The ripple effect, silence and powerlessness: hidden barriers to discussing suicide in Australian Aboriginal communities

Background: Suicide is one of the leading causes of death for Aboriginal Australians. There is an urgent need to actively engage with Aboriginal communities to better understand these issues and to develop solutions together to prevent deaths by suicide in Aboriginal communities. Methods: Utilising a qualitative, thematic, cross-sectional design, we conducted focus groups in three communities in the Hunter New England area in New South Wales (Australia) to explore the perceptions and views of Aboriginal participants in relation to discussing suicide. Results: The key themes found to influence discussions about suicide in Aboriginal communities included the sense that suicide is a whole of community issue, the ripple effect of suicide deaths, silence about suicide and the impact of this silence, and being powerless to act. Participants described a reluctance to have discussions about suicide; feeling they had limited skills and confidence to have these sorts of discussions; and multiple and interrelated barriers to discussing suicide, including shame, fear and negative experiences of mental health care. Participants also described how their experiences maintained these barriers and prevented Aboriginal Australians from seeking help in suicidal crises. Conclusion: Future initiatives should address the interrelated barriers by supporting Aboriginal people to build skills and confidence in discussing suicide and mental health and by improving access to, and the experience of, mental health care and psychosocial and community-based supports for Aboriginal Australians. We suggest trying to address any one of these factors in isolation may increase rather than decrease suicide risk in Aboriginal communities.