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Actual and attempted suicides in Broken Hill

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					Actual and attempted suicides in Broken Hill




by Henry Lohse




    This paper reports on
    and discusses an
    investigation into the
    suicide and attempted
                                        W      of youth suicide.
                                                HEREAS the overall rates for
                                                suicide in Australia have
                                        decreased from 1970 to 1980, the rates
                                        for particular age groups have increased
                                                                                     isolated from its state capital by some
                                                                                     1000 kms and is 500kms from the nearest
                                                                                     capital city, Adelaide. The primary
                                                                                     sources of income for the population are
                                                                                     mining, grazing, tourism and welfare
    suicide records in Broken           significantly. For example suicide           payments. Welfare payments support a
                                        among youth increased by over 30%            large part of the population with some
    Hill over the past 15               during this period                                                   6600 people on
    years, highlighting the             while the total rate                                                 some form of
    differences to national             decreased by some        In general terms suicide is the             pension. Broken
    trends, suggesting some             11%(Hassan 1990).        second largest class of death by            Hill has an
                                        Similarly Hawton         external causes after motor vehicle         unemployment
    local influences and                and Catalan (1987),      collisions (Hallenstein 1990).              rate            of
    offering                            referring to at-                                                     approximately
    recommendations for the             tempted suicides,                                                    14%. The popu-
                                        describe increases in rates over the last    lation, which is aging rapidly, has a
    future.                             30 years and particularly increases          small but significant Aboriginal
                                        among the young (15-19 years) age            population and a well integrated
    While the research does                                                          European ethnic population.
                                        group.
    not focus specifically on               My work as a school psychologist             Due to a combination of factors, the
    youth, the data for that            brought me into contact with cases of        city has seen its population decline from
    age group and the                   attempted suicide, self injurious            a high of 31,000 in 1971 to slightly
                                        behaviours and a community held              below 25,000 in 1990. There is a
    possible social factors             perspective that suicide was of              perception that the majority of lost
    contributing to suicide             significance. This experience and my         employment opportunities have been in
    make this research                  curiosity encouraged me to research the      the traditionally blue collar or mining
                                        area.                                        support areas. Another significant social
    relevant to those                                                                change occurred in the late 70s when
    interested in the problem           Broken Hill                                  the last barriers to the employment of
                                        Broken Hill, NSW, a regional city of         married women were removed.
                                        approximately 25,000, is physically              The attempted suicide data for this



Youth Studies Australia   Autumn 1992                                                                                      33
study was provided by the hospital            justifiably on the grounds of                             suicides per year over the study period.
authorities in summary form from their        confidentiality. The figures are in the                       From July 1979 to June 1990 there
admissions register.                          form of financial year (July to June)                     were 432 cases of self-injurious
    The completed suicide cases               summaries showing: total attempts, sex,                   behaviour or suicidal attempts treated
information was extracted from the            means, and age range. This precluded                      and recorded by the Broken Hill Base
coroner’s reports held in the Broken Hill     many specific analyses of the patterns in                 Hospital Admission Centre. The number
Court House. A physical search of the         suicide attempts.                                         of attempted suicides per year is shown
files was undertaken and each case where                                                                in Figure 2 where the range is from 29 to
the Broken Hill Coroner concluded             Data analysis                                             50 attempts per year with an average of
suicide or death at own hand, was             Statistical analysis of the data available                39 per year.
notated as part of this research. These       is limited to considerations of annual                        Of the 91 recorded suicides 80 were
included the cases from nearby centres        rates, totals, averages and, where                        by males compared with 11 by females.
using the Broken Hill Court facilities.       meaningful, standard deviations.                              Of the attempted suicides 248 (or
    The coroner’s reports are the most            With completed suicides a separate                    57.4%) were by females compared with
appropriate starting point as the             male/female analysis is meaningless as                    184 (or 42.6%) by males (Figure 3).
coroner’s function “is to investigate every   the number of female cases over the 15-                       The rates of suicide in Broken Hill
aspect of death reported to him in order      year period was too small. The numbers                    calculated to a standard measure of
to conclude...all the circumstances           involved in suicide attempts however                      incidence per 100,000 population are
surrounding the death” and to draw            were greater and an analysis based on                     illustrated in Figure 4. The range for
together all pertinent information “with      sex is provided.                                          Broken Hill is from a low of 12 per
a view to seeing if there is anything             Similarly the numbers of cases                        100,000 to a high of 45 per 100,000. This
which could be done to avoid the              determine the analysis opportunities                      compares with the national average of
unnecessary repetition of tragedy”            with consideration to age distribution.                   12 per 100,000. The standardised rate
(Hallenstein 1990). The Victorian State       Even with suicide attempts no age factor                  comparisons are not available for
Coroner further asserts that “perhaps         analysis is possible due to having access                 attempted suicides.
the most important function which the         to age ranges, not individual details.                        The most common method of suicide
coroner performs is one of providing              The generally accepted suicide rate                   in Broken Hill is shooting, with the next
information to the public and the             for Australia over the last 20 years is                   most common method being drug
government of the matters analysed,           11.7 per 100,000 (ABS 1989). For NSW                      overdose. Table 1 shows the proportions
learned and understood” with a view to        over the last 20 years the rate has ranged                of means of suicides as percentages while
forming preventive or remedial policies.      from a 1971 high of 13.5 to a 1984 low of                 the figures in brackets indicate the actual
The details available from all coronial       9.5 per 100,000 (ABS 1979).                               numbers.
reports were: date, sex, age, marital             For Broken Hill the calculation of                        Almost two-thirds (65%) of all
status, occupation, and means of              rates per 100,000 was made on the basis                   suicide attempts involved some type of
suiciding.                                    of a population of 27,000 to give an                      drug overdose. The next most likely
    Within each coroner’s report the          approximate mean for the time period                      means of attempting suicide was through
police statement in most cases provided       and to include some
additional information. This was usually      r e g i o n a l           Figure 1: Broken Hill Suicides – Actual rates
in the form of information received as to     population.               12
the “state of mind”of the victim,
contributory factors or often the officer’s   Results
own interpretation as to the reasons for      Over the 15-year                 10
the suicide.                                  period of the study
    The coroner’s reports do not provide      91 cases of suicide              8
a wide range of information apart from        were recorded and
the above points. Even then the               examined by the
                                                                     Numbers




categories such as marital status and         Broken         Hill              6
occupation were confusing at times, such      Coroner’s Court.
as separated, divorced or not married; or     Figure 1 illustrates             4
the distinctions between unemployed,          the variation in
retired, pensioner, not working and           numbers of suicides
home duties. These inconsistencies            per year, ranging                2
created difficulty in assessing these         from a low of three
categories for trends or significance.        in 1987 to a high of             0
    The hospital attempted suicide            11 in 1988, with an                   76   77   78   79   80   81   82    83 84   85   86   87   88   89   90
information is very bare of detail,           average of six                                                           Years




34                                                                                                  Youth Studies Australia               Autumn 1992
Figure 2: Attempted suicides – 1979-1990                                                      Figure 3: Attempted suicides – sexes

                     50                                                                                 30

                     45
                                                                                                        25
                     40

                     35
                                                                                                        20
Number of attempts




                     30




                                                                                              Numbers
                     25                                                                                 15

                     20
                                                                                                        10
                     15

                     10
                                                                                                        5
                     5

                     0
                                                                                                        0
                          79/80 80/81 81/82 82/83 83/84 84/85 85/86 86/87 87/88 88/89 89/90
                                                                                                             79/80 80/81 81/82 82/83 83/84 84/85 85/86 86/87 87/88 88/89 89/90
                                                        Years
                                                                                                                                           Years
                                                                                                              Males

                                                                                                              Females

the use of a cutting implement, usually                                                                                       and rural populations, pointing out that
to the wrists (9%). The third most                                       Police reports attached to the                       rural or country youth populations are
frequent means of attempt was through                                coroner’s findings mostly included some                  50% more likely to commit suicide than
the use of firearms (3%).                                            comments or “judgments” alluding to                      their urban counterparts. At twice the
    Figure 5 indicates the distribution of                           the reporting policeman’s assessment                     state average for overall suicides, Broken
age groups in actual suicides. The range                             of the underlying reason for the suicide.                Hill’s rate is of particular concern.
of ages is from 12 years to 78 years. (The                           These are summarised into categories
range of ages for attempted suicides over                            in Table 3 and the percentages where                     Table 4: Annual suicide rates
the same period is from 13 years to 80                               this “reason” is attributed is indicated.
years.)                                                                                                                       Year Actual                100,000
                                                                                                                                                Rate per Broken
                                                                                                                                                NSW                   Times
                                                                                                                                                            Hill      higher
    An analysis of the 26 different                                  Table 3: Contributing factors
descriptions of occupation shows the
major groups in Table 2.                                             Depression                                    20%        1976      7       10.7       25.4         2.4
                                                                     No reason attributed                          16%        1977      4       10.7       14.5         1.4
                                                                     Prior attempt                                 16%        1978      5       10.7       18.2         1.7
Table 1: Method – Completed suicides                                 Problem relationship                          14%        1979      5       10.6       18.2         1.7
                                                                     Alcohol                                        5%        1980      7       10.6       25.7         2.4
Firearms            51.6%                                 (47)       Psychiatric history                            3%        1981      7       10.6       25.9         2.4
                                                                                                                              1982      5       11.0       18.9         1.7
Drugs                 18.7                                (17)       Financial problems                             3%        1983      6        9.8       23.1         2.4
Car Exhaust         11.0                                  (10)                                                                1984      7        9.5       27.3         2.9
Hanging             11.0                                  (10)       Discussion                                               1985      6       11.7       23.8         2.0
                                                                                                                              1986      7       11.5       28.0         2.4
Other                 8.0                                  ( 7)      Rates                                                    1987      3       11.6       12.2         1.1
(Cutting, Drown,                                                                                                              1988     11       11.7       44.9         3.8
Electrocute, Explode,                                                The suicide numbers for Broken Hill                      1989      6       11.7       25.5         2.1
Immolate, Jump, Poison)                                              are significantly higher than could be                   1990      5       11.7       19.0         16
                                                                     expected by comparison to state averages
Table 2: Main occupation categories                                  (NSW Bureau of CSR 1990). Even during                    (NSW rates from NSW Bureau of CSR, Broken
                                                                                                                              Hill rates projected from population rates as
                                                                     the year of fewest suicides, 1987, Broken                described in Broken Hill City Council 1990
Pensioner                                             23 cases       Hill’s rate is above average. From the                   Annual Report.)
Unemployed                                                   15      figures below in Table 4 it can be seen
Labourer                                                     11                                                               Sex ratios
Miner                                                        10      that at its peak the suicide rate for Broken
Retired                                                       4      Hill is almost four times higher than the                Clearly the Broken Hill figures suggest
Student                                                       3      state average.                                           some significant differences to the state
All others                                      2 cases or less
                                                                         Dudley (1990) has described the                      and national trends. With suicide
                                                                     differences in suicide rates for urban                   attempts it is generally accepted that


Youth Studies Australia                           Autumn 1992                                                                                                             35
females outnumber males by some 2:1               The choice of firearms by over half of  Dudley (1990) has described the
(Hawton 1987) yet the local figures           suiciders in Broken Hill raises the         influences of isolation, loss of traditional
indicate an almost equal distribution,        question as to why this means to an end     support, rural recession, and the
57% vs 43%. Elsewhere the ratio of            is so popular here compared with other      crippling value system, on the rural
adolescent females to adolescent males        parts of the country. This rate of firearm  population. Add to these the pressures
is considerably higher. We can only           usage is at least twice that reported in    of small town fears of disclosure, gossip
conjecture what the age distribution in       any other study. Surely the high rate of    and alcohol abuse and it is little wonder
Broken Hill would be without more             gun ownership in this community must        that many seek a solution through
detailed information from hospital            be a factor. A more cynical perspective     suicide. Significantly, Silburn (1990)
records.                                      may be that few other means are available   reports that 50% of males in his study
    With completed suicides the usual         or known. Attempts at suicide using the     were drunk at the time of suiciding.
proportions are five males to each female     most favoured medium of drug overdose           Another factor alluded to by several
suicide but in Broken Hill the male rate      are liable to interruption by sophisticated writers (Hassan, Silburn, and Hart) is in
is substantially higher, the proportion       medical treatment,
being 8:1. The reason for this imbalance      whereas the fastest Figure 4: Suicide rates per 100,000 pop.
I believe is closely aligned to the above     medical response is         45
average use of firearms in local suicides.    slow compared
                                              with the effective-         40
Age distribution                              ness of a gun.
                                                                          35
Figure 5 shows the age distribution of            It is worth
completed suicides in five-year age           noting that among           30
groups. The largest group is predictable      others, Haines et al
                                                                      Numbers



from other research among the high risk       (1990) cite several         25
under 24 age group. Interestingly the         studies where the
                                                                          20
difference in age distribution is lessened    suicide rates are
when the figures are rearranged into 10-      established as being        15
year age groups as in Figure 6. These         significantly lower
figures seem to indicate a quite              where severely              10
homogeneous attitude to suicide.              restrictive gun laws
                                                                           5
    Variations in the rates for different     apply.
age groups are more significant when                                            0
the actual numbers are considered. For        Community values
                                                                                     76   77   78   79   80   81   82    83 84   85   86   87   88   89   90
example Silburn et al (1990) point out        Perhaps an over-                                                          Years
that although the rates of suicide have       view of an out-                        Broken Hill
increased for both the young and the          sider’s perceptions
                                                                                     National Average
very old, the sheer preponderance of          of     community
young suicides makes that figure the          values may add to
more significant.                             an understanding of     Figure 5: Age distribution
                                              the too high rate of              16
Method of suicide                             suicide in Broken
In contrast to the proportions in the         Hill.                             14
favoured means of suiciding in the                The rural or
Broken Hill sample, Silburn et al (1990)      outback mystique of               12
report a clear majority of cases preferring   self-reliance,
the use of carbon monoxide poisoning.         strength and mas-                 10
                                                                      Numbers




    Cantor (1990) on the other hand           culine     activity
reports national figures indicating a         (from shooting to                 8

preference for the ingestion of solid         domestic abuse),
                                                                                6
(drug) and liquid substances at 33%           combined with an
coming ahead of firearms and explosives       unfortunate
                                                                                4
at 27%.                                       attitude to such
    The Bureau of Crime Statistics and        support services as
                                                                                2
Research (1989) reports that among men        do exist, make a
the most common methods were hanging          resort to suicide                 0
(24%), shooting (21%) and carbon              almost inevitable
                                                                                         +
                                                                                       -14

                                                                                       -19

                                                                                       -24

                                                                                       -29

                                                                                       -34

                                                                                       -39

                                                                                       -44

                                                                                       -49

                                                                                       -54

                                                                                       -59

                                                                                       -64

                                                                                       -69

                                                                                       -74
                                                                                       75
                                                                                     10

                                                                                     15

                                                                                     20

                                                                                     25

                                                                                     30

                                                                                     35

                                                                                     40

                                                                                     45

                                                                                     50

                                                                                     55

                                                                                     60

                                                                                     65

                                                                                     70




monoxide poisoning (18%).                     for too many.
                                                                                                                   Age group



36                                                                                                  Youth Studies Australia                Autumn 1992
the area of risk taking behaviour. The             Adding to the problem of access-           Recommendations
high rate of youth unemployment, poor          ibility is the social stigma of being seen
recreational opportunities and alcohol         as weak enough, sick enough or “mad”          The way in which the facts of a suicide
abuse readily lead to a sense of getting       enough to allow the community to help         are reported leaves much to be desired.
high on risk. Traffic accidents are seldom     – even if the individual is aware of to       For example the police report gives little
included in suicide statistics but this is     whom or where to turn.                        scope for later preventive programs to
a most popular medium for risk takers.             It seems appropriate to report the        be established or even to give an
Further Hassan (1990) describes on the         findings of Hawton (1987) who surveyed        indication of whether or not any support
one hand a glorification of violence           suicide attempters for the reason behind      services have been set up for the
through entertainment and on the other         their actions. The greatest percentage of     survivors. The records are thin on the
an increase in actual violent crimes           responses implied that they did not know      lines of any sociological or psychological
reported through police records.               what else to do.This is very much in          viewpoint and perhaps the coroner’s
                                               keeping with the arguments put forward        office is the best starting point for some
Attempts, actual suicides and                                                                            social influence, possibly
occupations                         Figure 6: 10 Year age distribution                                   through the use of a
The link between attempters            20                                                                psychological autopsy.
and actual suicides is clearly                                                                               There is a need for a more
important. Attempters must             18                                                                systematic follow-up to
be considered as being more            16
                                                                                                         suicides and attempters and
in need of support and/or                                                                                to the people affected by the
education as figures from              14                                                                action.
Hawton (1987, p.21) suggest                                                                                  The perceived gap
                                       12
– the suicide rates of                                                                                   between the service providers
                                   Numbers




attempters range from .8% to           10                                                                and the users needs narrowing
3.3% compared with general                                                                               through means such as:
                                        8
population rates of .012%.                                                                               education (both school and
    In the case of completed            6                                                                community),            physical
suicides it is interesting to                                                                            location and visibility of
                                        4
note the large proportion of                                                                             premises. There is a need for
victims who have no                     2                                                                greater community efforts to
occupation. Table 2 shows                                                                                normalise the use of support
that 46% were either                    0                                                                services, perhaps by role
                                             0-14    15-24 25-34 35-44 45-54 55-64 65-74        75+
pensioners, retired or unem-                                                                             modelling.
                                                                   10 year groups
ployed. It is not difficult to                                                                               The issue of problem
conjecture that community                                                                                solving or coping skills must
contact and/or support for these people          by Hassan (1990) and Taylor (1990) that     be addressed through education at as
was less than for the employed.                  poor problem solving skills are strong      early a stage as possible (Mason 1990,
                                                 contributory factors in suicides. It’s my   p.71). This recommendation recognises
Conclusions                                      opinion that another factor inherent in     that the peak suicide age is post schooling
The community of Broken Hill has a               local suicide trends is one of socio-       age, but it is felt that the only stage at
problem with suicides. A suicide rate            politics. Many suicide victims have few     which a broad-ranging program of
which is on average twice that of the            personal resources with which to deal       problem solving strategies could be
nation – with highs of almost four times         with stressors, and they see few reasons    applied is during compulsory schooling.
the national rate – indicates that some          in their lives to bother.                       The over-representation of the
community initiatives must be taken.                 In conclusion it is clear that we still socially isolated suggests a need to
    The suicide issue is compounded by           do not know enough. Psychological           investigate the influence of isolation on
the accessibility of local support services.     “autopsies” ( Hallenstein 1990; Silburn     suicidal behaviour.
Many professional and appropriate                1990) – an attempt to establish                 Finally, gun laws must be changed to
services ranging from alcohol abuse              scientifically the state of mind of victims make a most lethal source of destruction
support to mental health teams to Family         and/or other contributory factors to        less readily available to the impulsive or
and Community Services are available,            suicides – may need to become a             drunken.
but not many people are ready to admit           mandatory part of coronial or even
to having a problem with alcohol,                hospital procedure. This may give us        References
violence or relationships until after some       vital information on patterns and trends    Cantor, C. 1990, Issues of Suicide Prevention
crisis is reached – unfortunately too late       or guide us in best use of the appropriate      – You Cannot Counsel the Dead, paper
for some of those with suicide in mind.          services.                                       presented at 1990 conference: Preventing




Youth Studies Australia      Autumn 1992                                                                                              37
    Youth Suicide, Australian Institute of
    Criminology, Adelaide.
Dudley, M., Waters, B., Kelk, N. & Howard, J.
    1990, Youth Suicide in NSW: Urban-
    Rural Trends 1964-1988, paper presented
    at 1990 conference: Preventing Youth                        Youth Monitor extra
    Suicide, Australian Institute of
    Criminology, Adelaide.
Haines, J., Hart, E., Williams, C., Davidson, J.,   Concern about suicide
    & Slaghuis, W. 1990, Trends in Youth            among rural youth
    Suicide in Tasmania: A Comparison
    Between Youth and Other Suicide, paper          o Western Australian statistics for 1990 show that 199 people of all ages
    presented at 1990 conference: Preventing        committed suicide during that year. Of these 46 were from the country –
    Youth Suicide, Australian Institute of          a rate per head of population double that of metropolitan areas. In an
    Criminology, Adelaide.                          effort to assist isolated young people, the WA Federation of Rural Youth
Hallenstein, H. 1990, Suicide – The Coroner         has produced a Youth Care Card to be distributed to country teenagers
    as Catalyst, paper presented at 1990            this year providing them with anonymous access to advice via the
    conference: Preventing Youth Suicide,           telephone.
    Australian Institute of Criminology,                Federation deputy president Felicity Brown said: "Stress in the family is
    Adelaide.                                       affecting everybody. But in rural areas there's the added problem of
Hassan, R. 1990, Unlived Lives: Trends in
                                                    isolation. These kids simply don't know where to go for help. In their own
    Youth Suicide, paper presented at 1990
                                                    towns they're not guaranteed confidentiality. They might be more
    conference: Preventing Youth Suicide,
    Australian Institute of Criminology,            confident ringing someone in Perth rather than someone with whom their
    Adelaide.                                       parents are likely to socialise” (West Australian, 21/11/91, p.22).
Hawton, R. & Catalan, J. 1987, Attempted
    Suicide: A Practical Guide to its Nature        o The Rural Doctors' Association of Queensland secretary, Dr Digby Hoyal,
    and Management, Oxford Medical                  said the rural recession, the drought and the high unemployment rate
    Publication, Oxford.                            were major contributing factors to a high rate of teenage suicide in rural
Mason, G. 1990, Youth Suicide in Australia:         areas: "They just don't see any future and they are finding it harder and
    Prevention Strategies, Department of            harder to compete with city kids. These kids are watching the banks come
    Employment, Education and Training              in and take everything their family has. This, in turn, can cause the
    (Youth Bureau), Canberra.                       break-up of families due to their situation and this directly affects the
NSW Bureau of Crime Statistics and
                                                    teenager as well." He said that while the association does not
    Research1990, “Suicide”, Crime and
    Justice Bulletin, 8 July, Sydney
                                                    underestimate the difficulty in getting sufficient mental health workers to
Silburn, S., Zubrick, S. and Hayward, L. 1990,      country towns, they would like to see more regional mental health teams.
    Completed Suicide in Western Australian         He said the long waiting list for appointments was a hindrance to the
    Youth: A Study of 96 Cases Aged 15-24           adequate mental care of teenagers who "live in an immediate world"
    Years, paper presented at 1990                  (Courier Mail, 19/12/91, p.19).
    conference: Preventing Youth Suicide,
    Australian Institute of Criminology,            o A study of adolescent suicide by Prof Brent Waters and Dr Michael
    Adelaide.                                       Dudley (Child and Adolescent Psychiatry unit, Prince of Wales Hospital,
Taylor, B. 1988, Swept Under the Carpet,            Sydney) suggests that one reason for the high rate of suicide among
    Report of the Youth Mental Health Project,      young males was their reluctance to seek help. The study focuses on
    New Zealand.                                    suicide in rural NSW where the suicide rate has multiplied more than
                                                    five-fold in the past 25 years and where the greatest increase has been in
                                                    the past five years. According to the report, girls aged 15 to 19 attempt
                                                    suicide three times as often as boys but they use less violent and reliable
                                                    means, and relatively few succeed. On the other hand, males aged 15 to
                                                    19 suicide at the rate of 21 per 100,000 – a rate four times higher than for
                                                    girls. The authors say that young men are more agressive and less inclined
     Henry Lohse is a                               to seek help – or to believe that talking might help. They say that young
     Psychologist who works as                      men in the country have easier access to firearms, the most common
                                                    method of male suicide; on top of this is the population drift to the cities,
     a District School                              the unravelling of close-knit communities and the lack of social and
     Counsellor with the NSW                        psychiatric services in the country. Dr Dudley said there is also the belief
     Department of School                           that males should be self-sufficient, which means that many see economic
                                                    hardship as their own moral failure. He also said early detection of suicidal
     Education                                      behaviour could prevent many suicides and that GPs "have a role to play
                                                    after a suicide attempt in preventing suicide clusters" (Age, 27/11/91,
                                                    Tempo p.4).
                                              YS

				
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