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New guidelines to improve assessments for Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts

The Menzies School of Health Research (Menzies), commissioned by the Centre for Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) have developed evidenced-based Guidelines for best practice psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts (Guidelines) to improve the quality of care and outcomes for people presenting with suicidal thoughts and behaviours.

A history of self-harm is one of the strongest known risk factors for suicide and represents an important opportunity to engage with people in a preventive intervention.

As Professor Pat Dudgeon, Director of CBPATSISP notes:

“There is now growing evidence that the legacy of colonisation has contributed to the disproportionate rates of suicide and suicidal behaviours and other disadvantages experienced by Aboriginal and Torres Strait Islander people. The effects of colonisation are evident in the structural barriers and lack of access to culturally responsive hospitals and family support services that underscore the urgent need for these guidelines as part of a broader suicide prevention strategy.”

The Guidelines contain 227 evidence-based recommendations that have been endorsed by an expert panel of Aboriginal and Torres Strait Islander and non-Indigenous professionals and those with lived experience using the Delphi method for establishing an expert consensus on best practice.

Aboriginal clinical psychologist, Tanja Hirvonen reports,

 “Assessing risk of suicide is a complex task in any setting, but particularly in the hospital setting, as it can be a very discomforting time for people.  There is a pressing need to respond adequately and carefully during this time.”

The Guidelines provide the principled basis for culturally appropriate health care. To better achieve cultural responsiveness in practice and improve the quality of care for Aboriginal and Torres Islander people presenting to hospital with self-harm and suicidal thoughts, the guidelines contains recommendations for appropriately and effectively interacting with and engaging Aboriginal and Torres Strait Islander people in ways that are empowering and de-stigmatising.

Tanja Hirvonen states,

“It was highlighted that the type of assessment tool that is used is significant, but just as critical is to ensure that the right information is gathered, and people are appropriately supported during a very critical time in their lives, within a culturally safe model of practice and care.”

Recommendations in the guidelines for evaluating risks, strengths and needs of Aboriginal and Torres Strait Islander people have a strong grounding in the concept of social and emotional wellbeing to ensure that assessments inform the most appropriate and effective options for care in the hospital and recovery in the community.

A number of recommendations have also been included to help clinicians respond in developmentally and culturally appropriate ways to self-harm and suicidal thoughts amongst young Aboriginal and Torres Strait Islander people.

Professor Pat Dudgeon concluded:

“These new Guidelines have potential to make a genuine difference for Aboriginal people at risk of suicide or self-harm who present at emergency departments. CBPATSISP is committed to disseminating these guidelines widely and we will advocate to ensure that relevant agencies, such as the Australian Indigenous Psychology Association, are supported to develop cultural competence training and engage hospitals in embedding these guidelines into practice at a national level.”

If you or someone you know needs help or support, you can contact your local Aboriginal Community-Controlled Organisation or

  • Lifeline: 131 114
  • Kids Helpline: 1800 551 800
  • Mensline: 1300 78 99 78
  • Beyondblue 1300 22 46 36
  • Q Life 1800 18 45 27,
  • Open Arms Veterans & Families Counselling 1800 01 10 46
  • The National Indigenous Critical Response Service 1800 80 58 01
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