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The grim reality is that the suicide toll is climbing

There is a humanitarian crisis in this affluent nation – a catastrophic systematic crisis – taking more than five per cent of Aboriginal and Torres Strait Islander deaths – suicide

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08 December 2016

The suicide prevention space is still raw and immature. There is a lot of work to be achieved in understanding the extensiveness of the space and its multifactorial issues. There is quite a bit of ground to travel in order to unveil the various ways forward. It's a space vulnerable to exploiters, carpetbaggers and snake oil merchants. To protect the space we need to explore the space, every bit of it. There are various traumas and contexts that remain effectively unexplored but which lead to suicide. There is much that we know works, much that works which is not applied and much that remains unexplored and as a result the suicide prevention space is an inauthentic one polluted with far too many with little idea of what they are doing and who are overinvolved or dangerously leading sections or layers of this life and death space. Far too many are in the space with limited knowledge and hence do more damage than good, indeed perpetuate trauma, compounding trauma.

Many have jumped into the space out of well-meaning or from tragic lived experiences to in at least be the shoulder that those with suicide related traumas rest on. Despite the great good, the solace that some provide, many fuel the anger, displace anger and hence traumas escalate. Then there are the specialist practitioners – some who consider themselves 'suicidologists' – and who argue their particular prevention, intervention or postvention program, therapy and counselling as the be-all end-all when in fact the issues and traumas culminating in suicide are various, different, multifactorial (even if many are intertwining). There are also the researchers, many driven by a profit-motive – funding – and accolades, many who are surface-level researchers and remain doggedly in the generalised instead of serious disaggregation not just demographically but more importantly to various contexts and therefore to elevated risk groups. Far too many are setting up in the suicide prevention space prematurely to tap into opportunity to scratch out a quid but at what price? Soaked in the blood of others? Soaked in the grief of those mourning? The space does need many more people, and interconnectivity, and the space does need the mavericks who will crash through the corrals of ignorance but what this life and death space does not need is snake oil merchants and carpetbaggers or if I can put this more civilly, the space should vet people ill- and uninformed. Many are speaking out as 'experts' without ever having studied or experienced in person the various traumas that lead to suicide and the anguish of the suicide related trauma of affected families. Some have soaked up a little knowledge and are running wild as workshop facilitators in prevention, intervention and postvention. Of concern are the carpetbaggers, not just the ones at the coalface extracting a pricey quid at the coalface but also those who should know better, the 'highly' titled up educated classes who scrummage government and philanthropic funding. This funding should be dedicated to those authentic within the suicide prevention space.

Without data disaggregation we make invisible the elevated risk groups and we leave unidentified the specific risk factors. When we leave behind people, we are discriminating. We must leave no-one behind.

Australia-wide, suicide takes more lives than all violence, including domestic homicides and military deaths and the road toll combined. The suicide toll should be the nation's most pressing issue, the issue of our time but alas it has not translated as national priority. I am deeply immersed in the suicide prevention space, as a researcher (on its extensiveness, the elevated risk groups and the ways forward), and daily absorb the grief and loss of the suicide-related-trauma of affected families.

There is a humanitarian crisis in this affluent nation – a catastrophic systematic crisis – taking more than five per cent of Aboriginal and Torres Strait Islander deaths – suicide. It's a staggering, harrowing statistic. In fact it's even higher. In my estimations, because of under-reporting issues, suicide is at 10 per cent of deaths. The contributing factors are many and intertwined, however, they are underwritten by acute poverty, disadvantage and marginalisation the likes that should make no sense in one of the world's wealthiest nations. But they are not limited to socioeconomic factors alone – from within the cesspool of this situational trauma, this narrative of victimhood, there has manifest a constancy of traumas – multiple, composite and aggressive complex traumas. They need to be addressed in addition to the socioeconomic disadvantages.

Friend and well-known former journalist, Jeff McMullen recently emailed, "The losses are staggering and yet the election campaign continues to focus largely on the material comfort of people who are among the most comfortable in the world. Does your calculation of five per cent of the Indigenous population dying through suicide engage politicians when you tell them this?"

"I find the numbers so catastrophic that it is hard to believe a nation can be so numb to this."

That the nation has not engaged with the tragedy of suicide has contributed to the carpetbaggers exploiting the suicide prevention space. When the nation seriously engages with the suicide crises, the suicide prevention space will benefit – the nation's engagement will be a protective factor, a contributing factor to developing authenticity.

We need more than just generalised counselling but this last resort is the first resort. Resilience selling is part of this generalised counselling where we beg the victim to adjust their behaviours – but how far and for how long without hope on the horizon? Self-destructive behaviours that can culminate in suicidal behaviours, and distress families and communities are a leading cause of familial breakdowns and of community distresses. Once again, the point is that the factors that can culminate in suicide are the most preventable of the various destructive behaviours that impact on families and communities. These need to be prioritised in national conversations. There are many ways forward. A national inquiry or royal commission into Aboriginal and Torres Strait Islander suicides – and in fact into all suicides – is long overdue. We cannot live in the silences and dangerously internalise this tragedy. I have travelled to hundreds of homeland communities and the people who are losing their loved ones are crying out to be heard, they are screaming. It is a myth and predominately a wider community perception that there is a silence, shame, taboo – it's the listening that is not happening. This humanitarian crisis needs to translate to a national priority. There is no greater legacy than to improve the lot of others, to the point of changing lives and saving lives.

The royal commission should be a must-do. Despite all the good work by many and the saving of lives, the suicide toll, particularly for the most elevated risk groups, is on the increase. Without the deep examination that a royal commission will provide the suicide prevention space will remain inauthentic, hostage to carpetbaggers and the ignorant and the toll will increase and a wilderness of grieving families and communities.

The "memory of wounds" remains but needs to be contextualised with an understanding that meanings dawn from an onus on outstripping negative risk factors with protective factors. But this cannot be achieved with the one stop shop counselling but by identifying the various trauma and identifying the perpetration, the impacts and the subsequent coherent tailor made education will rapidly unfold. It is never enough to deal with the symptoms; the cause must be validated without languishing within it so as to avoid drowning in negatives and misery and instead to move towards the positive self. Identifying trauma in any given population, whether demographical or topical such as LGBTQI, former inmates, foster children, the homeless, the chronically impoverished, newly arrived migrants, culturally and linguistically diverse migrants and Aboriginal and Torres Strait Islanders or from within composites, we start with behavioural observations and proceed with the opportunity for the individual to tell their story. People need people, 24/7. Our capacity to listen is an imperative and must be achieved without judgment for often redemption is needed, forgiveness in addition to sympathy and empathy. These skills do not come easy to everyone but they are vital in the suicide prevention space, in trauma counselling, in restorative therapies, in navigating people to a positive self.

Yesterday, I crossed paths with an individual I had not seen in two and half years. My partner, Jennifer Kaeshagen coordinates proactive programs with volunteers who gather together to 'clean up' public rental houses (social houses) where the Department of Housing has issued eviction notices. In the last two weekends, Jennifer's volunteers have saved three households – 19 individuals (10 children and another soon to be birthed) – from eviction. Yesterday, I turned out as a volunteer to one of these properties. The volunteers included two social workers, an artist, two high school students and a rabbi. One of the volunteers, a gentleman walked up to me, embraced me. I do my bit with an elevated risk group to suicide – the homeless. The last time we met, he had been sitting in a park where many of Perth's homeless congregate. He was on his own, tearful. I put my hand on his shoulder and said something to him that I will continue to keep private. He looked up at me forlorn, in a tumult of unbearable pain but with eyes screaming 'help'. I sat next to him and for a couple of hours I listened. We talked but mostly I listened. In his bag he had rope to hang himself.

We must be careful. Trauma expert, Emeritus Professor Judy Atkinson states, "We must act in a manner that does not re-traumatise those with whom we are working."

Suicidal behaviour is often the culmination of a set of experiences, events and of an underlay of feelings – how one feels about themselves contextually in light of the experiences and events. Self-destructive and suicidal behaviours can increase in a community that experiences trauma collectively – sharing around the trauma and the sense of hopelessness. Where governments continue to fail communities, especially those populated by minorities, with disparity and inequalities in social wealth and health that should have been equivalent to the rest of the nation's social wealth and health, then often it is up to communities to tap into their trusted leaders to look out for one another and educate others to empowerment of the self, to a sense of self and place, and similarly so communally. People need people, especially in these communities that are deprived and discriminated by governments. Many communities have third rate services, while some communities are effectively starved of some of the most basic services. In these discriminated communities, the residents cannot continue to cry out to governments, because it is the very government they cry out to who is their oppressor, who discriminates against them. Often if they cry out loud enough for long enough, the community is meted punitive measures and controls which are more about blaming the community than helping them. With some communities, governments have gone as far as shutting them down. Therefore the social and emotional well-being of the community is with a sense of resignation degraded.

Hopelessness is a strong indicator of heightened vulnerability to self-destructive behaviour. Hopelessness has to do with the culmination of overwhelming feelings or beliefs that the future is bleak. Hopelessness exhausts motivation. Where hopelessness is ingrained as a whole of family experience or whole of community approach, the despair and self-destruction begins from a younger age. "It's our lot". "It's the burden of our people." "Things will never get better."

The sense of hopelessness is chronic and for some becomes unbearable. Losing someone close to you is a devastating experience. Dealing with the distress in the lead up to their loss is a devastating experience. Having to deal with familial distresses, as if recurring, with other family members is destructive – the objects and functions of the family take a toll, a real beating. For some they are psychologically and emotionally battered, and the damage takes an overwhelmingly feeling of the irreparable. Having to deal with ongoing destructive behaviours, with a communal sense of hopelessness, with the overwhelming backdrop of a deprived and discriminated community, is tortuously exhausting and simply heartbreaking. Community distress and breakdowns occur collectively just like a family breakdown – indeed, a whole community can breakdown. Hopelessness and despair can be effected as if normalised.

Suicide prevention must be understood in terms of who it is we are responding to: an individual overwhelmed by expectations, an individual overwhelmed by a sense of failure, an individual overwhelmed by a sense of hopelessness, an individual overwhelmed by trauma, an individual overwhelmed by a sense that their identity is a liability, a family overwhelmed by trauma and grief, a community overwhelmed by most of the above: hopelessness, trauma, discrimination, deprivation, racism – the sense the future is 'bleak' and 'unfair'.In being honest about suicide prevention we must understand the person, family or community we are responding to. We must respond to who they are and therefore to how they should be treated. To act as if everyone in society is equal, as if there is no narrative of victimhood dangerously dismisses the stresses unique to some but not to others. To act as if life should be fair to people living in deprivation and discrimination when life is not fair to people living in deprivation and discrimination is to pass the buck. To quote Professor Taiaiakei Alfred, the 'chattering classes' can carry on all they like about 'reconciliation', and I'll add in, 'closing the gap' on inequalities, but life/society, the products of dominant cultures, of the ruling classes and of their governments, are unfair.

In order to deal with the narrative of those in the now, rather than deal with a body politic, we have to accept that life is shit for far too many and acknowledge their anguish, pain, discrimination and suffering as real and longstanding. Our immediate aim must be to help them to develop and understand resilience and help them with a context of a meaningful life from which they can beat a path away from or around the effects of the unfairness. But to do this we cannot abandon them to the notion of 'resilience' alone and instead must work alongside them patiently together navigating ways forward, to opportunities once they build up a suite of protective factors and have a sense of well-being. We cannot dictate to everyone who is discriminated while they are suffering that we must strive for a 'fair' or 'fairer' world. This will come at the cost of the immediacy of well-being and that of those to follow the example, who need to soak up well-being. Let us work with people first, and worry about changing the world second. To understand people in terms of their discrimination, whether this discrimination is dished out inadvertently or intentionally by governments, and by some of the 'chattering classes', is a step in the right direction. When I say or write that "people need people", I mean this in that we must focus on each other, not pass the buck to blaming someone for their lot. We can see the poor and marginalised are victims and blaming others will not help anyone. We must understand, that racism, and other imposts, are the landscape for many. To pass the buck here by blaming racists for racism, is a waste of time. The end to racism has quite a journey to go. In understanding this rather than denying this by getting angry at the unfairness of the racism, of the discrimination, by saying merely it should not be this way, is a step in the right direction. We should not posit the crap that the answer to someone's suffering is to change the landscape, because in doing so we leave behind the victims. We can do both but the onus must be on those in the here and now. Each person, each family, each community in distress needs our undivided attention – this constitutes the biggest first step in helping those who are victim day in day out to the relentless brutality of discrimination, unfairness and so on.

Suicidal behaviour does not mean that someone wants to die, this is another dangerous myth. Suicidal behaviour is a scream for help. It is a fallacy to presume 'self-responsibility' as a way forward for someone in a dark place. People need people to strengthen their resolve to the ways forward. Suicidal behaviour is destructive behaviour that can lead to impulsive actions such as a suicide attempt.

Access to emotional support can save lives. It may never be realised this was the case but person to person support is a huge factor in the improving and saving of lives. Resilience and empowerment are gradually accumulated, to the point there comes a time that there is no looking back. It is not true that once someone has exhibited suicidal behaviour that they are forever trapped in the heightened vulnerability to recurring suicidal behaviour.

It is true that a powerful indicator to future risk of suicide is a prior suicide attempt however this does not mean that the heightened risk shall be there for life. Indeed, with the coming together of emotional well-being and meaningful contexts, there develops resilience within the individual that can make one stronger than ever before. With the right sort of support, protective factors can guard people against the risk of suicide.

Suicide prevention should not be focused alone on reducing risk factors but just as focused, if not more so, on increasing protective factors. The most powerful protective factors include building a connectedness with other people – they do not need to be about direct and targeted support. This connectedness with other people should include the types of engagements that allow the individual to directly and indirectly draw on information about well-being, about navigating ones journey through society, and therefore predominately focus on self-worth, identity and conflict management.

Most importantly, healthy relationships will contextualise a meaningful life, an honest life, and this in itself is a relief from the conflict and discord that arise from unhealthy levels of expectations. Personal relationships are important, where the support person can understand that they are about support and not about any particular targeted responsibility to the individual. More research needs to be disaggregated on suicidal behaviour and mental disorders, but it appears the majority of suicidal behaviour is not linked to mental disorders and rather to a sense of deep unhappiness. Therefore families and communities can contribute significantly to the improving of the life understandings of a troubled person.

The risk of suicidal behaviour increases when individuals suffer discord – such as relationship conflict or from a sense of loss or from a sense of failure. People need people. Isolation is dangerous. The best support comes from ones closest social circle. Protective factors and profound support comes from the development of ones context of meanings but these too are contributed to by ones social circle. Where whole of communities are at heightened risk of community distress, the greatest success found in reducing the levels of communal distress is when the social circle that is the community comes together to support one another – therefore inherently working on the context of their meanings. Inherently rather than troubled individuals isolated and effectively judged, they are understood and supported. This type of coming together by families, friends and/or communities to a troubled and isolated individual is about well-being. There may have been childhood trauma, interrupted childhood development – a series of emotional instabilities and turmoils that have affected personality traits which have given rise to unhappiness and suicidal risk factors. But good self-esteem and protective well-being factors will come from people coming together with the troubled individual at whatever point in time.

These developmental interruptions, life stresses and unhappiness are not mental disorders that require specialist health practitioner support. Rather this is all about people coming together to secure healthy and positive relationship building, to patiently assist one with their self-esteem, to contextualise the path to positive self-identity and the pathway to positive outlooks. Attitude is imperative but it is something shaped by the individual and by those around the individual. People do listen; they listen to the negative and to the positive. Positive adaptive outcomes must be patiently educated and shaped, and the familial and community support self-evident and generous. Once positive attitudes and positive coping understandings settle in as personality traits, the formerly troubled individual is effectively 'safe'.

There needs to be in society greater onus on shared understandings of contextual meanings of what it takes to shape positive coping strategies in overcoming childhood adversity – abuse, maltreatment, of exposure to domestic violence, of parent mental disorders. There should be less focus and judgement on the fact of any difficult past, it should not be the focal point but if you read newspapers it is the focus. This bent for the past is damaging because it is a trapping. The discourse needs to be focused on the ways forward and in not holding oneself hostage to any past, or in holding any person or any set of events as responsible for any ongoing damage. Positive meanings and positive attitudes will lead to an understanding and forgiveness of the past and that the present and future can be shaped.

Destructive and self-destructive behaviours should be understood as situational and that individual, familial and community attitudes determine the length of these behaviours. Governments investing their attention in helping resource communities for instance to support others is imperative.

Suicide is the leading cause of violent deaths. Self-destructive and suicidal behaviours are responsible for more hospitalisations and for the descent into more social ills than by any other behaviour. Most suicidal behaviours are linked, and usually exclusively, to unhappiness. Therefore suicidal behaviour is preventable. I would argue that suicide and suicidal behaviour are the major health problems society face but of all our major health problems suicidal behaviour is the most preventable. Yet adequate suicide prevention is not prioritised by governments. Where causality is limited to relationship and social factors and to vulnerable individuals' sense or feelings of hopelessness, the descent into a sense of entrapment and the responsive trait of impulsivity, then this behaviour can be addressed by positive mentoring and by work towards a positive self.

Unhappiness is something that can be addressed holistically rather than it being compartmentalised as some sort of mental disorder manifestation and as of a runaway train risk factor to mental disorders. Unhappiness is not genomic and instead is a manifestation. The prevalence of suicide and suicidal behaviour is higher in high and middle income nations as opposed to in low income nations. Similarly, rates of reported depressions and of hospitalisations from self-harm are higher in high and middle income nations. Life stresses that lead to suicidal behaviour in some cultures do not lead to suicidal behaviour in other cultures. Therefore the context of our meanings and our support groups are pivotal.

Racism should never be played down. Racism plays out as a major cesspool of negatives and risk factors to high end levels of unhappiness, depressions and suicidal ideation. Racism goes to the heart of identity, to self-worth and esteem and their historical and contemporary identities become a liability.

Racialised groups within oppressor societies report the world's highest rates of depressions, unhappiness, self-harms, suicidal behaviour and suicide. It is all about identity, whether for a vulnerable child, young adult, cultural group – the answers lay in respecting one another, being there for the other, empowering each other through meanings, relationships, freedoms and attitudinally.

Suicide prevention is about the positive self and any comprehensive response includes everyone. A comprehensive national response for suicide prevention requires understanding the above. Loose understandings will tighten if we begin to understand that the majority of suicidal behaviours are directly linked to trauma and unhappiness – to situational events. Contexts and understandings can be changed before dangerous reliefs from substance abusing are sought or before serious mental disorders set in.

With this article, I have delved here into some of my examinations and the experiential within the suicide prevention space. The major point of this piece is that the suicide prevention space is predominately inauthentic, immature and extremely vulnerable to lousy carpetbaggers and to the ignorant however well-meaning. Simply, they should not exploit a life and death space, they should not scratch out their quid out of this space, they should not soak their hands in blood for ill-gotten gain. On average eight Australians per day suicide, scores more attempt suicide each day, thousands ideate suicide each day and many more grieve, suffer alongside.

* Gerry Georgatos is a suicide prevention and prison reform researcher and advocate with the Institute of Social Justice and Human Rights. He is a member of national projects further developing suicide prevention and prison to hope to well-being to education programs. He is also a prolific writer on the ways forward from racism.

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