which is currently in progress at the time of this report.