strategic framework for suicide prevention in nsw 2018 ...€¦ · we encourage everyone to have...

From consultations with people, communities and service providers across NSW

Strategic Framework for Suicide Prevention in NSW 2018-2023

Consultation paper – Young people’s perspectives

Thank you We would like to thank everyone who participated and contributed to the development of this Framework. In particular, we acknowledge the strength, courage and generosity of those who shared their personal stories and journeys with us.

We encourage everyone to have open, safe and honest conversations about suicide and for those in distress to put up their hand and ask for help.

DedicationThis Framework is dedicated to those who have died by suicide, those who have made an attempt on their own life and those who are bereaved by suicide.

Cover image

Waiting for the Sun

Acrylic painting by Owen LyonsOwen Lyons is a Wiradjuri man and was born in Narrandera, southwestern NSW. He is the second youngest in a family of 10 children (five girls and five boys) to a shire council labourer and a stay at home mum. Owen is married to Shay, and they have three children - Brooke, Josh and Lexi. Mental illness has had a great effect on Owen and his family. After a family member’s battle with mental illness, Owen hoped that by creating this painting he could help to raise awareness about suicide prevention.

Owen has been involved in Aboriginal art for most of his life, learning his craftsmanship and artwork early on from his father, and in later years his elder brother Michael. Like many other artists from this area in Wiradjuri country, Owen’s style has been derived from Michael’s. Owen has only to step outside his front door to get inspiration from his surroundings. The river is just down the road, wildlife abounds and the beautiful colours of nature are everywhere. Owen paints a variety of landscapes, animals and symbols, using the dotting method.

“Waiting for the Sun” tells the story of a person emerging from a dark place and being connected back into their community. The scar tree shows that even though it has been scarred, it still stands strong and proud with deep roots connected to its country.

The painting also illustrates pathways to services and supports available to help people get back on track. It shows people that there really can be a brighter future. You just need to ask for help. There’s no shame in that. Most importantly, there are people in our communities who do care about mental health and suicide prevention. We will work with these beautiful people to help others return to fulfilling lives.

Mental Health Commission of NSW (2020). Consultation paper – Young people’s perspectives

© State of NSW 2020 ISBN: 978-0-6488428-3-5

nswmentalhealthcommission.com.au

ContentsOverview ................................................................................................. 2Purpose ................................................................................................................................................. 3

Context .................................................................................................................................................. 3

Audience ................................................................................................................................................ 3

Approach ............................................................................................................................................... 3

What we heard: At a glance ..................................................................... 4Inclusion of people with lived experience ............................................................................................. 4

Building community resilience and wellbeing ....................................................................................... 4

Supporting excellence in clinical services ............................................................................................. 4

Enhancing coordination and integration ............................................................................................... 4

Enhancing capacity to respond to suicide ............................................................................................. 4

Supporting and promoting evidence-based practice ............................................................................ 5

Summary: Feedback on what is working well and areas for improvement ..................................................................... 6

What we heard: In detail........................................................................ 10Inclusion of people with lived experience ........................................................................................... 11

Building community resilience and wellbeing ..................................................................................... 12

Supporting excellence in clinical services ........................................................................................... 14

Enhancing coordination and integration ............................................................................................. 15

Enhancing capacity to respond to suicide ........................................................................................... 16

Supporting and promoting evidence-based practice .......................................................................... 17

Appendix 1: About youth suicide ........................................................... 18Youth suicide: The facts ....................................................................................................................... 18

At-risk populations ........................................................................................................................... 19

Factors affecting suicide attempts among young people ................................................................ 19

Indigenous young people and suicide .............................................................................................. 20

Appendix 2: The consultation process ................................................... 21Part A: NSW Suicide Prevention Framework Consultation – University of Wollongong .................. 22

Part B: Consultations led by the NSW Advocate for Children and Young People ............................ 22

Methodology ................................................................................................................................... 22

1Strategic Framework for Suicide Prevention in NSW 2018-2023

Contents

Overview

2Consultation paper – Young people’s perspectives Overview

Purpose This report records the experiences, perspectives and insights of young people, including those with lived experience of mental health issues and those who are working to prevent suicide in their communities.

The Mental Health Commission of NSW gratefully acknowledges the honesty, openness and courage of all those who contributed to this consultation process. It is only through listening to these direct community and service-level stories and experiences that better outcomes can be achieved.

Context In 2018, the Minister for Mental Health tasked the Mental Health Commission of NSW with developing a framework for suicide prevention in NSW in partnership with the NSW Ministry of Health. The Strategic Framework for Suicide Prevention in NSW 2018-2023 (the Framework) was launched on 17 October 2018 by the Honourable Gladys Berejiklian, Premier of NSW. View the Framework on the Commission’s website.

In developing the Framework, over 1,500 people participated in a series of consultations held in communities across NSW between March and July 2018. Up to 1,000 people provided written responses to an online survey.

AudienceThe Commission partnered with the Advocate for Children and Young People to consult with school-aged children. Consultations led by the NSW Advocate for Children and Young People were age-appropriate and presented in broader accessible terms. In addition, a separate focus group was held with students at Wollongong University.

Our hope is that this report helps to highlight some of the key issues and challenges facing young people and provides examples of what is working and what needs to be done to reduce the rate of youth suicide in NSW.

Approach Six guiding principles were developed by the NSW Suicide Prevention Advisory Group to guide the development of the Framework and the consultation process. They are:

• Inclusion of people with lived experience• Building community resilience and wellbeing • Supporting excellence in clinical services• Enhancing coordination and integration• Enhancing capacity to respond to suicide• Supporting and promoting evidence-based practice.

This report presents young people’s views of what is working, and what challenges and gaps exist against these principles.


Overview

https://nswmentalhealthcommission.com.au/resources/strategic-framework-for-suicide-prevention-in-nsw-2018-2023

What we heard: At a glance

Inclusion of people with lived experience • Young people want more opportunities to talk

about mental health and related issues with their peers and teachers.

• There is stigma associated with seeking support from the school counsellor.

• Young people would like to hear more about experiences of living with mental health conditions.

• Young people want more detailed, practical information about what to do if a friend confides in them that they are having a difficult time.

Building community resilience and wellbeing• Peer support and leadership makes a difference,

particularly in helping young people navigate the mental health support ecosystem and in supporting wellbeing.

• There are ‘high-risk’ times for students where there needs to be targeted suicide prevention activity (e.g. exam time). Community connection is vital, as is maintaining a focus on wellbeing.

• There needs to be additional support to ensure social connection for off-campus students. Many of the activities that students feel work well are student-led.

Supporting excellence in clinical services• There needs to be greater awareness and

understanding of the support available. • Flexible services and support options are also

highly valued.

Enhancing coordination and integration• Student leaders play an important triage and

referral role and are vital in helping people navigate services and supports. Triage nurses can also play an important role in improving coordination.

Enhancing capacity to respond to suicide• Training helps build the capacity of student leaders,

however there can be a loss of knowledge and capacity when students move on. Mental health training for staff is also valued by students, as are safe spaces for supportive conversations.

4Consultation paper – Young people’s perspectives What we heard: At a glance

Supporting and promoting evidence-based practice• In addition to direct communication, young people

want to be able to access information across a range of social and digital media platforms such as Instagram, Facebook, Snapchat, YouTube and Spotify, cinema advertising and Google Ads.

• Young people want to know how to recognise signs and symptoms of emerging mental health issues and when to seek professional help.

• In the community, young people identified similar face-to-face communication methods as important ways to learn more about mental health.

University-aged young people who participated in the consultation in Wollongong shared their perspective on key challenges and opportunities regarding suicide prevention. Below are their perspectives, some of which were shared by people of all age groups and some that are specific to university students.

The key issues identified include:

• Those who feel less connected to a community are at greater risk. For example, first year university students are a priority group that needs attention.

• Young men have particular needs and might need tailored support, especially in terms of early intervention.

• There is a lack of awareness of available services and support options.

• Student leaders play a critical role that needs to be supported.

When asked what is working well in relation to young people’s mental health and wellbeing, young people:

• spoke favourably about free national and state-wide support services such as Kids Helpline, Black Dog, Beyond Blue, Mission Australia, Lifeline and PCYC.

• like services that feel more relaxed, personalised and youth-friendly compared to larger general health services.

• said that advertisements about mental health on TV and social media are important and useful.

• value local mental health awareness initiatives as they help strengthen community and provide opportunities for people to connect with each other.

• highlighted the important role of schools in supporting students with their mental health and wellbeing.

• spoke positively about localised initiatives that schools had implemented.

• like that their schools provide education about mental health issues.

• spoke about the significant role played by family, friends and community members in supporting someone with mental health issues.

• highlighted the positive impact on mental wellbeing of being able to engage in other interests and activities.

When asked what is not working well, young people:

• highlighted the need for greater awareness around young people’s mental health and wellbeing.

• spoke favourably about discussing mental health in personal development, health and physical education lessons (PDHPE) but feel there are ways this can be improved.

• reinforced that there is uncertainty about the actual services provided by different organisations.

• said they want more opportunities to talk about mental health and related issues with their peers and teachers in small groups, as this would reduce the feelings of shame that many still associate with seeking help.

• highlighted that while mental health education is frequently offered in junior years, older years would benefit from ongoing education.

• discussed the stigma of seeking support from the school counsellor.

• felt that more needs to be done to address the underlying causes of mental health issues such as family breakdown, substance use, abuse, family violence and bullying.

• said that the attitudes of peers and family, as well as broader societal views about mental health issues and negative stereotypes associated with mental health conditions play a big part in how they deal with mental health concerns.

• believe that some people in the community do not take mental health seriously.

• discussed the complex influence of movies, television and social media.

Young people also said they would like more information on:

• what to do if a friend confides in them that they are having a difficult time.

• how to recognise signs and symptoms of emerging mental health issues and when to seek professional help.

• the support services that are available in their area and how to decide which one will best suit them.

• where they can access support and how to navigate referral pathways to mental health services.

• the experiences of other people living with mental health issues.


What we heard: At a glance

Summary: Feedback on what is working well and areas for improvement

6Consultation paper – Young people’s perspectives Summary: Feedback on what is working well and areas for improvement

Over 350 young people were consulted through various focus groups and forums conducted across metropolitan, regional and rural NSW in 2018.

Inclusion of people with lived experience

What is working well Areas for improvement

• Peer support and leadership.• Relatable stories from people living with

mental health issues.

• Better support for mental health professionals and people with lived experience to give talks and run school workshops with students about different pathways to recovery and education on accessing services.

• Supporting the development of more peer leaders.• Sharing lived experience stories of resilience and

recovery as well as stories of the impact of mental health issues.

• Providing detailed practical information about what to do if a friend confides in them that they are having a difficult time.

Building community resilience and wellbeing


• Social and community connection opportunities (e.g. university events, community wellbeing events, social groups).

• Wellbeing initiatives to minimise stress and distress at high pressure times (e.g. ‘stress less week’ pre-exams, study support, stress dogs on campus, exercise, cooking and social groups).

• Resilience training (classes on managing study load and time, and issues like bullying).

• Wellbeing apps and websites to support mindfulness, sleep and relaxation.

• Counselling services providing translation support to help international students and those not proficient in English better connect and access supports.

• Providing psychologically safe spaces (e.g. queer safe space, chill out spaces).

• Ensuring access to free, credible and youth-friendly information and support services, both online and local.

• Providing youth-friendly services that are easy to get to, relaxed, personalised and consistent, so that the young person sees the same worker each time and feels ‘known’ by the service.

• Providing targeted support for more vulnerable young people such as first year university students who are transitioning and not yet connected to others or supports.

• Tailoring prevention and early intervention to young men who are less likely to seek help from services.

• Assisting off-campus students to connect with others and support services.

• Addressing the underlying causes of mental health issues such as substance use, family breakdown, family violence and abuse, and bullying.

• Reducing drivers of poor mental health outcomes including discrimination, racism and inequality.

• Delivering anti-stigma initiatives to improve community, understanding and acceptance and to reduce gossip, particularly in smaller communities.

• Creating education and support groups for parents and families to help them better support their children tackling mental health issues.

• Expanding community awareness initiatives that bring young people, families, community members and services together to improve mental health and wellbeing across the whole community.

• Normalising conversations about mental health and help-seeking.



Supporting excellence in clinical services


• Online chat support from eheadspace.• 24-hour university helplines that link students

to trained mentors.• Counsellors keeping appointments free for

‘drop-ins’ (responding immediately to students experiencing stress/distress).

• Providing targeted supports following a suicide such as chill out spaces and dedicated areas for students to honour the person who died and gain support.

• Improving the location of counselling offices to be discreet yet accessible to ensure student confidentiality is not compromised by their location or the way they are required to access the service.

• Addressing long wait times to get into local mental health services.

• Using a range of online, digital and social media platforms to provide education and promote support services (e.g. advertisements, relatable stories about mental health experiences and recovery and informative websites).

• Improving students’ understanding of the role of school counsellors and increasing their visibility in schools.

• Running personal development programs in schools to tackle the causes of common mental health issues such as anxiety and depression (e.g. stress management, mindfulness, self-esteem and communication skills).

Enhancing coordination and integration


• Student leaders providing support including immediate responses to distress, system navigation and connection to social supports.

• Mentors also act as system navigators.• Nurses based at counselling centres assisting

in triage and referral to supports (including legal services).

• Investing in training for student leaders and mentors at all universities to provide support to students who live both off and on campus.

• Improving promotion to students by staff (including nurses), student leaders and mentors of the available mental health and academic services and supports available.

• Providing more information on local services and supports – including having services come to schools/universities to present their service offerings and advice on how to connect.

Enhancing capacity to respond to suicide


• Providing Mental Health First Aid training to student leaders and staff.

• Mentoring programs.• Training a range of education staff to connect

students to supports (e.g. counsellors, mentors, nurses, pastoral care staff in private schools, teachers and wellbeing staff).

• Coverage across university campuses of 24-hour support from student leaders or staff.

• Ongoing training of new student leaders when others leave.

• Training teaching staff in Mental Health First Aid. • Providing more information to young people about

the range of different mental health conditions, how they can recognise signs and symptoms of emerging mental health issues in themselves or their peers, and how to access support services.

8Consultation paper – Young people’s perspectives Summary: Feedback on what is working well and areas for improvement

Supporting and promoting evidence-based practice


• Sensitive and regular media promotion of mental health and wellbeing information, including the support services available. This helps normalise conversations, reduce stigma and improve access.

• Delivering mental health awareness programs through PDHPE classes.

• Community-led activities and events are run in rural NSW promoting mental health awareness.

• Placing greater emphasis on reducing cyberbullying.• Working to reduce misinformation or inappropriate

representation of suicide in the media, on television and in social media.

• Expanding the mental health content of PDHPE classes. Depression and anxiety, for example, may be more relevant to different age groups.

• Offering education and support groups for parents and families to help them support young people.

• Raising awareness of youth mental health and wellbeing issues to reduce stigma and normalise help-seeking behaviour. Activities in schools can be extended through:

> Education in classes and assemblies > Awareness campaigns > Visiting health professionals and lived

experience guest speakers > Displaying relevant information around the

school and on school websites.

• Developing strategies within schools to reduce the negative impact of school processes and procedures such as exam and assessment schedules on students’ mental health and wellbeing.



What we heard: in detail

10Consultation paper – Young people’s perspectives What we heard: In detail

What we heard from children and young people, communities, educational institutions and service providers

Children and young people, communities, educational institutions and services involved in consultations provided a comprehensive assessment of the major gaps and challenges for suicide prevention in their local communities and for children and young people in NSW. These are summarised below through the lens of the six guiding principles which shaped the consultation process and now underpin the Strategic Framework for Suicide Prevention in NSW 2018-2023:

• Inclusion of people with lived experience• Building community resilience and wellbeing• Supporting excellence in clinical services• Enhancing coordination and integration• Enhancing capacity to respond to suicide• Supporting and promoting evidence-based practice

Inclusion of people with lived experienceWe heard that young people want more opportunities to talk about mental health and related issues with their peers and teachers:

• Young people creating networks of small groups to discuss mental health and related issues can reduce the feelings of shame that many still associate with seeking help.

We heard about the stigma of seeking support from the school counsellor:

• Some students spoke about barriers created by the location of counsellor’s offices. For example, if it was in conspicuous areas of the school, where other students and teachers could easily see who was accessing the room.

• Students said if the office is in a discreet but central location, people would be able to see the counsellor more often and be more familiar with them.

• We also heard concerns about school counsellors not maintaining confidentiality and speaking to parents without informing the student.

We heard that young people want more detailed, practical information about what to do if a friend confides in them that they are having a difficult time:

• Many young people discussed the burden this places on them and the fear of saying or doing the wrong thing. They also feel that this information is important for parents, family, teachers and community members to know as well so they can better support young people.

We heard that young people said they would like to hear more about experiences living with mental health conditions:

• We heard that it is important for young people to learn that everyone’s mental health experiences are unique. They also want to hear recovery stories as they feel the focus is often only on the mental health condition, not that people get better.

• Some young people feel that using celebrities as role models to speak about their experiences is a good idea while others feel it is better to hear from real young people. The important factor is that stories are relatable to young people.


What we heard: In detail

Building community resilience and wellbeingWe heard about the important role of schools in supporting students with their mental health and wellbeing:

• Young people feel it is important to acknowledge the diversity of young people’s cultural backgrounds and ensure information is presented in culturally appropriate ways (e.g. language, images and content).

• We heard that the quality of the relationship with the school staff member providing support is the most important factor for young people in whether the interaction is helpful or not. School counsellors are seen as a key position within the school who deal with issues of mental health, although views on the effectiveness of school counsellors are mixed. Young people also spoke about teachers, wellbeing staff and pastoral care (private schools) teams being important too.

We heard that young people value local mental health awareness initiatives:

• Young people told us that local awareness initiatives help strengthen community and provide opportunities for people to connect with each other (e.g. community activities and events and launches of mental health services).

We heard young people speak positively about localised initiatives that schools implement:

• Students spoke about dedicated spaces within schools where students can relax and ‘chill out’. They particularly like that these spaces can be accessed without providing extensive documentation or reasoning.

• We also heard about the effectiveness of therapy dogs to assist students having difficulties.

We heard about the significant role that family, friends and community members play:

• A number of young people said that family and friends are often the first place they go to seek support for mental health issues.

We heard about the positive impact of being able to engage in other interests and activities:

• Young people are positive about the mental wellbeing benefits involvement of sport, music, art, recreational activities, gaming and socialising.

We heard that attitudes of peers and family, as well as broader negative stereotypes and societal views about mental health issues, play a big part in how young people deal with mental health concerns:

• We heard that some feel that young people lack confidence to reach out.

• Shame and embarrassment about what others might think are reasons for not seeking support. Young people in the regional consultations said that lack of confidentiality and gossip in small communities compounds this problem.

We heard that there is a belief that some people in the community do not take mental health seriously:

• Expressing attitudes such as “just get over it” or “toughen up” creates another barrier to young people asking for help. Additionally, many are concerned over the improper use of mental health terms in everyday language or jokes, for example “I have maths, I want to kill myself” and “you’re so organised you’re so OCD” as they feel it reflects the stigma surrounding those issues. We heard that societal pressure makes it particularly difficult for young men to speak up about mental health. Broader issues such as discrimination, racism and inequality also contribute to poor mental health outcomes for some young people.

We heard about the complex influence of movies, television and social media:

• We heard mixed feedback about the impact of media. There is a positive perception of the capacity of digital and social media to improve awareness by telling real stories and providing education and information. However, young people see negative impacts such as the use of social media for cyber bullying, misinformation given in TV/YouTube/movie storylines as well as the glorification of issues such as suicide. Often the same example was given by different groups as both positive and negative (e.g. the TV show 13 Reasons Why was mentioned several times as something that was both a helpful and an unhelpful depiction of the issues of youth suicide).


We heard that peer support and leadership makes a difference, particularly in helping young people navigate the mental health system:

• We heard that student leaders play an informal triage and referral role. They refer to counsellors, provide immediate responses, direct students to the wellbeing hub and provide knowledge of on campus services and referral pathways. Broadly, they act as system navigators. For students, it also means a friendly face around campus.

We heard there are ‘high-risk’ times when there needs to be targeted suicide prevention activity:

• University-age students told us about ‘high-risk’ times on campus like the end of semester and suggested the potential for starting a stress less week before exams.

• They also told us about the benefits of university classes on managing study load, using library resources to find texts and managing time, and learning co-ops at the library that provide support for referencing or reviewing work. We also heard about stress dogs being brought onto campus during exam week.

We heard that first year university students are a priority group that needs attention:

• We heard that process of beginning tertiary study can be overwhelming as it is a huge change and new students are not yet engaged with a community on campus. Young people spoke about the transition from different settings (like high school to university or from the community that you live in) where you may have existing supports and networks, to a new environment where you may not know anyone. ‘Community’ came up as a theme and was seen as a tool for supporting people. When young people move to a new city or country to attend university, they may lose the supports that existed within their communities.

We heard that community connection is vital, as is maintaining a focus on wellbeing:

• Young people told us that notions of prevention and supporting wellbeing are prevalent, and that many activities are student led. Participants suggested that if more people knew about the options that are available when prevention and early intervention are possible, then people might not get to the point of needing medication.

• We heard that tools like exercise or gym groups could be used to build resilience and engage difficult to reach groups (such as young men). One popular activity that students had devised was to hold a series of cooking workshops, perhaps fortnightly,

with a focus on how to make good food cheaply. This might include a trip to the cheap local farmers market or a bus trip (via the free green bus) to do a big group shop.

• We heard that wellbeing apps (including the University of Wollongong’s app) for sleep, relaxation, mindfulness – as “sleep is usually the first thing to go” – are an opportunity. Such a “wellbeing app” could link to different wellbeing initiatives targeting areas like sleep and healthy eating, as well as linking with local services. It also offers mood monitoring and advice on tricky situations such as “my friend is struggling” and a list of responses or offer additional links to community options such as a running club, cooking groups or on campus societies.

• We heard that the sense of belonging and finding like-minded people is crucial to young people’s mental health and wellbeing.

• Young people told us that events that bring young people together are important. Participants suggested that groups typically regarded as ‘hard to reach’ could be reframed as having a particular set of assets that could be shared with others. An example given was celebrating Chinese New Year as a means of connecting different cultural groups and create communities.

We heard there needs to be support for off-campus university students to ensure social connection:

• Participants noted that a lot of health promotion materials covering issues like mental health, sexual health and physical health are provided. However, there is significant concern that students living off campus do not have access to the same level of support.

• One student described supporting a suicidal friend and receiving a lot of support afterwards as a result of living on campus, including from friends, leaders and mentors. The student believes this level of support wouldn’t be available if the student was not on campus.

That feeling when you are walking around campus and someone says hello to you and knows your name is awesome.



Supporting excellence in clinical servicesWe heard that young people prefer services that feel more relaxed, personalised and youth-friendly compared to larger general health services:

• We heard that being able to see the same worker and feeling known within the organisation is important.

• The location of services is another important factor for young people accessing services. Services close to or co-located within schools are considered the best option.

We heard that many young people know about various mental health support services, however there is still opportunity for greater awareness and understanding about the specific services and supports available:

• Young people want to spend more time learning about available support services as well as being provided dedicated opportunities to search their websites in class or by inviting services to schools to speak to them directly.

• It was suggested that having local services visit schools would also allow students to become familiar with health workers which would help them to feel more comfortable seeking their support outside of school.

• Young people feel there is an opportunity for better awareness on campus, particularly with respect to help-seeking and understanding the range of supports available.

• Young people want to know how a particular service can help them and how to make contact. We also heard that taking the initial step of seeking help is very hard and scary for them and that better information about services will assist with this. Being able to familiarise themselves with local services and their staff (e.g. through services speaking at schools, visits to services, service expo-type events) would make it much easier to decide who to see.

• Young people want to know where they can access support and how to navigate referral pathways to mental health services, as these are sometimes complicated and confusing, especially the first time someone seeks help.

• Participants also feel that Youth Mental Health First Aid and Indigenous Mental Health First Aid training would improve capacity to respond to distress. This was discussed in relation to mental health lessons in schools and the need to reduce stigma through normalising help-seeking behaviour.

We heard that flexible services and support options are highly valued:

• Young people told us about a new 24-hour university service introduced to link those in need with trained mentors, as well as other supports on campus. Participants suggested that another support pathway could be to focus on making help available straight away via friends of the person in distress by equipping students with mental health first aid training. This is seen as additional to having student leaders available within minutes on campus and who are linked with counselling services.

• Participants recognised that counsellors on campus always keep a few appointments available for drop-ins.

• Participants noted that eheadspace now makes it possible to chat to counsellors online, but the service would be enhanced if it was 24-hour.


Enhancing coordination and integrationWe heard that outside of the school context, young people feel that more needs to be done to address the underlying causes of mental health issues such as family breakdown, substance use, abuse, family violence and bullying:

• Early intervention and prevention programs are seen as important in supporting young people before things reached a crisis point.

• Young people say they don’t know enough about what services they can access for support. They want to be able to see more information promoted about services and that services are accessible and approachable for young people.

• Some young people report that long waiting times to get into local mental health services are also an issue.

We heard that student leaders play an important triage and referral role – and are vital in helping people navigate services and supports:

• We heard about student leaders playing a critical (informal) triage and referral role. This includes providing immediate responses, referrals to counsellors and the campus wellbeing centre, guidance around accessing on-campus services and referral pathways.

• This triage and navigation role provided by student leaders and mentors extends to navigating the use of the many services or other resources available in the wider community. While services are not integrated, student leaders coordinate the process of accessing care and the experience may be very different off campus.

We heard that triage nurses can play an important role in improving coordination:

• We heard that triage nurses at the counselling centre know every program available including legal services. However, there is still a lack of awareness of the breadth of services available, including exam or assessment adjustments for students experiencing mental health issues.



Enhancing capacity to respond to suicide We heard young people speak favourably about free national and state-wide support services:

• Young people spoke about being able to access credible online information through websites managed by organisations such as Kids Helpline, Black Dog, Beyond Blue, Mission Australia, Lifeline and PCYC.

• Young people identified particular services in their local areas such as local headspace centres, youth centres, hospitals and child and adolescent mental health teams that are helpful. They named specific programs and community initiatives as having a positive impact for both young people and the broader community (e.g. the Winter Solstice suicide awareness events, Retro Café youth services, Hive Youth Resource Centre, the Big Splash mental health awareness events and the Maari Ma Aboriginal Health Service).

While we heard young people speak favourably about discussing mental health in PDHPE lessons, they also feel there are ways these lessons could be improved:

• Young people receive a lot of information about anxiety and depression, however there is a desire for education about the range of different mental health issues relevant to their peer group.

• Additionally, senior students feel that mental health education is frequently offered in junior years but that older years would benefit from ongoing education, especially help to develop strategies to manage pressures caused by school study and exam stress.

We heard that young men have particular needs around access to tailored support. It is especially important that early intervention services for young men are embedded within communities:

• Participants said that for young men, informal support from friends is the most accessible, compared with going to a service.

• Participants said that many of their peers don’t recognise the options available to them, including academic adjustments.

We heard that training helps build the capacity of student leaders in the university context:

• Student leaders act as system navigators, provide immediate response to distress and concern, as well as support social connection and community building. Participants expressed concern that those who do not live on campus do not have access to sufficient support or the same levels of social connection and system-knowledge that is provided by student leaders.

• Student leaders are trained in supporting people experiencing difficulties and responding to suicide. Mental health first aid training is given to many student leaders with a focus on recognising early signs and how to address them. There is also focus on reaching out as soon as you see that someone is different in their behaviour. Mental health first aid training is offered free to students through headspace, though there is not great promotion or awareness of the opportunity.

• Leaders are on duty 24-hours on a rotating roster. There is someone available to answer to the phone at any time. This is the case in every student residence. This is supported by a less formal process where leaders who are not on duty will also respond. During orientation week and the initial move in, student leaders are very present and help people move in, give orientation to services and supports. This supports the development of social connections from day one.

We heard that there can be a loss of knowledge and capacity when students move on:

• There is concern about the loss of knowledge that happens when students move on and take their understanding of the system with them. Participants suggested that ex-residents could volunteer at the campus wellbeing center or work at one of the residences to continue to harness capacity they have developed.

We heard that mental health training for staff is valued by students – as are safe spaces:

• We heard that the capacity for prevention and early response would be enhanced by training tutors and lecturers in mental health first aid to be able to support students who live off campus, as well as part time students and mature age students. Teaching staff are in a position where they can notice behaviour changes and are the primary contact points between the student.

• In addition, International students without much English are seen as a group at risk. There needs to be better engagement with this group, possibly through English classes run for international students.

• We heard about queer safe spaces. Participants emphasised the importance of having spaces that allow people to feel completely safe and supported.

Social approaches can help it feel like you have a community at your fingertips.


Supporting and promoting evidence-based practiceWe heard about the effectiveness of advertisements about mental health information and support services:

• Young people said that advertisements about mental health information and support services on TV and social media are important to help normalise conversations about mental health, provide information to people needing support and reduce stigma about seeking help for mental health issues.

We heard that young people like that their schools provide education about mental health issues:

• The common topics for mental health education within schools are anxiety and depression.

• Visits by external services and professionals to give talks or run workshops about mental health are viewed positively.

• Mental health service expos are viewed as a good opportunity to engage with students and helpful in promoting what supports were available in the respective areas.

• Programs that teach skills to cope with issues like bullying and stress are also seen as being beneficial.

We heard that young people want to know how to recognise signs and symptoms of emerging mental health issues and when to seek professional help:

• This is important so that they can help themselves and support their friends. They want information regarding underlying causes of different mental health issues, beyond anxiety and depression.

• They suggested it would be helpful to have a single website or list of reliable websites providing credible, accurate and up to date information as they feel overwhelmed by the amount of information available on the internet and don’t always know which sites are trustworthy.

We heard about the important role of schools in supporting students with their mental health and wellbeing through:

• providing information and education in classes and assemblies.

• promoting awareness campaigns.• arranging visiting health professionals and guest

speakers who share experiences of living with mental health conditions.

• displaying relevant information around the school and on school websites.

• creating opportunities to normalise conversations about mental health through informal discussions with school staff in small group settings, such as the home room or tutor groups.

We heard that young people want greater communication between teachers and students and for teachers to be more approachable about the issue. They also want access to approachable, available, friendly and well-informed school counsellors:

• Students suggested if school counsellors were visible around the school this would help. Some want mental health education and introductions to school counsellors to be compulsory for all students.

• Young people identified similar face to face communication methods as important ways to learn more about mental health.

• We heard that there needs to be better provision of information and promotion of health, youth and community services.

• Young people suggested information in the form of booklets, pamphlets and posters about mental health and promoting services be displayed in all areas around the community where young people go including places such as shopping centres, sporting venues, transport hubs and billboard advertisements as well as youth and health services. Community awareness events that educate people and promote support services are also seen as very beneficial. Young people spoke about the positive outcomes in their communities when people were able to connect with each other to tackle a particular issue.

• Young people suggested that a plastic card would be useful for young people with numbers of support services. Students could keep this in their wallet and feel that a plastic card (rather than paper) would make them feel like people care more.

We heard that in addition to direct communication, young people want to be able to access information across a range of social and digital media platforms such as Instagram, Facebook, Snapchat, YouTube and Spotify, cinema advertising and Google Ads:

• All of these could be utilised to improve knowledge and understanding about mental health and to promote support services.



Appendix 1: About youth suicide

Youth suicide: The facts

Youth suicide remains the leading cause of death amongst young people aged 15 and 24. In 2015, suicide accounted for a third of all deaths in this age group.

Although the youth suicide rate has been measured by many organisations, Orygen offers a succinct summary of the situation:

“ In 2015 more young people aged 15-24 years died by suicide than any other means (including transport accidents and accidental poisonings). Over the past 10 years, rather than making in-roads into reducing the number of young lives lost to suicide in Australia, there have instead been small but gradual increases in suicide rates. Twice as many young women aged 15-19 years died by suicide in 2015 than in 2005 and rates have also increased among young people under the age of 14 years.”1

1 Orygen. 2016. Raising the Bar for Youth Suicide Prevention. P 7. Online at https://www.orygen.org.au/Policy-Advocacy/Policy-Reports/Raising-the-bar-for-youth-suicide-prevention/orygen-Suicide-Prevention-Policy-Report.aspx?ext=. Accessed 11/7/2019.

18Consultation paper – Young people’s perspectives Appendix

Despite some fluctuations, overall suicide rates in Australia have remained generally stable over the past decade2. However, there has also been a slow but steady increase in suicide rates for young people. Whilst rare, there also has been increased suicide rates for children under 14.

It is difficult to research or estimate the overall rate of attempted suicide, or rates of suicidal ideation amongst young people because those people attempting, or thinking about, suicide may not come into contact with a medical or other formal organisation. However, in the recent Australian Child and Adolescent Health and Wellbeing Survey3, 7.5 per cent of 12-17 year olds in 2014 reported having considered suicide in the past year and 2.4 per cent had made an attempt. Among young people aged 16-24 years, the 2007 National Mental Health and Wellbeing Survey4 reported 5.1 per cent of young females and around 1.5 per cent of young males had suicidal thoughts, plans or attempts.

At-risk populationsThere are a number of population groups among young people that are at a higher rate of experiencing suicidality or performing suicidal acts. The groups include young men; young men complete suicide at about 3 times the rate of young women. Young people with experiences of mental health issues are at a higher rate, as are young people who identify as LGBTIQ+, young people who recently came into contact with the justice system, young people living in rural and remote areas, young people in contact with or having recently left statutory care and young people who have been exposed to suicide or suicide-related behaviour. Aboriginal young people are at a particular risk and are mentioned further below.

Factors affecting suicide attempts among young peopleThere are a range of factors that may be at play in the suicide or attempted suicide of a young person5. These factors are divided into individual factors, family factors, community factors and other environmental and social factors.

Individual factors affecting suicidality among young people prominently include a personal history of

childhood physical or sexual abuse. The first onset/presence of mental health issues can be another factor. Drug and alcohol use may also be a factor in developing suicidality, as may criminality and developmental changes during adolescence.

Family factors affecting suicidality among young people include family dysfunction generally. Parental discord, separation or divorce may influence a young person towards suicidality. A history of suicidality in the family may also pre-dispose a young person to suicidality.

Community factors affecting suicidality among young people revolve around community breakdown and the lack of community support. The phenomenon of ‘suicide clusters’ has also been observed, where the suicide of one person in a community group such as a school or youth group commits suicide and this encourages other young people in the group who are predisposed towards suicidality to complete the suicidal act. Media influences, such as graphic coverage of other suicides, may also influence young people towards suicidality.

Finally there are a number of environmental and social factors that impact upon suicidality in young people. These include poor educational outcomes and dysfunctional relationships at and with school. Social and economic disadvantage can also act to predispose young people to suicidality. Communities experiencing economic change and uncertainties through unemployment, loss of local industry, housing affordability and high costs of education and training may all contribute to suicide among young people. This may be especially strong in rural and remote communities. It has also been observed that rapid social, economic and technological changes more generally may create stressors that may influence a young person to suicidality.

Generally a combination of these factors will influence a young person to suicidal ideation or action:

“ The account that emerges suggests that suicidal behaviours in young people are frequently, although not invariably, the end-point of adverse life sequences in which multiple risk factors combine to encourage the development of suicidal behaviours.” 6

2 World Health Organisation. 2017. Suicide statistics for Australia. Online at https://www.who.int/mental_health/suicide-prevention/country-profiles/AUS.pdf?ua=1. Accessed 11/7/2019

3 Lawrence, D., Johnson, S. & Hafekost, J. 2015. The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra: Department of Health. Online at https://www.orygen.org.au/Policy-Advocacy/Policy-Reports/Raising-the-bar-for-youth-suicide-prevention/orygen-Suicide-Prevention-Policy-Report.aspx?ext=. Accessed 11/7/2019

4 Slade, t., Johnston, A., Tteeson, M., Whiteford, H., Burgess, P., Pirkis, J. & Saw, S. 2009. The Mental Health of Australians 2: Report on the 2007 National Survey of Mental Health and Wellbeing. Canberra: Department of Health and Ageing. Online at https://www.health.gov.au/internet/main/publishing.nsf/Content/A24556C814804A99CA257BF0001CAC45/$File/mhaust2.pdf. Accessed 11/7/2019

5 Beautrais, A.L., 2000. Risk factors for suicide and attempted suicide among young people. Australian & New Zealand Journal of Psychiatry, 34(3), pp.420-436.6 Ibid. P 429


Appendix

https://www.who.int/mental_health/suicide-prevention/country-profiles/AUS.pdf?ua=1.%20Accessed%2011/7/2019

https://www.who.int/mental_health/suicide-prevention/country-profiles/AUS.pdf?ua=1.%20Accessed%2011/7/2019

https://www.orygen.org.au/Policy/Policy-Reports/Raising-the-bar-for-youth-suicide-prevention/orygen-Suicide-Prevention-Policy-Report?ext=.%20Accessed%2011/7/2019

https://www.orygen.org.au/Policy/Policy-Reports/Raising-the-bar-for-youth-suicide-prevention/orygen-Suicide-Prevention-Policy-Report?ext=.%20Accessed%2011/7/2019

https://www1.health.gov.au/internet/main/publishing.nsf/Content/A24556C814804A99CA257BF0001CAC45/$File/mhaust2.pdf

https://www1.health.gov.au/internet/main/publishing.nsf/Content/A24556C814804A99CA257BF0001CAC45/$File/mhaust2.pdf

Aboriginal young people and suicideIt is an unfortunate fact that young Aboriginal people in Australia complete suicide at a significantly higher level than non-Aboriginal people. The statistics are stark:

Suicide deaths of Aboriginal and Torres Strait Islander children and young people7

For the purposes of the following analysis, children and young people are defined as those aged between 5 and 17 years of age.

• In 2017, suicide remained the leading cause of death for both Aboriginal and Torres Strait Islander and non-indigenous children and young people, accounting for 40% of all Indigenous child deaths.

• Those aged 15-17 contributed to 94.4% of all suicide deaths in young Indigenous people.

• When considering gender differences, 91.6% of Indigenous male youth suicides were aged 15-17. There were no female Aboriginal and Torres Strait Islander suicide deaths under the age of 15 in 2017.

• The age-specific death rate for Aboriginal and Torres Strait Islander children and young people was 10.1 deaths per 100,000 persons, compared to 2.0 per 100,000 for non-Indigenous persons.

There may be a number of reasons for higher suicide rates among young Aboriginal people. These include direct, secondary and generational trauma, experience with the criminal justice system, family disintegration, low socio-economic status and unemployment, effects of poor literacy, exposure to violence, increased levels of mental illness, alcohol and drug use and co-occuring mental illness and substance use. Community factors may also play some role, with community distress leading to a lack of sense of purpose, role models, and a general loss of communal support for young people at risk of suicidality.

Age-specific rates for intentional self-harm, by Indigenous status, 2013-2017 (a)(b)(c)(d)

10

15–24 25–34 35–44

Age Group (years)

45–54 55–64 65–74 75+

20

30

40

50

60

0

Aboriginal and Torres Strait Islander Non-Indigenous

7 Australian Bureau of Statistics. 2018. Intentional self-harm in Aboriginal and Torres Strait Islander People. Online at https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2017~Main%20Features~Intentional%20self-harm%20in%20Aboriginal%20and%20Torres%20Strait%20Islander%20people~10. Accessed 11/7/2019.


https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2017~Main%20Features~Intentional%20self-harm%20in%20Aboriginal%20and%20Torres%20Strait%20Islander%20people~10



Appendix 2: The consulation process

The consultation method was undertaken in two parts.

Part A was a focused consultation group with young people (10 university-aged students) held at the University of Wollongong in March 2018.

Part B were parallel consultations led by the NSW Advocate for Children and Young People (ACYP) during April to June 2018. In May 2018, ACYP met with 342 primary and high-school students from schools in Broken Hill, Kirrawee, and Albury to hear their views about what is and is not working well in their areas in relation to mental health and wellbeing in schools and local support services. These consultations were tailored to the unique needs of younger people and focused on how children and young people viewed their own mental health and wellbeing.

Part B also includes findings from consultations held with students from the Gosford area during November 2017 (requested by the NSW Department of Education and Training) that addressed similar issues and the views of young people who attended the NSW Youth Week Forum in April 2018.


Appendix

Youth issues and perspectives were also part of the other community consultations undertaken by the Commission this included representatives from primary and secondary schools, TAFEs, headspace centres, Aboriginal controlled health and medical services, local government, local health districts and primary health networks, as well as organisations that provide targeted programs and support for young people including Wesley Mission, PCYC NSW, ACON and One Eighty Avalon participated in forums across NSW. The Commission also heard from many parents and families bereaved by a young person’s suicide.

Part A: NSW Suicide Prevention Framework Consultation – University of WollongongOn 15 March 2018 the Mental Health Commission of NSW held an open consultation with young people living in Wollongong. Ten young people attended the consultation which was held at Kooloobong Village, a student residential facility within the University of Wollongong (the University).

Kooloobong Village houses over 400 students from a range of backgrounds. The accommodation is designed according to the principles of positive psychology and aims to provide an environment for all students to flourish during their studies. In this sense, the consultation was not necessarily representative of the experiences of all young people at university or in similar periods of transition elsewhere in NSW. It does reflect the responses of young people who live in or are familiar with an environment that focuses on mental health and actively tries to support the wellbeing of residents.

Part B: Consultations led by the NSW Advocate for Children and Young PeopleThe Advocate for Children and Young People (ACYP) is an independent statutory office established in 2014 with the mission to make NSW a better place for children and young people. It reports to the NSW Parliament through the Parliamentary Joint Committee on Children and Young People.

The topic of mental health has been raised by young people in previous ACYP consultations, including those undertaken for the NSW Strategic Plan for Children and Young People, as well as consultations covering issues such as bullying, homelessness, violence, and juvenile justice.

MethodologyFocus groups were held in high schools, both public and private, in Gosford, Broken Hill, Kirrawee, and Albury as well as with young people attending the NSW Youth Week Forum. Overall, 341 students took part in these consultations ranging in age from 14-24 years.

• Gosford – 8 focus groups• Broken Hill – 12 focus groups • Southern Sydney (Kirrawee) – 10 focus groups• Albury – 15 focus groups • NSW Youth Week Forum on 12 April 2018 –

75 young people.

Each focus group was conducted using the same format. Young people worked in small groups of between 4-10 students, depending on the class size, to answer the open-ended questions listed below. Students answered the questions one at a time, giving feedback about their answers to the whole group after each response.

1. What is working well in your area in relation to young people’s mental health and wellbeing?

2. What is not working well in your area in relation to young people’s mental health and wellbeing?

3. What would you like more information about?4. How should the information be promoted?

Additionally, young people attending the NSW Youth Week Forum answered the following question provided by the NSW Mental Health Commission: What do you need to support your own mental health and that of your friends?



Appendix

strategic framework for suicide prevention in nsw 2018 ...€¦ · we encourage everyone to have...

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