People living in rural and remote areas

People living in rural and remote Australia are identified as a population disproportionately impacted by suicide.

The term ‘rural and remote Australia’ represents the land area outside Australian major cities and includes inner and outer regional areas, remote or very remote areas.

What does the evidence tell us about suicide for those living in rural and remote areas?

In Australia, suicide rates are higher in regional, rural, and remote areas compared to metropolitan areas.

Almost one third of Australia’s population live outside of its capital cities. Data from the Australian Institute of Health and Welfare’s Suicide and Self Harm Monitoring System¹ show that suicide rates increase as population density decreases. This means that the further away from a major city there is a higher rate of suicide of suicide and suicidal behaviours.

Within rural and remote populations, data suggests that men and young people are at increased risk of suicide. Data also shows an over-representation of Aboriginal and Torres Strait Islander suicide in rural and remote areas, as well suicide deaths in people who work on the land in farming-related industries.

People living in regional and remote areas may experience poorer health outcomes compared to their metropolitan counterparts due to access, availability and resourcing of healthcare and community services.

Suicide prevention strategies in rural and remote Australia must be unique to the area, and require different approaches to those strategies used in metropolitan areas.

Strategies should consider the high variability between regions and adopt a flexible approach to developing suicide prevention programs.

Suicide prevention strategies in rural and remote areas are most effective when they are community-focused, accessible and inclusive of the unique needs of regional and remote populations. Community gatekeepers, and gatekeeper training that is led by community for community is one such example of a prevention activity that can support a rural and remote approach to prevention. Suicide prevention strategy that encompasses the constraints of geographical locations and investigates alternative methods of help offering and seeking can support prevention approaches in rural and remote areas.

Factors that may increase risk of suicide

Factors that may increase suicide risk, for people living in rural or remote settings include:

• Limited access to comprehensive support services across the life span.
• Fewer visits to GPs for mental health issues exacerbating by the stigma associated with distress or lack of access to a GP (or both)
• Increased access to firearms, chemicals or other means that might impact risk – especially on farming properties
• A lower likelihood to seek help (particularly by rural men)
• Increased distress and burden financially and socially, especially due to natural disasters or climate change
• Increased socioeconomic disadvantage due to job availability, job security or costs of living.
• Limited access to culturally appropriate services for Aboriginal and Torres Strait Islander peoples
• Ongoing and current impacts of intergenerational trauma, particularly for Aboriginal and Torres Strait Islander communities
• Discrimination and lack of specialised services for populations disproportionately impacted by suicide, such as young people, older people and LGBTQI+ communities.

Factors that protect against risk of suicide

Protective factors that may reduce risk of suicide for people living in rural and remote settings include:

• Increased capacity community connectedness leading to stronger relationships and decreased isolation
• In some areas, lower stress levels compared to metropolitan areas
• Reducing access to means (particularly firearms regulation, and safe storage of chemicals and pesticides)
• A community approach to social and emotional wellbeing for Aboriginal and Torres Strait Islander peoples, with an emphasis on greater connectedness with traditional culture, land and ways of living and being.

What does this mean for policy and practice?

Suicide prevention in rural and remote areas are most effective when strategy:

• Is co-designed and collaboration with communities who are at risk of suicide informs the strategy and activities.
• Represents and considers of the unique needs of each location.
• Explores community attitudes, access to information, and capacity to provide crisis services as well as a commitment to aftercare for those who experience a suicide attempt and suicide postvention for those bereaved by suicide.
• Is developed through the lens of identifying the lived experiences of those in regional, remote, and rural areas.
• Supports increased access to services.
• Acknowledges the impact of service delivery on the health and allied health workforce, as well as the role of peer workers in community capacity building.
• Considers cultural, economic, and social factors relevant to regions.