By Richard Woolveridge
The Silent Generation, Baby Boomers, Gen X, Y, Z, and Millennials, all have one generation in common. Generation Copeless.
Cope less, then hope less. For too many in every generation, that can be fatal.
In 2017, 3128 people died by suicide, a 9 per cent rise over 2016, figures from the Australian Bureau of Statistics show.
It’s time to try a different approach to suicide prevention, says clinical psychologist Dr Helen Stallman, a research fellow at the Basil Hetzel Institute at the Queen Elizabeth Hospital in Adelaide and senior lecturer at the University of South Australia specialising in health and well-being. It is called Care, Collaborate, Connect.
“I am talking about a paradigm shift in how we go about preventative work. Instead of risk planning, which is what has been done for decades and is not evidence based, we use coping planning. Suicide arises from a deficit in coping skills. When you have no other skills available, you start to wonder if you should be here.”
She says the existing risk management approach is based on relationships between data at a population level.
“In much the same way insurance companies calculate how likely you are to have an accident based on a few variables, such as age, sex, car colour and make rather than how good a driver you are, risk assessment practitioners ask a series of questions and then decide the probability of you dying by suicide. They then decide how to 'manage' you.
“Care, Collaborate, Connect on the other hand focuses on why someone shared that they had suicidal thoughts to get help to cope. It prevents suicide by supporting people to get their needs met.”
She teaches this approach to health professionals and students, and has devised a schools program to train students, staff and parents. The program focuses on health and wellbeing rather than mental ill health such as anxiety and depression. It does not medicalise unpleasant emotions but rather promotes healthy ways of coping with them and bouncing back.
“All emotions are normal, not just happiness, so Care, Collaborate, Connect is about noticing and connecting with people around you rather than waiting until you think they have a mental illness before you ask how they are.
“The point is de-stigmatising any negative feelings, then working on healthy ways to cope.”
Coping planning has been shown to reduce psychological distress and improve wellbeing, she says, citing two clinical trials she conducted, plus a study of women undergoing IVF who used the strategy.
“Every country is just doing risk assessment for suicide and focusing on what happens just before suicide and just after and we need to try something different or it will continue to worsen.
“We’ve raised a generation of children who have too little sleep, poor nutrition, poor physical activity, poor coping skills and through digital devices are more disconnected with physical relationships with people.
“We have to turn that around. We can’t just treat everything as mental illness because we don’t have the resources to create healthy environments. We have to work on prevention.”
Aids such as the My Coping Plan app show how to avoid resorting to unhealthy strategies such as over-eating, alcohol, self-harm, or suicidal thoughts.
Suicide Prevention Australia’s chief executive Nieves Murray says: “Safety planning is still vital to effective suicide prevention, but ‘coping planning’ is increasingly being incorporated into systematic evidence-based suicide prevention programs, services and trials.”
She says it is important to be guided by the evidence and experience of people with lived experience of suicide.
“Suicide prevention should be approached with an ‘and’ not an ‘or’. Achieving a meaningful reduction in Australia’s suicide rate will require effective interventions early, in building resilience and protective factors, and during and after times of crisis.”
Former Australian of the Year and mental health advocate Professor Patrick McGorry believes most of those who die by suicide have sought help but haven’t been able to access it or it hasn’t been of the right quality.
He says different types of intervention are needed, including less professional approaches such as Beyond Blue’s Way Back Support Service. This community volunteer program is being trialled in Newcastle, NSW, to give non-clinical support for three months after someone has attempted suicide and been discharged from the emergency department.
“There’s not a proper organised national response. If this was occurring as a physical illness at the rate it’s occurring there would be a much more serious response,” he says.
“The coping idea is a pretty basic idea and I would have thought it was already part of mainstream thinking in psychology and psychiatry but it may not be being practised … I think we need new ideas and a revival of old ideas, but you have to have evidence it works, so some research is needed.”
R U OK? was set up to encourage informal intervention by asking questions long before a crisis develops. CEO Brendan Maher believes Dr Stallman’s focus on strengthening resilience and coping planning seems credible, but not at the cost of primary prevention activity.
“R U OK?, through initiatives like Lifespan and #youcantalk is part of a future being shaped with stronger collaboration in suicide prevention, less duplication and a much greater focus on evidence-based suicide prevention strategies,” he says.
Roses in the Ocean founder and chief executive Bronwen Edwards, whose 43-year-old brother Mark, a former RAAF fighter pilot combat instructor, took his life in 2008, says: “Suicide has been treated with a medicalised model, a very clinical model, and that’s not what people are needing or asking for in every instance.
“It’s not one or the other, because there are definitely cases where people need clinical intervention. But there are a lot who don’t and who need alternative ways to get care and support than those currently available.
“What’s exciting is that those alternatives are very much on the agenda. They’re starting to pop up but they are not widespread.”
She cites NSW’s recently released Strategic Framework for Suicide Prevention 2018-23 , which includes investment in non-clinical after-care services, and Victoria’s Safe Haven cafe, modelled on a British idea. There is also Black Dog’s Lifespan trial, which has been running in NSW for three years and evaluates nine evidence-based prevention strategies.
Edwards says suicide prevention is a complex area because every case is different.
“Having said that, there are many people who have said ‘if someone had noticed and asked me if I was suicidal, that would have been enough to open me up to talk’ and ‘if someone hadn’t have sat down with me and had a big chat I was going to end my life that night’.
“Having people around you who might recognise you are going through some really tough stuff and who have the capacity and confidence to have a conversation that’s difficult to have – those things can save lives.”
Her colleague Katherine Poulton is someone who has lived experience of suicide, but only spoke to others years later after hearing someone bereaved by suicide speak of living their life after losing a loved one.
“I’m so glad I didn’t do that to my family. I don’t really know what stopped me. I think it was a moment in time and I was very lucky because now I am thankful for every day that I didn’t take my own life.
“Having suicidal ideation, it’s just regular people, everyday folk who find life just really hard and get to a point of thinking they’re not doing anyone any good, so I think Dr Stallman’s premise of talking about it from a non-clinical perspective is great, which is why I am glad to be part of the lived experience movement.”
Poulton cites going to a lunch recently with friends she hadn’t seen for a long time. When they asked what she was doing and she told them she was working for Roses in the Ocean “it was immediately ‘oh yeah!’ and they were telling me about people they knew with a lived experience.
“Once you start talking about it it’s not so daunting. It’s cathartic.”
The Care · Collaborate · Connect suicide prevention principles
- Suicide results from inadequate coping skills to reduce distress and is caused by problems in one or more domains of health and wellbeing—healthy environments, responsive parenting, sense of belonging, healthy behaviours, coping, resilience, and treatment of illness.
- Suicide prevention involves the whole community—individuals, families, communities, schools, workplaces, and government and non-government service providers.
- Investing in the seven components of health and wellbeing is critical to suicidal prevention.
- Appropriate support and treatment should be provided to everyone who asks for help.
- Suicide prevention activities should be evidence-based to improve problems with health and wellbeing that lead to suicide.
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