These guidelines are important for all practitioners, and particularly non-Indigenous practitioners, to better understand their capacity to engage more responsibly with Aboriginal people. The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) found that several critical changes were necessary to shift into a more empowering and effective space within Aboriginal suicide prevention. Ensuring that all relevant mental health staff achieve key performance indicators in cultural competence and delivery of trauma informed care was one of these recommendations.
Suicide is a critical issue for Aboriginal and Torres Strait Islander peoples and communities. The Australian government and Indigenous leaders are now accepting that the legacy of colonisation, across different levels, is responsible for Aboriginal communities’ disproportionate experiences of suicide and other disadvantages. Colonisation impacts all levels of society, from structural barriers to family support networks, and is made up of complex and interrelated factors. Any proposed solutions or measurements attempting to address the issues of suicide and self-harm for Aboriginal peoples must consider these historical and contemporary complexities.
- Suicide risk can be influenced by dynamic factors that are episodic or enduring factors that persist over time. It is important that assessments of current and longer-term suicidality distinguish between these influences and how they might be affected by cultural contexts by evaluating factors including but not limited to the methods and frequency of past self-harm and suicidal thoughts, and/or any evidence of warning signs.
- To obtain a medical and psychiatric history relevant to assessing Aboriginal and Torres Strait Islander people experiencing suicidal behaviours, clinicians should assess relevant symptoms and behaviours including but not limited to depression, anxiousness, recent angry or violent behaviour.
- To obtain a psychosocial history of the patient, clinicians should assess relevant and appropriate following family-related and other life stressors that may be relevant to current suicidality and future risk of self-harming behaviour. In most circumstances, the preferred approach to discussing psychosocial history and life stress is to start with open-ended questions that avoid any judgemental language and do not make any presumptions about the presence of these issues in the life of the person.
- To determine the person’s ability to recover in the community, clinicians should identify the person’s sense of belonging to, and support from, the community and family or kin. Clinicians should also assess the person’s engagement in, and knowledge, of positive health-related behaviours. Recovery requires the person to have beliefs that they can make positive changes in their life.
- Young people (i.e. Aboriginal and Torres Strait Islander children and adolescents up to 24 years of age), presenting to hospital with self-harm and suicidal thoughts, have distinct developmental needs. Young people should be assessed by a person with appropriate expertise in child and adolescent mental health. Clinicians should first determine if the young person has the capacity to give informed consent and can make independent decisions. Involvement of non-parent caregivers, such as aunts/uncles and grandparents, is recommended when appropriate and available.
Following the psychosocial assessment, clinicians should develop care and/or safety plans within a multidisciplinary team involving Aboriginal Health Workers and/or Cultural Consultants, where available. Care and/or safety plans should be undertaken collaboratively with the person, appropriate significant others. For regional and remote persons and their support groups, clinicians should ensure risk management plans are developed to facilitate healing in community, or on country where there is limited access to services, as well as identify warning signs for early intervention.