Communities with poor access to mental health services are eight times more likely to be youth suicide hotspots, according to new research by the Telethon Kids Institute.
In a paper published this week in the Australian and New Zealand Journal of Psychiatry, researchers used national coronial data to map the suicides of 1959 young people aged 10-24 who died between 2016-2020.
Led by suicide prevention researcher Dr Nicole Hill, the team identified eight suicide ‘hotspots’ where there were significantly more suicides than would be expected, and two ‘coldspots’ where rates of suicide were far lower.
WA was the largest of the hotspots identified across the country, with several affected communities spread across the state in remote and regional areas. Up to 19% of youth suicides (49) occurred within WA hotspot 1.
Similarly, large swathes of regional Queensland, as well as parts of country NSW and SA, were identified as particular hotspots for youth suicide, while areas of metropolitan Perth and metropolitan Sydney were identified as coldspots.
Although the year 2021 saw a decrease in Australian youth suicide rates for the first time in the last decade, overall rates of youth suicide remain notably higher than previous years (14.9 per 100,000 in 2021 compared to 10.2 per 100,000 in 2010).
“Spatial statistical techniques which identify areas where the incidence of suicide is highest, also known as suicide clusters, have the potential to identify the emergence of suicide clusters in real time, and equip decision makers with information to direct suicide prevention resources to areas where they are most needed,” Dr Hill explained.
Studies of suicide clusters in Australia have been largely limited to the examination of broad sociodemographic factors such as sex, remoteness, Aboriginal and/or Torres Strait Islander status and socioeconomic status.
“These studies have consistently found that people who reside in remote areas, characterised by low socioeconomic status, and who are Indigenous Australians are more likely to be involved in suicide clusters,” Dr Hill explained.
“However, the same risk factors are associated with suicide in the general population and although highly sensitive to suicide, lack the specificity to drive population-level suicide prevention interventions in geographic areas where need is greatest.”
Dr Hill explained that the team compared the characteristics of communities in these contrasting areas, including the number of mental health services and mental health staff available, opening times, and travel time to services at the time young people were in a state of acute suicidal crisis and died by suicide.
“This technique considered not just the number of services but how accessible they were to young people at the time of their death,” she said.
The findings showed that hotspot communities had substantially lower access to mental health services compared to coldspot communities, with the time taken to reach a service, opening hours, and their availability at the time of a young person’s suicidal crisis and death, being a significant factor.
“Specifically, we found areas with low mental health workforce supply were associated with eightfold greater odds of a suicide occurring in a hotspot compared to non-cluster suicides,” Dr Hill said.
In addition to access to mental health services, illicit substance use among young people at their time of death was 20% higher in hotspot communities.
In Australia, treatment for alcohol and other drug (AOD) use disorders is typically delivered separately to mental health services. A consequence is that mental health services often overlook or exclude AOD disorders, and AOD services have limited capacity to manage people with comorbid mental health concerns.
“It’s a known problem that people who have substance misuse problems are often not eligible to access mental health services. This is a real missed opportunity for youth suicide prevention and the prevention of suicide clusters,” Dr Hill said.
By comparing hotspots with coldspots the researchers were able to not only establish the link between higher suicide rates and lower access to services, but that high access to mental health services may be a protective factor against suicide in young people.
“These findings have important implications for postvention and the prevention of suicide contagion, where a cluster of suicides can follow the suicide of someone within a community,” Dr Hill said.
“When a young person dies by suicide, there is often a lot of fear and anxiety about the prospect of further deaths in the community. This research suggests that providing timely access to mental health services, particularly in the aftermath of a suicide, may potentially be protective against further deaths.”