Audio transcript (edited)

DR RIOSECO: Hello everyone, welcome to today's webinar called, 'Working together to prevent youth suicide: The power of Communication'. My name is Dr Pilar Rioseco. I'm a research fellow in the longitudinal studies - longitudinal and life course studies unit here at the Australian Institute of Family Studies. I work mainly on the Longitudinal Study of Australian Children in the Building a New Life in Australia which is the Longitudinal Study of Humanitarian Migrants.

I would like to start by acknowledging the traditional custodians of the land where we meet today. Lucky to be up here in sunny Townsville where the traditional custodians are the Bindal and Wulgurukaba People. I pay much respect to these elders - the elders past and present, and to the elders from other communities who may be participating today from all around Australia.

In today's webinar we are going to talk about approaches that are being used to support the prevention of suicide among young people, and how to minimise the difficult experiences of communities following suicide. Our presenters today will talk us through what is the most up to date evidence-based research in regards to suicide pre-imposed intervention. We'll also discuss some key risk factors for young people, particularly in the context of Covid-19. And we're also going to discuss very exciting strategies that are happening today including the chatsafe guidelines that have been designed to support young people to help others or help themselves.

Joining me today for our discussion we have Dr Louise La Sala. Hello Louise. Louise currently works at the suicide prevention unit at Orygen Youth Health in Victoria. She's interested in the social and psychological impact that digital technologies can have on young people, in particular the role that social media can play in youth suicide prevention. We also have today joining us Emily Boubis, hi Emily.

MS BOUBIS: Hi.

DR RIOSECO: Emily is a mental health advocate. She's got a background in Psychology and she became an advocate when she joined the Youth Advisory Group at Headspace, and she's been working in the eHealth space in a huge range of peer support programs. So it's going to be a great discussion today, we're going to have some really good insights on programs that are being successfully developed here in Victoria, or there in Victoria I should say.

And a lot of the resources that are going to be discussed in today's webinar are available for you in the CFCA event page so make sure you access those resources. There are not many slides in this presentation but Louise has a few and they have been made available in the resource section, the handout section, so you can access that with the other resources. 

I'll now hand over you to Louise and Louise is going to talk us through some new pre- and post-suicide intervention research. Thanks, Louise.

DR LA SALA: Awesome, all right, thanks Pilar. So as Pilar said, I'm Louise and I'm a research assistant on the youth suicide prevention team at Orygen here in Melbourne. I'm currently working on a universal suicide prevention project which is known as 'chatsafe'. And I will speak a little bit about chatsafe shortly but today I'm going to speak briefly on the current youth suicide situation here in Australia. I'm going to speak a little bit about some of the work that we're doing in the prevention and the Postvention space at Orygen, and I'm gonna wrap up with a little bit of an intro to chatsafe and introduce to you one of the resources that we have recently launched, which is designed to help communities who have been bereaved by a suicide.

So on the next slide, you will see a graph depicting the Australian suicide rates over the last decade - sorry, last 10 years for those under the age of 25 and so on that graph, sorry I just can't see - yep perfect, so on that graph you'll see the males are the blue line and females suicides depicted on the red line. And I suppose what this graph shows us quite clearly is that suicide rates have steadily increased over the last 10 years and as I'm sure a lot of you know, suicide is the leading cause of death for young Australians. And in fact, for those who are aged 15 to 19, in the last decade suicide has almost doubled for that age group.

Now this graph is already just slightly out of date as the ABS did release their causes of death data last Friday, so just after I had already submitted these slides. But what that told us was that in 2019, there were 3318 deaths by suicide in Australia last year, and of those, 480 of them were under the age of 25, and in fact 19 were under the age of 14, and these numbers are an increase in the numbers that were recorded in 2018. The ABS data also reported that for those under the age of 18 there were three top psychosocial risk factors for suicide and they were a personal history of self-harm, a disruption of family by separation and divorce or problems in relationships with significant others, so partners and spouses.

So with suicide rates in Australia, particularly with young people, there is a lot of talk and a lot of attention towards the impact that the Covid-19 pandemic has had or will have on young people in regards to suicide rates and their mental health more generally. Currently, there is no data to support a rise in suicide rates as a result of the pandemic however we have seen a 33 per cent increase in presentations to emergency departments with self-harm injuries by young people, and as we just saw with the ABS data, we know that previous histories of self-harm is a risk factor for future suicidal behaviour.

So Associate Professor Jo Robinson leads the suicide prevention team here at Orygen and she's part of a centre for research excellence with colleagues at the Brain and Mind Centre in Sydney. And through some dynamic modelling, they've estimated that by the time we do get to the end of the pandemic and once the social, the economic and the financial impacts are truly felt by young people; that we may expect to see an increase of up to 30 per cent in youth suicide rates over the next five years. And I think that really speaks to the urgency and the need for appropriate effective and youth-friendly suicide prevention and Postvention initiatives so that we are doing our best to keep the young people in our lives. And then young people we work with as safe as possible.

So, the work we do at the suicide prevention team obviously aims to reduce youth suicides and we do that kind of being underpinned by the principles of access, evidence and empowerment. And we really aim to strengthen the evidence base around suicide prevention research across a range of different settings. The other thing that kind of really underpins the work that we do at Orygen is the involvement of young people. So if you are aware of any of our projects or any of the work that is currently being conducted you will be aware that at the forefront of all of our work are young people, and we try to include young people from the very beginning of the work that we do all the way through to the end.

Now when it comes to youth suicide prevention and Postvention, we know that there is no one size fits all, and we know that we do need to work across settings and deliver interventions in a whole range of different ways so that we do reach all of the individuals that we are trying to target.

So you'll see here on the screen that we start off with universal interventions. Universal interventions are the kinds of things that we can deliver across a community regardless of the level of risk. So here we're looking to reduce risk factors and increase protective factors across an entire community. And this could be through things like awareness-raising campaigns. Or embedding, I suppose, within the school curriculum mental health or suicide prevention initiatives. Then we move into slightly more specific types of interventions and this one's referred to as 'Selective interventions'. And here we're looking to target those who are at a higher level of risk. So when it comes to selective interventions it's really about case detection and screening and responding to those who may have suicidal thoughts.

One of the projects that we are currently running within the team is doing this across schools in the northwest of Melbourne currently and the literature suggests that these sort of approaches can identify anywhere between four and 45 per cent of young people who may otherwise have slipped through the cracks, or who may not have sought help. So they're useful ways to reach young people before they reached out for help or it's in case they don't.

Then we move into the pointiest end of these interventions and that is indicated interventions, and here these interventions are for individuals who are already showing signs of suicidality; who have persistent challenges with suicidality or who may have made a suicide attempt. And these indicated interventions are activities that are embedded within clinical services or are embedded within emergency departments to really respond to that level of risk at that point in time.

Now some of the team that I've worked with have published a systematic review on this and in that review, they really look to see what works with young people in terms of youth suicide prevention, and specifically within education settings. And what they found is that there a number of interventions that are rolled out, and they're rolled out across a number of different settings, however, there isn't a lot of consistency in those interventions or in the way that they are delivered.

The other thing that's kind of a key issue when it comes to youth suicide prevention initiatives or trying to work out what is best practise is that there's no - well there's not a lot of comprehensive or robust studies that are conducted so it's quite difficult to run kind of a gold standard or a randomised controlled trial study in youth suicide prevention because suicides aren't all that common, and it can be difficult for a whole range of methodological reasons to run that sort of study. But to overcome some of that, what we're doing at the suicide prevention team at Orygen is trying to develop best practise guidelines or trying to come up with findings for each of these interventions across a whole range of settings so that we can inform the way that we do tailor youth suicide prevention interventions.

So I mentioned earlier that chatsafe is one of our biggest projects and that is a universal project that is attempting to deliver youth suicide prevention through social media and we're trying to reach a large number of young people across Australia. I also mentioned that we are running a large project in schools across the northwest of Melbourne and that is both a universal and a selective approach, kind of tied into one. And there my colleagues are trying to educate young, so year 10 students, with some safe talk training and that's to make them better equipped in talking and communicating and identifying risks of suicide in themselves and in others, and throughout that process they're also hoping to identify some students who are at risk and ensure that they get the support that they require.

We also have some colleagues who are running some gatekeeper training currently. So for any parents of those aged 12 to 25 in Victoria, we're currently running some training for parents - suicidal learners training, sorry, so that they also are better equipped in identifying signs of risk in the young people in their lives. Some of the researchers in our team are also doing work in emergency departments and we've also got a smaller study that's looking at young people's experience of presenting to emergency departments after they've had a series - sorry, an episode of self-harm or a suicidal crisis. So there's lot of work being done in this space and recently we've also submitted a report to the national mental health commission and in that report we've really tried to emphasise the importance of including young voices or including young people's experiences in not only seeking help but also in what they have found helpful or unhelpful along the way.

Now across all of these interventions is also the consideration of Postvention models. So, Postvention is activities that are put into place to protect individuals or communities following the suicide death or when a community has been bereaved by a suicide. And the reason that Postvention models are so important is because they aim to reduce the risk of contagion or the risk of further suicide deaths within that community.

Now when it comes to young people we know that exposure to peer suicides or to other youth suicides can be linked to things such as feelings of guilt, depression, suicidal ideation within themselves and symptoms of PTSD. And we also know that young people are more susceptible to being involved in a suicide cluster when compared to adults. So even though suicide clusters are quite rare, they do happen more commonly among young people, and after a suicide has occurred, this is when young people are at the greatest risk. And this is particularly true of those within school settings or education settings.

So when it comes to gold standard Postvention approaches, here we would look to things like the Headspace in schools or the Be You Postvention toolkit which you can find on their website. And again these documents or these Postvention toolkits speak to the need to have a Postvention initiative in place ready to go if and when a suicide does occur and so that you can offer support to your students or support to your communities immediately. One of the resources that we've released this year is called the chatsafe guide for communities, or we refer to it as the 'clusters resource', and it's a guide for using social media following a suicide of a young person and to help prevent suicide clusters, or to mitigate that risk of further suicides occurring. Now, the chatsafe clusters resource is an example of a Postvention approach that communities, schools or organisations could use to help disseminate information quickly and to share information across social media to reach a large number of people in a short space of time.

Now before I go into the guide, on the next slide please, for those of you that don't know chatsafe, the chatsafe guidelines are the world's first evidence-informed tools and tips designed to help young people communicate safely online about suicide. So we knew that young people were talking about suicide online. We were aware that suicide-related content was being seen online but there weren't any guidelines or any best practise tips on what to do if you do see that content or how to handle or manage that content.

So the chatsafe guidelines were developed in 2018 using a Delphi consensus methodology and they were developed in partnership with young people, suicide prevention experts and media professionals. And like I said, yep they were developed in 2018. Now in order to bring the guidelines to life we partnered with over 160 young people across Australia and in late 2019 we rolled out a nationwide suicide prevention social media campaign and we launched our chatsafe Instagram account, Facebook account, Twitter, Tumblr and Snapchat. And through that campaign and through sharing information via social media we managed to reach around 1.5 million young people across Australia with that information.

Now alongside the campaign, we also evaluated how helpful, how safe and how acceptable the content was and we're in the process of writing that up and hoping to submit that this week. But what I will tell you is that the findings were very promising. So for the young people who did help us evaluate that content, most of them reported an increased capacity, ability and confidence in intervening against suicide-related content online. Most of them reported an increased internet self-efficacy and increased safety in terms of their behaviours online. So it's all pointing in the right direction and we are, like I said, hoping to publish that very soon.

Now, at the core of the chatsafe - I suppose at the core of the chatsafe project, or fundamental to the chatsafe approach is that social media can be used for good. So, we know that there is a lot of fear and a lot of concern when it comes to social media and young people in particular and we know that adults and educators and parents are very concerned about the impact that social media might have on young people. However, in the work that we do with young people and in a lot of the literature there's also a lot of evidence to point to the positive role social media can play in young people's lives. And at chatsafe we're looking to harness those positive impacts and use them to help spread positive and helpful and safe messaging around youth suicide.

Now the other things is we know that social media does increase feelings of connectedness or belonging. We know that it's available to young people 24/7. We know that young people feel comfortable and confident talking about their lives and their experiences and their feelings on social media and we also are looking in the future to see how social media could be used as the soft entry point for care.

Now why social media is so important, particularly in terms of it being part of a Postvention strategy, is that we know that after a suicide has occurred it's really important that helpful and appropriate information is disseminated in a timely manner. And this is to support and provide help to those who have been directly impacted by a suicide, but it's also to minimise or limit the amount of gossip or the unsafe conversations or the unsafe or unhelpful language that sometimes occurs after a suicide has happened.

So we know, and the literature tells us, that the way a suicide is discussed or the way a suicide is reported on, especially if it's unhelpful or unsafe, can be a really big risk factor for future suicidal behaviour in others. And so that's why things like the Mindframe guidelines, and guidelines in other countries across the world, on safe reporting of suicide are so important. However, the Mindframe guidelines didn't really factor in social media and aren't really super relevant to young people, and so as we know those who have social media or those who create content on social media are in charge and create that content themselves, and so guidelines to or tips to safely do that were missing, and that's what the chatsafe guidelines filled. That's the gap they filled. And that's the gap that this cluster's response or the chatsafe guide for communities fills in terms of helping communities, workplaces or schools, deliver and roll out a safe Postvention approach using social media.

Now, the guide for communities does provide tangible ticks on how to share information around help-seeking. It helps model safe language, so language tips to do and language things not to do. It equips people within the community with the tools that they need to look after themselves but more importantly also the tools that they need to look after others if they do identify other people as being at risk. And it also helps provide some information on how communities can memorialise someone safely. So steering clear of things online that might sensationalise or glorify suicide, but paying tribute to someone in a safe way.

The guidelines also - sorry the guide for communities also will talk you through how to target people in your community through paid advertising on social media. It speaks a little bit about which social media platforms might be best to use and this really depends on who it is that you're trying to target and what age those people are, and it also speaks about how to develop meaningful content for the groups of people that you're trying to reach with that safe information.

Now off the back of this guide for communities, or this clusters resource, we're also currently running an evaluation on some clusters content that is being shared through the chatsafe Instagram page at the moment. And so there what we're doing is we're asking some young people who have been bereaved by a suicide recently. To help us evaluate content to see if it was safe, to see if it was helpful, and to get their perspectives on what sorts of things they'd like to see, you know, rolled out through their schools or through their communities online in order to equip them with the tools and the things that they need to look after themselves and others after a suicide has occurred. And the goal here is that we will develop a suite of content that communities can push out across their catchment areas, if you like, after a suicide has occurred so that they're ready to go and can offer help and support to the individuals there.

Now not so much of a Postvention technique, but similar to this guide for communities we've also just released a chatsafe educators resource. And the chatsafe for educators' resource is very much aimed towards teachers or educators at a tertiary level about how they can have safe conversations with their students. But more importantly how they can support their students to have safe conversations online. So we have heard from a number of school staff that they do become aware that conversations relating to self-harm and suicide are happening online. So not necessarily to the teachers but the teachers are aware of them happening. And this educators' resource helps guide teachers and how to communicate about that with their students and how they can support their students to make sure that they're staying safe online as well.

Now I could talk about chatsafe for days and days and days, but that's probably my cue to finish up. And so I am going to pass over to you now, to Emily, and Em was actually one of the young people who helped us out with the chatsafe study and has been involved in a number of our chatsafe activities. And she is going to speak to you from the perspective of a peer worker. Thanks, Em.

MS BOUBIS: Thanks Lou. So, good afternoon everyone. As Lou mentioned, my name is Emily and I'm a young person connected to the Orygen and Headspace network. Currently, I am a peer support worker at Headspace in Werribee but I'm also an Orygen digital and Headspace liaison for moderated online social therapy, and I've been a part of several peer work-related and non-peer work-related projects with Orygen as well including the chatsafe project.

Before I begin, I'd just like to also pay my respects to the traditional custodians of the land upon which we are gathered today. For myself this is Wurundjeri people of the Kulin nation. I'd like to pay my respects to owners past, present and emerging and extend that respect to any future young leaders that are present here with us today.

For those that might not have heard of peer work or a peer support worker before, please allow me a few minutes of this presentation to explain my role at Headspace where we also peer work a bit more broadly. So in the mental health field, peer workers such as myself value our own lived experience and the lived experience of others to provide more wrap-around support to people with ill mental health and facing various other challenges related to that: including vocational, social and emotional challenges. In short, peer work can be categorised as informal, naturally-occurring, sometimes you don't even notice that you're providing peer work to a friend or family member. Peers working in specific peer-run programs and peers employed within traditional services like employment services, disability, mental health. For example, Headspace and Orygen.

In our role as a peer worker we draw on our own lived experience, relevant training and various supervision in order to support someone else's journey towards recovery; whatever that means to them. This is achieved a number of ways including modelling certain behaviour, instilling hope in another person, encouraging and promoting resilience within them, support in taking ownership of one's life, focus on health both physical and mental health, quality of life and advocate for change.

In the mental health field, lived experience hasn't always been recognised as expertise or a learning opportunity, however, the sharing of lived experience is what equips peer workers with the unique skills to build connection, trust and rapport with other people, particularly young people, understand and interpret someone's mental health needs, and gather insights into the mental health system in order to better advocate for change.

Peer work is strengths-based, social and practical and is now more widely considered an integral component of the mental health system in particular. It's pretty reassuring to see that they've been increasing local, state and national efforts to support the growing peer work force in Australia and to see similar efforts being undertaken in other countries such as New Zealand, United Kingdom, the United States, Canada and Singapore. In the Orygen/Headspace network, peer work is predominantly one-on-one but might also occur in a range of other settings as well, as well as other specialisations and modes. This can include primary care, community care, inpatient/outpatient care, post-discharge, vocational care and as well as online.

Specifically, in my role at Headspace Werribee, my day‑to‑day is extremely variable and can include a number of responsibilities such as one-on-one peer work, group facilitation, peer education, community awareness and the mentoring of our youth advocacy group which is a group of young volunteers. Despite the progress of the last several decades, stigma associated with ill mental health still exists and is still prevalent in our community. The way that we talk about mental health including what we state or share on social media, at home, at work et cetera is therefore extremely important and can make a really strong difference towards reducing this stigma.

Certain ways of talking about mental health can alienate members of our community or sensationalise or romanticise a particular mental health challenge. This can contribute significantly to stigma and, by extension, discrimination because while mental illness is common it is still often extremely misunderstood. For example, calling someone living with a mental health challenge 'deranged' or 'psycho' while sensational describes behaviour that is inaccurate and implies the existence of a mental health challenge where one might not exist or is inappropriately represented.

Further, using terminology such as 'victim' or 'suffering' in adjunct to mental health suggests a lack of quality of life for people living with a mental health challenge, and a lot of this information can be found in the chatsafe guidelines as Lou has already promoted. However, it's also important that we communicate about suicide appropriately and safely, especially when we're online. The chatsafe guidelines provide a comprehensive overview on the importance of language when we talk about suicide. Specifically, they distinguish between helpful and unhelpful language and provide helpful alternatives to use when we talk about suicide and mental health more broadly. For example, the term 'committed suicide' is unhelpful as it describes suicide as a criminal and sinful act and may suggest to a person that what they're feeling is wrong or unacceptable in some way. Further, it may make a person worry that they'll be judged if they ask or reach out for help. Instead, the phrase, 'died by suicide' is recommended by the chatsafe guidelines.

More broadly speaking, we want to avoid language that glamorises, romanticises, sensationalises or trivialises suicide or makes it seem appealing or desirable. We should aim to use language that is non-descriptive and non-judgmental such as avoiding using words or phrases such as 'successful', 'unsuccessful', 'failed attempt' or that, 'suicide was achieved'. However, while we recognise that language is important, we also need to be mindful that it can and will be extremely challenging to correct how we communicate. The myths and misconceptions associated with mental health have existed for decades unchallenged, perpetuated and normalised by wider societal culture. So, it won't be easy to override how we communicate about mental health but by educating ourselves, our colleagues, our community et cetera, we can make really outstanding progress.

So just going back to peer work, the ways in which peer work is delivered is entirely dependent on the needs of a young person. And in my role at Headspace Werribee, I work with young people both one-on-one and in a group-based setting who are either currently experiencing suicidal thoughts or who have experienced suicide in some way in the past. Regardless of how peer support is delivered, there are certain guiding principles that underpin the relationship between a young person and a peer worker such as hope and recovery, mutual understanding, acceptance, respect and safety and connection. And these are really important guiding principles that underpin the nature of the work of the peer support worker.

In my role, I always aim to provide a young person with a safe space to share their struggles and all their challenges. This space is always non-judgmental and based on respect and acceptance however obviously keeping in mind that a young person's safety is always our first priority. Establishing trust with a young person starts with listening and understanding a young person's situation and their experiences. This can include connecting over shared experiences such as ethnicity, cultural background, lifestyle, health, faith, sexual orientation and more. However, where this mutuality might not exist, and it won't always exist with every young person that I meet or work with, it is important to connect to related thoughts, emotions, feeling et cetera above all else.

While lived experience is a cornerstone of peer work, it is the diversity of lived experience of young people that is important to focus on and to utilise a specific skillset every day. There are certain skills that a peer worker can utilise such as active listening. So actively listening to a young person when speaking with them. Being open to sharing and experiencing other world views and other perspectives. Obviously always being supportive of a young person. Maintaining a strengths-based focus. Sharing experiences safely and appropriately and being authentic in every interaction with the young person.

As I mentioned earlier, peer work can occur in many settings including educational and community settings. Often community awareness and peer support staff at a local Headspace centre will be asked by a community organisation or local school, for example, to give a presentation on a myriad of topics including mental health, literacy, help-seeking, stress, et cetera. However, while we might present on one or more of the above, it is often the case where a teacher, community member, a student will either mention suicide or suicidality and ask Headspace staff to also present on suicide or may present a question related to suicide in some way. This can really quickly become a difficult if not uncomfortable situation to be in. However, there are many resources that we refer to in order to convey the most accurate and appropriate information including the chatsafe guidelines. Again, keeping in mind that young people's safety is always a priority.

As Louise mentioned a little bit earlier, Headspace in schools is a program that Headspace National has, that supports secondary schools in response to and to aid recovery where there has been a death of a young person in the school community. And a lot of the information around Headspace in schools can be found on their website as well. While community awareness and peer support staff can provide information and support related to suicide, complex questions and concerns are typically referred to enhanced care or senior access staff at a Headspace centre, or Headspace in schools where there's been a death of a young person specifically.

So just in the last part of my presentation this afternoon, I just want to touch on why we don't or can't talk about suicide and why most people, particularly parents, feel unequipped to have a conversation about suicide with a young person. Specifically, when talking to a young person, why we can be scared of awkward silent breaks. As I mentioned earlier, in my role as a peer support worker I often work with young people in a one-on-one capacity and it is not uncommon to experience a significant amount of silence or to receive only vague non-committal responses from a young person like, 'Yeah', 'Nah', or 'Sure'. However, one thing that I've learned and learned to accept is that silence can be both advantageous and comfortable. Silence should be viewed as an opportunity to allow a young person to tell you how they're feeling or to express that something isn't right. But also an opportunity to be present in the moment with a young person then and there.

A young person might not have the exact words and you might not either, and that's okay. But just providing that physical and emotional space in that moment can be more than enough. It can be really frightening to have that conversation with a young person, or start that conversation, however I just want to note that you don't need to be a psychology or medical professional in that moment. The most important thing to do is to listen, to validate and to reaffirm a young person of your support. A young person might not be ready to have that conversation or want to seek help straight away. Reassuring them of your support, reminding them of help-seeking options and listening to what they're telling you either through their words or in their silence are the most important things to remember.

That brings me to the end of my formal presentation. Thank you so much to everyone for listening and for watching. I hope that you've learned something new and that there's something you can take away from this webinar and introduce either into your workspace or your home life or both. Thank you to Orygen as well as the chatsafe team for allowing me to present this afternoon and a massive shout out also to my team at Headspace Werribee. Thank you so much to everyone for watching and we'll now welcome both Louise and Pilar back onto the main screen.

DR RIOSECO: Thanks Emily. And thanks Louise. That was a fascinating, very, very interesting stuff happening here in the space of suicide prevention which is great, great to hear. We have lots of questions. So without putting my questions first, I'm gonna go straight to the audience. And there was a few people asking about the suicide alertness training for parents, I actually had a question on that too. How do people access this training and what setting does it happen?

DR LA SALA: Perfect, so the suicide alertness training for parents, like I said, is currently only available to parents in Victoria and they do need to be parents of those aged 12 to 25. There's a few different ways that people can find some information about this. So it is on the Orygen website. Alternatively, I'm more than happy to take emails and send you the research flyers and send out the research information as well. So on the very first slide of my presentation was my email address, and feel free to reach out to either myself or through the website and I will get that information to you. But the more parents that take part or the more people that get to share that information with, the better. So yeah that'd be great.

DR RIOSECO: Great, thanks Louise. Our next question is for both of you, Emily and Louise, it's about resources targeted for Aboriginal/Torres Strait Islander young people and communities, do we have any Headspace, Orygen, any resources that are - or in the peer workspace, Emily, that are specifically designed or targets for these community groups?

MS BOUBIS: Yeah, I think that's been a major project that's been worked on, I know, by Headspace National at the moment. So it's sort of in the process of being worked on. I know they're working on updating a lot of their resources targeted specifically to Aboriginal and Torres Strait Islander communities, so they're just updated all of that at the moment. So it's sort of like a 'watch this space' kind of situation but I know a lot of other organisations as well often as I guess specifically in the peer workspace, yeah try to recruit specifically Aboriginal/Torres Strait Islander young people to work in this space for that community. So they're really great resources as well, but in terms of like physical resources, that's something that Headspace National is working on at the moment so yeah unfortunately right now but hopefully really soon they can have all that yeah ready to go.

DR LA SALA: And I would echo that in terms of what Em said, Orygen is also working on some of those resources currently as well. When it comes to youth suicide prevention though involving Aboriginal and Torres Strait Islander communities, or organisations, can be difficult. Obviously, the way different communities talk about suicide or the words that we use when we are referring to a suicide is different.

Some of the content that is shared across the chatsafe Instagram page has been designed and co-designed by some Aboriginal and Torres Strait Islander young people who were involved in one of our workshops over in WA. But again it's a group that we are trying to actively, over the next little while, work with and it's something that we do know that we need to do better, but we also want to make sure that it's safe and acceptable.

DR RIOSECO: All right. Thank you. Coming to our next question, a few people asking about information and resources on how to speak to young people who have lost a friend to suicide, so Emily or Louise, if you can provide some information there, would be great.

DR LA SALA: Did you wanna go first, Em?

MS BOUBIS: Did you wanna go - I can, yeah I can. Yeah, I think just to echo I guess a little bit on what I've said, it can be a really difficult conversation to have and a lot of people don't know how to start that conversation or yeah just be a part of that conversation. But I think starting is always a really great thing to do and in terms of specific resources or information to draw from, there are so many organisations that have yeah specific resources on that like R U OK?, Beyond Blue, about how to start that conversation, but I think the most important thing to do in that conversation is to make sure your inner space, like physically, emotionally where you can have that conversation and not knowing what to say is okay, I think that's a massive misconception.

You know a lot of people of people are scared of saying the wrong thing or not saying the right thing at all or not being able to provide support then and there, but reaffirming someone that you know you're not just going to have this one-off chat, that you can you know check in a few times and be there for them maybe when they are a bit more ready to have a conversation.

It's also really important to kind of communicate to a friend that might be going through that situation as well, so yeah I think starting's a really great thing to do but it can be really an uncomfortable or difficult conversation to have but yeah reassuring them that you're there for them when they're ready to come to you for help or support or a chat, yeah is really important to try and communicate to them.

DR LA SALA: And I'd step in there and say as well that that's one of the goals of our current clusters resource and clusters social media study. So we are looking at developing content that does help people have those conversations. Young people tell us time and time again that you know it's the adults in their lives that are scared of the 'S' word and there's a lot of kind of fear around talking about suicide with young people in case you know they catch suicide or we're putting ideas in the minds of young people, and there's actually no evidence to support that.

In actual fact, talking about suicide is such a protective factor when it does come to young people, so I would suppose I would echo there as well what Em said in the terms of you know if you are a parent or if you are an adult, and you do have a young person who has been impacted by suicide, talk to them about it. You know there is fear as well like Em said, that saying the wrong thing is a problem but in actual fact saying nothing is worse. And that would be our advice: is just actually have that conversation.

DR RIOSECO: Thanks Louise and Em, yeah it seems like you know the power of communication, that's what we're calling for here. Maintaining those open lines of communication to be able to just be there for the young person, it's a very, very powerful thing. I've got another question coming through on - for both of you I guess, the benefits of using social media to - in prevent of youth suicide.

DR LA SALA: Yep. Yeah so I'll jump in there and just say that you know I suppose throughout the campaign or throughout the chatsafe campaign we've learnt that we - based with, in partnership with our social media accounts, we managed to get a lot of information out to, like I said, over 1.5 million young people in a 12 week period. And you know I'd like to think that that's a lot of young people who may not have seen any suicide prevention information across that time period otherwise, and you know for every young person who does feel a little bit more equipped or a little bit more empowered with some helpful information, that's a whole bunch of other young people that they can help.

So I think the benefits of social media, in terms of being able to reach a lot of people, in terms of it being a medium that young people seem to trust and they like to see information on, we can make it youth-friendly, we involve young people in helping us create that information so that it is meaningful to the others that see it. I just think you know a lot of the positives definitely outweigh the negatives.

DR RIOSECO: Great thank you. I have another question, Emily, for you. Thinking about the peer work. So, people who work with young people or educators who are in contact with, they may feel that somebody may be needing some support. Can you refer someone to go, 'Look, you will benefit from this program,' or how do people go about, like, 'this resource exists', can we direct young people to engage with peer support programs? How does that process work?

MS BOUBIS: It is tricky because peer work, while it's kind of gaining popularity and momentum, it's not everywhere. You know, hopefully, you know Headspace does have this peer program but it's not in every Headspace centre, and yeah especially the youth peer workforce is also you know relatively new when you consider other streams of support in the mental health field.

So it is sort of growing, but it isn't everywhere, but I would say if there is, like a service near you or even online, especially peer work especially is growing online very rapidly. If there is capacity and availability for peer work - to access peer work, whether it's in-person although obviously not at the moment. But also online, it's as simple as being referred to I guess a clinical stream of support, even easier because you technically don't need that formal referral, just to be tied into that service, so it can be a lot easier to see a peer worker in some cases, you don't need that you know GP referral or referral from a clinician and at least at my Headspace centre, yeah it doesn't need to be tied into other streams of support so it's really quite accessible for young people but it's just unfortunate that peer work is still kind of new in the field that it's not as widespread as hopefully maybe one day it will be.

So yeah, it's just about, if it is accessible to you and if it is something that you think a young person will benefit from, it's as simple as yeah kind of just referring them as you would to another stream of support, but usually quicker and easier as well.

DR RIOSECO: Right thank you. We've got many, many questions, keep going through them. Here, there's a question about concerns in terms of a young person's identity and how is that kind of protected when we are you know engaging with young people via social media?

DR LA SALA: Did they mean in terms of like as research participants or in terms of young people who might be sharing their stories? Does it say any more information - - -

DR RIOSECO: Maybe sharing content and - or you're reaching people via social media to share some messages, yeah.

DR LA SALA: Yeah. Yeah so I suppose, and please let me know if I haven't answered this question properly, but in terms of research participants being involved in some of the work that we do, we do not identify any of our participants and they wouldn't be able to be identified through any of our channels. So a lot of our research happens a little bit behind the scenes through direct messaging between us and the participant directly. So there's nothing really done in a group setting.

DR RIOSECO: Yep.

DR LA SALA: And the other thing, in terms of our ethical procedures, is that we would never identify or include identifying information in anything that we publish or present on. The other thing is in terms of protecting identity or, I think in terms of from a young person's perspective, you know the information that we would share or we would encourage in terms of what to post online or what to share online, a lot of that also comes back to being aware of what social media is and how that works, and just some more digital online safety.

So things like only sharing what you're comfortable with sharing, knowing that once you press send or submit or post it could be there forever. Things can be screenshot, things can be read outside of context, in terms of the way it's posted, so also empowering those sort of digital literacy and social media skills to accompany the information that a young person posts is really important.

DR RIOSECO: Yeah, great thanks - - -

DR LA SALA: Yeah, I don't know if that answers the question.

DR RIOSECO: Thanks Lou. We have time probably for two more questions. One, you both talked about the language and certain languages are helpful in how we can, with chatsafe for example, guidelines, provides some helpful alternatives. Someone's asking about another way of saying that someone has attempted suicide, is there another way this person works in the courts and sees this writing a lot and would like to educate others and what better ways to talk about this, better language to refer to this instead of saying, 'attempted suicide'. You can provide some guidance there?

DR LA SALA: I suppose like the big one for us is like the difference between 'committed suicide' or 'attempted suicide'.

MS BOUBIS: Yep.

DR LA SALA: 'Attempted', like in terms of what we advocate or what we encourage with the chatsafe guidelines, we don't necessarily steer people away from that language. I think we probably feel that there's other much more harmful language that we'd like to educate people on. Em, how would you - what would you say here?

MS BOUBIS: Yep you have touched on it already, Louise, but I think 'attempted' in the context of failed attempt is kind of where we distinguish between helpful and unhelpful. So that connotation of failed being kind of a goal to achieve, yeah, that negative connotation. So I think 'attempted' itself isn't unhelpful but in the context of 'failed attempt' it can be yeah quite negative and unhelpful.

DR LA SALA: Or 'unsuccessful', yeah.

MS BOUBIS: Yeah, 'unsuccessful.'

DR RIOSECO: Right, great clarification thank you. Some people are also asking about how they can keep up to date with the latest starter, latest research, most up to date resources and programs, is there I don't know a newsletter or somewhere where people can go to find- obviously Orygen and other organisations- but yeah if you can help people with where to go?

DR LA SALA: Yeah that's a great question. So in terms of keeping up to date with the chatsafe resources, with the Orygen resources, I'm sure Headspace is the same, anything on net - like we update our websites regularly and we do post some press releases and things like that when we do launch a new resource or a new handout, things like that. In terms of keeping up to date with the data around suicide, that's a kind of a bit of a topical issue, you know there is quite a lag or a delay between suicides occurring and suicide data becoming available, and so I know that again the centre for research excellence alongside the colleagues at the Brain and Mind Centre doing a lot of work in this space, trying to get that data made available more quickly. But yeah, we're not quite there yet.

MS BOUBIS: Yep.

DR RIOSECO: Thanks Lou. Emily, I've got a question for you. For other young people considering getting involved in youth peer work, how do you become comfortable discussing suicide with young people and other peers?

MS BOUBIS: Yeah, it takes a lot of time. Yeah so I sort of started my advocacy journey a few years ago when I volunteered for my local Headspace centre and through that have gotten involved in peer work, starting with Orygen and a few peer projects there and yeah and now the peer support role at Headspace Werribee so it's kind of through different projects and learning different skills through these projects that I've kind of gotten to this point where part of my role is having those conversations with young people.

But I've also been fortunate enough to do quite a bit of training as part of my role in terms of yeah sharing your lived experienced, sharing your story, and learning how to do that meaningfully, appropriately, how to do it as well. So a large part of that has come from training opportunities which I'm very grateful for. But yeah it also comes with practise and sometimes there are situations where you might disclose part of your story that maybe in hindsight it wasn't very comfortable to do or you realise wasn't meaningful, so yeah from that, learning how to go about it the next time. So there's a bit of failure involved in sharing your story unfortunately.

DR RIOSECO: (Indistinct).

MS BOUBIS: (Indistinct). So it's a lot of practise and knowing that you don't need to share any part of your journey or your story as well, it's entirely up to you whether you want to talk about it or how to talk about it or what parts to talk about, and yeah that comfort kind of comes with time which isn't always a great answer because you know I wish you could wake up and just have the confidence or the skills to do it. But yeah time and I've also been able to have some relevant educational opportunities as well, so it's a bit of a mixture but definitely time has been the best learning as well.

DR RIOSECO: Yeah great, thank you Emily. What have you seen in terms of demand from mental health services or you have any information or data on this and what's happened in terms of self-harm and suicide among young people during this period?

DR LA SALA: So, that's a great question. And it's something we are very interested in seeing especially how it plays out over the next few years. Unfortunately with the way that the suicide data is recorded and shared, we don't have up to date real-time data on suicides as they occur so currently there is no data to support the fact that there have been a rise in suicides due to the Covid-19 pandemic. But like I said in the presentation, we have seen a rise, a 33 per cent rise in self-harm presentations to emergency departments and we do know that self-harm is a number one predictor - or sorry, a high predictor of future suicidal behaviour.

So as we are seeing that rise in self-harm behaviours currently, we may expect that to translate into higher rates of suicide down the track. And like I said, my colleagues at the Brain and Mind Centre in Sydney are using some modelling techniques and they do expect up to a 30 per cent increase in suicides over the next five years. And that's when things like JobSeeker, JobKeeper and all of those economic and social and financial impacts are truly felt. And, sorry, in terms of demand, we are also aware that Headspace centres and our clinicians at Orygen are quite overwhelmed with the level of demand that they are seeing by young people seeking help, and I'm sure Em could see to this better than I.

MS BOUBIS: M'hmm. Definitely, I mean absolutely there's been really substantial increase in demands, at least particularly speaking for my centre but I know the other Headspace centres in the northwest of Melbourne that are parented by Orygen have seen similar increase in demand. So that's definitely been one of the things to come out of Covid but it's definitely not - I guess I wouldn't say it would be a massive deterrent for young people or for anyone wanting to seek help. It's just you know the nature or things at the moment but absolutely there's been yeah a massive demand on our access team and allied health professionals, 100 per cent- with everything going online and just to jump off that as well, a massive demand put online and telephone services as well in the past few months with Covid‑19 escalating so yep, that's 100 per cent been felt around the mental health space.

DR RIOSECO: And Lou, you were saying that we don't have real-time data on suicide, so what's the lag from like official statistics when the data is collected, when do we get to see that data, how old is it basically?

DR LA SALA: Yeah there is quite a lag so, for instance, the 2019 causes of death data was released last Friday, so what was that, like 25th, 26 October 2020, and so the lag can be anywhere between a year, two years at time and again a lot of our colleagues are you know pushing and advocating for a more real-time approach to suicide and arguing for the worth in terms of rolling out interventions in a timely manner, getting out information across communities as suicides have occurred because the longer we leave the Postvention approach, the less effective it will be.

DR RIOSECO: Yeah definitely. The other question that we didn't have time to look up before is in terms of contagion, suicide contagion, and what advice could you give to address this risk on social media?

DR LA SALA: Yep, and that's another good question. So I know I spoke in the presentation about harnessing the positives of social media and that you know social media can be used for good and that there's a lot of really good things that we can do, but we can shy away from the fact that social media can also cause harm and we are upfront about that in the chatsafe guidelines, especially when information is shared in an unhelpful or unsafe way.

So unhelpful and unsafe reporting of suicide is quite harmful and increases the risk of the people who see it. We know that social media is also a place where misinformation or rumours or gossip can spread. We also know that you know once something is on social media it's there, like it can be there for a long time, and so we might be seeing it more than we would in a conversation offline.

And so in terms of managing contagion across social media I think it's really important that we're all aware of what is harmful so things like this information, you know, talking about methods or you know sharing photos or information about locations of suicide, all of that is really harmful and unsafe, and so the more people that are aware of what's harmful, the more I suppose we can have people that are able to pull down or report that content if they see it in terms of trying to keep social media a safe space so yeah, if it is harmful or it is unsafe, the risk of contagion does increase, but the more people who are equipped with that knowledge I suppose the more people that are kind of hoping or trying to make social media a safer space.

DR RIOSECO: And there are some specific guidelines on the chatsafe about that right?

DR LA SALA: Yeah so there's information within the chatsafe guidelines about what constitutes 'safe' or 'unsafe' communication or posts. And there's also information in the clusters resource or the chatsafe guide for communities around what sorts of information they should be pushing out and what sorts of information they should be monitoring their posts for and removing or reporting.

So the other thing there is the chatsafe guidelines does educate all social media users I suppose on what tools are available to them through their social media platforms. So things like reporting content, hiding, snoozing, removing followers, things like that, those kinds of technological tools at our disposal to minimise how many people see unhelpful content.

DR RIOSECO: Em, do you find that you come across these issues in your peer support work?

MS BOUBIS: Absolutely. Young people are all across social media, almost 24/7, so it's not about removing that from their everyday, it's about cultivating it to be something safe and positive and helpful. So I mean we're never gonna win the battle against social media I don't think, but we can definitely make them safer spaces, so I think that's about all we're choosing to focus on, at least with the chatsafe guidelines.

DR RIOSECO: Great. And our last question for today, it's about whether you know about specific statistics or data information on self-harm and suicide behaviours among people from refugee or migrant backgrounds?

DR LA SALA: That's another really good question and again it's not a group that we have managed to engage well yet, with the chatsafe work that we do or with the work that we do within our team. We would acknowledge that refugee or migrant youth are at greater risk and do have some risk factors that do need some special consideration but in terms of, 'Am I aware of data in terms of self-harm and suicide behaviour, I'm not to be honest with you, I'd love to know if there is. But again, yeah there would be some really unique risk factors there that are worth exploring.

DR RIOSECO: Yep.

DR LA SALA: And again I think it's something that you know we could do down the track with chatsafe in terms of trying to get out the message to as many young people from as many different backgrounds as possible. It's not super related but you know one of the projects we're currently running is with culturally and linguistically diverse groups across the northwest of Melbourne and there we're trying to do things like getting resources and content in the languages that are spoken within the home, so that we're trying to kind of promote conversations between young people and their parents. I know schools in the northwest have struggled to send home information around mental health, self-harm and suicide if parents don't speak English. So there are, that kind of work's being done but in terms of collecting the data at this stage, no.

DR RIOSECO: In your experience, Emily, you've come across working with migrant - refugees and migrant young people?

MS BOUBIS: Yeah so in Werribee in the Wyndham region, yeah, refugee, migrant, culturally and linguistically diverse people, particularly young people make up a really significant part of the community and we've done a little bit of research in that area to inform some of the community work and the school work that we're doing in our Wyndham region, so we've definitely seen the numbers and we recognise how much of the community are from those demographics and those groups of people. So it's a massive part of our community and like Lou said, there isn't a lot of information particularly about mental health that are in those accessible languages for those communities and families. Particularly in the school setting. So yeah, we also recognise that's a massive gap in our work and in our community that hopefully we can do a little better at in the future.

DR RIOSECO: Great. Well thank you Emily, thank you Louise for hanging around and responding to a few more questions. But before we say goodbye to our audience, if you could quickly just give us a takeaway message, just something for people to think about?

DR LA SALA: Em?

MS BOUBIS: I would say I sort of mentioned this in what I said before, but not being afraid of silence or uncomfortable opportunities to talk with a young person. Let them find the right words, let them find comfort in physical space, emotional space, to tell you what's going on and be there for them if and when they're ready to have that conversation. Yeah, silence can be really powerful. You just sort of have to sit in it for a little bit sometimes but it can be a great opportunity to be in a moment with a young person and allow them to share what's going on.

DR RIOSECO: Thanks Em, Louise?

DR LA SALA: That's really good. I would probably say you know if we think back to the different types of interventions that we run and try to reach young people through, I would say it's really important that we involve young people in the creation of those, in the evaluation of those, and in the roll out of those, you know if we want something to have impact and if we want something to be meaningful for those people, they need to be included every step of the way. So we need to stop kind of making decisions on their behalf or you know assuming that we know what's going to work best, and start involving the people that have the experience.

DR RIOSECO: Great, thanks Lou. Thanks everybody for joining us today and we'll - make sure you're signed up for the CFCA news so you can receive the link and have a look at the entire - the whole session. Thanks for joining us and thanks Emily and Lou for your insights. Thanks everyone.

DR LA SALA: Awesome, thanks for having us.

WEBINAR CONCLUDED

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Slide outline

1. Working together to prevent youth suicide: The power of communication

Dr Louise La Sala and Emily Boubis 
CFCA Webinar 
28 October 2020

2. Working together to prevent youth suicide: The power of communication

Dr Louise La Sala, [email protected], @louiselasala
Emily Boubis, [email protected]

3. Suicide rates in young people 2008-18

4. Best practice across settings

1. Indicated interventions for people already showing signs of suicidality
2. Selective interventions for those at high risk i.e. with MH problems
3. Universal interventions across the whole community, regardless of risk

5. #CHATSAFE: Responding to Youth Suicide and preventing suicide clusters

Alt text: #Chatsafe resource: A guide for communities - using social media following the suicide of a young person and to help prevent suicide clusters

• If you've lost someone to suicide, you're likely to be experiencing lots of different feelings
• And it's okay to talk about these feelings with people you trust.
• The language you use matters: 
  • Suicide is preventable
  • Recovery is possible
  • Help is available
• Self-care should be something that you enjoy and helps you relax. I like to do the mindful colouring (Maddy)

6. Continue the conversation

For more information and the complete webinar head to:

https://aifs.gov.au/cfca/webinars/working-together-prevent-youth-suicide-power-communication