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Valuing young lives Evaluation of the National Youth Suicide Prevention Strategy Australian Institute of Family Studies Valuing young lives We cannot afford to be self absorbed. We cannot afford to pursue our work narrowly, unaligned or isolated from other disciplines and from citizens, too complacent or too busy to generate a poem, a vision, a multi- leveled and multidisciplinary strategy, for our complicated times. All our children need us to do this, and more. – Kenneth I. Maton, 1999. Valuing young lives Evaluation of the National Youth Suicide Prevention Strategy Penny Mitchell Australian Institute of Family Studies © Australian Institute of Family Studies – Commonwealth of Australia 2000 Australian Institute of Family Studies 300 Queen Street, Melbourne, Victoria 3000 Australia Phone (03) 9214 7888. Fax (03) 9214 7839. Internet www.aifs.org.au/ All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic, or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the Australian Institute of Family Studies. The Australian Institute of Family Studies is committed to the creation and dissemination of research-based information on family functioning and wellbeing. Views expressed in its publications are those of individual authors and may not reflect Institute policy or the opinions of the Institute’s Board of Management. National Library of Australia Cataloguing-in-Publication Data Mitchell, Penny. Valuing young lives: evaluation of the National Youth Suicide Prevention Strategy Bibliography. Includes index. ISBN 0 642 39475 X 1. National Youth Suicide Prevention Strategy (Australia). 2. Suicide - Aus- tralia - Prevention. 3. Youth - Suicidal behaviour - Australia - Prevention. I. Australian Institute of Family Studies. II. Title. 362.287 Designed by Double Jay Graphic Design Printed by Impact Printing Foreword The Australian Institute of Family Studies was commissioned by the Common- wealth Department of Health and Aged Care to evaluate the National Youth Suicide Prevention Strategy, which ran from 1995 to 1999. This report aims to identify lessons from the Strategy to carry forward for the future. During the 1980s and 1990s, rates of suicide among Australia’s young people became a focus of both community and government concern. In response to these concerns, State and Territory governments began developing strategies aimed at identifying ‘at risk’ young people and locating programs and initiatives within frameworks appropriate to their needs. The National Youth Suicide Prevention Strategy represented the first attempt to provide a nationally-coordinated approach to youth suicide prevention throughout Australia. In publishing a set of guidelines for the development of national suicide preven- tion programs, the United Nations (1996) recognised suicide as multi-factorial and multi-determined in origin, and recommended a multi-faceted response. In keeping with United Nations recommendations, the Strategy funded a range of projects within a public health framework guided by panels of experts and community representatives. Development and implementation of the Strategy included broad consultation and research. In keeping with internationally accepted principles of best practice, evaluation was built in to all aspects of the Strategy. Each project funded under the Strategy had an evaluation component, and the Australian Institute of Family Studies was charged with the responsibility for the overall evaluation of the Strategy. The Australian Institute of Family Studies, through its research and information activities, seeks to enhance understanding of the factors that affect family well- being and stability in Australia. The suicide of a young person is a devastating experience for the surviving members of the families concerned. We hope and trust that our evaluation will contribute to enhanced public policy and practice to inhibit the tragic loss of young Australians in our society. David I. Stanton Director Australian Institute of Family Studies June 2000 Foreword v Contents Foreword v Acknowledgements xii About the author xii Evaluation format xiii Executive summary 1 Recommendations 10 SECTION ONE: BACKGROUND 1 The scope of youth suicide 24 Reviews the most recent Australian suicide statistics and discusses the scope of the problem of youth suicide in Australia. Rise of youth suicide in Australia 24 Changes over time and variations between sub-populations 24 Attempted suicide and deliberate self-harm 27 Focus for government action 28 2 History and development of the Strategy 29 Describes the policy context of the Strategy in terms of national and international developments that led to its initiation, as well as the policy and program context in which the Strategy operated. International recognition 28 Finland’s suicide prevention initiative 30 Developments in Australia 31 Mason report 31 State initiatives 31 NH&MRC working party 31 Human rights and people with mental illness 32 National health goals and targets for children and young people 32 National health goals and targets for mental health 33 Public health significance of suicide prevention strategies 34 Here for Life: a national plan for youth in distress 34 National Youth Suicide Prevention Strategy 35 3 Policy and program context 37 Discusses national policies and programs in the areas of mental health, and the health and welfare of children and adolescents, that are complementary to the Strategy. Developments in Australia 37 Mental health 37 Child and youth health 38 Aboriginal and Torres Strait Islander wellbeing 38 Family and community 40 Substance misuse 41 Violence and crime 42 Homelessness 42 Employment and training 43 Income support 43 Public health 44 Rural health and infrastructure 45 Youth affairs 46 Coordinated care trials 47 Significance of the context 47 SECTION 2: THE STRATEGY AND ITS EVALUATION 4 Description of the Strategy 50 Describes the goals, administration, philosophy, principles and activities of the Strategy. Goals and administration 50 Philosophy and principles 51 Biopsychosocial model 52 Public Health Approach 52 Evidence-based practice 53 Population-based and individual approaches 53 A planned approach 55 Involvement of community, consumers and young people 56 Intersectorial collaboration 57 Sensitivity to cultural diversity 58 viii Valuing young lives 5 Strategy approaches and activities 60 Describes Strategy activities undertaken, grouped according to direct and system-level approaches. Approaches 60 Direct prevention approaches 61 Primary prevention and cultural change 61 Early intervention 62 Crisis intervention and primary care 64 Treatment, support and postvention 65 Restricting access to means 66 System level approachs 66 Policy and planning activities 67 Research and evaluation 68 Communications 69 Education and training 70 Networking and intersectoral collaboration 71 Community development 72 6 AIFS evaluation of the Strategy 74 Describes the purpose, aims, framework, design and scope of the Institute’s evaluation of the Strategy, and the methods used to collect and analyse the data. Purpose of the evaluation 74 Aims of the evaluation 75 Scope of the evaluation 76 Design issues 77 Short time since initiation of Strategy 77 Suicide rates and the Strategy 77 Absence of measurable intermediate objectives 78 Lack of baseline data for intermediate indicators 78 Confounding factors 79 Framework 79 Public Health Approach 79 Program Theory / Program Logic 80 Methods of data collection and analysis 82 Qualitative meta-analysis of project evaluation reports 83 Survey of key stakeholders 83 Informal consultations with key stakeholders 84 Review of research and practice literature 84 Review of policy and program context 84 Contents ix National stocktake of programs and activities 85 Research and consultation with young people 86 Summary 86 SECTION THREE: RESULTS 7 Major achievements 88 Outlines the Strategy’s major achievements, grouped according to processes, impacts and outcomes, and identifies gaps. Processes 89 Program level processes 89 Wider system level processes 92 Impacts 93 Clinical/program impacts 94 Population level impacts 94 Outcomes 95 Clinical/program outcomes 95 Population level outcomes 96 Gaps in the Strategy 96 Risk factors not addressed 97 Organisational and structural barriers 99 8 Good practice findings 101 Describes the major areas of learning that have emerged out of the experience of implementing the Strategy, and identifies the factors facilitating and inhibiting achievement. Multdimensional approach 102 Multiple populations 102 Spectrum of interventions 103 Settings 104 Sectors 104 Levels of action 105 Access 105 Universal andselective targeting 106 Flexible services 107 Promotion 110 Outreach 110 x Valuing young lives
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