How a Wellbeing Budget could help save lives at a critical time

Melissa Sweet
Nieves Murray
Tuesday, October 25, 2022

Federal Budget October 2022, Social determinants of health, Social policy, Mental health, Suicide, Prevention, Health in All Policies

Could the Federal Government’s Wellbeing Budget save lives by preventing suicides?

Only if a comprehensive approach is taken across portfolios, writes Nieves Murray, CEO of Suicide Prevention Australia, who stresses the importance of whole-of-government and whole-of-community approaches.

Nieves Murray writes:

There are high levels of distress in our community. We’re experiencing compounding environmental disasters, emerging from a global pandemic, the rising cost of living and mortgages are set to increase financial, housing and relationship stress, and we’re facing geo-political tensions.

Crisis calls, reported distress and emergency department presentations for suicidal ideation, attempts and self-harm remain high and above pre-pandemic levels. Australians are reaching out to Lifeline’s crisis support and suicide prevention services in record numbers, hitting more than 3,700 calls in one day in January 2022. People are struggling.

Over 3,000 people tragically die by suicide each year, and only half are accessing mental health services at the time. To reach our vision of zero suicides, we need investment in mental health services, but equally as important, we need to address the many varied risks factors and social determinants of suicide.

This is why we need a whole-of-government approach to suicide prevention, and a Wellbeing Budget is a step in that direction. A fiscal approach that looks not just at economic indicators, but a range of social and cost-of-living metrics used to prioritise what gets funded.

Soon after his appointment as Treasurer, Jim Chalmers announced his interest in a Wellbeing Budget. Not only is it an important way of putting a human face and focus on the Commonwealth Budget, it also presents a real opportunity to make smart decisions that can save lives by reducing distress.

Just recently, Chalmers laid out a few of the finer details and outlined what the “starting points” will be – education standards, the quality of health services and the state of the environment. These are all important, but it must also include a key focus on suicide prevention.

Suicide is complex

So how can a Wellbeing Budget help us at this critical time? It’s important firstly to outline the complexity of suicide.

Suicide has many varied risk factors – it is not just a mental-ill health issue. In fact, 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.

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.

Suicide prevention therefore needs focus from many areas of government. Changes in welfare support need to consider impacts on suicide. Just look at Robodebt, which increased financial insecurity for hundreds of people – it was implicated in a number of suicide deaths. Housing insecurity can drive suicide, and tenancy laws strongly impact housing security for renters. If you look at the justice system, 17 percent of young males and 40 percent of young females in detention have attempted suicide.

There are also a range of reforms, recently implemented or being considered, that will impact the social determinants of suicide. Some states have banned or limited no-grounds evictions, and there is a push for other jurisdictions to follow. Many groups are advocating for an increase to government unemployment supports. Some jurisdictions will be raising the age of criminal responsibility, leading to less children and young people being incarcerated. Plus, the stage three tax cuts may well result in cuts to a range of services, which can have an impact on suicide prevention.

Aboriginal and Torres Strait Islander people die from suicide at double the rate of the rest of the Australian population and on average 10 years younger. We know issues such as employment status, social support, and social inclusion can have particularly strong impacts on Aboriginal and Torres Strait Islander individuals and communities.

We also need to take into account the risk factors unique to Aboriginal and Torres Strait Islander peoples. Intergenerational trauma, social marginalisation, dispossession, loss of cultural identity, community breakdown and the artefacts of colonialism have had a profound impact on the mental health, wellbeing and lives of Aboriginal and Torres Strait Islander peoples.

When the cause is complex, so too is the cure. We need to address it across government and the community. This requires action in the areas of welfare support, social housing, alcohol and other drugs, to name only a few. We must acknowledge all the broader social determinants of suicide – the upstream causes – before we can truly start to turn the trend towards zero.

Whole-of-government, whole-of-community approach

We can do this through a whole-of-government approach to suicide prevention. A Wellbeing Budget is a step in the right direction. It can help to measure those broader risk factors so that there is more of a focus on preventative measures rather than reactive measures.

Effective preventative measures can, and must, come from across a range of government agencies. Since suicide is much broader than mental health, the solutions must be too. Actions to prevent suicide must occur outside mental health, outside health.

A lot of the work we do at Suicide Prevention Australia sits outside of health. We develop policy positions on anything from social security to environmental disasters and veterans. We provide recommendations like abolish the Cashless Debit Scheme (which has just been done), permanently increase the base rates of income support payments in-line with the Raise the Rate campaign, budget annually in discretionary funds to respond to need for suicide prevention in the event of future disasters or economic crises, increase investment in supporting social connections for veterans, include education around help-seeking in the national curriculum, to name a few. These are examples of the types of things a Wellbeing Budget can measure the impacts of.

If we look to New Zealand, its Wellbeing Budget includes measures of suicide, distress and a range of related social determinants including addiction, child poverty, housing and cost-of-living. This isn’t necessarily the model to emulate, but it’s progress. It’s too early to tell if the New Zealand Wellbeing Budget is working to reduce distress and improve wellbeing. Reform doesn’t happen overnight, but it certainly moves the goalposts in a positive way.

A critical juncture

We need to act now. Research shows us that it’s two to three years after a natural or economic disaster that suicide rates can increase. We saw this with increases to suicide rates during the recessions of the 1980s and 1990s, and we’ve seen it after bushfires, Cyclone Yasi and the Christchurch earthquake.

In the 10 years following the Black Saturday bushfires, the number of people reporting mental health disorders (PTSD, depression, and psychological distress) in high-impact communities was double compared to people from low to no impact communities.

If we don’t implement smart policy reform now, distress may continue to rise. We’re already seeing a worrying indication from the Australian Institute of Health and Welfare (AIHW) Suicide and Self-harm register. Only NSW and Victoria publicly report recent deaths by suicide, but together the two states represent 57 percent of the national population. Concerningly, the number in July this year was higher than at the same time in the last three years.

An effective Wellbeing Budget in Australia can help. It must have a clear focus on suicide prevention by including metrics on suicide, distress, attempts and deaths but equally those broader risk and protective factors, including alcohol and other drugs, housing, family and domestic violence, poverty, loneliness and more.

This is not designed to be a handbrake on progressing economic policy or budget repair. Quite the opposite. It’s about giving Treasury and other central departments the confidence to progress with big – and at times tough – budgetary decisions knowing that any risks to suicide and other social stressors are not just identified but acknowledged, mitigated, and managed as best as possible.

The upcoming Budget and subsequent financial decisions in this term of Parliament therefore take place at a critical time. If designed effectively, the Wellbeing Budget can be an important enabler of suicide prevention by facilitating a cross-government approach to the issue. It would encourage all ministers, whether they work in housing, education or health, to consider how their policies may or may not cause distress.

As the old adage states, what doesn’t get measured, doesn’t get managed. Accountability is key. A Wellbeing Budget that considers suicide prevention is a first step. It has the potential to save lives.