There’s something distasteful about politicians promising to halve the number of suicides in 10 years. That’s the commitment of the Victorian government. It’s also the policy that federal Labor leader Bill Shorten took to the electorate at this year’s election. But can it really be that simple? Can the tragic epidemic of suicide be solved as an equation? In just 10 years?
Despite the epic dimensions of the suicide crisis in Australia – each year 2000-plus Australians end their own lives – politicians have mostly looked the other way. But suicide has finally made it on to the political agenda, thanks to the tireless efforts of mental health activists.
It is just like politicians to reduce suicide to a mindless slogan, a mathematical fancy, oblivious to the agonising and very personal hell that each case of suicide represents. We cannot know what torment tears at the heart and mind of someone who feels he has no choice but to take his own life. Stephen Fry speaks of the “blackness, lethargy, hopelessness, and loneliness” of depression, and so it must be with suicide. Suicide is an escape from an unremitting and deeply ingrained hell.
Despite the unimaginable burdens that suicide victims carry, when they finally do take their own lives, even the closest family and friends report no clues or warning signs beforehand.
So, while halving the suicide rate in 10 years might sound a worthy and decisive goal, given the complex, personal, determined and often very secretive nature of suicide, how can politicians make this bold, not to say rash, commitment with such confidence? There is no doubt that carefully targeted strategies can prevent some suicides from occurring – particularly in communities with a high prevalence of suicide and suicide attempts – but it’s also true, if you will forgive the black turn of phrase, that suicide has a life of its own. No effort should be spared to reach every potential suicide victim, but bumper-sticker targets only trivialise the agony that somebody contemplating suicide must experience. Australia’s suicide epidemic is much more complex than such such neat targets allow for.
To some extent politicians can be let off the hook on this occasion because the ambitious and catchy promise to halve suicide in 10 years originated with the experts.
Three years ago this month an Expert Reference Group (ERG) on Mental Health Reform – headed by Allan Fels – presented a series of targets to then new Health Minister Peter Dutton which included the recommendation to reduce Australia’s suicide rate by 10% within four years and 50% within 10 years. (Another target was to “reduce stigma against those living with mental illness” by 25% within 10 years, which seems a somewhat nebulous goal.)
Jack Heath, CEO of SANE Australia and ERG member said at the time that the targets “have come from the mental health sector and the wider community”.
“Holding ourselves responsible to specific targets is essential to mental health reform,” Heath said. “They are ambitious targets but Australia can meet them – if we put our minds to it.”
The target strategy is well understood in business, as reflected in two well-worn management maxims: if you can’t measure it, you can’t manage it; and if you don’t know where you’re heading, you’ll never get there.
‘Suicide rates haven’t changed in the last 10 years’
The National Coalition for Suicide Prevention (NCSP) believes targets, when supported by “evidence-based strategies”, are attainable.
Professor Helen Christensen, NCSP member and director of the Black Dog Institute, says such strategies have helped to reduce suicide by 30% in Europe.
“Suicide rates haven’t changed in the last 10 years in Australia and just doing what we have always done is not really going to make any difference to those rates,” Christensen told the ABC last year.
“It has been a scattergun approach and funding has been distributed in a non-organised way. Initiatives are very fragmented and some are run by the government and others by NGOs.”
Christensen rejects the view that suicide is “an individual thing” and therefore not preventable: “[T]he evidence is very clearly the case that we can prevent suicide.”
There can be no ignoring the tragic proportions of suicide in Australia – and therefore the need for action – but until recently that’s exactly what has happened.
According to Australian Bureau of Statistics data released in March, there were 2,864 deaths from “intentional self-harm” in 2014, making suicide the 13th leading cause of deaths in Australia. (Around 65,000 attempted suicide.) Three-quarters (75.4%) of people who died by suicide were male, elevating suicide to the 10th leading cause of death for males.
Suicide is endemically rooted in Australian society. Annual death tolls are remarkably consistent and suicide is the most common cause of death among Australians aged 15-44. At the beginning of this century (2001), 2,457 Australians took their own lives, similar to the toll in 2013 (2,522) and 2012 (2,574). The 2014 spike is the highest since 1997, when 2,720 died by suicide.
It seems remarkable given such colossal loss of life that it has taken this long for politicians to confront Australia’s suicide epidemic. That they have finally done so is only because mental health activists have been relentless in their calls for government action.
Activists took full advantage of this being an election year to make suicide a policy priority for the major parties.
During the election campaign, an alliance of leading mental health advocates led by former CEO of the Mental Health Council of Australia and inaugural chairman of the National Advisory Council on Mental Health, John Mendoza, released suicide data in 28 federal electorates to stir candidates and MPs into supporting a national suicide-prevention strategy.
Its analysis of the 28 electorates found that between 2009-12 suicide rates exceeded the road toll and all but five had suicide rates at “high to extreme in levels”.
Any other cause of death at such magnitudes would have resulted in “a very assertive, nationally co-ordinated response”, Mendoza said. “Suicide and self-harm are now major public health problems in Australia that require a [national] public health response.”
To the credit of Mendoza and other suicide-prevention activists, this year has seen promising if belated political recognition of the need for concerted action on suicide.
‘No parent should ever bury their child’
Bill Shorten adopted the experts’ target of halving suicide rates over the next decade when he announced that a Labor government would invest $72 million to establish 12 regional suicide-prevention pilot programs in communities with high suicide rates, including in at least three indigenous communities.
Describing suicide as a “hidden story in this country” – in fact, not hidden, just ignored – Shorten also pledged $9 million for a national suicide prevention fund to support research into reducing suicides and programs to break down social stigma.
“Teenagers are taking days off school to attend the funerals of classmates who have taken their own life,” he said.
“Parents are sitting at kitchen tables, numb with incomprehension, shattered by grief, trying to write a eulogy for their child. No parent should ever bury their child. Yet seven Australians die every day at their own hand, every single day.”
Shorten didn’t get the chance to implement his promises, but for the first time a party of government had placed suicide front and centre on the national political agenda.
Victoria’s Labor government led by Premier Daniel Andrews is, however, in the position to implement a suicide-prevention strategy in his state. In 2015, 646 Victorians took their own lives.
“We cannot sit back and do nothing, and somehow accept that it is just the way things are,” Andrews said.
In July, he announced a strategy to halve Victoria’s suicide rate over the next 10 years by targeting at-risk communities.
The government has committed $27 million towards community-based support trials that will be implemented through sporting clubs, schools and other local networks. The program will also provide intensive support for people who have previously attempted suicide at six suicide hot spots throughout state.
The Victorian program will be implemented in 2017.
In August, an “integrated suicide prevention program” was launched in NSW with backing from the NSW Government, Commonwealth Primary Health Networks (PHN) and a $15 million grant from the Paul Ramsay Foundation.
Based on successful European models, the “Lifespan” program was developed by the Black Dog Institute and the NHMRC Centre for Research Excellence in Suicide Prevention.
The “evidence-based systems approach” will be implemented in four regional locations in NSW and involves the implementation of nine suicide-prevention strategies, including improved access to mental health care, quality education programs for people at the front line (emergency staff, teachers, GPs) and encouraging safe conversations about suicide in schools, workplaces and communities.
It is estimated that this new evidence-based program will reduce the suicide rate by at least 20% in “a few years” and suicide attempts by 30%.
These are welcome initiatives and hopefully herald ongoing government efforts to reduce the incidence of suicide in Australia.
Perhaps the “halving suicide in 10 years” promise was a clever ruse by savvy mental health activists to reel in politicians who tend to see things in terms of slogans and catchphrases. Given that politicians have notoriously short attention spans, it might also have been an attempt to lock them in for 10 years.
With suicide now on the political agenda, it might be best if we never hear again about halving suicide in a decade. Such promises have a way of turning into political red herrings that overshadow and even derail original good intentions. We need only recall Bob Hawke’s sincere but doomed “by 1990 no Australian child will be living in poverty”.
We don’t need the artificial inspiration of arbitrary targets when it comes to the scourge of suicide – or child poverty, for that matter – we must simply acknowledge the problem and ensure that governments take the best-informed actions to overcome it. At long last, we now appear to be on that path.
In the meantime, as a community we can play our part by bringing suicide out in the open and ensuring that it never again becomes a “hidden story”. We must talk about it, we must confront it and we must do everything we can to understand and overcome this corrosive epidemic which is killing so many of our young people, and many others, in communities around Australia.
Leo D’Angelo Fisher is a former associate editor and columnist with BRW and columnist for the Australian Financial Review. He was also a senior writer at The Bulletin magazine. Follow him on Twitter @DAngeloFisher or correspond via firstname.lastname@example.org
If you or someone you know may be at risk of suicide, help is available from Lifeline (13 11 14), the Suicide Call Back Service (1300 659 467) or Kids Helpline (1800 55 1800).