The winds of change: Emergent, strength-based approaches to reducing risk of youth suicide across the Mid North Coast region

This blog post may be upsetting to some readers. If you would like free and confidential support, I encourage you to reach out to someone at Lifeline by phoning 13 11 14, or visiting https://www.lifeline.org.au/

Hello everyone. Readers who know me well would have a good idea of why I’ve chosen to live most of my life in the Mid North Coast (MNC) region of New South Wales, Australia. Stunningly beautiful as this region is, there is a dark side: the relative prevalence of young people dying by suicide.

Growing up here, I have gone to school with and have known personally young people who have died by suicide. I now have school aged kids of my own, and empathise with the many challenges – some old, many new – that the next generation face.

As a professional researcher, I have come across some troubling statistics that suggest an urgent need to address youth mental health in the MNC region. After almost three years of research and analysis, I recently published a five-year social profile for the region. There are dedicated chapters on mental health, housing affordability and homelessness, domestic and family violence, substance abuse, and others. It is in those pages we see that local young communities are exposed to relatively high levels of risk and, worse, some of the risk factors appear to be growing over time (e.g. Figure 15, p. 76).

In 2017, the NSW parliament established an inquiry into the current approaches aimed at preventing youth suicide across the state. The University of New England shared their perspective on youth mental health and suicide prevention as it relates to the New England North West region, noting that, “The issues are comparable for all rural and regional areas of the state.” (Submission 10, p. 1). In Clarence Valley Council’s submission to the parliamentary enquiry (Submission 18), we see that within the wider North Coast region, Coffs Harbour is a youth suicide hotspot, along with neighbouring localities of Kempsey, Clarence, and Port Macquarie.

What are the regional community of practice doing about this? All that they can, and I want to acknowledge the immense courage and goodwill that people who work with young people possess. The trickier question to address is, Why are our best efforts apparently not enough?

There are probably many valid answers. One seems to be the evidence-funding circle: Traditional therapeutic approaches that are strongly evidence-based receive the bulk of funding, therefore practitioners can afford to gather more evidence on their effectiveness. Meanwhile, newer approaches may in fact be more attuned to young people’s strengths and aspirations, yet because of the evidence-funding cycle, it is difficult to advocate for these approaches on firm data grounds.

To discuss this further, it is my pleasure to introduce Ally Kelly, CEO and founder of mental health charity, Mind Blank. Ally’s mission with Mind Blank is to reduce the risk of suicide, through interactive performances in schools and communities.

Welcome Ally. First, please tell us a little about your story, and what Mind Blank does for regional communities, like the young people who call the MNC their home?

Mental health issues are close to home for me. My first experience with it in the family was at the age of 6 where I became a carer for my mother who has been suicidal various times in her life. I too am a survivor of PTSD. So I know what it’s like to stumble through the health system. Statistics show that due to my history I am more at risk of ongoing mental health challenges. I am living proof that you can change this reality.

I come from a theatre and psychology background in my studies. For me, Mind Blank was a natural way to challenge both my passions.

Mind Blank is a health promotion charity and we aim to reduce this risk of suicide through interactive theatre in schools and communities. In Australia suicide is the leading cause of death for young people aged 15-44 years old.

Youths from regional communities are 66% more at risk than their peers in the city. There are many reasons for this difference. Feedback we have received from the MNC youths suggest the following: increase chance stigma due to the size of towns, fewer services available for young people to access, lack of resources, farms struggling and sometimes town planning has failed to capture new innovative ways to engage with youth people.

Mind Blank includes young people in the progress of health promotion. We bring professional actors in that share stories of lived experience of mental health issues on stage. The play ends on a negative note and the young people in the audience get a chance to go back through the storyline to intervene with the actors, to help find a better outcome for the protagonist. Our programs primarily exist to a) help young people identify the signs and symptoms of mental ill health and b) know how to seek help or support a friend in a time of need.

We offer regional tours to communities where we run programs at several schools over a 3-5 day period. The second model the Mind Blank team can offer regional towns is peer support training. This is where our team provides skills training to a group of young people so that they deliver the program to their peers. E.g. we train a year 10 drama group to run the program for the year 9 students in their school.

I recently coordinated a Mental Health Professionals’ Network meeting in Coffs Harbour. My invited guest, Prof John Hurley, presented findings of a mental health program, designed to build local young people’s resilience, social connection and self-confidence. Unlike traditional talk or psychiatric interventions, Prof Hurley’s program achieved good outcomes through a visual art making session and public exhibition.

In a nutshell, a group of young people from the Coffs Harbour area created their own artworks, expressing their personal mental health journeys. They then had those de-identified artworks displayed among their local community. Passers-by were interviewed about the themes apparent in the young people’s artwork. The encouraging feedback collected from the local community was then conveyed back to the young creators.

What do you think such participatory approaches to therapy has to offer young people, which the ‘tried and true’ approaches don’t (or maybe can’t) offer? In particular, what do you believe is unique and innovative about the Mind Blank approach to helping young people?

I am a huge supporter of the arts providing methods for therapeutic self-discovery.

Many individuals may not realise that there are many art therapy modalities that can help people to express, validate and voice some meaning behind their distresses.

There are some great studies that link art and health programs to wellness. Unfortunately there is more research published in this sector space overseas than there is here in Australia.  For example, I once read about a study in Germany that linked art classes to being an excellent contributor of reducing patient hospital time. In London, I hear that a GP can now prescribe art classes as part of a wellness journey.

I believe that some of the reasons Mind Blank is an innovate approach is due to the fact:

• We include young people in the design process. When you give young people a voice you immediately gain their buy into the process.
• Using creative arts methodology we create a safe space where they can build trust quickly.
• We have fun with young people. When young people laugh we give them permission to bring down some of the guards and barriers they may have. This helps us talk about serious subject matter and have fun at the same time.

This is in contrast to many traditional approaches to health promotion. Using facts and figures to engage young people does not work. Another unhelpful approach is to dictate what you think is best to a teenager. The reality is that you will likely end up with the opposite outcome than what you desire.

Research conducted by a university student at the University of Wollongong showed that many young people expect that most mental health education sessions are going to be a) boring or b) they will leave crying. Our research shows that creative arts methodologies are an effective engaging method to support young people learning about mental health knowledge.

How can regional or rural practitioners and community members make a positive difference in young people’s lives, in spite of the evidence-funding cycle that ensures the popularity of talk and drug therapies?

Good question. Yes health has a very clinical focus. This is something that our organisation is mindful of. My tactic to handle this is to find the organisations in the community who value prevention, and then we partner with them. Together we will only be stronger.

There is a lot of evidence to show that a strength based approach, mentoring, peer support and creative arts methods are huge contributors to making a difference in young people’s lives.  My tips to anyone wanting to create community action, goes as such:

1. Find out if there are any like minded programs in the community that exists. If so perhaps you could be of use helping them create greater impact?
2. If you are going to start a project be clear with what outcomes you will aim to make.
3. How can you keep supporting young people in the community after the project trial ends?
4. Embed program evaluation elements into the rollout of the program

Arts and Health agendas can work well together.  In collaboration, you will need to build a case of evidence. This can be achieved without the need for a heavy clinical emphasise.

As a writer and research supervisor, the motto I teach students is that personal wellbeing antecedes professional excellence. What personal principles, values or philosophies characterise your work with Mind Blank?

Our values are:

We are Creatively Committed to Mindfulness and Integrity. Everything we do must have these four values embedded into our practice.

What role does research – quantitative, qualitative, or mixed methods – play in your organisation? More broadly, do you think there is an emerging drive in the not-for-profit and non-government organisational sector, toward collecting and analysing data to inform best practice?

Mind Blank’s work is guided by an evaluation framework and evidence practice guidelines. This means that research and program evaluation are prioritised highly with everything that we do.  Our first research pieces took place in 2011. Since then we have continued to collect data from post production surveys.  We capture several responses from students, teachers, and staff. This is in order to continue delivering the highest quality and standard that we can bring.

We aim to take part in new research projects, collect pre-post and follow up surveys and gather data from mixed method analysis as frequently as we can. In practice this can be challenging. I say this because research and data evaluation can be costly. It takes up a lot of time and often fleshed out research pieces can be very expensive to execute.

There absolutely is an emerging drive in the not-for-profit and non-government organisational sector to show outcomes. I have seen businesses close down because of this competing demand.

Personally, I get it. Some charities have had histories where for 30+ years they received funding without ever needing to prove effectiveness.  The reality is, now that there is a pressure to show best practice some programs that have been running for years have proven to be ineffective, some have even shown their outcomes end up doing harm instead of helping.

One downside is that it is starting to go down the other extreme. What happens then is that no-one wants to try something new because it’s not evidence based, and then we get stuck as a sector doing what we have always done in order to stay on the safe side of things.

Very recently, Turning Point and Monash University released a report on male suicide prevalence in Australia, demonstrating a substantial discrepancy between overt and covert self-harm data. According to their analyses, the true rate of male self-harm incidents is five times larger than recorded, because hospital emergency departments do not recognise suicide ideation (e.g. planning and preparing for a suicide) as a form of self-harm behaviour.

In your experience, do you think there is legitimacy to the claim that males are less likely to ask for help than females? Why or why not, and does the claim extend to boys as well as men?

The statistics with health, in general, show that there is a gender difference. Men are less likely to go to the doctor for prevention or minor health issues, whereas woman often invest in their health and seek support from their network to source out advice early on.

When it comes to mental health, the downward spirals get worse if left untreated. We are currently in an epidemic where because of stigma we wait too long before we get help. Often we wait for a crisis, and then we seek help. The thing about the Australian health care system is that our services are at maximum capacity. Therefore if you need help you may need to wait anywhere between 6 weeks to 6 months before you can access a service.

Aside from research, what about the role of others in the community, in minimising the risk of youth self-harm and suicide? I’m particularly interested in your thoughts on the role of media in communicating findings and stories about such sensitive issues.

There is so much we can do as individuals and as a community to help minimise the risk of youth self-harm and suicide.  Young people need to have a purpose to encourage wellness. They need care and love to thrive and grow into the best versions of themselves. With social media spiralling out of control, they need boundaries and invested stakeholders to help guide them.

Unfortunately there will always be more people in need out in the community than there are social workers, councillors, doctors etc. My utopian version of society is to equip everyone with the general knowledge of what to do in a time of need. Imagine if we focused on prevention and resilience building so much that our services were no longer at maximum capacity!

When it comes to the media, Mindframe has some great guidance for Australian television, print, and stage to present sensitive subject matter like suicide.  There are research pieces that have shown that incorrect reporting can lead to more incidences and copycat stories.  I think what is important to keep in mind is that if someone is in a vulnerable place, then stories that are not sensitive to their suffering can provoke further actions for harm. If you follow Mindframe’s guidelines you will be following rules based on best practice. The internet exposes us to media from all over the world. This can make it challenging to monitor and control what is being broadcast.

The media reports on youth suicide in Indigenous communities are terrifying. (Recent examples may be found here and here.) There is a clear need to ensure that youth suicide prevention research and practice is conducted in a culturally safe and inclusive manner. How does Mind Blank tailor its programs to empower Indigenous young people, and young people with culturally and linguistically diverse backgrounds?

Wherever we go with Mind Blank we aim to make sure our programs are tailored to address local stories. Since 2017 we have been touring the Top End of Australia. In an alliance with TeamHEALTH (Top End mental health service provider) our team tour 26 local schools in Darwin, Palmerston and rural communities around Kakadu National Park.  In order to create work in a culturally safe and inclusive manner we have conducted several community consultations. We have worked with a local NT script writer to share community stories from some Indigenous youths’ perspectives. This has helped to create authenticity of the story telling process.  Wherever we can we do also encourage local young people to join in the productions as part of the process.

Our Sydney team service the Western Sydney population on a regular basis. In order to do this they have made a slight adjustment to the subject matter. However, in general, there is not much they need to change from our programs’ content as we tend to get feedback that it’s the same teen issues that remain relevant for CALD youths. 2013 was when Mind Blank first commenced working with CALD lead organisations. Together as an interagency collaboration we formed a program to work with young people from new arrival refugee backgrounds.  Working in a 10x week workshop session our team introduced general mental health concepts and captured stories lead by workshop attendees.

Thanks so much for your insights, Ally. Please let our readers know how they can learn more about your work with Mind Blank.

Absolutely. If you want to get in touch go to www.mindblank.org.au. In you want to chat about any of the above you can grab me at info@mindblank.org.au or 0468912399.

If you or anyone you know needs help or support, you can call Lifeline on 13 11 14.