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Monitoring mental health and suicide prevention reform: National Report 2020

Appendix A: National Report 2019 recommendations update

Recommendation Progess Update
Addressing population data gaps
Recommendation 1: The Australian Government supports an ongoing program of prevalence data collection, conducted at regular intervals, and commits to a feasibility study to investigate options for expanding the scope of disorders and high-risk community groups included in the prevalence data collection program. The Australian Government has committed $89.5 million to implement the Intergenerational Study of Health and Mental Health, beginning with the National Study of Mental Health and Wellbeing (NSMHWB), scheduled to go into the field from January 2021 (subject to COVID-19). Initial findings are expected from late 2021.
Recommendation 2: The Australian Government supports the development of a culturally appropriate version of the National Survey of Mental Health and Wellbeing, to collect high quality data on the prevalence of mental illness in Aboriginal and Torres Strait Islander communities. Discussions between the Australian Bureau of Statistics (ABS), the Australian Government Department of Health and the National Indigenous Australians Agency (NIAA) have identified a range of issues with regard to including Aboriginal and Torres Islander–specific mental health and wellbeing data in the Intergenerational Health and Mental Health Study (either the NSMHWB or subsequent modules):
  • • The survey instrument, incorporating a diagnostic interview similar to that used in the NSMHWB, needs to be both culturally appropriate and able to adequately capture relevant social and cultural determinants of mental health for Aboriginal and Torres Strait Islander people.
  • • Consultation needs to be conducted with Aboriginal and Torres Strait Islander people, health services and other key stakeholders before undertaking any national survey, particularly on a sensitive topic such as mental health. In particular, issues related to informed consent, data linkage, and requirements for ethics approvals and/or privacy impact assessment would need to be discussed with stakeholders and the community.
  • • Managing respondent burden requires careful consideration in terms of the impact on individuals who may require access to appropriate support.
  • • Consideration of timing of such a survey is important in terms of:
    • o the sequence and potential clash with other important Indigenous-specific surveys from the ABS and the survey burden on the population
    • o whether comparability with the mainstream mental health survey is a priority; if so, a comparable time period would be needed.
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  • • The collection approach for Aboriginal and Torres Strait Islander surveys needs to be enhanced, including communication and engagement practices.

The Australian Government Department of Health will continue to work closely with the ABS, the NIAA and other stakeholders to plan for future collection of Aboriginal and Torres Strait Islander mental health data, informed by further research.

The National Aboriginal and Torres Strait Islander Health Survey (2018–19) included various data items relating to mental health and wellbeing, including:

  • • whether the respondent has ever been diagnosed with a mental health condition
  • • type of diagnosed mental health condition
  • • whether the respondent has psychological disability
  • • whether the respondent has accessed/used health services for a mental health condition
  • • whether the respondent has been to a counselling service in the past 12 months
  • • reason(s) they did not go to a counsellor in the past 12 months
  • • whether the respondent consulted a psychologist in the past two weeks
  • • social and emotional wellbeing.
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Recommendation 3: The Australian Government supports the ongoing inclusion and further development of psychosocial risk factor analysis in the routinely published deaths data collection. The ABS has released the results of a pilot study into the psychosocial risk factors associated with suicide deaths in 2017.

The ABS Causes of death, Australia, 2019 publication extended this analysis and published psychosocial risk factors from 2017, 2018 and 2019 data.

The Commission is currently seeking further information regarding an ongoing commitment to analysis of psychosocial risk factors in the routinely published deaths data collection.

The ABS has worked with the National Coronial Information System and data custodians to embed psychosocial risk factors in future national mortality datasets.

Supporting work is published by the Australian National University and the ABS on psychosocial risk factors as they relate to coroner-referred deaths in Australia.
Australia's mental health system
Recommendation 4: Subject to the findings of the Productivity Commission inquiry into the social and economic benefits of improving mental health, governments support a national mental health service gaps analysis. Following release of the final report of the Productivity Commission's inquiry into mental health in November 2020, the Australian Government has indicated that it will consider the report and respond as part of the 2020–21 Budget.
Recommendation 5: The Australian Government produces a clear implementation plan to accompany the development and release of the National Mental Health Workforce Strategy. A National Mental Health Workforce Strategy Taskforce has been established. It is anticipated that the taskforce will provide initial recommendations to the Australian Government by December 2020. A final report will be provided to the Australian Government by late 2021.
Meeting the needs of consumer and carers
Recommendation 6: The National Mental Health Commission suggests that state and territory governments offer the Your Experience of Service (YES) survey to consumers during every hospital stay or community health centre visit, and contribute to the national data collection on consumer perspectives of mental health care. YES survey data for 2018–19 was published in October 2020. At this time, only three jurisdictions—New South Wales, Queensland and Victoria—contributed to YES data collection. In 2018–19, New South Wales consumers were offered the YES survey during every hospital stay or community episode of care. In Queensland and Victoria, consumers were offered the YES survey at a particular time of the year.
Recommendation 7: The National Mental Health Commission suggests that state and territory governments investigate the feasibility of implementing the Mental Health Carer Experience Survey. New South Wales implemented the survey in 2018, and Queensland implemented it in 2019. Victoria implemented the survey in 2020.

Data from these jurisdictions has not yet been aggregated into a routinely published, publicly available report.
Recommendation 8: The Australian Government supports the implementation of the Living in the Community Questionnaire Summary Form in the mental health services they fund. The National Mental Health Commission suggests that state and territory governments implement the Living in the Community Questionnaire Summary Form in mental health services they fund. All resulting data should be publicly reported. The Australian Government invested in the development of the Living in the Community Questionnaire (LCQ), which is now available for use.

The LCQ has been designed to explore aspects of a consumer's life in the community, including social activities, participation in employment or study, living situation and physical health care.

The summary form of the LCQ (the LCQ-S) has been created and can be used within services to support consumer–clinician dialogue and care planning.

Primary Health Networks (PHNs) are required to provide data about the delivery of commissioned mental health services to the Australian Government Department of Health through the PHN Primary Mental Health Care Minimum Data Set. PHNs are also able to collect any other data appropriate for evaluation and performance improvement.
Social determinants
Recommendation 9: Subject to the findings of the Productivity Commission inquiry into the social and economic benefits of improving mental health, the Australian Government considers the role of a central government agency to coordinate a whole-of-government approach to mental health policy. Following release of the final report of the Productivity Commission's inquiry into mental health in November 2020, the Australian Government has indicated that it will consider the report and respond as part of the 2020–21 Budget.
Recommendation 10: Subject to the findings of the Productivity Commission inquiry into the social and economic benefits of improving mental health, the Australian Government considers the role of an independent statutory body to monitor and evaluate mental health policy outcomes. This includes the current levels of expenditure on mental health and whether investment in mental health is effective, efficient and informed by evidence-based policy. Following release of the final report of the Productivity Commission's inquiry into mental health in November 2020, the Australian Government has indicated that it will consider the report and respond as part of the 2020–21 Budget.
Primary Health Networks
Recommendation 11: In consultation with PHNs, the Australian Government establishes an overarching entity to govern, support and build PHN capacity on a national scale. The Australian Government has advised that it does not consider that an additional organisation is required. In 2014, the Review of Medicare Locals recommended that the Australian Government should not fund a national alliance for Primary Health Organisations, now known as PHNs.

The Australian Government Department of Health provides national support for the PHN program through national direction and leadership, performance setting and monitoring, including facilitating opportunities for knowledge sharing and learning, engagement and communications, and financial management of the program.

In addition to the department's role, the 31 PHNs have formed the PHN Cooperative, which serves as a single point of contact for the PHNs, and provides a forum for PHNs to shape and inform shared agendas.

There are also a number of state- and territory-based alliances among PHNs that optimise the collective capabilities of PHNs as a sector, proactively align efforts and advance primary care reform with a jurisdictional purview. They also shape, strengthen and sustain primary health care through partnerships and strategies that improve people's access and health outcomes.

The Productivity Commission has recommended that the Australian Government support state and territory governments that choose to establish regional commissioning authorities to administer mental health funding as an alternative to PHN–Local Health Network groupings.
Recommendation 12: The Australian Government responds to the 17 recommendations in the PHN Advisory Panel Final Report. The mental health policy landscape has evolved considerably since this report was delivered, and future policy and programs will be informed by this report and other significant reviews, such as the Productivity Commission inquiry into mental health.
Recommendation 13: The Australian Government endorses the implementation of the Five-Year Horizon for PHNs. The mental health policy landscape has evolved considerably since these reports were delivered, and future policy and programs will be informed by these reports and other significant reviews, such as the Productivity Commission Inquiry into mental health.
Recommendation 14: The report on the performance of the PHN Program to be released by the Australian Government include baseline data about how the PHN Program is meeting outcomes under the new PHN Performance and Quality framework. The Australian Government Department of Health's 2018–19 PHN Program Performance and Quality Framework report, which includes baseline data, was published on 1 October 2020. This was the first PHN program-wide performance report conducted under the PHN Program Performance and Quality Framework.
Recommendation 15: The Australian Government encourages PHNs to extend contracts with existing service providers who can demonstrate efficacy and suitability in providing services in their region; and where feasible, enter into longer-term contracts when commissioning services with new providers. The Australian Government has committed to providing the PHN program with performance-based 3-year contracts to support longer-term service planning and system improvement.

The Australian Government Department of Health has highlighted that it expects that PHNs will pass on longer-term funding certainty to service providers who meet performance expectations, where the underlying funding is available, and where the commissioning cycle indicates that a new approach to market is not needed.

It is not always appropriate for PHN-commissioned service providers to be placed on 3-year contracts. For example, PHNs may put in place surge arrangements or offer additional support for a limited period, such as during COVID-19 lockdown periods. In such cases, it may be more suitable for PHNs to offer a shorter contract length.

The Productivity Commission recommends that the Australian Government should require PHNs to enter into longer contracts when commissioning psychosocial services.
Recommendation 16: The Australian Government encourages PHNs to position Aboriginal Community Controlled Health Services as preferred providers for mental health and suicide prevention services for Aboriginal and Torres Strait Islander people. The PHNs and Aboriginal Community Controlled Health Organisations (ACCHOs) Guiding principles document recognises the commitment by PHNs and Aboriginal Community Controlled Health Services (ACCHSs) to work together to improve access to health services and improve health outcomes for Aboriginal and Torres Strait Islander people.

The Guiding Principles acknowledge and respect the essential role that ACCHSs play in delivering culturally safe, holistic models of care, including comprehensive primary health care for Aboriginal and Torres Strait Islander people, and the important leadership role of the sector in improving the health and wellbeing of Aboriginal and Torres Strait Islander people.

The Guiding Principles were developed in consultation with ACCHO peak bodies and are publicly available.
National Disability Insurance Scheme
Recommendation 17: The NDIA publishes information about the outcomes of the complex support needs pathway and the psychosocial disability service stream, and the evaluation outcomes of streamlined access for people with psychosocial disability. Recent improvements to access for people with psychosocial disability, such as the recovery coach, have recently been implemented, and the psychosocial framework is expected to be completed in 2021. As of 30 September 2020, 40,508 participants with a primary psychosocial disability had accessed the National Disability Insurance Scheme (NDIS).
Recommendation 18: The Australian Government: extends support for Commonwealth community mental health program clients to at least June 2021; considers whether the funding available under the National Psychosocial Support and Continuity of Support measures matches the needs of people who are ineligible for the NDIS; and considers how funding and access to services for people ineligible for the NDIS can be simplified. The Australian Government Department of Health continues to carefully monitor the transition of clients from ceased Commonwealth community mental health programs (Partners in Recovery, Day to Day Living, and Personal Helpers and Mentors) to accessing support through National Psychosocial Support Transition measure arrangements from 1 July 2019.

Additional funding of $28.4 million is being provided in 2020–21 to continue support for 12 months from 1 July 2020 to 30 June 2021 for clients who are yet to test eligibility for the NDIS.

An evaluation of the National Psychosocial Support measure and Continuity of Support program commenced in February 2020 and is due to be completed in December 2020. The findings of this evaluation, as well as the findings from other reviews such as the Productivity Commission inquiry into mental health, will inform broader policy and funding reforms, including access to services and integration with state and territory services.

The Australian Government has implemented three programs to help with the transition of people from a number of Australian Government–funded mental health programs that have ceased due to the transfer of funding to the NDIS. Unfortunately, not all people from these programs have access to the NDIS, because they do not meet the eligibility criteria or choose not to apply.

Continuity of Support

In the 2018–19 Budget, the Australian Government announced that it had committed $109.8 million from 1 July 2019 for the Continuity of Support (CoS) measure. This measure provides psychosocial supports to former clients of ceased Commonwealth community mental health programs (Partners in Recovery, Support for Day to Day Living, and Personal Helpers and Mentors Service) who were receiving services at 30 June 2019 and are ineligible for supports under the NDIS. CoS will provide ongoing funding, ensuring that CoS clients continue to have access to responsive support as needed.

National Psychosocial Support Transition measure (NPS-T)

The NPS-T program provides targeted support to people who were previously accessing psychosocial services through ceased Commonwealth community mental health programs (Partners in Recovery, Support for Day to Day Living, and Personal Helpers and Mentors Service) on 30 June 2019 to test their eligibility for the NDIS. Clients in NPS-T can also access psychosocial supports while they undertake this process. Clients of NPS-T who are found ineligible for the NDIS will be able to access psychosocial support through the CoS program.

On 29 March 2020, the Australian Government announced that it would invest a further $28.4 million in NPS-T from 1 July 2020 to 30 June 2021, to extend support for the 2,709 remaining clients (from 15,484 clients at 1 July 2019) to test eligibility for the NDIS.

National Psychosocial Support measure (NPS-M)

In the 2017–18 Budget, the Australian Government committed $80 million over four years for the NPS-M. The states and territories have matched funding for this measure, and the Australian Government has bilateral agreements in place with each jurisdiction to support coordinated delivery of these services.

The NPS-M is designed to:
  • •support people with severe mental illness and associated psychosocial functional impairment who are not more appropriately supported through the NDIS
  • •reduce the avoidable need for high-intensity, acute health services and promote effective use of the health system.
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Recommendation 19: The Australian Government, with state and territory governments ensure that people who are ineligible for the NDIS have access to adequate psychosocial support services The National Disability Insurance Agency (NDIA) has implemented projects to support PHNs and provider organisations to support people transitioning to the NDIS from Commonwealth mental health programs.

The NDIA is improving linkages and referrals to mainstream mental health supports and the community mental health sector for people not eligible for the NDIS, with new arrangements commencing from March 2020.

To improve access for prospective participants, the NDIA has implemented a number of improvements:

  • •new streamlined access processes that support prospective participants to begin their access request verbally with a support worker or another trusted person
  • •new resources to clarify information needed to demonstrate evidence of disability for people with psychosocial disability
  • •enhanced role of Partners in the Community to undertake outreach activities to increase access to the NDIS for people with psychosocial disability, with role specifications completed by April 2020, after which new information and marketing strategies will be rolled out
  • •additional $20 million for the Community Connector program, which will be expanding into urban and rural settings. The additional funding will be targeted to culturally and linguistically diverse communities, people experiencing psychosocial disabilities, ageing parents or carers of people with disability and Indigenous communities. The NDIA plans to have the program in place by April 2020
  • •strengthened information sharing between Australian Government and state and territory governments and the NDIA, including a six monthly NDIS data report on psychosocial disability so that jurisdictions can monitor developments.
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On 9 October 2019, disability ministers under the Disability Reform Council committed to improving access and experiences for participants with psychosocial disability.

The NDIA is working collaboratively with the Australian Government Department of Social Services and Department of Health, and state and territory health department representatives on the following key initiatives:

  • • undertaking a joint examination of access and eligibility
  • • improving linkages and referral to mental health supports for people not eligible for the NDIS
  • • undertaking assertive outreach to increase access to the NDIS for people with psychosocial disability
  • • implementing a psychosocial disability recovery approach
  • • implementing a national approach to concurrent supports.
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A Stakeholder Reference Group of sector peak bodies and representatives with lived experience has been established to provide input into priority areas, including development of the NDIS Psychosocial Disability Recovery Framework.
Recommendation 20: The NDIA works with state and territory governments to progress the Maintain Critical Supports policy and release detail on what is happening with the policy. On 29 May 2020, National Cabinet agreed to reconsider the structure of the Council of Australian Governments and the supporting councils. A decision on the restructure is pending.

The Disability Reform Council is the forum for member governments to discuss matters of mutual interest and progress key national reform in disability policy, including the NDIS. The council has continued to guide work on the NDIS.

The council noted at its March 2020 meeting that the priorities during the COVID-19 pandemic were to:
  • · ensure the ongoing delivery of core NDIA services as part of the NDIA's Pandemic Plan, including a shift from face-to-face planning to telephone planning, and redirecting NDIA staff and partners to priority service delivery roles that support participants in responding to COVID-19
  • · ensure that appropriate plans are in place to respond to any workforce shortages that may arise as a result of COVID-19
  • · ensure that providers are supported to remain viable during the period of impact of COVID-19 and beyond
  • · ensure the continuation of services to NDIS participants through extension and increased flexibility of NDIS plans, where necessary, so that the NDIA can focus on reviewing plans that may require amendment in response to the impact of COVID-19.
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At its July 2020 meeting, the council agreed to continue monitoring the NDIS support market, and work to finalise an NDIS workforce plan later in 2020 in light of COVID-19.
Recommendation 21: The NDIA includes support coordination as a standard item in all plans for people with psychosocial disability. From 1 July 2020, greater flexibility will be introduced into plan funding to allow participants to use their funding across all aspects of the plan. This means that participants will be able to use the funding for support coordination or recovery coach support. The recovery coach role provides a greater level of support for participants with psychosocial disability. Participants can choose from two streams of recovery coach: those with lived experience and those with learned experience.
Recommendation 22: The NDIA routinely publishes data about participants with psychosocial disability including information about application, access and planning outcomes by population groups, eligible/ineligible status, plan utilisation, the extent of support coordination in plans, and current rates of expenditure on supports in plans. In June 2019, the NDIA published a report on participants with psychosocial disability, providing information about plan funding, numbers of participants, client satisfaction and outcomes.

The NDIS publishes a quarterly report of data on NDIS participants. The quarterly report provides basic figures on how many new participants with psychosocial disability have accessed the scheme.

The National Mental Health Sector Reference Group is also provided with more detailed information at its quarterly meeting.
Suicide prevention
These recommendations are pending the final report of the National Suicide Prevention Taskforce.
Recommendation 23: In acknowledgement of their shared responsibility for preventing suicide, any future national suicide prevention strategies be co-designed and co-governed by all relevant portfolios under the Australian Government, including health, education, justice, social services and employment. The Australian Government is working towards zero suicides. It appointed the first National Suicide Prevention Adviser, who reports directly to the Prime Minister. The National Suicide Prevention Adviser will work with relevant ministers to drive a whole-of-government approach to suicide prevention activities. The National Suicide Prevention Taskforce supports the National Suicide Prevention Adviser. Interim advice and in-principal recommendations were released in November 2020, following consultation with almost 2,000 people with lived experience, experts in suicide prevention and government representatives. The interim advice will be used to consult further with government representatives on implementing the recommendations. The final advice is due to the Australian Government in December 2020.
Recommendation 24: The Australian Government work with the state and territory governments to commit to a national Aboriginal and Torres Strait Islander suicide prevention plan, that is led by the knowledge and expertise of Indigenous people. In the 2019–20 Budget, the Australian Government allocated $4.5 million to support the establishment of a national independent and inclusive Indigenous social and emotional wellbeing, mental health and suicide prevention leadership body: Gayaa Dhuwi (Proud Spirit) Australia. Gayaa Dhuwi (Proud Spirit) Australia has commenced renewing the 2013 National Aboriginal and Torres Strait Islander Suicide Prevention Strategy in consultation with stakeholders and community members, and is working closely with the National Suicide Prevention Adviser and Taskforce.
Recommendation 25: The Australian Government work with state and territory governments to ensure that all evaluations of initiatives to improve emergency department care extend beyond measures of process and impact on hospital staff, to include impact on meaningful outcomes for consumers and carers as a primary outcome measure. The New South Wales Government has introduced 20 new services across the state that provide an alternative to emergency presentations as part of the Towards Zero Suicides initiatives. The centres are based on the United Kingdom Safe Haven cafes that have shown positive reductions in emergency admissions. The Safe Haven model is also being trialled in Victoria.

The Australian Government is trialling eight Adult Mental Health Centres, one in each state and territory, to assist in reducing presentations to emergency departments. The centres will be established and led by PHNs from 2020–21, and service delivery will commence in 2021–22. An evaluation framework will assist in understanding the trials' effectiveness and informing their potential for future expansion.
Recommendation 26: The Australian Government work with the Safety and Quality Partnership Standing Committee to ensure that the mental health supplement to the National Safety and Quality Health Service Standards includes detailed requirements and guidance on the care required by people at risk of suicide. Under the Fifth National Mental Health and Suicide Prevention Plan Implementation Plan, the Safety and Quality Principal Standing Committee of the Mental Health Principal Committee is to work with the Australian Commission on Safety and Quality in Health Care to develop the mental health supplement to the National Safety and Quality Health Service Standards (second edition).

A National Safety and Quality Community Mental Health Standards (NSQCMHS) advisory group, comprising representatives from key sectors (including the Australian Government Department of Health), has been established and has had its initial meeting. The department will ensure that guidance on the care required by people at risk of suicide is included in the NSQCMHS through its representation on the advisory group.
Recommendation 27: The Australian Government work with the Mental Health Principal Committee, to oversee the development of best practice suicide prevention guidelines that cover the full range of suicide prevention activities, from primary prevention to postvention, in all settings. On 29 May 2020, National Cabinet agreed to reconsider the structure of the Council of Australian Governments and the supporting councils. A decision on the restructure is pending.

As part of the role, the National Suicide Prevention Adviser will develop options to improve the whole-of-government coordination and delivery of suicide prevention activities across portfolios, to address the complex issues contributing to Australia's suicide rate and find community-led, person-centred solutions. The interim advice was provided to the Prime Minister in August 2020 and made public in November 2020, outlining in-principle recommendations. The key recommendations focus on a whole-of-government approach, and the need for ongoing engagement with people with lived experience in the development and design of services.

The interim advice will be used for further consultations with governments to inform the final report and recommendations, which will be provided to the Prime Minister in December 2020.
Recommendation 28: The Australian Government work with the state and territory governments on the development of routinely collected data on suicide prevention expenditure, workforce and program and service activity. The Australian Government has committed $15 million from 2019–20 to 2021–22 to establish a new national system for collection and coordination of information on suicide and self-harm. Bringing together region- and demographic-specific information on the incidence of suicide and suicidal behaviour, this system will ensure that governments and communities will be able to rapidly deliver the right type of services when and where they are needed most, to prevent suicides and suicide clusters. The Suicide and Self-harm Monitoring website was launched on 29 September 2020. Data will continue to be released over the course of the project. Coronial suicide registers capable of timely data have been established in Victoria, New South Wales, Queensland, Western Australia and Tasmania. The Australian Institute of Health and Welfare is working with the Australian Capital Territory, South Australia and the Northern Territory to establish suicide registers.

The Productivity Commission recommended that relevant data should be shared and the Commission should assess evaluations of current suicide prevention activities.
Recommendation 29: The Australian Government, with the state and territory governments commit to longer-term funding for suicide prevention activities and evaluations of these activities to better assess outcomes over a longer period of time. PHNs receive Australian Government funding to commission suicide prevention activities at the local level, responding to regional need.

In addition, through the National Suicide Prevention Leadership and Support Program, the Australian Government provides funding for a range of national activities that contribute to reducing deaths by suicide across the Australian population and among at-risk groups, and reducing suicidal behaviour.

Projects include research, anti-stigma and awareness campaigns, face-to-face support for individuals in need, and training for frontline services.

The Australian Government has committed a further year of funding for the program to June 2022.

There is still no clarity around roles and responsibilities for suicide prevention activities. Whole-of-government engagement is needed to ensure that outcomes can be achieved.

Recommendation 30: The Australian Government commit to the timely public release of the evaluation of the National Suicide Prevention Trial. The Australian Government should also work with the Victorian Government, Australian Capital Territory Government and the Black Dog Institute to encourage the timely public release of their evaluations of the local area suicide prevention trials. The evaluation of the National Suicide Prevention Trial has now been finalised.

There has been significant investment in suicide prevention trials across the country (Victoria, LifeSpan in New South Wales and the Australian Capital Territory, and Australian Government trials). The Australian Government is providing funding to gather and analyse findings from evaluations of the suicide prevention trials to improve the evidence base available at the national level.

The Australian Government Department of Health has engaged a consultant to progress this initiative. This work supports the recommendation of the National Suicide Prevention Adviser for “enhanced coordination of all suicide prevention trial site evaluations to enhance understanding of effective interventions and inform future decisions”.