Suicide risk and Aboriginal people

The incidence of suicide in Aboriginal and Torres Strait Islander communities has increased since the 1970s, and is estimated to be 40 per cent higher than in the general Australian population. Suicides predominantly occur among indigenous males under 35 years of age, who often face serious issues of social isolation, discrimination, unemployment, family breakdown and drug and alcohol abuse.

The close links between suicide, alienation and loss of identity make it imperative for risk-reduction measures to incorporate efforts to preserve indigenous culture and lift levels of social wellbeing.

Wherever possible, clinicians should engage the services of Aboriginal health liaison officers, Koori mental health liaison officers and interpreters, when assessing and providing care for at-risk individuals.

Assessing risk for Aboriginal people

It is important for clinicians to understand that the risks of suicide or self-harm for Aboriginal people extend beyond an expression of mental or alcohol-related disorder. Social and cultural risk factors such as social cohesion, spirituality, sexual abuse, family violence, racism, removal policies, unemployment and lack of connection to country must always be considered.

Building rapport is especially relevant when interviewing Aboriginal people, for whom personal relationships and community respect are highly valued:

• Interviews should be conducted at a relaxed pace that tolerates periods of silence and allows people to tell their story at their own pace.
• Aboriginal people may be guarded and reticent in a clinical setting, but usually respond well to respectful, non-intrusive approaches.
• Clinicians who take time to find out who a person is as an individual and where they stand in the community will increase their capacity to forge a genuine therapeutic relationship.

Although open dialogue about suicide is encouraged with non-Aboriginal clients, many Aboriginal people prefer to not speak about suicide directly, but rather to focus the conversation on protective factors.

Planning treatment for Aboriginal people

Recommended treatments or interventions should be culturally sensitive to work within the most accessible levels of the person’s social system. Traditional treatments can be considered as viable alternatives, and follow-up referrals should wherever possible be made to Aboriginal health professionals and services.

Indigenous communities will often try to care for people within their community until they become violent, and may not seek help from health services until times of great crisis.

Increasing cultural awareness

The Department of Health & Human Services’ guidelines provide the following tips to help mental health services increase the cultural awareness of their staff and their service systems and practices.

• Be aware of gender-sensitivity issues: An Aboriginal man may find it awkward to talk to a female clinician and may prefer to have a family member or an Aboriginal health worker present.
• Identify and respect local cultural belief systems concerning suicide or mental illness.
• Mobilise personal, family and community resources to address any problems identified by the person or clinician.
• Negotiate a therapeutic strategy that is meaningful and acceptable to the person, their family, community members and the clinician.
• When making referrals to GPs or specialist mental health services, select Aboriginal mental health professionals and services, or work with an Aboriginal health worker.
• Determine whether the person is willing to be seen in their own community or would prefer to attend an external site.
• Consider the traditional treatment system as a viable alternative to mainstream services.
• Consider involving family members, close friends or community elders in discussions about treatment (after seeking the person’s approval), and accommodate the person’s views to promote treatment compliance.

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