Suicide prevention in Australia: Does the funding match the burden?

Estimates from the Global Burden of Disease indicate that suicide accounts for 18% of all deaths among persons aged 15–49 years in Australia (Institute for Health Metrics and Evaluation, 2016). The rate of hospitalisation for self-harm is approximately 118 per 100,000 persons per year (Australian Institute for Health and Welfare, 2017). There has been a recent reform of mental health and suicide prevention activities in Australia from being a government responsibility to one that is managed by Primary Health Networks (PHNs), following the review of their predecessors Medicare Locals (Horvath, 2014). There are currently 31 PHNs operating in Australia.

Although what PHNs commission in terms of suicide prevention is critically important, it is not the focus of the current commentary. Rather, we are interested in extent to which the financial support PHNs have been allocated matches the burden of suicide and self-harm within the local area they support. The rationale for this investigation comes from an earlier paper in Australia, which found that suicide rates in younger men (aged 19–24 years) were already lower in areas that received locally targeted suicide prevention activity than in those that had no activities (Page et al., 2011). In this study, we explored whether the PHN funding is aligned with the burden of suicide and self-harm across Australia, for example, whether more funding has been allocated to areas with higher rates of suicide and self-harm.

Methods

We obtained the list of grants for the years 2015–2017 from the Department of Health website (contact authors for these websites). We identified information about how funding was allocated to PHNs using the Senate Order 192 (Murray Motion) on Departmental and Agency Contracts. Within this, we looked at the Department of Health grant contracts to identify funding allocated to PHNs. The data provided information including grantee name, main purpose of the grant, duration and total amount allocated for the grant duration. We identified PHNs using name of the grantee. In terms of the geographical coverage of the grantees that were not explicitly tied to a specific PHN, we conducted a search of the grantee to identify its services (to assess whether suicide prevention was in the organisations remit) and its geographical coverage.

To identify funds allocated to suicide, we conducted a keyword search for ‘self-harm’ and ‘suicide’ within health-related grants for each year. All other grants (including those focusing on broader mental health issues) were excluded for the analysis. As most of the grants were for more than one year, we calculated the average amount allocated per year amount given to the grantees during the years 2013, 2014, 2015, 2016 and 2017, 2018 and 2019. We calculated a per capita amount of spending on PHNs using population data for each PHN. Suicide and intentional self-harm hospitalisation data by PHN were extracted from the Australian Institute of Health and Welfare (AIHW) for the years 2010–2014 (suicide) and 2013–2015 (self-harm). PHNs have been de-identified and numbered from 1 to 31. We conducted descriptive analysis and regression analysis to examine whether suicide/self-harm predicted funding levels.

Results

As can be seen in Figures 1 and 2, the funds allocated to PHNs do not necessarily correspond to the burden of suicide or intentional self-harm in a given region. Areas with lower suicide and self-harm had comparatively higher funding for PHNs than other areas with a comparatively higher burden of suicide and self-harm. The funds allocated to PHNs ranged from AUD$8.60 to just over AUD$57.50 per capita per year. Funding did not appear to be related to suicide or self-harm rates in regression analysis.

Figure 1.

Crude suicide rates per 100,000 versus average dollars allocated per capita for suicide prevention in 2015, by Primary Health Networks.

Figure 2.

Hospitalisation for intentional self-harm (ISH) in 2014–2015 versus average dollars allocated per capita for suicide prevention in 2015, by Primary Health Networks.

Thus, it appears that there is not necessarily an alignment between the overall burden of suicide in an area with the resources provided to PHNs. In saying this, we have only highlighted differences based on the burden of suicide and self-harm. There may be other priorities regarding the allocation of suicide prevention funds (e.g. population size, other resources in the area and the different cost of services in regional versus metropolitan areas). Related to this, we do not have data on the cost of services provided by hospitals and related state health services in PHNs (which are funded by states) or information on spending on suicide prevention prior to 2013. Given these limitations, we believe that there is a dire need for an in-depth economic evaluation of national suicide prevention efforts in order to assess whether the activities undertaken by PHNs are related to reductions in suicide and self-harm. More rigorous analysis could also identify specific services in PHNs in relation to age-standard rates by gender. Last, we acknowledge that money might not be the only answer to the problem of suicide and self-harm, but well-resourced (and evaluated) suicide prevention is surely part of the solution.