Suicide prevention and alcohol and other drug use in Aboriginal and Torres Strait Islander communities

What's the issue?

Suicide rates remain high in Aboriginal and Torres Strait Islander communities, and are associated with complex factors including the impacts of colonisation, oppression and displacement. It is important that suicide prevention efforts include diverse, coordinated responses that support Aboriginal and Torres Strait Islander people and communities. Examining key risk and protective factors, along with clinical indicators such as the number people presenting to hospital after using alcohol and other drugs can help shape effective prevention strategies and responses.

There is a clear link in the evidence between alcohol and other drug (AOD) use and suicide risk among Aboriginal and Torres Strait Islander people. However, current policies and practices do not adequately address this complex issue, highlighting the need for more studies led by Aboriginal and Torres Strait Islander researchers to explore effective strategies.

What was done?

The Australian Institute of Health and Welfare (AIHW) used a scoping review method. To ensure relevance and inclusivity, the review followed specific principles:

• Only relevant papers were included.
• Aboriginal and Torres Strait Islander voices and research were prioritised.
• Studies without clear Aboriginal and Torres Strait Islander community oversight were excluded unless agreed upon by the research team.
• Research on First Nations people from other countries was generally not included.

The aims of the report were to:

• Explore how AOD use, and suicide risk are linked, including the connection between alcohol use, suicide risk and mental ill-health.
• Review current policies on harmful AOD use and suicide prevention to find out what works best.
• Identify the most effective approaches within existing programs that combine AOD and suicide prevention efforts, including support after a suicide.

What was found?

The review found several key points about the relationship between harmful AOD use and suicide risk in Aboriginal and Torres Strait Islander communities:

• AOD use is a key risk factor for suicidal behaviour, both globally and among Aboriginal and Torres Strait Islander people. Alcohol is often involved in deaths by suicide and presentations of self-harm in emergency departments.
• Aboriginal and Torres Strait Islander people are disproportionately impacted by AOD, with estimates suggesting that the impacts experienced are 2.3 times greater than those for the broader population.
• Aboriginal and Torres Strait Islander communities name alcohol, cannabis and methamphetamine as the three most common drugs of concern.
• Aboriginal and Torres Strait Islander men are more likely to die by suicide and use AOD compared to women. However, suicide is a leading cause of alcohol-related deaths among Aboriginal and Torres Strait Islander women.
• Specific groups, like young people, incarcerated people, and those with mental health concerns, have an increased risk of suicide when using AOD.
• The connection between AOD use and suicide is complex. Suicidal distress experienced by Aboriginal and Torres Strait Islander people is influenced by multiple factors, including the long-term effects of colonisation, trauma and disconnection from family and culture.
• Despite these challenges, Aboriginal and Torres Strait Islander communities have cultural, communal, and familial strengths that can help prevent suicide and reduce harmful AOD use.

Why are the findings important?

The review highlights the need for culturally responsive strategies, frameworks and research to address the interconnected issues of AOD harm and suicide risk in Aboriginal and Torres Strait Islander communities.

Policy implications

• The lack of an Aboriginal and Torres Strait Islander-specific frameworks and implementation plans for AOD reduction is a significant policy gap.
• Policies need to be co-designed with Aboriginal and Torres Strait Islander communities and adequately funded.
• The report calls for integrated approaches where suicide prevention policies explicitly address AOD harm. Long-term, systemic solutions are necessary, and empowering Aboriginal and Torres Strait Islander leadership is essential for effective, locally tailored responses.

Practice implications

• Effective interventions should be holistic and culturally centred, and developed by Aboriginal and Torres Strait Islander communities.
• AOD considerations must be included in suicide prevention services, with ongoing funding and flexibility.
• Workforce training should focus on the impact trauma has on AOD concerns and suicide risk.
• Solutions to challenges such as stigma around suicide and insufficient services need to be culturally informed and led by Aboriginal and Torres Strait Islander community members.