Now we will hear from Jan Adams. Jan is project officer with VYNE, Vision for Youth through Knowledge and Education. Her background is in education and she was formerly a school counsellor at Lake Tuggeranong College. Thank you Jan.

Jan Adams: Thank you very much and thank you for having me speak tonight. Drug taking and suicide are very serious topics. VYNE was set up under the National Youth Suicide Prevention strategy to provide education and training to people in the area of youth suicide because there was an increasing peak in youth suicide at that time. Since then we have been refunded to take education and training across the life span. We don’t work with people who are actually suicidal themselves. We work with the people who are working with them. It feels to me a little bit like I am working with the yellow pages.

So where does drug taking fit in with suicide? Overdosing on prescribed drugs has been a common method of suicide for a long time, especially amongst women. For forty years alcohol has been recognised as a major contributor to suicide. The recent increased abuse of other substances, mostly illicit drugs, has been paralleled and may be responsible for an increase in suicide in young people, especially in young men. One researcher, George Murphy of Washington University, estimates that substance abuse is found in 25 to 55% of suicides, a rate which far exceeds substance abuse in the general adult population. Even so these numbers may still be an underestimate because many overdose deaths are not registered as suicides at all nor are deaths that might be called suicide by lifestyle which might take many years but which usually include some form of chronic substance abuse.

In the ACT looking at successive suicides registered at the ACT Coroners’ Court over a six month period last year it appears that alcohol or illicit drugs where involved in approximately 85% of the suicides. While some of the people involved were known to have had a history of drug abuse, others were believed to be self medicating - self medicating the chaos in their own inner worlds.

How can we tell who is at risk of suicide? Some of the most significant risk factors for suicide are a previous suicide attempt depression and substance abuse. Unfortunately it is impossible to set up a cut and dried list of risk factors. Wouldn’t we all love to do it? No matter how good our list is we always miss a significant number and we’ll pull out a large number of false positives. However, it is important to be aware of risk factors and substance abuse is one of the most important factors in itself but particularly important as a number of speakers have said if it is combined with other risk factors.

One thing that I haven’t mentioned here is that within suicide (and it may be true of other things as well) there is quite a bit of research and theory to show that we may do better and get to more people if instead of concentrating all our efforts on people who are at risk (which we have to do) we also concentrate on moving the whole population a little bit away from risk and little bit towards resilience. I will talk about resilience a bit later on. We might pick up more people this way. Certainly some of the work I was telling you about in schools before is taking that on, that is, looking at whole population approaches to some of these things.

So some of the reasons that substance use or abuse may be associated with suicide are that drugs are often used to get a deliberate dimming of critical consciousness. This in turn leads to difficulties in making other decisions and choices. Social relationships are often damaged, work performance is often affected, personal care suffers and with it health. Impulsivity and risk taking may increase and these lower the threshold for suicidal behaviour. As trouble mounts so does the danger of suicide as the consequences of substance abuse can be accumulative .

The most significant description I have found at the inner state of suicidal people seems to be a sense of entrapment: feeling as though you are stuck and you can’t get out and hopelessness. It’s like having tunnel vision. The choices seem to have narrowed down and the person isn’t able to change things for the better or feels that he or she can’t. When people are in this state, what triggers a suicide attempt may not be what we have always thought about as the last straw of another stress happening. It may be as much a reminder of their entrapment and hopelessness. Timing seems to be a crucial element in this. Amongst substance abusing people who suicide, about a third of the suicides seem to have been precipitated by the loss or the anticipated loss of a partner. So in terms of timing the first couple of months after this loss or anticipated loss is a time of particular risk.

Substance abusing people are often incarcerated. The first 24 hours in a remand or prison situation seems to be times of particular risk for suicide in those people. If the people are placed in mental health institutions risk level increases at times of change and not always bad change. Even at times of being granted leave might be a time of increased risk. There seems to be in these times of change a time that people reassess their self worth and their mastery and compare it with their feelings of entrapment and being trapped and feeling hopeless.

There is not as yet a great deal of research in this area of timing but it might be a very profitable one for further study. However, what is known (and I am sure that the next speaker will talk a lot more about this) is that a major depressive episode is found to have occurred in two-thirds or more of substance abusing individuals who suicide.

Depression often goes undiagnosed whilst it is poorly treated, particularly in some groups like older men. Since this is so this might be a treatment avenue that could be much more vigorously pursued. Substance abuse with other psychiatric conditions such as schizophrenia and bi-polar disorder are also of great concern because it appears that many of these people are drug taking in an attempt to moderate their inner chaos. But when they do this the affect can be lethal. Young people with multiple drug use and a dual diagnosis can be particularly at risk because they often fall into the cracks between mental health and substance abuse services. Fortunately these two services are increasingly aware of the need for a more co-ordinated approach and the Carers’ Association must be complemented on their efforts to do something about this.

So is there any good news? I believe there is and especially for young people. What has been found is that many of the characteristics or conditions that inhibit, reduce or protect against other forms of dangerous risk taking, including drug taking, also protect against suicide. Many of these protective factors cluster around things such as increasing social connectedness, school success, church affiliation, improved problem solving and help-seeking. These factors are said to improve resilience where resilience is the ability to bungee jump back from the stresses of life.

What might help to reduce suicide amongst these people? One, we must recognise that not all suicides are preventable. As parents we can do some things that help. If you are interested in this area I would like to introduce you to some helpful little books put out by the Scouts Association.. They include things like youth suicide prevention and information for parents, "Raising resilient young people: the parent’s guide" and that’s the guide "Bungee jumping" and their latest is "Reducing the Risk". I really compliment the Scouts Association.

So what are some of the other things we might do that might help? These can be as individuals or as communities. There is evidence accumulating as to what types of treatment strategies might be useful. Some of these include group therapy, cognitive behaviour therapy. VYNE from time to time runs training courses on these types of therapies. People treating others with substance abuse problems can watch more carefully at critical times, for instance after the loss of a partner, and they can also treat depression more vigorously. Suicide rates can be reduced by limiting access to means. Guns need to be locked up because alcohol and suicide by shooting have a long history. Some medications need to be sold in smaller packs so it is harder to get enough to be lethal. Service delivery especially for young people needs to be more flexible, accessible and co-ordinated and services may need to be more aggressive in trying to engage and follow up young people and some other groups.

I recommend to you then as a community that there are things that we can do to recognise risk factors and to learn how to intervene. VYNE runs a two day assist course which can help you intervene as community members and I would also recommend to you a session that we have coming up very shortly with John Howard - not the man from the Hill but Dr. John Howard who is now in charge of programs and research with the Ted Noffs Foundation which has opened premises in Canberra. John will be talking on new treatments for young people with problematic drug use. (Applause.)