Towards Zero Suicide

South Australia’s journey towards reducing self-harm and suicide related distress.

Where can you find help?

Mental health services – SA Health

Lists a variety of mental health services in South Australia
Website: Mental Health Services

Mental Health Triage Service - 24 hours/7 days

Phone: 13 14 65
Website: Mental Health Triage Service

Lifeline

Phone: 13 11 14
Website: Lifeline

Urgent Mental Health Care Centre

Phone: (08) 8448 9100
Website: Urgent Mental Health Care Centre

Head to Health

Phone: 1800 595 212
Website: Head to Health

QLife

LGBTIQ+SB communities
Phone: 1800 184 527
Website: QLife

13YARN - 24 hours/7 days

For Aboriginal and Torres Strait Islander people
Phone: 13 92 76
Website: 13YARN

Crisis Support line with Open Arms

Veterans and Families Counselling
Phone: 1800 011 046
Website: Crisis Support line with Open Arms

Lived Experience Telephone Support Service - 5:00 pm to 11:30 pm

Phone: 1800 013 755
Website: Lived Experience Telephone Support Service

Beyond Blue

Phone: 1300 224 636
Website: Beyond Blue

Youth Beyond Blue

Phone: 1300 224 636
Website: Youth Beyond Blue

Headspace -  Ages 12 – 25

Phone: 1800 650 890
Website: Headspace

Kids Helpline - Ages 5 to 25

Phone: 1800 551 800
Website: Kids Helpline

Eating Disorders Families Australia

Families of loved ones with eating disorders
Phone: 1300 195 626
Website: Eating Disorders Families Australia

Butterfly Foundation

Eating disorder foundation
Phone: 1800 334 673
Website: Butterfly Foundation

Suicide Prevention Network (not a crisis service)

Website: Find a Suicide Prevention Network near you

MensLine Australia (24/7 telephone counselling support for men)

Phone: 1300 789 978
Website: MensLine Australia

Standby Support After Suicide

Phone: 1300 727 247
Website: Standby Support

What is Towards Zero Suicide?

Towards Zero Suicide (TZS) is an initiative that aspires to prevent self-harm and death by suicide for those receiving care from health services. It is a key priority of the South Australian Mental Health Services Plan 2020-2025.

TZS provides a framework to guide healthcare staff. It supports health services to review, identify and improve areas of practice and service delivery. It seeks to enhance organisational capability and engage stakeholders. It promotes organisational change in a way that supports and engages both staff, people presenting to our services and their significant others. It is a long-term improvement approach that signals a journey towards zero suicides as an aspirational goal to provide an accessible, compassionate, collaborative, and culturally respectful service response.

This approach has successfully reduced suicide rates both within Australia and overseas. Most states in Australia and some areas of New Zealand are implementing TZS approaches in their health services. It is envisaged that this will also support continuity of care.

TZS has a framework for health services to follow that supports effective implementation. The framework was developed by the Zero Suicide Institute and is sometimes called the Zero Suicide Toolkit. It consists of seven elements:

• LEAD - system-wide culture change committed to reducing suicides.
• TRAIN - a competent, confident, compassionate and culturally respectful workforce up to date in suicide care.
• IDENTIFY - people with suicide risk via comprehensive screenings.
• ENGAGE - all individuals at-risk of suicide in a suicide care management plan, as well as their nominated support person/s.
• TREAT - suicidal thoughts and behaviours using evidence-based treatments.
• TRANSITION - individuals and nominated support person/s through collaborative warm hand-overs to aftercare providers.
• IMPROVE - policies and procedures through a continuous quality improvement plan including feedback from staff, individuals and their nominated support person/s.

For further information please see:

• Fact sheet – What is Zero Suicide? (PDF 434KB)

The following animation, developed by David W Covington LPC, is a Zero Suicide Healthcare call to action.

A central part of the TZS approach is working with, and learning from, the experiences, engagement, and connection with people with lived and living experience of suicide and self-harm related distress, especially Peer Workers. Their partnership in embedding the TZS approach is invaluable and a key part of the lead component of the TZS approach.

Peer workers not only provide valuable input and support into a person’s journey but can also assist in providing education and support to staff.

Tracey tells her story in this short video produced by the Zero Suicide Institute of Australasia.

The case for change

The death of a person by suicide has a devastating and enduring impact on families, friends, and communities.

In 2022, more than 3000 Australians died by suicide¹. This equates to an average of 63 people dying each week, and 9 people dying each day. Suicide is the leading cause of death for people aged between 15-44 years, and the second leading cause of child death in Australia¹. Aboriginal and Torres Strait Islander peoples are more than twice as likely to die by suicide than non-Aboriginal and Torres Strait Islander people¹.

In South Australia, there is an average of 20 deaths by suicide each month, which equates to an average of 4 lives lost and innumerable people impacted by suicide each week¹.

Australian research has identified that up to half of those people who attempt suicide have been in contact with health services in the period immediately prior². Towards Zero Suicide gives our mental health system an important opportunity to achieve better outcomes for people who come to health services with suicide and self-harm related distress and needing help. It provides a hopeful and practical way forward so that people do not die alone and in despair.

What does a TZS approach look like?

TZS is an approach that is applicable to all levels of staff across health services, people in distress, and their carers, family and significant others.

• See Fact sheet – What is Zero Suicide (PDF 434KB)

For people who may experience thoughts about harming themselves or ending their life, TZS aspires to ensure they:

• Feel safer, respected, and connected when talking with healthcare staff about how they are feeling and discussing the cause of their distress.
• Receive the right support to take action to minimise any increase in suicidal distress in the least restrictive, recovery-orientated way.
• Receive advice and information from staff about treatment options and then with help from staff, nominated support person/s, choose the right approach to meet their needs.
• Feel connected and committed to the planned ongoing care and after care arrangements and needs.

For carers, family, friends, significant others:

• The rights of carers, family and significant others is a priority when providing care to people in distress. It is important that they also feel connected, empathy, respect and compassion.
  See the Rights of carers of people receiving mental health care fact sheet (PDF 282KB)
• The person receiving health care services will be encouraged to include carers, family, and significant others in all elements of the pathway of care. This may include the assessment and engagement stages, decision points, types of treatment options, follow up plans and the transfer of care.
• For carers, family, and significant others to be included in reviewing incidents and be a part of identifying quality improvement strategies.

For all levels of staff in health services:

• System-wide culture change means engaging with staff to develop and implement a culture based on restorative principles that work for everyone.
• Staff will not be blamed and will be included and respected in reviewing incidents with the ability to safely offer options for quality improvement strategies to improve services and care.
• Staff will be provided training, education and supervision in working with people who have self-harm or suicide related distress, so they feel confident and competent to deliver a compassionate and culturally respectful service regardless of their individual role.
• Important training for staff includes but is not limited to:
  • Working in partnership with people in distress, their family and significant others with the understanding that not all suicidal and self-harm distress is based upon a mental health diagnosis or severity of risk.
  • Establishing a connection with all involved through a respectful and collaborative approach.
  • Skills in providing contemporary practices in assessment and clinical formulation.
    
  • Confidently discussing safety planning and lethal means counselling.
  • Understanding the various suicide treatment options that are available to meet the varying needs of people in distress.
  • How to provide appropriate warm handovers to other services involved in that person’s care.
  • Conducting follow-up within 48-72 hours of leaving the service to ensure the person has connected with the aftercare provider and that they are managing.

What is a Suicide Prevention Pathway (SPP)?

A Suicide Prevention Pathway is a guide that shows the steps to take when thinking about what care a person needs when they present to a health service in suicide related distress. It sets out the path that workers and people who are in suicide related distress can walk together.

When a person presents to a health service with suicide and/or self-harm related distress:

• They will be given time and space to talk about their distress and history.
• An assessment will be undertaken with the person and additional information to support that person may also be asked from their carer, family or nominated support person/s.
• Any identified risks will be discussed in collaboration with the person, to develop a collaborative safety plan that is owned by the person. This will include the provision of lethal means counselling to help the person and their nominated support person/s with strategies and actions for when things are not going well, or suicidal thoughts or urges are increasing.
• The person and support people (where relevant) will be provided with a copy of the safety plan, so it can be updated and added to as the person feels the need.
• A decision will then be made if this person is to be supported by the TZS Suicide Prevention Pathway of care.
• Options for ongoing treatment and support will be discussed with the person and their supports, and where these services may be provided.
• A follow-up call or face-to-face contact will be made in the following 48-72 hours after discharge.
• Staff will discuss what appointments and referrals have been made and what services are recommended for further support and treatment.
• Staff will also advise the person and their support person/s who will be provided with a handover of the person’s journey and their individual safety plan.
  

Chief Psychiatrist Suicide Prevention Pathway (SPP) Standard and Guideline

For further information on how SA Health are implementing Towards Zero Suicide, please see the SA Chief Psychiatrist Draft Suicide Prevention Pathway (SPP) Standard and Guideline. Policies and Standards | Office of the Chief Psychiatrist | SA Health

Restorative Just and Learning Culture (RJLC)

A Restorative Just and Learning Culture provides a foundation to effective suicide and self-harm care. RJLC engages with people receiving care and support, their families, carers, significant others, as well as staff providing the care and support to develop a culture of respect, trust, learning, support, and accountability.

RJLC provides a working environment which actively promotes and fosters good mental wellbeing for staff, even when things go wrong. Staff feel supported to raise concerns, contribute their viewpoint and receive timely support when they need it.

This type of culture focuses on recovery, healing and learning for all. When something goes wrong, the following questions are asked:

• Who has been hurt?
• What are their needs?
• Whose obligations are these?
• How do we involve the community?

Everyone impacted is involved in understanding what happened and contributes to organisational learning.

References

¹ Australian Bureau of Statistics. Cases of Death, Australia, 2022 [internet]. ABS; 2024 [cited 2024 February 20]. Available from: https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2022.
² Shand F, Christensen H, al. E. Care After a Suicide Attempt. Sydney, Australia: National Mental Health Commission; 2015