Closing the Gap targets: key findings and implications

Target

The target associated with Outcome 14 of the 2020 National Agreement is a significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero.

Background

The reasons behind suicide are complex, involving individual circumstances and interaction between several protective and risk factors. The key protective/risk factors associated with suicide among Aboriginal and Torres Strait Islander (First Nations) people can be clustered into 3 main groups; namely, factors that affect connection to:

• body, mind and emotions
• family, kinship and community
• culture and Country.

Poor mental health outcomes and suicide in First Nations communities are also related to collective trauma, disempowerment, the enduring effects of colonisation and being a survivor of the Stolen Generations.

In 2017–2021, 71% of all First Nations deaths by suicide had one or more psychosocial risk factors identified, the most frequently occurring being:

• a personal history of self-harm (25% of suicide deaths)
• problems in relationship with spouse or partner (20%)
• disruption of family by separation and divorce (14%).

The most frequently occurring types of psychosocial risk factors associated with deaths by suicide differed by sex, with just over one-third (34%) of First Nations females having a personal history of self-harm as a risk factor, compared with 21% of First Nations males. First Nations males (13%) were more likely to have problems related to other legal circumstances than First Nations females (4.3%).

Current status

In 2022, there were around 210 deaths by suicide among First Nations people in the 5 jurisdictions for which Indigenous identification in the National Mortality Database is considered adequate – New South Wales, Queensland, Western Australia, South Australia and the Northern Territory.

Since the baseline year of 2018, this target is worsening. In these 5 jurisdictions, the number of suicide deaths among First Nations people increased from 120 in 2012 to around 210 in 2022.

Over the same period, the age-standardised rate of suicide deaths in the 5 jurisdictions increased from 19 to 30 per 100,000 (using populations based on the Australian Bureau of Statistics’ (ABS’s) 2016 Census of Population and Housing [Census]).

In 2018–2022, the rate of suicide among First Nations males was higher than that for First Nations females in all age groups, except ages 5–17.

The rate of suicide among First Nations people in 2018–2022 ranged from 7 per 100,000 for those aged 5–17 to 52 per 100,000 for those aged 35–44, and 20 per 100,000 for those aged 45 and over.

Key findings

Multivariate analyses showed that, controlling for other factors, the risk of dying by suicide for First Nations people were statistically significantly:

• higher for males than females
• higher for those aged 25–34 than for those aged 15–24
• higher for those in need of assistance than for those with no need
• lower for those in the highest income quintile than for those in the middle quintile.

Analysis modelling psychological distress as a measure of social and emotional wellbeing showed that the odds of having high or very high psychological distress for First Nations people were statistically significantly higher for people:

• with a long-term non-mental health condition
• with severe or profound disability
• using substances
• who went days without money for necessities
• not in the labour force
• who experienced domestic/family violence
• who were removed from family
• who experienced threatened non-domestic/family face-to-face violence
• who experienced unfair treatment because they are Indigenous
• who avoided events because of unfair treatment because they are Indigenous
• who were not proud to be Indigenous
• who were female.

Strategies for improvement

While some factors identified in our analysis are non-modifiable, such as sex, age and living in remote areas, they can help determine who may be at increased risk and so improve responses and support services for those who need them.

Other factors, such as economic wellbeing, labour force participation, alcohol and substance use, and the experience of unfair treatment and violence are modifiable and can be countered through social policy and programs. These can include:

• dealing with community challenges, poverty, and social determinants of health
• building identity, social and emotional wellbeing, and healing
• reducing alcohol /drug use
• continuing care/assertive outreach post emergency department after a suicide attempt/mental health support.

The policy responses to social and emotional wellbeing and suicide prevention need to be multidimensional and involve a wide range of stakeholders, including services outside the health sector, such as housing, education, employment, recreation, child protection and family services, crime prevention and justice.

Approaches to suicide prevention should be led by First Nations people and include healing activities.

For suicide prevention, it is also important to improve access to mental health services, increase community awareness and provide culturally appropriate training.

The barriers to First Nations people’s accessing mental health services may be that services are inaccessible for financial or geographical reasons, or there may be a reluctance to use services because they are not perceived as culturally safe environments.

Developing general population services that are trauma informed and culturally safe, and expanding Aboriginal Community Controlled Health Services to provide mental health services to First Nations people are critical to improving access to mental health services.

It is also important that crisis support services are available 24 hours a day, 7 days a week for people who are at risk of suicide.

As well as support within prisons aimed at reducing suicide/self-harm risk, there should be post-release mentoring and justice reinvestment where the money that would have been spent on imprisonment is reinvested into services that counter the underlying causes of crime, including mental health, and alcohol and other drug services.

Another important part of suicide prevention is cultural continuity or community control. The evidence suggests that there are no suicides among young First Nations people in communities with all the ‘cultural continuity factors’, while those communities with none of these factors had the highest suicide rates.

Some examples of success factors and related programs are:

• the National Empowerment Project: a First Nations-led community empowerment responding to community challenges, poverty, social determinants of health
• appropriate and continuing care once people leave an emergency department, and for those at risk in the community at any one time: this is one of the strategies in the ‘systems approach’ to suicide prevention that underpins the Primary Health Network guidelines for the planning and commissioning of suicide prevention activity across Australia.