Suicide is the leading cause of death in Australian children. But the mothers and fathers of a tight-knit community are fighting the black dog plaguing their town.
Through Ursula Wharton’s kitchen window, cane fields and mountain silhouettes line the horizon — a legacy of the Mt Warning shield volcano that dominates the landscape around it.
Nestled on the foothills of the McPherson Range in northern New South Wales, Murwillumbah is typical of the Tweed Valley’s allure.
Here, everyone knows each other.
It’s one of those hackneyed cliches often assigned to country communities.
Through Ursula Wharton’s kitchen window, cane fields and mountain silhouettes line the horizon. (ABC News: Natalie Grono)
But ask around and you’ll understand why the phrase has stuck.
It’s not that everyone knows each other by name — it’s that everyone seems to know someone. Someone who has lost a loved one to suicide; someone who has become acquainted with the black dog.
For Ursula, the human toll of the crisis is written in ink.
“Love. Peace. Help the world,” her 17-year-old son Joshua scrawled on a scrap of paper, the day after leaving the emergency department for the final time.
“It will get better… can only get better.”
The note Joshua left his family after leaving the emergency department. (ABC News: Natalie Grono)
Fixed in a lavender frame adorned by puzzle pieces, his words leave an unsettling dichotomy: a childlike innocence veiling the internal battles of a boy determined to keep his head above water, even in the face of uncertain seas.
Diagnosed with autism spectrum disorder as a child, the 17-year-old was no stranger to the health system, nor the cracks that have come to define it.
But after a traumatic incident some two years prior, Joshua’s mental state deteriorated. Dogged by major depressive episodes and repeated suicide attempts, he was admitted to hospital in September 2017, desperate for support.
After a traumatic incident some two years prior, Joshua’s mental state deteriorated. (ABC News: Natalie Grono)
“We had a four-hour wait and after that were told, ‘If we haven’t been able to help you so far, we won’t be able to help you tonight’,” Ursula says softly.
“And that was just what broke his faith in the system.”
Three days later, Joshua made another attempt. After 11 days in the intensive care unit, he passed away.
His death would be but one of 98 that year nationally among children aged between five and 17 — a 10 per cent increase on the previous year.
In 2018, the most recent data available, that figure rose once more, making suicide the leading cause of death among Australian children.
Sometimes the big picture is best seen by looking at its smallest parts — the lives lost and the communities that mourn them.
‘It doesn’t happen during business hours’
While the scope of the problem is difficult to quantify across the North Coast region — a sprawling expanse of fertile valleys and panoramic coastlines, extending south from the Queensland border to Port Macquarie — its impact is profound.
In 2016-17, the rate of self-harm hospitalisations among 15-24 year olds in Northern NSW (821.7 per 100,000 people) was more than double that of the NSW state average (363.6 per 100,000 people).
A community survey conducted by the North Coast Primary Health Network found that mental health issues (64.9 per cent) and suicide (39.5 per cent) were among the top three most serious health concerns for young people who live here.
But despite this, it also found 27.1 per cent of younger respondents found it “difficult” or “very difficult” to access specialists, like a psychiatrist.
For those over 24 years of age, that figure is closer to one in every two people.
A youth and family support worker with the Family Centre by day, Kat Fermanis is also chairperson of Cabarita Youth Services. (ABC News: Natalie Grono)
For Kat Fermanis, these aren’t just statistics. They’re people — neighbours.
A youth and family support worker by day, Kat is also chairperson of Cabarita Youth Services — the only volunteer-run youth services platform on the Tweed Coast.
“If you’re not suicidal between the hours of nine to five, your ability to access services becomes very limited,” she offers.
“People in crisis, it doesn’t happen during business hours. It’s often in the wee hours of the morning or the after hours stuff.”
‘Not a lot has shifted’
Pull up stumps along the Cabarita foreshore, a 20-minute drive east of Murwillumbah, and you’ll come to understand Kat’s deep-seated connection to the region.
When she speaks about home, it’s impossible to mask her pride. “I’m a community member,” she says. “For me that never stops.”
Down the main street, school kids weave their bikes through a maze of lazy shoppers. Nearby, a hurried waitress breaks from her endless rotation of tables to join the doting crowds of new parents, before disappearing with their plates.
Down the main street, school kids weave their bikes through a maze of lazy shoppers. (ABC News: Natalie Grono)
But beneath this postcard exterior lies an insidious problem with tentacles throughout the community.
Kat stops and gestures to a wall.
There, in neatly-stencilled graffiti, is a memorial to a young teenager lost to the darkness.
It’s a story that repeats.
In neatly-stencilled graffiti is a memorial to a young teenager lost to the darkness. (ABC News: Natalie Grono)
When Kat was just 16 years old, her childhood friend ended their life.
Earlier this year, her son was forced to confront the same situation.
“He was 15 and the young boy was 18,” she says.
“For me to see it replicated for my son … not a lot has shifted.”
‘I think there’s a disconnect’
Seated across the table in a nondescript office in Tweed Heads, a stone’s throw from the Queensland-New South Wales border, David Boutkan pauses to choose his words.
“I think there’s a disconnect often between ordinary people and practitioners and professionals and that’s a hard one to kind of break,” he says.
“Often people can have a poor experience with practitioners in the community.”
David Boutkan is the CEO of the Family Centre, a social services organisation covering the Tweed, Byron and Ballina Shires, up to the southern Gold Coast. (ABC News: Natalie Grono)
Boutkan is the CEO of the Family Centre, a social services organisation covering the Tweed, Byron and Ballina Shires, up to the southern Gold Coast.
He’s deeply embedded in the community, and is acutely aware of the challenges it faces.
Marred by widespread socioeconomic disadvantage, more than 12 per cent of one-parent families in the region live on a weekly family income of less than $650 per week.
Estimated child poverty rates far exceed the national mean, and with the exception of Ballina, all Local Government Areas across the North Coast footprint fall in the bottom two quintiles on the Child Social Exclusion index, representing the most disadvantaged populations.
Opportunities for young people in the region are limited, Boutkan concurs, and high unemployment rates continue to be “a big issue”.
More than 12 per cent of one-parent families in the region live on a weekly family income of less than $650 per week. (ABC News: Natalie Grono)
Opportunities for young people in the region are limited and high unemployment rates continue to be “a big issue”. (ABC News: Natalie Grono)
But he points to another problem.
According to the North Coast Primary Health Network survey, 92.1 per cent of respondents with a mental health challenge indicated they needed to get help with mental health over the past 12 months.
But when asked about their ability to access those services, nearly half (49.6 per cent) experienced barriers.
While it is a multi-faceted problem with no easy solutions, Boutkan rejects the notion that means the region’s suicide rate is somehow an inevitability the community must resign itself to.
Rather, they’re taking a refreshingly pragmatic approach.
If the current system isn’t working, why not try something new?
Thinking outside the box
Left to reckon with the “chasms” in the mental health system through which her son slipped, Ursula doesn’t mince words.
“Our lives are complex,” she says. “And the solution to this needs to be complex.”
She found one piece of the puzzle 11,000 kilometres away.
Outside a clinic in Highfield, south of the Zimbabwe capital of Harare, a group of grandmothers convene on a park bench.
It’s not a therapist’s couch — at least, not in the traditional sense — but these trained but unqualified health workers provide an outlet for those suffering from depression, known as kufungisisa, or “thinking too much”.
The Zimbabwe Friendship Bench may be a world away, but as the scale of the crisis forces new solutions, communities across the North Coast are prepared to look outside the box for inspiration.
“When it comes down to it, we’re human beings. we need to be heard, we need to be validated and we need to belong in our community,” offers Ursula.
“The talking bench is a mechanism for bringing that back. It’s about cultural change in the community.”
Ursula Wharton and her daughter chase after chickens in her backyard. (ABC News: Natalie Grono)
Nestled on the foothills of the McPherson Range in northern New South Wales, Murwillumbah is typical of the Tweed Valley’s allure. (ABC News: Natalie Grono)
Ursula Wharton with her partner and their daughter in their backyard in Murwillumbah. (ABC News: Natalie Grono)
The initiative forms part of the Deep Listeners project, founded by Ursula, an early intervention strategy designed to ensure members of the community are “prepared, visible and accessible”.
It hopes to break down clinical silos by training locals to act as “gatekeepers” — those equipped to recognise someone experiencing a mental health crisis and to refer them to the appropriate supports, or to simply lend a sympathetic ear.
“We’ve got people in training at the moment,” Ursula says. “So they’ll be wearing a badge out in town and that indicates that they’re ready to listen.
“We’re meeting the needs of people who are okay to pick up the phone and call Lifeline… but there’s a whole range of people who will not do that.
“And sure, there’s professional assistance, but there’s a lot of blockages in terms of logistics, or money or availability of people.”
The project is being supported by the Tweed-Byron Suicide Prevention Action Plan — one of about 20 communities across the country with a higher than average suicide rate, participating in the Federal Government’s National Suicide Prevention Trial.
Implemented at the local level by the Family Centre, the aim is to do away with the one-size-fits-all approach to suicide prevention by putting power back in the hands of the community.
Boutkan is candid about the state of play.
“It’s experimental,” he says of the talking bench. “We don’t know how it’s going to go.”
But short of a silver bullet, they’re prepared to try a range of different strategies — and that means putting the focus back on lived experiences.
“We’re looking for community-based solutions rather than some of the clinical solutions that have been used in the past,” Boutkan says.
“People who came onto this program, they’re saying [they have challenges accessing services]. And we’re listening and we’re nurturing their ideas.”
Giving the community a voice
As you look around at the faces in Boutkan’s office one Friday afternoon, the ethos of the project is clear: if the community is at the centre of the conversation, they must be given a voice.
There’s Sharon Somer, who established a survivors of suicide support group after losing her husband Peter, only to discover she would have to cross the Queensland border or travel some 200 kilometres south to Grafton to access bereavement services.
On the line is Tim Fisk, who survived a suicide attempt and now hosts weekly meetings for men who traditionally fail to engage with mainstream mental health services.
Behind the scenes, countless others — psychologists, health workers, teachers and volunteers — all taking a multi-faceted approach to early intervention.
Based on the Black Dog Institute’s LifeSpan model — an “integrated approach to suicide prevention” — the action plan has established five evidence-based priorities, ranging from strengthening early intervention through schools, to improving crisis and aftercare support.
Above all, Boutkan says, the aim is to fill some of the gaps in clinical services by giving residents the tools to better respond to someone experiencing a suicidal crisis.
In schools, parents and teachers are being trained to act as gatekeepers through community-based programs like Question, Persuade, Refer (QPR), Youth Mental First Aid and safeTALK — an initiative that has been extended across the region more broadly.
In collaboration with the Tweed Aboriginal community, authorities are also working to develop culturally appropriate strategies to identify and respond to those most at risk, including providing Indigenous Network Suicide Intervention Skills Training (INSIST) and exploring opportunities to establish an Aboriginal Mental Health Nurse position.
“As of May this year, we had over 300 community members who took part in one of those training processes,” Boutkan says.
“The second focus has been skilling up mental health workers and professionals — we’ve had 71 health workers and frontline professionals who participated in those programs.”
The elephant in the room
It’s a local solution symptomatic of a much wider, national problem.
In its 2016 report into suicide prevention, youth mental health organisation Orygen noted that “rather than making inroads into reducing the number of lives lost to suicide in Australia” in the decade from 2005 to 2015, “there have instead been small but gradual increases in suicide rates”.
“Twice as many young women aged 15–19 years died by suicide in 2015 than in 2005 and rates have also increased among young people under the age of 14 years,” it found.
“This has mirrored high rates of self-harm among young people. Recent reports indicate that approximately one in four young women aged 16–17 years have self-harmed in their lifetime.”
Amid an increase in youth suicide rates in the years since, Jo Robinson, Orygen’s head of suicide prevention research, believes successive interventions haven’t been centred around “what young people think will work”.
Clinical services and the education system have failed to keep pace with the demand for digital and online interventions, she says, and we have not “historically done a good job at talking about suicide in school settings”.
“There’s programs that go on around raising resilience and mental health awareness, but they don’t really get to grips with the cause, the root of the problem, when a young person feels suicidal,” says Associate Professor Robinson.
The mental health system, however, remains the elephant in the room.
While pointing to the importance of community-led responses (“You’re never going to get a one-size-fits-all when it comes to suicide prevention across a country like Australia”), Associate Professor Robinson says it’s imperative they foster a link to seeking help.
“I think one of the problems that we have in government is they like to fund programs, the Federal Government in particular likes to fund programs, and it likes to fund shiny programs,” she says.
“It’s done in a piecemeal way and it’s not linked to service access … You can’t expect a lay person in the community to be able to manage someone’s suicide risk necessarily.
“If there’s nowhere to get help from or you refer them to a service and they sit on a waiting list for a month, that’s not ideal and that’s where you see an increase in suicide rates.”
Will the strategy work?
Boutkan is frank: “It’s hard to get statistical information about whether there’s been a reduction [in suicide attempts].”
While the action plan is bolstering training and support, they won’t know if, or what, impact it has had on rates of self-harm and suicide until an evaluation is finalised.
The results of the Federal Government’s National Suicide Prevention Trial are not scheduled for completion until the end of the year, while the outcomes of LifeSpan — which the action plan is based on — will not be available until 2022 and 2023.
“We hope that the University of Melbourne who are doing the evaluation will be able to measure where there’s been less suicide attempts or less suicides,” Boutkan says.
“We’re interested in outcomes in our organisation, and they’re questions we ask a lot.”
For those left to reckon with the human toll of suicide, the impact is about far more than reports or statistics.
Over the past year, the Charity Cup Touch Football Competition — a grassroots organisation based in Cabarita — has put more than 100 people through Mental Health First Aid courses.
“We’ve had a number of youth suicides in our area, and even people’s parents committing suicide,” says co-organiser Simon Tate.
“We were sick of hearing about it but then sitting back and not doing anything.”
The impact, Tate says, was immediate. The day after finishing the course, he heard about a mother “going through some hard times with her son”.
“I was able to reach out to her and give her some phone numbers and he was able to get help with the troubles he was going through,” he says.
“I’m a father of two myself and you sort of feel the pressure of ‘How am I going to raise these children?’.
“And then you realise that it takes a village to raise a child through to adulthood, and if you have that support network of people that will help you, it just takes off that pressure.”
‘Saving the world one child at a time’
Stoic and collected, Kat is not easily rattled.
But when asked what the future holds for her coastal community, her voice starts to break.
Stoic and collected, Kat is not easily rattled. But when asked what the future holds for her coastal community, her voice starts to break. (ABC News: Natalie Grono)
“I’d like no more young people to take their lives,” she says.
“I don’t want to see the hundreds of family members and friends be heartbroken because of that choice.
“Saving the world one child at a time, that’s my dream.”
It is a sentiment echoed across the region, where the waves of grief ripple outward.
They don’t know if the strategy is the panacea they’ve been waiting for.
But in the face of unprecedented heartbreak, they’re prepared to give it their all.
Because if it takes a village to raise a child, then everyone must play their part.
Left to reckon with the “chasms” in the mental health system through which her son slipped, Ursula doesn’t mince words. (ABC News: Natalie Grono)
“Part of this is about restoring that community attitude,” Ursula offers.
“To be part of a community is to care about people around you.”
Words: Bridget Judd
Photographs: Natalie Grono
Editor: Leigh Tonkin