Just as health services, aged care and the drug and alcohol sector are guided by standards, so too does the suicide prevention sector need quality assurance, writes Suicide Prevention Australia Acting CEO, Matthew McLean.
Matthew McLean writes:
Talk to any suicide prevention service in the country and they’ll tell you they are busier than ever. Almost 90 percent of our sector have reported an increased demand for their services over the past 12 months.
Last year alone Lifeline answered over 1.1 million calls, over 300,000 contacts were made to Beyond Blue services and some 150,000 young people were helped through Kids Helpline. There’s a lot of distress out there, yet more than ever people are reaching out for help.
So how can we ensure when someone reaches out for help, they are getting safe care? And what does “safe” care actually mean?
It can take a lot of courage for people to reach out for help when they’re struggling. When someone asks for support, they’re often feeling vulnerable, overwhelmed and isolated. It’s therefore critical that the first time someone reaches out for care it is a positive and supportive experience with a service that is effective, high quality, and safe.
As the peak body for suicide prevention, our goal is to support our members so that together we can save lives.
In 2021, we partnered with people with lived experience of suicide, clinicians, Primary Health Networks (PHNs), service providers and accreditation experts to develop Australia’s first independent accreditation program for suicide prevention.
Since the launch, almost 140 programs have become accredited or are working towards it. This is a small proportion of the suicide prevention programs and services in Australia – our goal is for this to become commonplace for the sector so that every person doing it tough has access to consistently safe and high-quality standard of care. The service that someone receives when they’re in crisis can be an instrumental factor for whether or not they survive their suicidal ideation.
Compassionate and unique care
The reason for this is grounded in what people with lived experience are saying. People need access to, and deserve, compassionate care that is suited to their needs at the time they seek help. Suicide is complex, multi-factorial human behaviour with no single cause.
There needs to be a system of care that is delivered in a way that is coordinated and takes into consideration the various unique reasons why someone may be in distress – whether it’s due to contact with the justice system, living in poverty, adverse childhood experiences, domestic violence, or social isolation. Many people reach out for help because of these social determinants or “upstream factors”.
The Final Advice handed down by the National Suicide Prevention Adviser in 2021 stated that we need to “move from providing isolated and one-off interventions to an integrated system of care that has a focus on providing accessible, coordinated and compassionate services – linking people to the right supports at the right time”.
We know that suicide is not just a mental health issue; 63 percent of people who died by suicide in 2021 had a mental and/or behaviour disorder, meaning over a third of people did not. More than that, of those who die by suicide each year, only half are in contact with the mental health system in the 12 months prior.
The social determinants of health can have a direct impact on an individual’s health and wellbeing. Problems in a relationship with a spouse or partner and disruption of family by separation and divorce are some of the most common risk factors after mental illness.
Housing insecurity and homelessness are linked to higher rates of suicide, as well as financial distress, unemployment, loneliness and isolation. Psychosocial risk factors are associated with 90 percent of suicide deaths.
Therefore, when it comes to the appropriate support for an individual, research prepared for the National Suicide Prevention Task Force shows us that we need to take a multi-component and multi-layered approach to addressing the risk of suicide.
Alcohol is implicated in approximately one third of suicide deaths. It is critical, therefore, that suicide prevention programs have the capacity and capability to respond to the complexity of AOD use as a risk factor (Fisher et al, 2020).
A 2020 report, led by University of New England Professor Myfanwy Maple, prepared for the National Suicide Prevention Advisor and National Suicide Prevention Taskforce, advised that, if the equity, health and social issues which contribute to suicide risk are understood and the “touchpoints in people’s journeys are identified and resourced to provide support, there are numerous opportunities to assist people before they reach crisis point.”
The importance of lived experience
To do this, we must continue to draw on the knowledge of those with lived and living experience. This knowledge contributes to safer and more effective suicide prevention programs and is crucial to best practice.
Maple’s report found that lived experience must be at the table for all that we do: from policy design and development to service delivery, research and evaluation. The voices of lived experience need to be heard, “not just as anecdotal ‘quasi-evidence’ but with the same epistemological value as the knowledge of academics and people in the mental health and suicide prevention workforce.”
We need lived experience-informed services that are informed by and targeted to the unique needs of the community they are intended to help. We do this through raising the bar collectively as a sector and striving for continuous quality improvement so that everyone has access to a safe, high-quality standard of care that is appropriate to their needs at the time.
How accreditation can help save lives
This is why accreditation in the suicide prevention sector is key to supporting people in distress.
In the same way that health services are guided by the National Safety and Quality Health Service (NSQHS) Standards, the aged care sector is guided by Aged Care Quality Standards, and the drug and alcohol sector is guided by the National Quality Framework for Drug and Alcohol Treatment Services, the suicide prevention sector needs the same quality assurance.
The suicide prevention accreditation program measures each service against a set of standards that set a nationally consistent benchmark. This supports community confidence in suicide prevention programs, especially for those seeking help for suicidal behaviour or those supporting someone who is suicidal.
It also helps to provide clarity for funders (government, and Primary Health Networks) when they’re looking for quality parameters to help guide where to invest their money. This isn’t to disregard the importance of also investing in other social determinants such as housing security or raising the rate – these are equally as important. But no matter how much upstream capability we have, some people will still fall into a point of distress and they therefore need safe quality support.
The suicide prevention landscape is always changing. Risk factors and social determinants are evolving alongside research and policy. The accreditation program helps to build capacity of the wider suicide prevention sector as well as knowledge sharing so that programs are keeping up with the latest updates.
Quality assurances for suicide prevention programs and services, informed by meaningful co-creation with people who have a lived experience, ensures every person seeking help has access to compassionate, consistent, and coordinated, quality care.
Now is a critical time for suicide prevention. By any measure, there are high levels of distress in the community. Victorian and New South Wales suicide registers respectively revealed last month a nine percent and five percent increase in the numbers of Australians taking their own life for the 2022 calendar year compared to 2021. In January this year alone, Lifeline reported its highest ever number of online searches.
It’s therefore more important than ever that people have access to timely support that has been tried and rigorously tested. Our community needs and deserves to have the assurance that Australia’s suicide prevention programs are providing care that is safe and unique to an individual’s needs.
It is our hope that this approach will ultimately result in lives saved. Being accredited doesn’t mean there is no risk. But it does mean that the programs have incorporated quality systems and safety into the program to support a safe environment and the risks of harm are identified and managed.
For assistance
Lifeline 13 11 14 www.lifeline.org.au
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au
beyondblue 1300 224 636 www.beyondblue.org.au
13Yarn 13 92 76 13yarn.org.au
Kids Helpline 1800 551 800 kidshelpline.com.au
QLife 1800 184 527 https://qlife.org.au/
Check-In (VMIAC, Victoria) 1800 845 109 https://www.vmiac.org.au/check-in/
Lived Experience Telephone Line Service 1800 013 755 https://www.linkstowellbeing.org.au/
