Lack of impact of past efforts to prevent suicide in Australia: Please explain

Australia’s suicide rate has been trending upwards in recent years, leading to renewed efforts to prevent suicide. In addition to a new Fifth National Mental Health and Suicide Prevention Plan, which was agreed to by the Australian, State and Territory governments in 2017, there have been a number of new innovative regional trials on suicide prevention. At a national level, the Australian government is supporting a National Suicide Prevention Trial involving 12 sites across Australia (Life in Mind, 2019). The Black Dog Institute in New South Wales has initiated LifeSpan with philanthropic and government support, which involves the implementation of nine evidence-based strategies in four sites and aims to reduce suicide by 21% (Black Dog Institute, 2018). In Victoria, the government has funded place-based trials of suicide prevention in 12 locations and trials of assertive outreach following a suicide attempt in another 12 locations. These Victorian initiatives aim to halve the suicide rate by 2025 (Victoria State Government, 2018).

While there has been this recent upsurge in government and philanthropic support for suicide prevention, efforts to reduce the suicide rate in Australia are not new. There was the National Youth Suicide Prevention Strategy from 1995 to 1999, which was replaced by the National Suicide Prevention Strategy in 2000. These strategies led to the funding of a number of specific programmes aimed at reducing suicide. In addition, there have been large increases in the uptake of pharmacological and psychological treatments for mental disorders in Australia, and it has been suggested that such treatments may reduce suicide risk (Christensen, 2016; Hall et al., 2003).

Out of curiosity about whether these past efforts have worked, I constructed a graph of the suicide rate in Australia from 1991 to 2016 and marked the start of various plans, strategies, reforms, organizations and treatments (hereafter referred collectively to as ‘interventions’) which might have been expected to reduce suicide, either directly or indirectly via treatment of mental disorders (see Figure 1). Some of these interventions lasted for a period of years (e.g. various national plans), but most have been ongoing (e.g. restrictions on guns, beyondblue, headspace) or even increased over time (e.g. use of antidepressants, psychological treatments under Better Access). The list of interventions in Figure 1 is based on ones I thought might have an effect, supplemented by suggestions from colleagues with expertise in the area. There are no doubt others that could be added. However, even though the interventions in Figure 1 may not be exhaustive, the striking impression is that past efforts appear to have made no discernable difference! The period from 1997 to 2006 saw a steady decline, which appeared to support the effectiveness of a range of interventions that were introduced during that period. However, the upturn in the suicide rate since that time appears to be contrary to their effectiveness.

Figure 1.

Historical changes in the suicide rate in Australia, showing the points at which various interventions and plans were introduced. Descriptions of the interventions are given in Supplementary File 1.

In view of this apparent lack of success, the ANZJP has invited several suicide prevention experts to answer the following questions:

• Why have past suicide prevention efforts not clearly worked?

• What should we be doing in the future that is different?

Their responses follow. The journal also welcomes other contributions on this important issue.

Supplemental Material

Supplementary_File – Supplemental material for Lack of impact of past efforts to prevent suicide in Australia: Please explain

Supplemental material, Supplementary_File for Lack of impact of past efforts to prevent suicide in Australia: Please explain by Anthony F Jorm in Australian & New Zealand Journal of Psychiatry