The Inequality Of Suicide Rates In Indigenous Australians
The alarmingly high rate of suicide experienced by Indigenous Australians poses a complicated difficulty for Australia to overcome. The Australian Bureau of Statistics (ABS; 2018) found that Indigenous Australians were more than twice as likely to die by suicide than non-indigenous Australians. Of particular concern, young Indigenous adults, the majority of whom were male, accounted for more than two-thirds of Indigenous suicides (ABS,2018). Furthermore, between the periods of 2008-2012 and 2013-2017, the rate of Indigenous suicide increased by 21.46% (ABS, 2018). The following essay reviews research conducted over the past two decades pertaining to individual, community, and sociopolitical factors that may contribute to the disproportionate rates of Indigenous suicide. Furthermore, this essay evaluates the efficacy of current policies and programs targeted at reducing Indigenous suicide rates.
On an individual level, alcohol-abuse was found to be a significant factor in Indigenous suicide and, according to Elliot-Farrely (2004), Indigenous suicide often occurred whilst under intoxication. Indeed, research by Hanssens (2007) found that alcohol was associated with 77% of Indigenous suicides. However, Hunter and Milroy (2006) note that intoxication should not be viewed as the sole contributing factor, that alcohol was instead used to repress mental anguish. Furthermore, prolonged alcohol-dependence may have resulted in an inability to form adaptive coping mechanisms that can protect against self-harming behaviours (Hunter & Milroy, 2006). Indeed, this may have contributed to the substantial rise in mental disorders in Indigenous populations over the past two decades (Hunter, 2013). Furthermore, Indigenous Australians were hospitalised for mental disorders and self-harm at a rate of two and three times greater than that of non-indigenous populations, respectively (Sveticic, Milner & De Leo, 2012). This is important as mental disorders were found to be significantly correlated with suicide in young Indigenous youth and young adults (Hanssens, 2007). Therefore, whilst intoxication was a common factor in Indigenous suicides, it may instead be viewed as a symptom of an inability to cope with underlying mental turmoil.
With that being said, identification and treatment of mental disorders may be difficult. Sveticic et al. (2012) found that Indigenous Australians were far less likely to seek help than non-Indigenous Australians. Alarmingly, they found that just 14% of Indigenous Australians with a diagnosed with a mental disorder sought help prior to suicide. Avoidance of seeking help may result in a reliance on internal coping-mechanisms which, as in the case of alcohol abuse, can have deleterious results. A central limitation to Sveticic et al.’s (2012) research was that the clinical data relating to formal help-services may have been underreported and informal help-sources were not recorded. They recommended seeking qualitative data from community members, as was utilised by Farrelly (2008). According to Farrelly, a commonly reported barrier to seeking help from mainstream health services was that they were culturally inappropriate and lacked understanding of Indigenous-specific issues, such as racism or intergenerational trauma. However, in some cases, non-Indigenous run services were preferred due to assurances of confidentiality. Indeed, Farrelly found that some individuals were hesitant to access Indigenous-run services, as they may be staffed by someone they knew, however, the Indigenous-run services were largely preferred. Lesser-known was how often Indigenous Australians sought help from informal help sources, such as family and community members. Informal sources may provide invaluable support when an individual is unwilling or unable to seek formal help. However, Farrelly (2008) found that individuals were hesitant to disclose their problems with people they knew, as they feared breaches of confidentiality or they felt shame and fear of appearing weak. Therefore, it appears evident that Indigenous Australians are faced with substantial barriers to seeking both formal and informal help.
It is certainly beneficial to understand individual factors implicated in Indigenous suicide. However, community factors may be just as, if not more, important when identifying suicide risk (Silburn, Glaskin, Henry & Drew, 2010). Suicide was found to have a particularly devastating impact on Indigenous communities, due to the degree of interconnectedness of familial and social networks (Hanssens, 2011). Furthermore, according to Silburn et al. (2010), due to higher rates of suicide and premature death generally, communities were often in a prolonged state of grief that overwhelmed their capacity to heal. Silburn et al. stated that a possible outcome of this prolonged grief is the phenomenon of suicide clustering, where one suicide increased the potential for more. Indeed, they found that over three-quarters of Indigenous suicides occurred within particular communities in a relatively short amount of time. Beyond the trauma experienced by community members, they may have identified with the distress experienced by the individual who suicided, which may have triggered suicidal ideation in themselves (Silburn et al., 2010). These findings are aligned with previous research by Hanssens (2007), who suggested that individuals may have formed a learned response towards suicide as a way to escape their pain, which further normalised suicide within the community. Whilst there is ample research that analysed the distinct phenomena of suicide clusters, Hanssens (2007) noted that the evidence was not conclusive. Hanssens recommended that researchers conduct psychological interviews with those close to a person who had suicided. This would provide greater evidence of suicidal ideation following the suicide of a community member. However, the coroner had not allowed these interviews. Nonetheless, without adequate opportunities to recover from grief, Indigenous communities are likely vulnerable to further risk of suicide.
However much individual and community factors influence Indigenous suicide, the effects of the historical and sociopolitical factors cannot be understated. Indigenous suicide was rare before the 1980s and the rate of suicide has increased exponentially since then (Ridani et al., 2015). This has been attributed to the effects of intergenerational trauma, where those who suicided in the 1980s were the children of those affected by past trauma (Hunter & Milroy, 2006). Of particular note, a history of forced removal in the family was found to be significantly correlated with suicide and mental disorders (Silburn et al., 2010). Ridani et al. (2015) stated that parental trauma led to these children being raised in the context of fear, despair, and anger, which may have impacted healthy development. Furthermore, cultural disconnection resulted in these children being caught between Indigenous and non-indigenous cultures. Young men, in particular, saw their roles within traditional family structures diminished and faced greater economic disempowerment than Indigenous women (Hunter & Milroy, 2006). Without a stable sense of purpose or positive role-models, young Indigenous men were less likely to develop a coherent identity, which may lead to alienation, confusion, and a lack of acceptance, increasing their risk for suicide (Silburn et al., 2010). Therefore, the cumulative effects of intergenerational trauma and cultural disconnection experienced by Indigenous Australians must be considered when evaluating factors contributing to Indigenous suicides.
Beyond intergenerational trauma and cultural disconnection, one of the greatest challenges facing Indigenous Australians is the level of socio-economic disadvantage they still face. Indeed, Hanssens (2011) identified a significant correlation between increased social and economic disparity and rates of Indigenous suicide. She stated that substance abuse, mental disorders, and family violence were more prevalent in low socio-economic areas, which can increase suicide risk. Furthermore, Indigenous Australians were found to be more likely to be poorly educated, unemployed, live in insecure or overcrowded housing, live in remote areas, and have reduced access to essential services than non-Indigenous Australians; all of which are factors that increase suicide risk (Hanssens, 2007). Therefore, increasing the socio-economic status of Indigenous Australians via policy change may be a key factor in addressing the disproportionate rate of Indigenous suicide.
Work is currently being undertaken by the Australian Government to reduce Indigenous suicides by identifying the causes and impacts of suicide to implement effective interventions. The National Aboriginal and Torres Strait Islander Suicide Prevention Strategy (NATSISPS; Department of Health and Aging [DHA], 2013) aims to increase resilience on an individual and community level by promoting community leadership and socio-economic empowerment. Furthermore, it aims to implement targeted and culturally appropriate interventions to groups with the highest risk, such as those with mental illnesses, history of substance abuse, and exposure to trauma. The NATSISPS shows potential for reducing the rate of Indigenous suicide. It includes culturally-appropriate strategies that provide support on an individual, social, and socio-political level, which are deemed to be crucial for success (Dudgeon, Calma & Holland, 2016). However, the full effects of the NATSISPS will not be evident until 2022, as its ten-year strategy is still underway (DHA, 2013). With that being said, current federal policies may be hindering the efforts of the NATSISPS. Of particular note is the federal government’s rejection of the Uluru Statement from the Heart, which sought to institute constitutional recognition of a First Nations Voice that would provide Indigenous Australians with greater control over policies that affect them (Australian Human Rights Commission, 2018). By dismissing the Uluru Statement from the Heart, the government are denying Indigenous Australians the right to self-determination. This is important as self-determination has been linked to decreased suicide rates (Hunter, 2013).
On a community level, several programs were aimed at reducing Indigenous suicide. Ridani et al. (2015) conducted a review of some of these programs and overall, they found that most of the programs were run by Indigenous organisations with support from non-Indigenous sources. These programs incorporated individual, social, and socio-political elements, and demonstrated culturally-appropriate delivery. Again, these factors may be essential to strong outcomes (Dudgeon et al., 2016). Furthermore, programs that were wholly run by the communities they are based in demonstrated the most success. They incorporated a holistic approach that included counselling, crisis intervention, and education. Furthermore, they were more likely to include creative and culturally relevant activities, such as art and dance classes, and community-based activities. Ridani et al. (2015) noted that these activities fostered community and cultural connectedness, which can reduce the risk of suicide (Silburn et al., 2010). Ridani et al. (2015) identified several limitations within the programs they reviewed. Many programs lacked sustainability due to limited funding or were not designed to be run in the long-term, however, the greater challenge was found in inadequate evaluations of programs. As randomised controlled trials were not feasible or ethical, alternative measures were necessary. However, many programs did not sufficiently document post-program measures related to suicidal ideation. And, as programs often included multiple interventions, it was unclear if a single, or combination of, interventions were impactful. Moreover, it was unclear if decreased suicide rates were as a result of the program, or a non-significant fluctuation. Finally, as the success of interventions can take years to demonstrate lasting impact, Ridani et al. (2015) recommended that programs incorporate measures related to suicidal ideation and self-harm rates, as well as establish partnerships with researchers to implement formal outcome measures.
In conclusion, the factors that lead to the disproportionate rates of Indigenous suicide are immensely complex. Indigenous Australians were found to be more likely than non-Indigenous Australians to experience alcohol-dependence, mental disorders, and barriers to seeking help. Each of these elements had been implicated as significant risk factors for suicide (Farrelly, 2008; Hanssens, 2007; Sveticic et al., 2012). However, community factors such as prolonged grief and suicide clusters may be more important when considering individual risk (Hanssens, 2011; Silburn et al., 2010). Furthermore, Indigenous suicide must be viewed in the historical and socio-political context of intergenerational trauma, cultural disconnection, and socio-economic disadvantage (Hunter & Milroy, 2006; Silburn et al., 2010). Whilst some programs aimed at reducing Indigenous suicide have demonstrated successful outcomes, the lack of sufficient outcome measures means that the effectiveness of these programs is inconclusive (Ridani et al., 2015). Furthermore, whilst the government is currently undertaking work to reduce Indigenous suicide via the NATSISPS (DHA, 2013), outcomes will not be fully evident until 2022. Finally, Indigenous suicide rates have increased over the past decade (ABS, 2018) in direct correlation to rising socio-economic disparities (Hanssens, 2011). Therefore systemic change that promotes self-determination and lifts Indigenous Australians out of poverty is likely required to effect lasting change for the whole population.