What are the causes of Indigenous suicides?

As an Indigenous clinical psychologist who has spent the better part of the past twenty years working solidly in Aboriginal suicide, I keep getting asked “What are the causes of Indigenous suicides?”

ANSWER:
I have long been concerned by public commentary on the causes of suicide & the impacts of this in finding evidence-based solutions. Simply put, suicide risk factors are being incorrectly and consistently stated as CAUSES of suicide. So:

• Poverty is not the cause of suicide
• Abuse is not the cause of suicide
• Alcohol is not the cause of suicide, nor is Foetal Alcohol Syndrome by the way!
• They are all very likely risk factors, but they are not CAUSES.

If we have clear evidence of the causes, this will ensure that programs are better focused on suicide reduction. So, for example, what separates person A who has been abused and becomes suicidal from person B who does not?

Is it that the abuse has manifested as depression for Person A, compared to person B who is not at suicide risk? While this is an essential question – we currently do not have clear evidence of such causal relationships. This is staggering given we have the highest rates of child suicide in the world.

What is the value of better understanding suicide causes?

Research amongst non-Aboriginal populations has depression as an established causal pathway to suicide in around 50% of cases of suicide.

Research then further indicated that if we could eliminate depression from the suicide equation by determining treatments of best practice for depression, we can effectively reduce up to 50% of suicide deaths!!!!

See how important causal pathways are!

Unfortunately, we have limited evidence on Indigenous specific suicide risk factors and therefore no evidence establishing causal pathways. Therefore best practice treatments cannot be established with Aboriginal people (see how these things have a knock-on effect?)

Research has shown that racism impacts on Aboriginal people in the same way as a traumatic event.

Is there a different nature to Aboriginal Suicide?

My PhD research determined a different set of risk factors to Indigenous suicide finding, amongst other things, that up to 60% of suicide risk is accounted for by impulsivity. Mostly the impulsivity is a reaction to conflict; an absence of self-soothing capacity comes into play, alcohol and drugs are used as an enabler and then suicide attempt/death occurs. This pattern is often the case with those who have trauma and attachment related issues.

Whilst Impulse control can be addressed as a focus of treatment, if the underlying cause of the impulsivity is not determined then treatment effectiveness is limited. The Westerman Aboriginal Symptom Checklist for Youth (WASC-Y) and Adult version (WASC-A) enables clinicians to undertake thorough risk assessments to determine this better and have focused treatment, capable of tracking client outcomes. This is a world first and I have personally trained over 25,000 individuals in its use. However, we need this to be a uniform measure across this country and particularly into high risk areas. It enables us to screen for early risk and respond accordingly.

Why do we keep confusing these two things?

The diplomatic (and painfully simple) answer to this is that the data has just not been analysed to clearly establish causal pathways as noted in my post last week.

The less diplomatic one is that those deciding on funding want simple, linear causes and it seems that ‘blaming’ victims for their circumstances has always been popular.

Starting a few decades ago alcohol was reported as the CAUSE of suicide…. If it was a cause, everyone who drinks to excess would be at suicide risk. Clearly not!

It is also of note that Aboriginal people are up to 8 times more likely than non-Indigenous people to be non-drinkers.

Alcohol is a strong RISK factor, or enabler to suicide not a CAUSE.

So, the government decided to SOLVE suicides by eliminating alcohol through establishing dry communities and restricting alcohol. There has not been a decrease in suicide in many alcohol restricted communities, in fact the opposite is true.

Policies that restrict human choices contribute to established risk factors for suicide, being hopelessness and helplessness – a negative attributional style about prospects for the future – leads depressed individuals to view suicide as the only way out of insoluble problems.

For example, in the 10 years since the NT Intervention the average birth weight of an Indigenous child has DECREASED overall by 600 grams. This is staggering given that infant mortality rates were already higher than many third world countries. Research in the US has shown that racism impacts in-utero disrupting the basic brain stem development. Why? Research has shown that racism impacts on Aboriginal people in the same way as a traumatic event. We know that trauma can also impact in-utero so why can’t racism?

We are hopeful that we will be able to gain access to the suicide mortality data to fully analyse this and determine causal pathways. This will change the paradigm of this area.

Results of confusing risk factors with causes:

1. The media, general public, become ill informed about the complexity of suicide.

2. Public policy gets directed in a way that is focused on ‘eliminating the cause” and contributes to the intergenerational cycle of suicide and poor health and mental health outcomes.

3. Research is not undertaken to provide evidence of what accounts for suicide risk and establish causes.

4. We fail to provide a range of programs into high risk communities. For example, alcohol restrictions may be a short-term approach to prevention (as rehab is). However, simply implementing such approaches, while failing to undertake appropriate research overlooks the possibility of understanding the complex relationship between alcohol and suicide risk and having programs that prevent and treat known risk factors for alcohol addiction. If research can confirm this we can, for example, have informed programs on treating trauma or depression as established causes.

5. Suggesting abuse and /or alcohol is the cause of suicides further stigmatises Aboriginal people inferring that most, if not all, Aboriginal people are victims of abuse or, worse, that all Aboriginal people are perpetrators or drunks.

6. Perpetuating such stereotypes contributes to a general lack of empathy for Aboriginal people who are bereaved by suicide and increases any potential risk to them through greater levels of complicated grief. It is a sort of “they did it to themselves” mentality that is not only inaccurate, but unhelpful and unkind”.

Future work into risk factors

We are hopeful that we will be able to gain access to the suicide mortality data to fully analyse this and determine causal pathways. This will change the paradigm of this area.

Let me explain in (hopefully) the most simple terms I can.

We can track continuous suicide data (suicide risk factors that move and change) that is gathered by the WASCY and determine whether a reduction in these factors reduces the overall suicide rate (morbidity data).

Hopefully you are still with me….

This is complex but the guts of it is that we can then determine what risk factors are reducing the suicide death rate in more of an immediate, measurable and responsive way.

These are the things that are needed to better inform prevention, early intervention and measure the impacts of suicide prevention activities. Hopefully access to this data will come soon!