Indigenous Suicide Prevention Package

Hunter New England Area Health Service

This project was entered in the Baxter 2006 NSW Health Awards, Education and Training category.

 Presentation given at the 2006 NSW Health Expo.

Contact: Tina Maybury

Abstract

Suicide prevention has been identified as a priority mental health issue for Aboriginal communities with suicide rates as much as 40% higher than the general Australian population. A culturally appropriate Aboriginal suicide prevention education package was developed after extensive consultation with local Aboriginal communities, service providers and stakeholders, and was piloted within the New England region. The aim of the education package was to provide capacity for suicide prevention by supporting Aboriginal and non-Aboriginal workers in health and education sectors and the local Aboriginal communities to more confidently recognize mental disorders and the early signs of suicide risk within their community.

In 2004 the pilot Indigenous Suicide Prevention Training was undertaken with 25 service providers and community members with skills in suicide risk assessment.  The program has since been revised and updated and run a number of times with Elders of our Aboriginal Community, Aboriginal Medical Service, Aboriginal and non-Aboriginal mental health workers, Aboriginal community members, TAFE and other organizations such as Refuge workers, University students, Department of Community Service staff and other non-government organization staff.  Delivery of the education package was by both an Aboriginal and non-Aboriginal facilitator further modeling cross-cultural partnerships.

Aim

By mid 2006 develop and deliver a socially acceptable training program to a 60% representative of aboriginal communities and a 20% representation of local service providers to increase their awareness of suicide risk assessment in a cross cultural environment

Background

It has been shown that Aboriginal and Torres Strait Islander people have a higher incidence of risk factors for suicide, such as stressful life events and depression. (Tatz 1999).

Statistics show:

• External causes of death for Indigenous Australians accounted for 16% of all Indigenous deaths.
• 70% of these deaths were male of which 33% accounted for intentional self harm (suicide) and 24% transport accidents
• Females accounted for 15% of deaths for intentional self harm, 28% transport accidents, 22% assault.
• Young Aboriginal males are up to 4 times more at risk of suicide than non-Aboriginal young males (Harrison & Bordeaux, 1997).
• The greater proportion of Aboriginal population are under 20 years of age (cited Australian Institute of Health and Welfare, 2004))

Method

2001 saw the initiation of the diagnostic phase of the project, including extensive community consultation, a needs assessment and anecdotal feedback from the Aboriginal community members and service providers.

Community consultation occurred on several different levels, including focus groups, group surveys and one-to-one interviews from 2001 through to 2003. Initial consultations revealed the need for community ownership of the project for it to be firstly accepted but also meet the projects objectives. Importantly, the groups consulted represented the whole persons? life span.

Needs Assessments revealed:

• a lack of education, knowledge and training for the local community regarding mental health issues and suicide prevention.
• a lack of knowledge in the community about risk and protective factors for suicide, warning signs of suicide, how to engage a person at risk of suicide and where to access help
• A review of suicide prevention programs and relevant literature showed most suicide prevention programs are neither culturally relevant nor culturally appropriate.

A literature review around youth suicide showed protective factors for suicide included:

• Strengthening and supporting the community. 
• Traditional culture offers some protection in some communities. (Swan & Raphael 1995)
• Involving a person?s family has been shown to improve outcomes for young people with depression and first episode psychosis.

Planning and Implementation

From the literature review, community consultations and needs assessment it was concluded that a culturally sensitive suicide awareness and prevention training package aimed at empowering and up skilling the Aboriginal community in suicide awareness and prevention be developed.  The package addresses the gaps identified within the community in regards to identifying those at risk of suicide and aims to:

• Increase the skills of the Aboriginal communities to detect mental disorders and suicidal tendencies.
• Increase early identification of those Aboriginal students at risk of developing a mental illness or suicidal tendencies.
• Increase awareness of depressive symtomatology, anxiety, substance abuse and suicidal behaviours
• Educate Aboriginal communities about the Mental Health Services available and where help can be accessed
• Increase the knowledge and skills of Aboriginal workers in the mental health field.
• Increase knowledge of non-Aboriginal service providers in how to engage with Aboriginal people.

The program :

• Is presented by two people, an Aboriginal mental health worker and a mental health clinician.
• Is delivered over two days.
• Participants receive a work manual of the program that includes: definitions, myths and facts, warning signs, risk and protective factors of related illnesses, tips for working with Indigenous communities, issues in development of identity and culture, 4 scenarios looking at risk, protective factors and warning signs specifically to Aboriginal children, adults and elderly, responding to a child at risk, where can you get assistance and support after a suicide event.

The package was piloted in Tamworth in August 2004, since then several workshops have been conducted in 2004, 2005 & 2006 with participant and presenter feedback contributing to several amendments to the training package and delivery mode.

Outcomes and Evaluation

An evaluation form is completed at the end of each workshop. Some quotes from the evaluations include:

"The presenters are easy to understand and it doesn't matter whether you are a service provider, community member or student you get so much information to help you work with people at risk and the information from the Aboriginal and non-Aboriginal participants is outstanding"

"I have learnt more about Aboriginal culture in the first day of this workshop than I have in my entire life"

A total of 150 people have participated in the workshops up until May 2006. A breakdown of various groups at the workshops includes:

• 60% from the Aboriginal community
• 16% Department of Education
• 9% TAFE
• 8% Centre Link
• 7% Refuge Workers
• 62% of participants have rated the workshop as excellent and 38% rated it as very good
• Participation in the training by Aboriginal Educational Assistant's and representatives from the Department of Eduction has increased the number of Aboriginal staff working locally within education services with skills in suicide risk assessment
• Inclusion of information about mental health services across the area in the training package has contributed to an increase in the awareness of available services amongst participants from Aboriginal communities
• The attendance of participants from a range of settings has increased opportunities to collaborate and build partnerships between Aboriginal and non-aboriginal service providers

Future scope

To date there is no other suicide prevention training package that is culturally sensitive and relevant to the needs of the indigenous community in New South Wales. Aboriginal and non-Aboriginal participants gain valuable insights into cultural sensitivity as well as information regarding the prevention of suicide such as risk and protective factors from the program. There have been requests from other Area Health Services and Aboriginal Medical Services across NSW for the Indigenous suicide prevention training package, with the evaluation of the program supporting its application much wider than the Hunter New England Health. A recommendation from the recent NSW Aboriginal Mental Health Forum held in Orange was for the package to be rolled out statewide.

The package has just won the 2006 Aboriginal health awards category one. Most innovative Aboriginal Health project.