Community-based interventions can reduce suicide rates and lessen the suicide-related burden on hospitals, says new research using modelling by the Sax Institute.
Researchers from the Institute led the development of a system dynamics model to test the likely impact of suicide prevention interventions in New South Wales for adults 20 years and older. The interventions were:
- Community-based suicide prevention outreach teams
- Peer-led drop-in facilities as alternatives to hospital emergency departments
- Training for key community members (or “gatekeepers”)
- Post-suicide attempt aftercare support services
- Peer support groups
- Expansion to clinical counselling in rural communities
The research, published in the journal Systems, found that all interventions combined would avert 6.8% of suicides and 6.3% of attempted suicides over five years, which would correspond to avoiding 295 deaths and 9327 suicide attempts in NSW over five years.
The two most effective interventions were outreach teams and peer-led drop-in facilities, preventing 2.8% and 3.3% of suicides respectively.
“Our modelling showed that interventions based in the community, that can offer non-medicalised support and support from people who have lived experience at times of crisis, are most effective,” says lead study author Eileen Goldberg from the Sax Institute.
Suicide is the leading cause of death among Australians aged 15 to 44 years. In 2022, there were 963 suspected or confirmed suicide deaths recorded in NSW. Targeted suicide prevention investments for the state have been made with a goal to reduce suicide rates by 20%.
What reduces suicide in the long-term?
The system dynamics model measured the success of interventions over a five-year period, from 2019 to 2023, and also projected suicide rates up until 2031. The impact of interventions on people who had previously made a suicide attempt was compared to the impact on people who had not.
The researchers found that while short-term reductions in suicide can be achieved by focusing interventions on people at risk of a suicide re-attempt, this will be at the expense of potential longer-term reductions in the rate of suicide in the population that could be achieved by focusing on people experiencing suicidal ideation who have not yet made a suicide attempt.
“After-care support for people who have attempted suicide is really important, but if you want to reduce the rate of suicides over a longer period, say 10 or 20 years, then we need interventions for people before their first attempt,” Eileen says. “Our modelling shows that reaching people in their first year of suicidal ideation with interventions like outreach teams and peer-led drop-in centres is best for long-term reduction of suicide rates.”
The findings from this research have been used to inform thinking about suicide prevention by decision makers. “We’ve created a bird’s-eye view of the mental health system, and we’ve fed in quantitative data around population dynamics, stages of suicidal behaviour, acute care and community support,” Eileen says.
The model was developed in partnership with NSW Health and in collaboration with a consortium of stakeholders across NSW including government and non-government health service providers, health policy agencies, academics and consumers with lived experience. “Bringing all these people together to discuss suicide prevention, and hearing different perspectives on it, was valuable in itself,” Eileen says. “It’s a great example of the translational work of the Sax Institute.”