Marc Fennell:        
G'day, my name is Marc Fennell and welcome to the MindMatters spotlight on Suicide prevention.  Now, before get started in what we’re hoping is going to be a very practical discussion, if you’ve been affected by a recent suicide, we’d encourage you to take full advantage of the support services that are available.  They have some really experienced professionals who can give you very direct support and advice.  But right now here on our panel, will you please welcome Kristen Douglas from headspace School Support.  We have Indigenous Mental Health and Suicide Prevention consultant, Adele Cox.  Andrew Fuller from the Resilient Youth Australia Organisation and Dr Jo Robinson from Origin, The National Centre for Excellence in Youth Mental Health.  Andrew, I’m going to start with you.  Can suicide actually be prevented?

Andrew Fuller:        
Yes, definitely.  By promoting wellbeing, by promoting resilience, by, I suppose, preventing depression.  These are things all schools, communities, families, can really play a role in and it’s very effective.

Marc Fennell:        
Jo, can you give us a picture of, what is the status of suicide, youth suicide, in Australia?  What are the stats?

Jo Robinson:        
So, if you look at the data for around the last ten years, what we are seeing is a steady increase in suicide rates amongst young people, and in particular amongst young females, which makes suicide the leading cause of death amongst young people in Australia and it accounts for around a third of youth deaths.

Kristen Douglas:    
Well, I think in schools and in education we’ve come a long way.  It’s far more sophisticated in the way that we approach this in the last ten, twenty years, and it’s really simple.  There’s a continuum: prevention, early intervention, intervention and now a relatively new term in the last couple of years is post-vention.  I think schools have a really good understanding about prevention.  I think we’re getting better about early intervention but it means connecting with services and understanding skill capacity for teachers and things.  Intervention, we’re still getting there; connecting schools and interface with mental health and health.  Post-vention, as I’ve said, is really new but schools play a massive role.  They play a massive role in making sure that after the event of suicide, health and wellbeing becomes a priority.  We get young people and teachers back into recovery, school communities in recovery, back to prevention and health promotion.  And that can take years after a suicide.

Andrew Fuller:        
It’s often said that General Practitioners are the frontline workers in terms of suicide prevention but I don’t think that’s true; I think it’s teachers.  Now, we can’t research this because we can’t research what doesn’t happen, but it’s very hard to estimate how many lives teachers save every year.  Teachers basically, by bringing in that kid who’s on the margins.  Who doesn’t feel like they belong, doesn’t feel like they have a great home life, doesn’t feel like they’re the well-to-do, and bringing them in and showing them that success is possible for them.  That here in this classroom you have a place to belong, a place where you’re respected, a place where possibilities are talked about, is probably the most powerful suicide intervention any of us can make.  And so, I think it’s important to recognise it’s the power and the capacity of teachers to do that.

Marc Fennell:        
Andrew, when we talk about protective factors in a school, what sort of things are we talking about?

Andrew Fuller:        
Well, successful schools really promote belonging and that belonging really has at its very heart good relationships.  So, a school that builds that sense of strong belonging, that even if you come from a household which is less than optimal or a family that’s pretty dysfunctional, you have a place to come where basically, there’s people that are hopeful, where there’s a sense of fun, enjoyment, linkage, and also a sense of empowerment.

Marc Fennell:        
Jo, are there really great examples where schools who have put into place programs or ideas that boost those factors?

Jo Robinson:        
Yeah, there are.  There are lots of examples where schools have done - there are some great programs out there for schools and there are lots of examples where schools have engaged with those sorts of programs.  And what that’s done is, it’s done all of those things that Andrew’s talked about, so promoted belonging and a sense of wellbeing and hopefulness in their students.  But they’ve also done a couple of other things which is destigmatise mental illness and suicide and promoted help seeking, and I think they’re the two things that we also want to be seeing in schools.  So, a school environment where the culture is that it’s okay to talk about these things and it’s okay to seek help and seeking help isn’t stigmatised.

Marc Fennell:        
And Adele, what are the sorts of signs, if you were a teacher, if you were a school staff member, what should you be looking for?

Adele Cox:        
Well look, I think the obvious ones are disengagement, lack of interest.  The minute you start to see someone who has that personality change to the complete opposite, then I think it should automatically raise alarm bells.

Marc Fennell:        
Can you give me some specifics?  I want you to image I’m a teacher and I’m about to walk into a class.  What are the sorts of things that I should be keeping an eye out for?

Jo Robinson:        
So, what you’re looking for is a significant change that’s sustained over a period of time in a young person’s behaviour.  And then I think there are some more obvious ones.  So, we know, for example, that often a young person who’s contemplating suicide might have previously harmed themselves, so we might be looking for signs of self-harm and we might also be looking for expressions of suicidal thoughts or feelings in people’s schoolwork or in some conversations that you might overhear them having.  I think, probably one of the strongest messages to get across though, is if you’re worried about a young person the best way to know if they’re at risk is to ask them.

Marc Fennell:        
A lot of teachers have acquired this idea that talking about suicide can act as a trigger.  What’s your reaction to that?

Kristen Douglas:    
Well, I think we’re probably faced with education sectors in schools who had information many years ago, “Don’t do this, it’s going to make self-harm or attempts spike.”  And now what we’re saying is almost the complete opposite.  But international and national evidence absolutely reinforces that having the conversation does not put that young person more at risk.  In fact, it opens up honest dialogue.  It allows them actually to help seek.

Jo Robinson:        
There’s a growing body of evidence to suggest that it is safe and acceptable and okay to ask young people whether they feel suicidal if you’re worried about them.  And most young people who are feeling suicidal will be relieved that somebody has actually asked the question and given a voice to probably a word that they’re a little bit afraid to say out loud.  So, if you can act, if you can ask questions in a very clear way, in a very gentle and a very supportive way, then what you’re doing is modelling a really calm way of having a sensible conversation about suicide risk and I think that’s really important.

Marc Fennell:        
So, let’s talk about that.  What is the right kind of question?  You’ve picked up on some signs, you’ve initiated a conversation.  Take me through an ideal conversation.

Kristen Douglas:    
So, you’ve done essentially the first step of ‘notice, enquire, plan’; this is what teachers need to do.  They’ve noticed a problem.  Enquire requires skills and it requires sound training, potentially, to make sure that you’re asking the right questions.  And you need to do it safely, you need to do it without judgement and you certainly need to do it in a way that you can contain the safety around that conversation.

Marc Fennell:        
Define ‘safety’ for me.  When you say you need to do it safely, what does that look like?

Kristen Douglas:    
I think you need to stay away from shock reactions, you need to stay away from judgement, “Come on.  You’re only young; you don’t know what stress is.”  You need to stay clear of putting values and any parameters around that that’s going to stunt their conversation or make them withdraw from that conversation.  You want it to make safe, honest - but then you’ve got to do something with that information.

Andrew Fuller:        
So, generally the way I would start a conversation is saying something like, “You don’t seem as happy as I’ve seen you in the past.  Are things okay?”  Now, that will generally get shrugged off as, “Oh, yeah.  I’m fine.”  And, “Well, I’m still not feeling really comfortable about that.  Can you tell me what’s going on for you?”  And generally, often kids will start to say a little bit about what’s going on.  And I think it’s important sometimes to be prepared to be a bit pig-headed about it and not really let the conversation go until you’ve got some sense of reassurance because life’s too short to be worrying about all these kind of things.  It’s then saying to them, “Well, gee.  Somebody in that sort of situation, sometimes they feel like life’s not worth living.  Is that a thought that’s happened for you?”  And generally, people pause and, “Oh, yeah.  A bit.”  “How serious has that thought been?  Has it been something that you’ve thought about doing something about or is it just an idea?”  So, you’re just teasing and expanding out your understanding of what the hell’s going on for this kid at this stage.  

Kristen Douglas:    
Just that sometimes it’s not teachers having this conversation with kids, it’s kids and kids.  And I think we need to give young people the same amount of skills about enquiring with mates as much as we do with teachers because sometimes it’s the young person who’s asking and getting the disclosure as opposed to a school teacher.

Andrew Fuller:        
The very act of getting somebody to talk about their feelings, their logic around what’s going on, offers them an alternative solution just through talking about it.  And so, by asking about that, by exploring and deepening your understanding of their situation, not only will you be in a better position then to decide what sort of appropriate action to take but also they themselves will be relieved of some of that pressure.

Marc Fennell:        
The world isn’t perfect and sometimes these things do happen and that’s when you get called in.  A big part of your job is post-vention, coming into a school after a suicide has occurred.

Kristen Douglas:    
The impact’s huge.  It’s a profound impact when somebody dies by suicide; on the teachers, on the school community, on other kids.

Marc Fennell:        
How important is it to have a plan, so that when this horrifying thing happens there is a set of rules in place to follow?  How important is it for schools to have something like that?

Kristen Douglas:    
Huge!  And, I think, schools have become really good at having plans around bushfires and bomb threats and that sort of stuff.  Suicide’s no different in some ways but it is really different to other critical incidents in other ways.  We all know that as a principal or a school leader, the minute you’re plunged into crisis your frontal lobe goes, your good thinking, your good leadership’s out the window.  You’ve got to have a plan to come back to.  Some principals don’t know the first thing to do.  So, having a plan brings you back, makes it considered, makes it thoughtful and most of all it makes it really clinically sound because you can make decisions that may actually put your community and kids more at risk.  By telling the whole 900 or 1,000 kids on assembly what’s just happened, that’s going to create risks and vulnerability.  There’s a whole range of strategies that are much safer in the way informing kids, so you’ve got to know what evidence is good practice and what evidence is actually going to create more risk after that death.

Marc Fennell:        
There are also certain groups within school communities that are more at risk.  Is it worth, Adele, being aware of that?

Adele Cox:        
Look, absolutely.  And I think we are at a place and a space where, I think, the general population is aware that the Indigenous suicide rates more broadly are higher than that of the general Australian population.

Kristen Douglas:    
I think the way to consider it is not really about, as I said, profiling kids.  It’s more, what do we know about the risk and the stressors on this young person’s life?  The question is, what can schools do about building health literacy specifically around how do I get young people to seek help?  Because if you seek help, you can then start helping and start preventing some of these stressors.

Andrew Fuller:        
I think for all of us there are times in our lives where we question our existence.  So, the idea of thinking, “Is life worth living?” is a reasonably normal thought; it’s what you do with that.  And, of course, when you have that thought then, I guess, there are a number of burdens that can be added upon that, if you like, weights on your shoulder.  Perhaps you’re in a minority group, perhaps you feel your sexuality’s not as acceptable as other peoples, perhaps you feel shamed, perhaps you feel bullied, perhaps you’ve got violence at home; there’s a whole series of things that can build up and all of those increase the potential but they’re not within the person, they’re events around them.

Kristen Douglas:    
I think also, Marc, your average person thinks that somebody dies by suicide wanted to die.  And essentially, I think, what they want to do is be released from pain and they want to not have distress anymore.

Marc Fennell:        
One final thought, Kristen.

Kristen Douglas:    
There’s a whole range of skill sets in groups of teachers.  So, not only can you do the broad brush stuff with health promotion and awareness, having particular skill sets and educating the rest of the staff with practical strategies.  But also, educating kids on how to be good and safe and look after their own health and wellbeing.  I think, we disempower kids by saying it’s all the responsibility of parents and families and teachers.  Kids are really smart at empowering themselves.  We’ve got to give them assistance with emotional intelligence, communication strategies, better understanding of use of online stuff.  But empower them to own their own health just like we do with physical health; own their own mental health, help seek and engage in a way that’s positive and safe.