Suicide is a humanitarian crisis; it is the fifth deadly killer of Indigenous people and according to the Australian Bureau of Statistics, over the past decade there has been a 21% increase in youth suicide rates. Mental health is a multi-layered issue that requires a holistic tailored response to adequately address the root social, economic and historic causes of suicide in Indigenous communities. It is alarming to think about the suicide of a young adult who still has much to experience from life, emphasising severe underlying issues in our society and systems and suggesting youth are reacting to this toxic environment. The journey of healing is imperative, it is not one dimensional and requires a more profound level of knowing at the individual, community and societal level. We need successful programs that effectively address mental health in relation to suicide using a strong Indigenous context to strengthen the future generation by employing powerful Indigenous knowledge. As Professor Dudgeon said, “there is a serious need to overhaul the current system”.
A dynamic state of interconnectedness exists; no single aspect of an Indigenous person's life can be considered in isolation. Different aspects impact on or are impacted by others, highlighting a “multi-directional” continuous cycle that defies simplicity. Policy and programs can’t be reduced to the simple interplay of isolated risk and protective factors as they fail to acknowledge a broad range of interconnected factors that leave youth feeling inadequate and vulnerable, neglecting the opportunity to prioritise their mental health as their relatives are forced to deal with other issues. There is an overarching theme of loss in relation to suicide. Historic rulings have propagated intergenerational trauma and now more influencers only complicate the situation. Youth have been challenged by the continual degradation of social support networks; where ties with family and community traditions have weakened, particularly in relation to the roles of elders and Indigenous males advancing feelings of isolation. For males, this has been associated to the concerning 24% increase in suicides.
“Young kids especially here look up to lead teams and people that play so as a club we decided to promote the awareness of youth suicide. I’ve been personally affected by suicide where family members actually did it, so it hit home for me and so I find it kind of meaningful to go along with the whole idea of [raising awareness about] youth suicide” - Tristram Pigram- Captain of the Broome Saints.
Action Learning Models like those in Inala (QLD) and Alive and Kicking Goals! (AKG) (WA) captivates youth and consequently diverts them from damaging influences. Youth develop personally and professionally; gaining interpersonal and teamwork skills and respect for themselves. Peer status is influential and significant in Warlpiri youth culture; support from a different peer, older person, or health professional may not be accepted as they are deemed untrustworthy or unsuitable to deliver this type of support. Volunteer youth leaders like Pigram emphasise that pursuing help is not an indication of weakness; peer-to-peer support also guides youth by giving them necessary tools to inspire resilience and strength to build their own solutions to overcome tough events. “Indigenous people have been treated as second class citizens for too long” , programs like these are instrumental to elicit societal change as youth have a sense of belonging by understanding their role within their communities and society at large. Youth learn and respect Indigenous ways of life, boosting their sense of control and optimism as they recognise the importance of Indigenous knowledge of mindfulness and interconnectedness as the awareness of one’s self empowers them to improve their mental health and continue on their personal healing journey.
There is a fear of Western mental health treatment and practitioners; distressing incidents of people hospitalised far from country and failure to satisfy familial and community roles impacted on how youth understand Western models of healing. Hence, families would delaying getting help until breaking point. The Mt Theo Program engages a permanent, community-based, competent counsellor to develop healing plans to overcome these embedded fears. The counsellor can encourage critical evaluation of deeper causes and triggers and helps select and apply tailored coping strategies giving youth access to support. This diminishes an unequal ‘pear shaped’ delivery of services with minimum training and accountability and makes seeing an Indigenous health professional or accessing higher levels of help possible, allowing healing at the individual and communal level. These programs also address socioeconomic subjugation as Indigenous youth can overcome inequalities in our systems to gain access to the support they deserve.
Western practices tend to ‘label’ individuals from their diagnosis and this ‘othering’ is problematic in Indigenous communities as it connotates shame and stigma. The Suicide Prevention Project: Lighting the Dark works alongside local communities to augment individual, family and community capacity against suicidal actions. Using DVDs and working with local languages this program and AKG educate youth without assumptions of literacy. DVDs are made relatable and specific to the communities; having a constructive influence by increasing awareness around suicide. The importance of conveying these ideas could be seen strongly with depression, a risk factor for suicide, as some Indigenous people considered depression to be part of an individuals’ character where signs were dismissed as ‘that's just the way he is’.
Indigenous voices need to be heard to understand and gain knowledge about conceptualisations of suicide. Cross-cultural psychiatry contrasts the danger of categorising Indigenous people as one analogous cultural group, as recognising differences in cultural beliefs can help build understanding about extra dynamics like place. For example, globalisation, the media and western notions could influence youth in urban areas resulting in a conjugation of cultural beliefs and understandings about mental health. Critical understanding of culture and knowledge as active, living systems that continually change is essential to understand how programs can better relate to and reach youth.
“Even if you’re not sure on exactly what’s going on with yourself but you know something’s not right it can definitely help. There’s activities on the app that can help you figure out where to go from there…” - Dane Gagai
Internet-delivered therapy are just as effective as one-on-one methods for depression and anxiety. The iBobbly smartphone app, developed by the Black Dog Institute targets young Indigenous people at risk of suicide. As Gangai affirms, it allows confused youth to easily access help and information at the touch of a button, highlighting how innovative technology-based approaches can work with our ever-changing world as a preventative tool.
Empowerment can contribute to suicide prevention as communities can address their needs specifically. Cultural congeniality is fundamental; culture and traditions need to be respected and it emphasises the need for human rights considerations that can aid healing. Programs need to abide by the United Nation’s Declaration that recognises Indigenous peoples’ cultural difference and needs, and histories of colonisation affirming their individual and collective human rights (Article 1), but more importantly states Indigenous peoples have the right to self-determination (Article 3). The Yiriman Project (WA) is a community-based approach that is built on the human rights framework and forms stories in young people by bringing them back to country. Back to country trips allow youth to learn about Indigenous culture and knowledge, allowing youth to fully experience life and connect with country and community. Such programs work with individuals and communities to reinvigorate family and community values, re-building and strengthening youth support networks to prevent suicide. I believe earnest attempts like this can be extremely effective as they don’t operated on an inherent assumption of knowing the ‘best interests’ of Indigenous communities. The power of shifting control allows “Indigenous health to be led by Indigenous people” ; given the opportunity and resources their strength and resilience will rise above our current rigid social plane.
Similarly, the Mowanjum Keeping Place and Media Project (WA) documents culturally specific stories of people, places, language and perspectives. The program employs intergenerational teaching and learning to encourage the value for culture and lore as digital multimedia collections encapsulate storylines, songs and dance. This modern twist ensures knowledge is preserved and sustained as it appeals to youth who form a connection to culture on their terms. Youth are also able to contribute to the archives making this process of healing extremely personal and unique. Likewise, the Junba project (WA) uses ‘Junba’, a type of storytelling using traditional song and dance to widen myriad opportunities for youth to participate in workshops that couples youth with Elders and multimedia specialists. Junba gatherings on country are arranged before the annual Mowanjum Festival. The community come together and practice Junba together aiding individual and communal healing.
Social and cultural changes experienced by youth call for an expansion of biopsychosocial models to encompass sociocultural and spiritual aspects as these two programs highlight. Youth have a right to cultural healing customs in both traditional and modern revitalised forms. Acknowledging the healing and cultural learning frameworks that exist within Indigenous conceptualisations helps utilise the power of culture and community to heal from the past and build a stronger future. These programs restore connection to spirituality and culture to positively shape identity and allow youth to handle taxing circumstances. Approaches that draw on Indigenous knowledge to construct culturally appropriate programs provide a unique opportunity to develop ‘two-way understandings’ between Indigenous knowledge and Western models of care that will fulfil successful mental health outcomes with and for Indigenous youth.
Many policies have failed to realise the true potential of community-driven, Indigenous knowledge specific programs from the way they are evaluated. The next step is to ensure effective programs like the ones mentioned are kept and funded for. The current challenge is to develop meaningful indicators/measures for data collection, research and government reporting frameworks so that they accurately capture what is fundamental and meaningful to Indigenous people and how they view mental health and wellbeing. Currently, data is solely sourced from hospitalization and mortality data to inform policy and program development causing severe difficulties in identifying and interpreting suicidal factors which leaves issues unresolved or wrongly approached. Even the current high suicide rates are underestimated as many suicides go unreported or falsely classified. We need more in-depth accounts based on experiences of those within the community to shed light on the perspectives around suicide in different communities, their families and broader support structures. I believe more time needs to be invested in evaluating community-driven programs so communities are given a fair chance to see what suits them. Many feelings and experiences can’t be quantified; so it forms a complex issue when practical considerations require ‘proof’ in the form of quick and adequate statistics to continue funding a program. Communities shouldn’t be reduced to numbers; it is this misconception of success that needs to be tackled next as it prevents societal healing.
Suicide is a cause for concern. Western and Indigenous models of knowledge need to work together to secure a safe and prosperous future for Indigenous youth. Ultimately, the aim should be that Indigenous youth have access to mental health services that have the equivalent quality, dependability and service continuity as other Australians. We are all in the process of healing; understanding and learning more about Indigenous knowledge can help provide us with the answers to build and sustain successful programs that effectively address mental health in relation to suicide. Suicide is a social phenomenon; when we change it will cease to be a deadly killer.