In Queensland, throughout Australia and internationally, males continue to experience disproportionately high rates of suicide. We funded an independent systemic review of male deaths by suicide in Queensland to examine any patterns, contribute new knowledge and build understanding to assist suicide prevention efforts.
What we did
Every life: The Queensland Suicide Prevention Plan 2019–2029 (Every life) includes a range of strategies to better understand, respond to, and reduce and prevent suicide among high-risk groups.
The Every life plan made a specific commitment to do a systemic review of male suicide to inform a comprehensive strategy for men’s suicide prevention.
This project was delivered in partnership between the Commission and the Coroners Court of Queensland.
It focused on moving understanding beyond the well-established information about who dies by suicide to better understand why suicide among males occurs, and how it may be more effectively prevented.
The Coroners Court of Queensland provided case records for 155 male deaths by suicide for examination. This focal group included all males aged 25 years and over who died by suicide in Queensland over approximately three months in 2021.
What we found
Behaviour and experiences before death
The review found the following:
- Almost half of all cases were known to have communicated suicidal thoughts, plans or intent at some point in their lives
- Almost half of all cases had evidence of some form of contact with health professionals for mental health issues
- Just under one-third of cases had apparent mental health-related service contact. General practitioners were most commonly contacted for mental health concerns (34 cases, or 76 per cent of all cases with known mental health contact)
- Almost half of all cases had access at the time of their death to at least one form of psychiatric medication (commonly, anti-depressants)
- Almost three out of four cases had at least one form of help-seeking behaviour
- Almost all cases (around nine out of 10) had life histories characterised by negative or stressful life circumstances and events, including:
- history of criminal offending
- relationship breakdown
- physical condition/illness (this included chronic pain, which was often not explicitly recognised as a potential trigger for suicide)
- housing instability/insecurity
- financial problems
- prospect of criminal sanction
- being in a carer relationship.
These findings challenge the perception that men do not seek help; but suggest that help-seeking may not result in effective responses to the underlying needs and circumstances of males experiencing suicidality.
Systemic issues and missed opportunities for prevention
Thirteen cases who had known service contact in the lead-up to their deaths were reviewed in-depth. This identified systemic issues associated with suicide, as well as potential missed opportunities for prevention.
Findings suggest that improvements can be made to service responses, particularly in areas such as integrated case management and communication between different services.
Other supports needed
It appears that a ‘medicalised’ model of suicide may be creating challenges for effective service delivery.
Most cases who had hospital contact for suicidal thoughts or behaviours appear to have been offered referrals and advice about support services. However, referrals were almost exclusively for outpatient or community-based mental health services and/or alcohol and other drugs services.
Many cases had needs that extended far beyond these outpatient or community-based services, such as relationship support, housing support, and employment or financial services. There were notable gaps in referrals to community-based services for these kinds of needs, and mismatches between the needs identified during psychosocial assessments and the supports offered or made available.
Many cases had dual diagnoses, multi-morbidity or additional complicating factors.
Services appeared to find it particularly challenging to respond to people who were also experiencing personality disorders, chronic pain and acquired brain injury/intellectual impairment.
Limited early intervention
Most responses were crisis-focused and emphasised mental health services.
A number of cases had life circumstances where other (non-mental health) services may have been relevant—not only to reduce the likelihood of eventual suicide, but also to reduce or prevent suicidality from developing in the first instance. However, there was little evidence of early intervention from a whole-of-systems perspective, or recognition of the role multiple systems can play in suicide prevention efforts.
The review identified opportunities to improve the collection and use of information about suicide in Queensland, and the Commission has started the Reforming Suicide Surveillance project to implement these recommendations.
The report strongly suggests that a ‘one size fits all’ response is unlikely to successfully reduce or prevent male suicide, and that the help men receive may not be the help they want or need.
The Commission is currently exploring ways to enhance system responsiveness to men’s needs through the ongoing implementation of Every life.
Also, the report found there were relatively few indicators of early intervention and/or holistic responses across agencies or services in any of the examined cases. Improving early intervention and whole-of-community responses to men in distress will be an area of focus for the Commission in the ongoing implementation of Every life.
Review the presentation given by project lead, Dr Samara McPhedran, at the Commission’s Leading Reform Summit 2022, or review the project executive summary.