Suicide is the leading cause of death among Australians aged 15-24 years. Statistics show that the more remote one’s area of residence is, the greater the associated suicide risk. For example, youth who live in remote areas have a suicide rate about twice as high as those who live in cities.

The disparity has left experts asking how to address this issue. Patients in rural areas have limited access to mental health services, partly because of difficulties in attracting and retaining a rural health workforce. In response, experts are developing community-led preventive solutions.

The shift in focus toward community-embedded suicide prevention efforts is part of a wider shift in recognizing and acting on the knowledge that such efforts should reflect the realities, strengths, and priorities of communities.

Rural communities face unique challenges, such as long wait times, isolation, and smaller social networks, Laura Grattidge, PhD, research and evaluation lead at Live4Life, told Medscape News Australia. Live4Life is Australia’s only youth suicide prevention model designed specifically for rural and regional communities.

“But rural communities also have strong protective elements, including connection, familiarity, and a willingness to support one another,” Grattidge said. “The challenge is that our systems haven’t always been designed to work with that reality or to harness those strengths effectively.”

Toward Community Systems

Underpinning the shift toward community-oriented approaches is also an acknowledgment that Western health systems have too narrowly defined suicide as a consequence of mental illness. “While mental ill health can absolutely play a role for some people, that framing is too narrow to explain what we actually see, especially in young people,” said Grattidge.

“It’s not usually one thing, it’s the interaction between distress, context, and opportunity. We’re talking about things like isolation, disrupted education and employment pathways, financial stress, exposure to trauma, relationship breakdowns, and barriers to accessing support. For a lot of young people, particularly in rural areas, these factors are compounded over time. So rather than asking, ‘Does this person have a mental illness?’ a more useful question is often ‘What’s happening around this young person, and what support do they have access to?’ That shift is important because it opens many more opportunities for prevention.”

In 2023, the regional city of Ballarat launched the Live4Life mental health education and youth suicide prevention program following a spate of suicides. The program, which began in the Macedon Ranges in 2010, involves a collective of secondary schools, health provider networks, and community organizations. It aims to train youth in mental health first aid. It has since expanded across rural Victoria and, more recently, Tasmania, reaching almost 40,000 young people.

Grattidge, who recently co-led an independent evaluation of the program in Break O’Day on the east coast of Tasmania, said that the model illustrated the power of thinking in terms of community systems, rather than relying on a clinical model of suicide prevention.

“Young people felt more confident to help, adults felt more equipped to respond, and conversations about mental health became more open and earlier across the community” during the program, she said.

“We need to move beyond a purely clinical model and think in terms of community systems. This [approach] includes building mental health literacy; reducing stigma; strengthening peer support; improving help-seeking pathways; and connecting schools, services, and communities,” Grattidge continued. “Prevention is most effective when communities themselves are supported to hold knowledge, skills, and responsibility collectively.”

Strengthening the Evidence Base

Andreia Schineanu, PhD, lecturer in First Nations mental health at Charles Sturt University in Wagga Wagga, Australia, agreed. While she recognizes the important role that mental health professionals play, particularly general practitioners in rural areas, she’d like to see more focus on communitywide prevention “so in the future we won’t have these high numbers of people wanting to commit suicide,” she told Medscape News Australia.

“Of course, we need support right now for individuals already suffering, [but] primary healthcare providers are already overburdened in rural and remote areas, filling in service gaps, including for mental health services,” she added.

Schineanu recently undertook an evaluation of community-based suicide prevention initiatives in rural and remote Australia and found that evidence-based strategies were scarce. “Strengthening the evidence base through rigorous, context-sensitive evaluation will be essential to inform policy and support the development of sustainable, community-driven suicide prevention strategies in rural and remote settings,” the authors concluded.

But multipronged, whole-of-community approaches appeared effective, said Schineanu. Such approaches could include education and awareness-raising at all levels; training for local figures such as community leaders, pharmacists, police, and football coaches; programs in schools that build resilience, destigmatize mental health and help seeking, and focus on tackling bullying and decreasing alcohol and drug use; and the promotion of a community and sporting culture that is not imbued with aggression or linked to alcohol.

Grattidge is working on supporting more coordinated, evidence-informed approaches by developing the Best Practice Guidelines for Youth Suicide Prevention in Rural Australian Communities. The guidelines, which are currently in the pilot phase, bring together evidence from research, evaluation, and lived experience to articulate what good prevention looks like in practice (eg, multilevel, community-based, youth-partnered approaches). They translate this information into practical steps for schools, councils, and services.

“Many communities are doing important work, but often without a clear, consistent framework to support quality, safety, and sustainability. The guidelines are intended to help address that gap and to support more coordinated, evidence-informed approaches across different regions,” said Grattidge.

Targeting the Classroom

An “eco-system” approach for youth suicide prevention could ensure that effective interventions are delivered to young people in the right settings, at scale, and early enough to prevent suicidal crisis, Michelle Tye, PhD, associate professor and program head of youth suicide prevention at the Black Dog Institute, told Medscape News Australia. The Black Dog Institute is an independent mental health research institute connected to the University of New South Wales (NSW) in Sydney, Australia.

Tye is working with the NSW Department of Education to embed a new early universal prevention program to address self-harm and well-being into primary schools. It’s currently in the pilot phase, and a 3-year trial will begin next year.

“We’re targeting the classroom because it’s a potential environment that can cause children to become more dysregulated. Poor emotional regulation is a major driver of self-harm behavior,” said Tye.

“We want the classroom to become a coping space: one that can build lifelong health and well-being. My research asks, ‘How do we target the factors of a school that drive risk and that are protective?’” Factors that could be protective, Tye said, include children’s ability to make decisions, access to opportunities, school safety, and fair treatment.

As part of the program, parents are also being taught about relational and attachment style practices and emotion regulation. Teachers are being trained in pedagogical skills and practices that can support safety, belonging, and regulation.

“Adults are often not explicitly taught good emotional regulation, and children model the adults in their life. So if you’re displaying poor emotional regulation, that’s what they’re learning,” she said.

“This is the beginning of a much bigger program of reimagining what prevention looks like in schools. Schools matter a lot for prevention. It’s a genuine opportunity to set the foundations for mental health and well-being. We don’t know if the program will work, but if it’s shown to yield benefits, we hope it will become a national program.”

While Schineanu is encouraged by the development of new community-led programs, she stressed that they require sustainable funding and the will to continue. “Sometimes a suicide can be a catalyst for a community to change, but unless there are people driving it, it tends to peter out after a while,” she said.

Grattidge, Schineanu, and Tye reported having no relevant financial relationships.