Targeted Regional Initiatives for Suicide Prevention: listening to many voices to save lives

All communities in the North Western Melbourne Primary Health Network’s (NWMPHN) 3,200 square-kilometre catchment area are affected by suicide.

Suicide prevention is a high priority for us, as it is for every health organisation. Finding ways to do this effectively is a complex and fluid challenge. There is no universal approach, and no single solution.

Following the conclusion of 3 carefully designed multi-year trials, NWMPHN is now set to consult on the design of new programs to reduce suicide and suicidal ideation in our catchment.

The program is called Targeted Regional Initiatives for Suicide Prevention, or TRISP, and is being rolled out across all 31 primary health networks in Australia. It is part of an Australian Government initiative that builds on lessons from the National Suicide Prevention Trial.

Each primary health network will look to build on the lessons and insights of the National Suicide Prevention Trial, formulating approaches that respond to conditions and communities in its catchment. The results will address local and regional priorities.

To guide its implementation of TRISP, NWMPHN is guided by a framework called LifeSpan, created by Sydney’s Black Dog Institute. LifeSpan combines 9 strategies that have evidence for suicide prevention into one community-led approach incorporating health, education, frontline services, business and the community.

NWMPHN’s approach to TRISP program development recognises that residents and workers with lived experience of the impact of suicide have critical contributions to make.

As such, our first major initiative will be to gather voices to create a wide range of perspectives. We are set to generate conversation and invite ideas from suicide prevention agencies, mental health practitioners, hospitals, general practices, community organisations, first responders, university researchers, local councils, and, always, people who have been impacted by suicide or suicidal distress directly or within their family or friend circles.

All our communities – whether defined by location or other shared factors, across all faiths and in all languages – will be invited to join the conversation. Only by seeking the most diverse inputs possible can we ensure that every voice has the opportunity to be heard.

NWMPHN also conducts rigorous health needs assessments for its catchment, so we can properly map demand for many services, including suicide prevention and suicide bereavement support.

These projects will inform the next phase of TRISP planning – the development of a regional suicide prevention action plan, a critical tool to guide mechanisms and resources to enact local and community-based priorities.

And only by doing this can we fashion strategies that can play a real role in reducing suicide and saving lives.

Why is it important to develop local suicide prevention strategies?

According to the Australian Institute of Health and Welfare, between 2010 and 2021, approximately 1700 people died by suicide within NWMPHN’s catchment. Every day people attempt suicide or live with thoughts of suicide.

The impact is felt widely among families, friends, communities and social networks. US research suggests that every suicide death directly affects up to 135 people.

On that basis, this suggests that in the past 11 years, perhaps 238,000 people in our region have been impacted by suicide – that’s about 19,850 each year.

While no community is free from suicide and its effects, research indicates that some experience it at a higher incidence than others. These might be populations defined by geographic location, or by a different shared characteristic.

For instance, national and international data tells us that young people, LGBTIQ+ people, culturally diverse people, Aboriginal and Torres Strait Islander people, and older men are among the populations disproportionately impacted by suicide and suicidal distress.

What has NWMPHN done so far?

Starting in 2017, NWMPHN undertook 3 suicide prevention trials. Two were place-based, focused on Melton-Brimbank, and the Macedon Ranges. The third was a national trial, focused on the LGBTIQ+ community.

Each trial produced valuable and distinct findings, but some similarities were also revealed. These are being used to shape the development of the next iteration of suicide prevention activities.

Key trial insights included:

• People with lived and living experience of suicidality must be involved in all aspects of suicide prevention activities. This is particularly so in matters involving intersectionality. This includes involvement in planning and governance as well as service design and delivery.
• Community capability, ownership and empowerment are essential to appropriately target and drive suicide prevention activities in ways create sustained change in suicide prevention and response.
• Being data-led is integral to ensuring activities are targeted to those most at risk. Data – appropriately accessed and shared – can highlight the impact of ongoing prevention and response activities within the community.
• Communities and workforce are eager to build their capacity and capability to respond to suicide – increasing confidence to discuss the subject and access appropriate support.

How is NWMPHN active in suicide prevention right now?

We commission, fund and in some cases directly operate a number of mental health services that support people at risk of suicide by finding them the health care they need. In addition to CAREinMIND™, and Head to Health, NWMPHN fund a postvention suicide bereavement program, Support After Suicide, and several targeted suicide prevention capability building activities for community and workforce.

We also play a critical role in commissioning headspace services in our region, and work closely with services offering mental health support to at-risk populations. These include YSAS, Switchboard, Himilo, Orygen, Royal Children’s Hospital and the Victorian Aboriginal Health Service.

In addition, we play a critical role ensuring that mental health services provided by Federal, State and independent organisations work in an integrated environment.

Our guiding principle to equity and access is that there should be “no wrong door” for entry into care. People should not have to tell their stories more than once, and should receive the right care at the right time in the right place.