Suicide prevention & mental health research

[0:00:47]  A: Thank you. Thank you, guys. It's great to be here. I am well, I'm really excited about this conversation. So every mind is the National Institute. We are based out of Newcastle, about 2 hours north of Sydney on a wobblykle land, beautiful coastline, and our work focuses on the prevention of mental ill health, health and suicide. So we're not a clinical service. What we want to do is work with organizations, governments and communities to really focus on how we prevent the negative outcomes of both mental ill health and suicide.

[0:01:47]  A: It's a really great question and you are absolutely right. So more than half of all Australians, most of us, when we feel really anxious, when we feel worried, when we start to think about suicide, most of us don't actually seek formal treatment. Or if we do want to, we can't actually find it at the moment. Which means most people aren't getting the help that they want. And therefore most of the support they receive is likely to come from those around them, from their family and friends.

[0:02:16]  A: That could be your wife, your husband, your mother, your colleague down the road, a mate that you play footy with. And you know what? These family and friends really are the silent workforce in our community. We really couldn't get by without them. There were some recent estimates looking at informal carers or people that provide that informal support in Australia, and there's an estimation that they provide 208,000,000 hours of care nationally across Australia, and that would cost governments more than $13 billion to replace the care that we provide.

[0:03:21]  A: Yeah, you're absolutely right. Most parents, though, do tell us that being a carer, and by a carer, I mean that support person, most family and friends tell us that doing that is really satisfying. But almost everyone does acknowledge that being a caregiver can be really hard. Even on those really good days that bring joy and fulfillment, it can be quite tough. It requires a lot of dedication, a lot of determination and certainly a lot of time.

[0:03:48]  A: And I suppose for caregivers, they can often feel overwhelmed. They can feel worried or unsure of what they should say or even do to support the person in their life. They may not understand what's going on for them and they may not know how to respond. And that's especially true when you're supporting someone who's attempted suicide. The range of emotions that families and friends feel when someone in their life attempts suicide is really strong. So it can include things like even being angry at the person, feeling guilty, feeling a sense of anxiety and worry, not knowing what the future is going to be like.

[0:04:26]  A: You can feel powerless and you can feel hopeless, which can make it really hard to then know what to say and do. The research also tells us that the caring role can also cause strain for the carer. So it's not only about how you respond to the person in your life, it can be the impact that has on you. So we know that Australian carers are twice as likely to have lower well being compared to other Australians.

[0:04:55]  A: And this really gets higher when you have more complex or time consuming caring responsibility. We know that most carers have moderate to high levels of psychological distress so they're more likely to be feeling anxious and depressed themselves. We know that they're more likely to have poor physical health, they're more likely to feel lonely and they're more likely to experience financial distress.

[0:05:22]  A: And that can come from not being able to work as much as they would like, not being able to pay bills, going without meals all due to the caring responsibilities that they have. So the outcomes for carers can be quite wide ranging. Carers really want to focus when they talk to us on the positives of the things that are going right. It's really important that we support our carers as much as we support those in distress.

[0:06:06]  A: So when we're looking at suicide particularly, it's really complex behavior and it's going to be influenced by a range of really many different factors. Some factors that have been shown to increase the risk of suicide include a previous suicide attempt, a history of mental illness or self harm what psychologists refer to as adverse childhood experiences. So they're the sorts of things that may have gone or been difficult in childhood or even been exposed to the suicide of another person.

[0:06:38]  A: But it's really, really important to remember that none of these factors alone are going to explain suicide or suicide attempts. It's a really personal and complex set of behaviors we're talking about and we really don't know why or how people move from thinking about suicide into actually attempting suicide. We do know that there are some warning signs and tipping points that you might start to notice in people that could include them feeling hopeless, withdrawing from their family and friends, maybe using drugs or alcohol more than you would expect them to.

[0:07:13]  A: Other tipping points can be relationship breakdown or maybe physical illness or disability or even hearing about suicide in the media. So there's a range of factors, none of which you can put your finger on, though, and say that was the cause. It's much more complex than that. Yeah, there are certain groups that we call priority populations, as you said. And these groups are disproportionately impacted by suicide.

[0:08:01]  A: So not so much predisposed, but they may have a set of circumstances around them which can increase that risk level. And we're talking of groups like Men, Aboriginal and Torres Strait Islander communities, LGBTIQA plus communities, culturally and linguistically diverse communities, young people and veterans. And you can see from that list that these populations are really diverse, aren't they? And so the reasons that they're disproportionately impacted are going to be really varied as well.

[0:08:37]  A: I think it's really important to remember that being part of any of these communities doesn't actually increase your risk of suicide per se, but at a population level, these groups might experience greater rates of discrimination. They might have more barriers accessing health care, they might be more socially excluded and isolated. And it's those sort of factors which really can come into play. You're absolutely right. There's quite a few myths around suicide out there that we absolutely want to be able to challenge.

[0:09:43]  A: And the myths about suicide sometimes make it difficult for people to recognize when someone is at risk or when people may need support. And these sorts of misinformation are going to increase stigma. They're going to increase shame and guilt experienced by people who are thinking about or have attempted suicide. So it's really, really important that we break them down. So let me give you maybe two really key examples of myth that we give.

[0:10:11]  A: The first one, and is a really common myth, is a belief that everyone who engages in suicidal behavior has a mental illness. And that's just not true. Thoughts of suicide can happen to anyone, including those who have no history of mental illness. And people with a living and lived experience of suicide will tell you very loudly and very clearly that they want to be understood for the experience they're having.

[0:10:39]  A: And they don't want people to presume that if you do experience suicidal distress and that means that you're mentally ill, it's not the case. The second myth that we often hear people talk about is that they have a belief that if you ask someone if they're suicidal, then that actually puts the idea of suicide in their heads. Experts generally agree that asking about suicide won't make people suicidal, it won't make the situation worse.

[0:11:09]  A: And ultimately we think it's the opposite, that only really knowing if a person is thinking about suicide. The best way to know that is to ask them to be able to reach out and say, are you okay? Are you thinking about suicide? I'm really concerned about you, is more likely to evoke a conversation that can lead to help and support than to the person actually acting on any thoughts they may be having.

[0:12:06]  A: Yeah, I think there's been a real move in our communities over recent years, and there's a lot of great organizations out there doing work to encourage us to ask the conversation so we all know about are you okay, Dave? And actually reaching out and being able to say, can I just check whether you're feeling okay? Are you okay? And organizations like that and many others encourage us to start the conversation and also provide resources and information about how to take those next steps.

[0:12:39]  A: I agree. I think they're hard conversations to have. But I think fear gets in the way of actually us reaching out and wanting to check in on someone. And ultimately that fear can mean that we don't actually provide the support that we want to be able to do. So I encourage anyone listening to reach out to someone if you're concerned about them, check in on them, ask them if they're okay, ask them whether there's anything you can do to support them or anyone else if that's not you.

[0:13:12]  A: And if you're really concerned about them having the courage to say is suicide something you're thinking about? Because if it isn't, people will go, hell no, not even going there. If it is, people will go, yeah, actually, that is something that's in my mind. And the door then is open to a conversation. Much better to ask than to worry. So at every mine, we're really focused on how we provide support to family and friends. We recognize that because not all Australians go out and seek that support themselves, we want to be able to support those people in the environment around them. And we have a suite of programs called Minds Together, and these are both face to face and online programs for partners, spouses, family members, friends, colleagues who provide that support to someone who's feeling worried, saddled, suicidal.

[0:14:21]  A: And the program really provides practical ways of dealing with the challenges of caring for someone in distress for yourself and for other people in your life that you might be looking after, because you might have someone who's in distress, that you might be supporting your children or your elderly parents at the same time. So the program covers things like managing increased responsibilities, strategies for sharing the load, healthy coping strategies, ways to strengthen communication and relationships, and how to maintain hope for the future regardless of where the person in your life is.

[0:14:56]  A: And I think the reason we want to do this is that the biggest barrier to providing support to family and friends is actually reaching them. As I said earlier, most people don't see themselves as a caregiver. It's the relationship we have with someone that's really important. And we often find ourselves in these relationships or these caregiving roles inadvertently and not something that we actually plan to do.

[0:15:22]  A: Which means that it can be really hard to know what to say, what to do, how to respond. And seeking support is something we want to do. Literally anyone can be a carer, and we want people to know that if you are supporting someone, there's support out there. Rosalind Carter, who's a former first lady in the US. Famously said there's only four kinds of people in the world those who have been caregivers, those who are caregivers, those who will be caregivers, or those who need caregivers.

[0:15:53]  A: So supporting family and friends, this touches on every single one of our lives. And our goal is to really be able to support those people doing what they want to do. Yeah, absolutely. The reason we're focused on paramedics is there's 21,000 of them in Australia, and they are typically ranked as the most trusted profession across our nation. But these are the guys and women who face high stress exposure to trauma, long shift hours, and they have really low rates of help seeking for their mental health.

[0:16:46]  A: They're nearly twice as likely as the general population to experience anxiety, depression, to experience trauma, PTSD and even suicidal behavior, which means that they come home wearing all of the impact of their work. And the people around them really notice that most we spend a lot of time talking to paramedics and they often say to me, sally, when I go to work, I wear my Superman uniform. That uniform is meant to not allow anything to get through and I need that to be able to cope with what I do on a daily basis, job by job, not knowing what's coming up.

[0:17:22]  A: But what they do is they take off that uniform and they also don't want to be able to impact the people at home, so they keep it all to themselves. That uniform holds all of the stuff that they do at work as well as all their personal responses to the consequences of that work. But none of us get to keep all of that inside. It's going to leak. And I think the difficulty for family and friends of paramedics is that the paramedic doesn't often want to open up and you don't know how to support them, you don't know what to say, you don't know how to encourage them to be able to look after themselves and to be able to take the steps they need. So this program really is helping family and friends do that.

[0:18:01]  A: The response has been really positive. Paramedics think it's a great idea when their family and friends do so too. Yeah, look, I think caring is certainly in the DNA of all of those first responders and there's a real similarity in that across first responders. But I also think that they're very conscious that they get to see the worst of the worst and they don't want to create further impact by necessarily hurting the people around them by they perceive talking about it or wearing those consequences at home.

[0:19:07]  A: And the message I have for paramedics is, it's okay not to be okay. There's things you can do to support yourself. And the message I have for family and friends is there's some things that you can do to support the paramedic in your life or the first responder that's also going to help them. So if the person you support or even yourself is at immediate risk, then you need to call triple a very first thing that you do.

[0:19:37]  A: But there's also a range of support lines that you can call for advice or help. Lifeline is probably the one that we know the most and their number is one, three, double one, one, four. And there's a whole range of other support lines and you can find them on our Minds Together page on our website. I really want people to understand that there is support available for the person you support as well as for yourself.

[0:20:03]  A: And the first step really is trying to understand what's happening. Having that conversation that we talked about directly with the person, asking if they're okay, asking them what they need and what they'd like from you, or maybe it's not you asking them what they would like from someone else. Sometimes we can't provide all the support ourselves and it's better to have multiple people providing that support.

[0:20:26]  A: If you're concerned as a family or friends, get some advice, talk to another family member, talk to your GP, talk to a helpline. I think one of the other things that's really important for carers to know is that they need to look after themselves. Just like paramedics or first responders may not want to seek help, caregivers are renowned for not wanting to seek help because we often don't even realize we're in that role in the first place.

[0:20:53]  A: But all carers say to us that if you don't have the capacity to support the person in your life, you're not going to be able to do that. You need to be able to support yourself as well. Great. So there's a whole lot of resources out there. Two that I'm going to give your listeners are in Australia. The carersgateway is really helpful. So www dot carersgateway gov au has a whole range of resources and information for caregivers generally and then our Minds Together program specifically to be able to build the capability and capacity of family and friends to support someone.

[0:21:37]  A: Go to our website, mindstogether.org au and you can register for one of our programs there that we often find that we are supporting someone in a way that is over and above the relationship that we would expect to have with that person. And it's okay not to know what to do, what to say, how to respond. But there are resources there to support and help you reach out because that will not only support the person in your life, it will help you as well.

[0:22:52]  A: My pleasure. Thank you for having me.