HLN004 – Chronic Conditions Prevention and Management

Tutorial 3: Creating an Action Plan: Aim, Objectives, Strategies and Actions
PART A
CASE STUDY: Suicide and self-harm among young people from refugee backgrounds
Suicide and self-harm among young people from refugee backgrounds There is some evidence that youth
born in Australia from migrant parents have suicide rates consistent with those of the general
Australian population1. Moreover, in 2008 suicide rates among overseas-born males and females aged 15-
24 were 15.6 and 5.7 (per 100,000) respectively (compared to 17.5 and 4.7 among Australian-born males
and females aged 1524)2.
There is however a lack of solid data on the rates of suicide and self-harm among young people from
refugee backgrounds3 4. The ABS 2008 Causes of Death2 reports suicide rates of 14.7 among males and 7.5
among females aged 15-24 born in Sub Saharan Africa (where a proportion of young people from refugee
backgrounds who have arrived in Australia over the last decade have come from). ABS data however do not
provide specific suicide rates for young people born in other regions of interest such as South East
Asia and the Middle East.
In general, the available literature on the link between immigration status and suicide shows mixed
results. A recent review of immigration and suicidality in young people found that “the relation
between immigration status and suicidal behaviour appears to vary by ethnicity and country of
settlement” (p. 280)5. Other factors can influence self-harm and suicide rates among immigrant youth. A
national cohort study among Swedish youth found an increased risk of self-harm in ethnic minorities
(except those from Southern Europe)6. The authors concluded that “socio-economic disadvantage is the
main explanation for the increased risk of self-harm in minority youth in Sweden” (p.90)6. Other
factors such as time spent in the new country, acculturation, high academic and employment
expectations, low locus of control, and intergenerational conflict between youth and their parents can
also impact on suicidal behaviour among immigrant youth.
The 2008 overview of “Research and evidence in suicide prevention” produced by the LIFE (Living is for
Everyone) Framework7, highlighted the following reasons for considering suicide prevention in relation
to culturally and linguistically diverse (CALD) communities: x Adapting to a new culture can be
stressful x For some groups (e.g. elderly, socially isolated, health problems, unemployed) separation
from their culture can be particularly traumatic x People from CALD backgrounds are less likely to seek
help for their mental health problems, and face greater barriers accessing health and support services
x The traumatic past of refugee communities may increase their risk of mental illness The same report
summarized the most commonly found risk factors for suicide among refugees: “exposure to violence and
trauma, lack of family [and social] support, living with a mentally ill family member, family stress,
being alone or unaccompanied, prolonged 1
Department of Communities. Responding to people at risk of suicide: How can you and your organisation
help? Brisbane: Department of Communities, Queensland Government, 2008 2 Australian Bureau of
Statistics. 2008 Causes of Death – 3303.0. Canberra: ABS, 2010. 3 Colucci E, Martin G. Ethnocultural
Aspects of Suicide in Young People: A Systematic Literature Review. Part 1: Rates and Methods of Youth
Suicide. Suicide & Life-Threatening Behaviour 2007;37(2):197-221 4 Department of Health and Ageing.
LIFE: Research and evidence in suicide prevention. Canberra: Department of Health and Ageing,
Commonwealth of Australia, 2008 5 Bursztein Lipsicas C, Makinen IH. Immigration and suicidality in the
young. Canadian Journal of Psychiatry 2010;55(5):274-281 6 Jablonska B, Lindberg L, Lindblad F, Hjern
A. Ethnicity, socio-economic status and self-harm in Swedish youth: a national cohort study.
Psychological Medicine 2010;39:87-94 7 Department of Health and Ageing. LIFE: Research and evidence in
suicide prevention. Canberra: Department of Health and Ageing, Commonwealth of Australia, 2008.
incarceration (more than 6 months) in immigration detention centres, poor coping skills and
resettlement stress. Poverty, discrimination and acculturation stress are all thought to be linked to
low self-esteem, depression and suicide attempts.” (p.40). Importantly the authors of the LIFE document
state that “effective suicide prevention activities in refugee communities need to include culturally
appropriate mental health interventions, particularly for people who have experienced pre-migration
torture and trauma, refugee camp internment, periods of containment in immigration detention and post-
migration stresses” (p.40)8. Post-migration factors are of particular relevance given the increasing
evidence that social inclusion/exclusion factors (e.g. subjective social status in the host community,
discrimination and bullying) are strong predictors of wellbeing among resettled refugee youth9.

8 Department of Health and Ageing. LIFE:
Research and evidence in suicide prevention. Canberra: Department of Health and Ageing, Commonwealth of
Australia, 2008. 9 Correa-Velez I, Gifford SM, Barnett AG. Longing to belong: Social inclusion and
wellbeing among youth with refugee backgrounds in the first three years in Melbourne, Australia. Social
Science & Medicine 2010;71:13991408
PART B
Assignment 2: PROFESSIONAL ACTION PLAN
STEP 1:
POPULATION AND SETTING: Young people from refugee backgrounds attending X and Y High Schools in
Brisbane
STEP 2:
AIM: To reduce risk factors for suicide and self-harm among young people from refugee backgrounds
attending X and Y High Schools in Brisbane
STEP 3 – SMART OBJECTIVES:
OBJECTIVE 1: To increase by 20% the number and quality of social networks among students from refugee
backgrounds at X and Y High Schools by end of 2016.
OBJECTIVE 2: To decrease by 15% levels of psychological distress due to high academic expectations
among students from refugee backgrounds at X and Y High Schools by end of 2016.
STEP 4 – STRATEGIES (some examples):
x National Youth Suicide Prevention Strategy (see page 146 onwards):
http://www.aifs.gov.au/institute/pubs/ysp/evalrep1.pdf
x LIFE: A framework for prevention of suicide in Australia (see page 24 onwards):
http://www.livingisforeveryone.com.au/uploads/docs/LIFE_framewor k-web.pdf
x VicHealth Mental Health Promotion Framework
x Mental Health Strategy Canada – Mental Health Promotion
Strengths and limitations Effectiveness
STEP 5 – ACTIONS, OUTCOME MEASURES, OUTCOME INDICATORS, BY WHOM? TIMELINE

STEP 5 – Action Plan Template
Aim: To reduce risk factors for suicide and self-harm among young people from refugee backgrounds
attending X and Y High Schools in Brisbane
Objective Strategy Actions Outcome measures Outcome indicators
By who? Timeline
1) To increase by 20% the number and quality of social networks among students from refugee backgrounds
at X and Y High Schools by end of 2016.
Social Inclusion (VicHealth Mental Health Promotion Framework)
– Baseline survey of number and quality of social networks – Welcoming and orientation event – Book
Club at X and Y schools – Sport festival after school – Post-program survey of number and quality of
social networks
– Questionnaire assessing number and quality of social networks – Welcoming event attendance list –
Book club attendance list and record of sessions – Sport festival attendance and sessions record –
Post-program questionnaire
– Number and quality of social networks have increased by 20%
Current students at X and Y school Teachers School Librarian Parents Department of Education
representative School counsellor Public Health professional
End of 2016
2) To decrease by 15% levels of psychological distress due to high academic expectations among students
from refugee backgrounds at X and Y High Schools by end of 2016.
– Community development (Recovery framework for Survivors of Torture and Trauma)
– Baseline survey assessing levels of psychological distress and academic expectations – Parent and
teacher meetings – Cognitive Behavioural Therapy sessions for students (psychological intervention) –
Fun extracurricular activities – Peer mentoring program – Parents/communities workshops about academic
expectations – Post-program survey
– Questionnaire
– Attendance record parent/teacher meetings – Record of CBT sessions – Attendance records; program of
extracurricular activities – Record of sessions/attendan ce peer mentoring program – Record attendance
parents/communit y workshops – Post-program questionnaire
Level of psychological distress due to high academic expectations decreased by 15%
Students Public Health professional Social workers Parents Teachers Psychologist Community leaders
Interpreters
End of 2016
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