Suicide Prevention in the West Kimberley - Derby Forum

1. Suicide Prevention in the West Kimberley - Derby Forum Project Need: Rates of suicide in Derby Region 2.3 the rate of non-indigenous Australians Recent suicides in area; IPS suicide and depression workshop in Broome in 2001; Concern expressed by local youth and service providers about rates of suicide and lack of culturally relevant training in suicide intervention.

2. Suicide Prevention in the West Kimberley Stage One: Development of project parameters Funding of $20,000 obtained by OAH; Community Development approach - training of youth, community and service providers (Neill, 2002); Uniqueness of such an approach to intervention Content to address indigenous specific suicide risk and protective factors The role of IPS

3. Suicide Prevention in the West Kimberley Stage Two: Consultation with local service providers: 1. DASA and OAH organised Telelink with Broome, Derby and Fitzroy Service Providers; 2. Invitations extended to all service providers to participate in Forum.

4. Suicide Prevention in the West Kimberley Stage Three (a): Development of Final Program Thursday and Friday - Service Providers Evenings - Counselling / debriefing provided Saturday / Sunday - counselling / debriefing to families and individuals Monday - Community Forum Tuesday and Wednesday - Youth Forum Thursday - Counselling / debriefing provided to families

5. Suicide Prevention in the West Kimberley – Service Providers Forum Forum Philosophy: “To discuss the issue of Aboriginal Youth Suicide with West Kimberley Service Providers in an open, candid and non-threatening manner. It was envisaged that information gained through Forum delegate’s participation would provide a greater understanding of both the issue's and potential gaps in service. It was also anticipated that Forum delegates might also make recommendations for potential interventions for the target cohort”.

6. Suicide Prevention in the West Kimberley – Service Providers Forum Major Aims of the Forum; • To identify services already providing programs to the Aboriginal community of the West Kimberley. • To understand the nature of the services provided (e.g., perceived strengths and limitations due to funding, distance, lack of staff etc). • To identify the gaps in suicide prevention services offered in the West Kimberley. • To identify collaborative strategies that might be employed to offer a more holistic services to suicidal Aboriginal people. • To identify new strategies for suicide prevention in the West Kimberley. • To provide current and relevant research and practice information to aid Forum processes.

7. Suicide Prevention in the West Kimberley – Service Providers Forum THE FORUM INTERVENTION: • The Service Providers forum was conceptualised as a community development intervention. • The latest psycho-educational and psychotherapeutic research information was presented to provide the group with a consistent and common frame of reference to guide Forum discussions. • All information provided was presented within the context of the Aboriginal terms of reference developed at the Centre for Aboriginal Studies at Curtin University. • Group work, group process, role play, self disclosure, self awareness and a genuine desire to make an impact on the problem of youth suicide were the major tools employed to encourage discussion and creativity at the Forum. • It was envisaged the Forum be a safe, creative and non-judgemental environment to encourage fresh and new ideas to address the suicide problem in the West Kimberley.

8. Suicide Prevention in the West Kimberley – Service Providers Forum A Brief Overview: • The Service Providers Forum was held on the 12th and 13th of July in Derby at the King Sound Resort. • The Forum was well attended with 31 delegates from 24 West Kimberley agencies attending the two days. • Delegates were from a mix of Aboriginal and mainstream and statutory (e.g., Western Australian Police Force) and non-statutory agencies (DASA). • All delegates either worked with suicidal clients or expressed a desire to assist in preventing the high levels of youth suicide currently experienced in the West Kimberley.

9. Suicide Prevention in the West Kimberley – Service Providers Forum Gaps In Services (the service shortfalls identified and listed here do not necessary represent all of the delegates opinions are indicative of opinions expressed by the group). • Pre-Case Management (Nil). • Multiple agencies unable to provide a service (e.g., hand-balling clients). • Remote Communities have a paucity of services. • Lack of money to provide services to clients in towns and remote communities. • Lack of support to suicidal clients, families and workers at the coal face. • Train the Trainer (Culturally appropriate Suicide Prevention Course). Local people need to be trained, especially those permanent residents. The community and staff from Agencies need ongoing support & debriefing

10. Suicide Prevention in the West Kimberley – Service Providers Forum GAPS IN SERVICE (CONT…) • Lack of 24 hour service • Downgrading of Derby Health Service • For suicidal youth/families no “one stop shop” re primary through to tertiary services • Poor accessibility to services • The stigma of accessing mental health services • Limited of collaboration between service providers • Lack of funds being targeted properly for this specialist area. Need a specialist service. • Clients concerned about their confidentiality • Suicide awareness should be commenced in school • There is no 24 hour crisis response for suicidal clients. • The families and the victims left after a suicide completion require a support service. This service would address building resilience in the other siblings and extended family.

11. Suicide Prevention in the West Kimberley – Service Providers Forum RECOMMENDATIONS: These recommendations were presented by Forum Delegates to the Hon. Carol Martin, Member for Kimberley. • Employment of a West Kimberley Youth Suicide Prevention Coordinator • Establishment of a West Kimberley Youth Suicide Prevention Committee • Support from Mental Health Division • Permanent Mental Health Worker in Fitzroy Crossing. Currently there is a monthly visiting service from NW Mental Health Services and is run in conjunction with their normal monthly visit throughout the Kimberley. Alternatively, that a mobile counselling service visits Fitzroy and spend a week offering counselling services.

12. Suicide Prevention in the West Kimberley – Service Providers Forum RECOMMENDATIONS (continued) • Minister for Health, Bob Kucera’s phone/door be open to this committee • Carol Martin be presented with these recommendations for her support, and that it is stressed to her that we do not want a band-aid service. That this service will need to be recurrent • Office of Aboriginal Health ongoing support • Indigenous Psychological Services training made available to more community people, and that the relevant services/departments undertake this training as part of their core business • That DASA is supported to provide these youth services and be recognized as the key provider for youth services in the Derby area.

13. Suicide Prevention in the West Kimberley – Community Forum Forum Philosophy: “To train a cohort of Aboriginal Community members from within the West Kimberley in suicide intervention and prevention. This approach is consistent with a community development framework in encouraging skill facilitation within community to address specific needs. Training of community acknowledges and validates the role that they currently play in supporting families and members of the community who are exhibiting suicidal behaviours”.

14. Suicide Prevention in the West Kimberley – Community Forum Major Aims of the Forum; • To identify community perception of services already providing programmes to the Aboriginal community of the West Kimberley. • To understand the nature of the services provided (e.g., perceived strengths and limitations due to funding, distance, lack of staff etc). • To identify the gaps in suicide prevention services offered in the West Kimberley. • To identify collaborative strategies that might be employed to offer a more holistic service to suicidal Aboriginal people. • To identify new strategies for suicide prevention in the West Kimberley. • To provide current and relevant research and practice information to aid Forum processes.

15. Suicide Prevention in the West Kimberley – Community Forum A Brief Overview: • The Community Forum was held on Monday 15th July in Derby at the King Sound Resort. • The Forum was well attended with 27 participants from Derby and Fitzroy Crossing communities attending the days training. • Participants were from a range of family groups within the region who were concerned about the escalating rates of youth suicide in the region. A smaller number represented agencies who did not have a direct role in the provision of suicide intervention services.

16. Suicide Prevention in the West Kimberley – Community Forum The Community forum involved the delivering of IPS’ suicide intervention package; • Adaptation was made to the content to address the wider issues of skills facilitation and development with community members; • Training was adapted to a one day forum which included the following content; • suicide myths within Aboriginal communities; • the nature of Aboriginal suicide - how does this look in Aboriginal people? • Depression and it’s role in suicide for Aboriginal people • Impulsivity and its role in completed suicides in Aboriginal communities • What am I looking for? Conducting culturally relevant risk assessments with suicidal youth • Developing concrete community strategies to address issues of immediate risk when help is not available • understanding our rights within the community - the Mental Health Act and its relevance to Aboriginal people; • Interventions to prevent contagion in my community - what can I do? • Self-care and understanding my limitations • A debriefing process occurred at the commencement and completion of each group • Facilitators were also available for one one counselling following the group

17. Suicide Prevention in the West Kimberley – Youth Forum Forum Philosophy: “To provide training to a pool of Aboriginal youth to acknowledge the vital role they currently play in the identification of peers at risk. In addition, a psychoeducational package regarding suicide intervention was provided. Finally, youth were educated in a range of coping strategies aimed at reducing the incidence of suicide attempts amongst youth”.

18. Suicide Prevention in the West Kimberley – Youth Forum A Brief Overview: • The Youth Forum was held on Tuesday 16th and Wednesday 17th of July in Derby at the King Sound Resort. • The Forum was well attended with 41 youth attending the two days. • Youth were from Derby (N=29) Fitzroy Crossing (N=10), Broome (N=2). • All youth had experiences of suicide.

19. Suicide Prevention in the West Kimberley – Youth Forum • Major Aims of the Forum; • To identify services already providing programmes to the youth of the West Kimberley. • To identify the gaps in suicide prevention services offered for youth in the West Kimberley. • To identify strategies that might be employed to offer a more appropriate service to suicidal Aboriginal youth • To provide cultural and age appropriate youth suicide intervention training based on a psychoeducational model • Provide intervention in a range of internal and external coping strategies aimed at addressing suicide risk in Aboriginal youth

20. Suicide Prevention in the West Kimberley – Youth Forum THE FORUM INTERVENTION: • The Youth forum was developed specifically for Youth in the West Kimberley • All youth were prettested using culturally appropriate measure of presenting symptoms • Based upon existing research and clinically validated therapeutic interventions which will formulate the basis of a innovative research grant acquired by IPS in conjunction with The School of Psychology, Cutrin University; • Culturally appropriate psychotherapeutic techniques including adaptation of CBT’s for use with Aboriginal youth developed by IPS; • The content of this training was presented in the most efficient and appropriate cultural methodologies, including; • Group work • role plays based upon real life scenarios and difficult situations; • development of a range of concrete strategies based upon identifiable risk factors for Aboriginal people (eg. Impulsivity and contagion suicides)

21. Suicide Prevention in the West Kimberley – Youth Forum THE FINAL PROGRAM: • The Youth forum included: • Suicide myths that youth and others have about those who have suicided; • depression and what it looks like - how do I tell when someone is depressed? • Impulsivity - how to pick who is most likely to harm themselves • Developing a plan for reducing the risk in friends and community • How to prevent contagion suicides in my community • recognising my limitations - where can I go for help • Managing my emotions - recognising what impulsivity looks like and developing strategies to reduce the negative impact of my impulsivity; • anger management - why do I get angry, and what can I do about it? • Development of disputational strategies for negative thought processes • Conflict - its’ role in suicidal behaviours - how can I handle conflict in my community • Payback and its implications; • cultural conflicts - why do I get involved - my behaviour and what I do to contribute to escalating conflicts • Assertive and effective communication strategies • Techniques for diffusing conflict • Development of a range of recommendations to address youth suicide

22. Suicide Prevention in the West Kimberley – Youth Forum RECOMMENDATIONS: These recommendations were developed by the youth during a group facilitation process and presented to local service providers and some of the participants from the Community Forum. • Employment of a West Kimberley Youth Suicide Prevention Coordinator to be based at a Youth Service like DASA; • That a Drop In Centre be added on to Derby Aboriginal Sporting Association (DASA) (add more facilities and services for youth at the DASA property); • There should only be one place for youth to go to - 24 hour centre “Cry for Help” • This Centre should have a counsellor there for youth to talk to. • More training for youth in IPS’ training • Youth need more help from other services to run activities etc and to form a committee made up of major organisations

23. Suicide Prevention in the West Kimberley – Youth Forum RECOMMENDATIONS: • (FX)There needs to be more structured activities for youth - elders teaching kids about culture; fishing and hunting; sporting activities; • Youth workers (counsellors) to talk to more regularly; • Youth Drop in Centre with counsellors available - kids need somewhere that they can be safe and even be fed • That debriefing and healing days are provided to communities regularly, not just in times of crisis • All youth agreed that there needed to be more EARLY INTERVENTION programs to address youth suicide - including an ongoing and intensive youth suicide psychoeducational package such as that delivered by IPS.

24. Suicide Prevention in the West Kimberley – Results Qualitative Evaluation: • High reports of satisfaction with the training including comments such as: “I have been to other workshops on suicide, but doing this one I felt free to be involved.” “Being here over these few days, I feel I can finally stop blaming myself” “Actually able to talk and felt comfortable asking questions” 19 year old male from Fitzroy Crossing “This course Tracy has put together is easy to understand, not too high English like other courses. I found them too hard to understand. This course should be available to all Aboriginal people”

25. Suicide Prevention in the West Kimberley – Results Community member, “I feel like I have the confidence to talk about suicide, because in this workshop I have gained some skills to talk to kids, people, families… There were also comments made by various members in the group who have attended other mainstream suicide intervention training's:- • that it is not culturally appropriate • it is not transferable to the Aboriginal community or through service providers who have attended this course • The use of language is not appropriate and not directed to the target group • It needs to be delivered as a train the trainer package by suitable Aboriginal people, in a cultural way. “I feel a lot more confident in being able to help people who might be feeling this way as a result of the training”

26. Suicide Prevention in the West Kimberley Forum BRIEF ANALYSIS: • there was poor integration and communication exchange between services working with suicidal youth. This has the potential “for clients to fall through the gaps”. • Some services were not aware of the work of other agencies. • Poor understanding of the role delineation between agencies. • There is no one group (Committee) dealing with and co-ordinating interventions for Youth Suicide in the West Kimberley. This committee would facilitate information exchange and co-ordinate joint training etc. • No Suicide Prevention Officer for the West Kimberley. • Lack of/or poor community consultation to identify appropriate interventions. • Lack of specific and realistic funding for specialised suicide prevention interventions. • Lack of funding (including access to resources in program development) in agencies to deliver specialised services in an ongoing, aggressive and intensive manner. • Culturally appropriate suicide prevention workshops would increase the understanding of the suicide dynamic and possibly assist in suicide prevention in the townsite and communities.

27. Suicide Prevention in the West Kimberley – Service Providers Forum FOLLOW-UP: • To provide Culturally Appropriate Suicide Prevention Training to community members who were not able to attend the last training workshop. • To provide Culturally Appropriate Suicide Prevention Training to the remote communities who requested that the training be delivered on a “community wide” basis (e.g., the whole community undertake the training) • To provide advanced suicide prevention training to Service providers • To undertake community consultation, in collaboration with the West Kimberley suicide Prevention Committee, with community members to examine appropriate methods of suicide prevention and intervention. • To meet with Service Providers to review how interagency collaboration is working in providing an integrated safety network for suicidal clients. • To review the progress and advancements the money promised by the Hon. Carol Martin has made. (e.g., the Suicide Prevention Officer). • To undertake individual and family work if and when required.

28. Suicide Prevention in the West Kimberley – Community Forum FOLLOW-UP: • To provide Culturally Appropriate Suicide Prevention Training to community members who were not able to attend the last training workshop. • To provide Culturally Appropriate Suicide Prevention Training to the remote communities who requested that the training be delivered on a “community wide” basis (e.g., the whole community undertake the training) • To provide advanced suicide prevention training to Community Members and incorporate debriefing; stress management and managing crisis modules (including development of a local crisis management strategy); • To undertake community consultation, in collaboration with the West Kimberley suicide Prevention Committee, with community members to examine appropriate methods of suicide prevention and intervention. • To evaluate participant skill in core competencies of suicide knowledge, skills application, intentions to help behaviours and barriers to help seeking behaviours and assisting suicidal youth (as per existing questionnaire) • To undertake individual and family work when required.

29. Suicide Prevention in the West Kimberley – Youth Forum FOLLOW-UP: With existing cohort of youth. • Posttesting using culturally appropriate screening inventory of presenting symptoms • Additional ‘advanced skills’ training in suicide intervention and prevention with identifiable youth leaders; • Additional clinical intervention with youth ‘at risk’; • Consolidation of coping skills already learnt; • With new cohort • To provide a second youth forum to those who were not able to attend the last training workshop. • To provide advanced suicide prevention training to core group of identified ‘youth leaders’ through linking in with YCNs and/or RYNs; • To undertake individual and family work if and when required.