Aboriginal and Torres Strait Islander people

Aboriginal and Torres Strait Islander people^* are significantly overrepresented in rates of suicide across NSW and Australia.

Data from the Australian Bureau of Statistics indicate:

• the rate of deaths by suicide is around two and a half times higher among Aboriginal people compared with non-Indigenous Australians¹
• in 2022, suicide was the fifth leading cause of death among Aboriginal people².

At a system level, there is an urgent need to actively engage with Aboriginal communities to better understand these issues and develop solutions together to prevent deaths by suicide among Aboriginal people.³

At an individual level, aftercare services can safely and meaningfully engage with Aboriginal people to support them in their recovery.

^* Aboriginal and Torres Strait Islander people are respectfully referred to as Aboriginal people, in recognition that Aboriginal people are the first inhabitants of NSW.

Risk factors and challenges

Experiences of racism, trauma, grief, loss and lack of autonomy collectively contribute to an increased risk of suicide for Aboriginal people.³ The factors contributing to this are complex and interwoven.

Below are some common risk factors; however, this is not exhaustive, and nor will it be the experience of every Aboriginal person.

• Continued injustice caused by colonisation, including the forced removal of communities from Country and of children from their families, genocide and dispossession.⁴
• Cultural devastation, including loss of connection to Country; identity, language and spirituality.
• Lateral violence – harmful behaviours or actions that occur between people or groups within the same community or cultural background, often stemming from historical trauma, oppression and the impact of colonisation.
• Colonial load – the ongoing psychological and emotional burden Aboriginal people carry due to the lasting impacts of colonisation, including trauma, cultural loss and systemic inequality.
• Distrust of, and negative experiences with, the health system and services.
• Higher prevalence of disease burden and drug and alcohol misuse.
• Overrepresentation in the justice system.
• Overrepresentation in domestic and family violence.
• Transgenerational trauma.
• Impacts of overt and covert racism, and systemic racism and discrimination.
• Experiences of trauma, grief and loss.
• Social isolation and loneliness.
• Other social determinants of health, such as poverty, housing security and physical health.

Considerations

Adapt your service delivery to meet the person's needs. For example, tailor communication, the environment, and the types of assessment tools and resources used.

Be aware of Aboriginal cultural practices and protocols, and ensure you are providing care in a culturally safe way.

Before engaging with Aboriginal people

• Complete cultural capability training.
• Recognise the consumer’s right to choice. For example, not all Aboriginal people will choose to receive their care from the local ACCHO. This may be due to:
  • difficulty maintaining privacy
  • not wanting to identify as Aboriginal
  • complicated kinship and familial relationships.
• Speak with local Aboriginal stakeholders or representatives identified through service mapping, especially regarding cultural considerations, such as local Sorry Business. This may include:
  • the local Aboriginal mental health clinical leader or district coordinator
  • the local health district or specialty health network Aboriginal health unit
  • Aboriginal community controlled organisations (ACCOs) and ACCHOs
  • other local Aboriginal organisations
  • the Aboriginal representative within your suicide response group.

Considerations throughout aftercare

Choice, comfort and respectful care

• Ask consumers if they prefer to talk to an Aboriginal person.
• Give people choice about their preferred mode for receiving care (virtually or in person) and let them identify a space where they feel safe.

Cultural awareness and sensitivity

• Ask permission before using titles like Aunt or Uncle.
• Be aware of kinship structures and how this impacts their support networks. Ask who their support people are.
• Be aware of language barriers – not all Aboriginal people speak English as a first language.
• Cultural perceptions around a person's age, e.g. it might not be respectful or appropriate for a younger peer worker or care coordinator to support an older person and vice versa. Ask consumers what they are comfortable with.
• Cultural considerations regarding men’s and women’s business – it might not be respectful or appropriate for a female peer worker or care coordinator to support a male and vice versa. Ask consumers what they are comfortable with.
• Be curious – ask about traditional language if it is being used by a person to describe their experiences.
• Be aware of Sorry Business protocols and how this may impact your engagements with the person.

Trauma-informed and inclusive care

• Minimise the need for the person to repeat their story, acknowledging the emotional burden of this.
• Be aware of colonial load – it is your responsibility to educate yourself. Ask your local partners for guidance.
• Understand the intersectionality with LGBTIQSB+: lesbian, gay, bisexual, transgender and gender diverse, intersex, queer, sistagirl and brothaboy.

References

1. Australian Institute of Health and Welfare. Suicide Among Indigenous Australians. Canberra (AU): AIHW; 2023 [cited 25 Sept 2024].
2. Suicide Prevention: Indigenous Mental Health. Canberra (AU): Indigenous Mental Health and Suicide Prevention Clearinghouse; 2023 [cited 25 Sept 2024].
3. Heard TR, McGill K, Skehan J, et al. The Ripple Effect, Silence And Powerlessness: Hidden Barriers To Discussing Suicide In Australian Aboriginal Communities. BMC Psychol. 2022;10:23. DOI: 10.1186/s40359-022-00724-9
4. Gibson M, Stuart J, Leske S, et al. Suicide Rates for Young Aboriginal and Torres Strait Islander People: The Influence Of Community Level Cultural Connectedness. Med J Aust. 2021;214(11):514-518. DOI: 10.5694/mja2.51084