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National Children’s Commissioner—Children’s Rights—Report for 2013-14


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Children’s Rights

Report 2014 NATIONAL CHILDREN’S COMMISSIONER

The Australian Human Rights Commission encourages the dissemination and exchange of information provided in this publication.

All material presented in this publication is provided under Creative Commons Attribution 3.0 Australia, with the exception of:

• the Australian Human Rights Commission Logo • photographs and images • any content or material provided by third parties.

The details of the relevant licence conditions are available on the Creative Commons website, as is the full legal code for the CC BY 3.0 AU licence.

Attribution

Material obtained from this publication is to be attributed to the Australian Human Rights Commission with the following copyright notice:

© Australian Human Rights Commission 2014.

Children’s Rights Report 2014

ISSN 2203-0948 (Print)

ISSN 2204-1176 (Online)

Acknowledgments

The Children’s Rights Report 2014 was drafted by Susan Nicolson, Loki Ball and Jennifer Ross.

The National Children’s Commissioner thanks the following staff of the Australian Human Rights Commission: Padma Raman, Darren Dick, Jessica Bell, Melanie McLean, Julie O’Brien, John Howell, Anastacia Totoeva.

The National Children’s Commissioner also thanks interns Matthew Johns and Livia Lu.

Design and layout Dancingirl Designs

Printing Centrum

Cover photography

Photograph of a quilt made by children and young people at the CREATE Foundation, presented as a gift to the National Children’s Commissioner.

Photograph taken by Matthew Bretag, Web Developer, Communications Team.

Electronic format

This publication can be found in electronic format on the website of the Australian Human Rights Commission: http://www.humanrights.gov.au/about/publications/.

Contact details

For further information about the Australian Human Rights Commission, please visit www.humanrights.gov.au or email communications@humanrights.gov.au. You can also write to:

Monitoring and Reporting Team

Australian Human Rights Commission GPO Box 5218

Sydney NSW 2001

Children’s Rights Report 2014 • 1

Australian Human Rights Commission

Level 3, 175 Pitt Street, Sydney NSW 2000 GPO Box 5218, Sydney NSW 2001

Telephone: 02 9284 9600 Facsimile: 02 9284 9611 Website: www.humanrights.gov.au

20 October 2014

Senator the Hon George Brandis QC Attorney-General Parliament House CANBERRA ACT 2600

Dear Attorney

Children’s Rights Report 2014

I am pleased to present to you the Children’s Rights Report 2014, in accordance with section 46MB of the Australian Human Rights Commission Act 1986 (Cth) (the Act). The Act requires that I submit a report relating to the enjoyment and exercise of human rights by children in Australia on an annual basis.

This report covers the period from 1 July 2013 to 30 June 2014.

The report examines the work I have undertaken throughout the past year to promote discussion and awareness of matters relating to the human rights of children and young people in Australia. It also discusses the progress of the recommendations that I made in my Children’s Rights Report 2013. The substantive part of my 2014 report focuses on the findings of my examination into intentional self-harm with or without suicidal intent and death by intentional self-harm.

This report includes four recommendations on future actions that should be taken to ensure the enjoyment and exercise of human rights by children in Australia.

I look forward to discussing the report with you.

Yours sincerely

Megan Mitchell National Children’s Commissioner

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About the National Children’s Commissioner

About the

National Children’s Commissioner

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Legislation establishing the position of National Children’s Commissioner was passed by the federal Parliament on 25 June 2012.

I was appointed as the inaugural National Children’s Commissioner on 25 February 2013 and commenced my role on 25 March 2013.

Section 46MB of the Australian Human Rights Commission Act 1986 (Cth) (the Act) describes the functions that are to be performed by the National Children’s Commissioner:

• to submit a report to the Minister as soon as practicable after 30 June in each year. This report must deal with matters, relating to the enjoyment and exercise of human rights by children in Australia, as the National Children’s Commissioner considers appropriate; and may include recommendations that the Commissioner considers appropriate as to the action that should be taken to ensure the enjoyment and exercise of human rights by children in Australia

• to promote discussion and awareness of matters relating to the human rights of children in Australia

• to undertake research, or educational or other programs, for the purpose of promoting respect for the human rights of children in Australia, and promoting the enjoyment and exercise of human rights by children in Australia

• to examine existing and proposed Commonwealth enactments for the purpose of ascertaining whether they recognise and protect the human rights of children in Australia, and to report to the Minister the results of any such examination.

In performing these functions, I may give particular attention to children who are at risk or vulnerable. I may also consult with children; Departments and authorities of the Commonwealth, and of the States and Territories; non- governmental organisations; international organisations and agencies; and other organisations, agencies or persons as I consider appropriate.

I must, as appropriate, have regard to the following human rights instruments:

• Universal Declaration of Human Rights • International Convention on the Elimination of All Forms of Racial Discrimination • International Covenant on Economic, Social and

Cultural Rights • International Covenant on Civil and Political Rights • Convention on the Elimination of All Forms of

Discrimination Against Women • Convention on the Rights of the Child • Convention on the Rights of Persons with

Disabilities

and such other instruments relating to human rights as I consider relevant.1

I am also responsible, along with the President and all other Commissioners, for performing a range of statutory functions that are conferred on the Australian Human Rights Commission (the Commission) as a whole. Section 8(2) of the Act states that I, as a member of the Commission, must act in a way that promotes the collegiate nature of the Commission.

The Commission is able to receive complaints from or about the treatment of children in relation to discrimination and breaches of their human rights. The complaint handling role is vested solely in the Commission President and, accordingly, I do not have a complaint-handling role or a role in dealing with individual children. This includes individual children’s cases in the context of child protection or family law. Nor do I have any guardianship role. However, in court cases that involve human rights, including children’s rights, I may seek leave of the court to appear as an intervener or as amicus curiae.

All Australian states and territories have Children’s Commissioners and/or Guardians and/or Advocates. The legislative functions of these Children’s Commissioners and Guardians differ between jurisdictions. Some have a broad focus, which includes all children, whereas others have specified responsibilities relating to children who are at risk or who are vulnerable. Their primary focus is state laws, programs and issues affecting children.

Children’s Rights Report 2014 • 3

Megan Mitchell

National Children’s Commissioner

Children’s Rights Report 2014 • 3

I work collegiately with the state and territory Children’s Commissioners and Guardians through the Australian Children’s Commissioners and Guardians group. The existence of Children’s Commissioners and Guardians explains why my functions to examine laws, and compel the production of documents, are limited to the Commonwealth level.

I have extensive experience working with children from all types of backgrounds, including undertaking significant work with vulnerable children. I have practical expertise in child protection, foster and kinship care, juvenile justice, children’s services, disabilities, and early intervention and prevention services.

My previous roles include NSW Commissioner for Children and Young People, Executive Director of the ACT Office for Children, Youth and Family Support, Executive Director for Out-of-Home Care in the NSW Department of Community Services, and CEO of the Australian Council of Social Service.

I hold qualifications in social policy, psychology and education, having completed a Bachelor of Arts from the University of Sydney (1979), a Diploma of Education from the Sydney Teachers College (1980), a Master of Arts (Psychology) from the University of Sydney (1982), and a Master of Arts (Social Policy) from the University of York (1989).

For information on the work of the National Children’s Commissioner, please visit: http://www.humanrights.gov.au/our-work/childrens-rights.

1 Note: When the draft bill for a National Children’s Commissioner was considered, concern was expressed by the Australian Human Rights Commission and non-government organisations at the lack of explicit recognition of the International Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment.

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Contents

Overview 9

Recommendations 10

Chapter 1: My work to promote children’s rights during 2013-2014 12

1.1 Introduction 14

1.2 Children’s rights in early childhood education and care 14

1.3 Children’s rights and e-safety 16

1.4 Children’s rights and privacy 19

1.5 National Inquiry into children in immigration detention 20

1.6 Children’s rights and participation 20

1.7 Development of child-friendly materials 22

1.8 Human rights education in schools 22

1.9 Submissions 23

1.10 Membership of advisory groups and ambassadorships 23

1.11 Reporting on the actions taken in response to the recommendations in the Children’s Rights Report 2013 24

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights 30 2.1 Bills introduced during my reporting period 32

2.1.1 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were promoted 33

2.1.2 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were not engaged and the PJCHR commented about potential incompatibility 39

2.1.3 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were not engaged and the PJCHR sought further information 42

2.1.4 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were engaged and any limitation was reasonable and proportionate 47

2.1.5 Bills with accompanying Statements of Compatibility with Human Rights which contested the requirement to provide a human rights impact assessment 51

Children’s Rights Report 2014 • 5

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age 58

3.1 What do we know about intentional self-harm, with or without suicidal intent, in children and young people? 60

3.2 An identified need for further investigation 62

3.3 Why is intentional self-harm, with or without suicidal intent, a child rights issue? 63

3.4 How I conducted my examination 65

3.4.1 Data requests 66

3.4.2 Accessing the experiences of children and young people 66

3.4.3 Call for written submissions 68

3.4.4 Roundtables and individual consultations 69

3.5 Key findings 71

3.5.1 Definitional challenges and research considerations 71

3.5.2 Why do children and young people engage in non-suicidal self-harm and suicidal behaviour? 76

3.5.3 Clusters and contagion 80

3.5.4 Barriers that prevent children and young people from seeking help 88

3.5.5 Supporting children and young people who are engaging in intentional self-harm, with or without suicidal intent 97

3.5.6 Groups of children and young people with particular vulnerabilities 104

3.5.7 The context of the data that I was able to source for my examination 115

3.6 What did the data from NCIS, ABS, AIHW and Kids Helpline tell me? 124

3.6.1 NCIS data about death due to intentional self-harm 124

3.6.2 ABS data about death due to intentional self-harm 130

3.6.3 AIHW data about hospitalisation for intentional self-harm 133

3.6.4 Kids Helpline data about children and young people seeking help 138

3.7 What does the data tell us? 149

3.7.1 Death due to intentional self-harm 149

3.7.2 Hospitalisation for intentional self-harm 152

3.7.3 Seeking help for intentional self-harm, with or without suicidal intent 153

3.7.4 Where to from here? 155

3.7.5 Summary of key findings 156

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Appendices 182

Appendix 1: Speaking engagements 184

Appendix 2: Face-to-face meetings and teleconferences about issues affecting children and young people 186

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights 192

Appendix 4: Consultations with children and young people 208

Appendix 5: Submissions to my examination into intentional self-harm, with or without suicidal intent, in children and young people 209

Appendix 6: National roundtables 214

Appendix 7: Individual consultations with stakeholders relating to the examination on into intentional self-harm, with or without suicidal intent, in children and young people 222

Appendix 8: DLA Piper 223

Appendix 9: Letter to the Minister for Health, and the Minister’s reply 224

Contents

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The National Children’s Commissioner with a child at Amy Hurd Early Learning Centre, Wagga Wagga Photo courtesy of The Daily Advertiser, Wagga Wagga

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Children’s Rights Report 2014 • 9

Overview It is with great pleasure that I present my second Children’s Rights Report as the National Children’s Commissioner.

This report details how I have fulfilled my statutory functions, outlined in Section 46MB of the Australian Human Rights Commission Act 1986 (Cth) (the Act) during the 2013-14 period.

Chapter 1: My work to promote children’s rights during 2013-2014

Chapter 1 examines the work I have undertaken throughout the past year to promote discussion and awareness of matters relating to the human rights of children and young people in Australia. It also discusses the progress of the recommendations that I made in my Children’s Rights Report 2013.

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Chapter 2 reports on my survey of the comments made by the Parliamentary Joint Committee on Human Rights regarding how the human rights of children and young people were taken into account by the Statements of Compatibility with Human Rights accompanying Bills introduced to Parliament during the reporting period. Where the Australian Human Rights Commission examined Bills in more detail and made submissions about these Bills, I have included a summary of our position.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Chapter 3 details the examination that I undertook during 2014 on how the human rights of children and young people engaging in intentional self-harm with and without suicidal intent can be better protected. I received 140 responses to my call for submissions and I held roundtables with experts in intentional self-harm, with or without suicidal intent, in all capital cities across Australia. I also sourced previously unpublished data from the Australian Bureau of Statistics, the Australian Institute of Health and Welfare and the National Coronial Information System.

The primary finding from my examination is that too much continues to be unknown and this is impeding us from predicting and preventing injury and death resulting from intentional self-harm, with or without suicidal intent, in children and young people. I make four recommendations which provide direction for moving forward.

Support services

If you are feeling distressed or would like to talk to someone, please contact:

• Kids Helpline on 1800 55 1800 or www.kidshelp.com.au

• Lifeline on 13 11 14 or www.lifeline.org.au

• headspace on 1800 650 890 or www.headspace.org.au

• ReachOut at http://au.reachout.com/.

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Recommendations

I make the following recommendations based on the public health model where:

suicide prevention begins with surveillance to define the problem and to understand it, followed by the identification of risk and protective factors (as well as effective interventions), and culminates in implementation, which includes evaluation and scale-up of interventions and leads to revisiting surveillance and the ensuing steps.2

1. Establish a national research agenda for children and young people engaging in non-suicidal self-harm and suicidal behaviour through the new National Strategic Framework for Child and Youth Health. This should be supported by the soon to be established National Centre for Excellence in Youth Mental Health. This research agenda should prioritise:

• the standardisation of terms and definitions to describe the range of thoughts, communications, and behaviours that are related to intentional self-harm, with or without the intent to die • understanding the multiplicity of risk factors central to effectively targeting and supporting children and young people • understanding the impact of different protective factors, how they are interrelated, whether some

are more predominant than others, or whether specific combinations offer more protection • the direct participation of children and young people in research about intentional self-harm, with or without suicidal intent • understanding the psychological mechanisms underlying suicide clusters • understanding incidence and mechanisms leading to clustering of intentional self-harm without

suicidal intent • evaluating the effectiveness of postvention services • evaluating the effectiveness of gatekeeping training programs on actual outcomes for children

and young people • increasing the awareness of primary caregivers about risk factors and warning signs • investigating ways to restrict access to the means used for intentional self-poisoning in children

and young people • finding effective ways to encourage children and young people to access appropriate help or support for early signs and symptoms of difficulties.

2. Strengthen and develop surveillance of intentional self-harm, with or without suicidal intent, through:

a. The Australian Government funding an annual report on deaths due to intentional self-harm involving children and young people aged 0-17 years using the agreement reached between the Australian Bureau of Statistics; the Registrars of Births, Deaths and Marriages; and state and territory coroners on the dissemination of unit record data.

b. The Australian Institute of Health and Welfare including a section using disaggregated data about hospitalisations for intentional self-harm involving children and young people aged 0-17 years in its regular series on hospitalisations for injury and poisoning in Australia.

c. The Australian and New Zealand Child Death Review and Prevention Group continuing its work in relation to the development of a national child death database, in conjunction with the Australian Institute of Health and Welfare, and providing an annual progress report.

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Children’s Rights Report 2014 • 11 Children’s Rights Report 2014 • 11

3. Collect national data on children and young people who die due to intentional self-harm through:

a. The use of the standardised National Police Form, in all jurisdictions, by 2015. This should include an electronic transfer to the National Coronial Information System. A plan to monitor the outcomes of all jurisdictions using the standardised National Police Form should be developed, and the possibility of incorporating a range of demographic, psychosocial and psychiatric information specific to children and young people should be investigated.

b. The Standing Council on Law, Crime and Community Safety putting the issue of standardisation of coronial legislation and/or coronial systems on its agenda. Standardisation should require that where all state and territory coroners find a death under investigation to be caused by an action of the deceased, the coroner must make a further finding of intent, based on the evidence, to clarify whether the deceased intended to take the action which caused his or her death; the deceased lacked capacity to recognise that his or her action would cause his or her death but death was a reasonably foreseeable consequence of the action; or it is not clear from the evidence whether the deceased intended to cause his or her death.

4. The Royal Australian and New Zealand College of Psychiatrists should review and, where appropriate, update its Guidelines for the Management of Deliberate Self Harm in Young People (2000).

2 World Health Organisation, Preventing suicide: A global imperative (2014), p 12. At http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ (viewed 1 October 2014).

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Chapter 1: My work to promote children’s rights during 2013-2014

Children’s Rights Report 2014 • 13

The National Children’s Commissioner with two children from Marrickville West Primary School, New South Wales, at the launch of the Children’s Rights Report 2013

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1.1 Introduction This chapter reports on the work I have undertaken throughout the past year to promote discussion and awareness of matters relating to the human rights of children and young people in Australia. It also discusses the progress of the recommendations that I made in my first statutory report.

My major project during 2014 on intentional self-harm, with or without suicidal intent, in children and young people is reported in Chapter 3.

My first statutory report to Parliament was released in 2013. It outlined five key themes to guide my work as National Children’s Commissioner. These themes were identified following national consultations (the Big Banter) at the commencement of my term, as well as from considering the human rights issues identified by the United Nations Committee on the Rights of the Child in its Concluding Observations on Australia’s compliance with its obligations under the Convention on the Rights of the Child (CRC) in June 2012.1

These key themes are:

1. A right to be heard: children’s voice and participation in decision-making processes; specifically involving children in issues that affect them; and ensuring that existing mechanisms for resolving disputes are accessible and available to children.

2. Freedom from violence, abuse and neglect: ensuring safe environments and respect for the dignity of the child; specifically making sure that the commitments made in national frameworks are achieved and built upon, through adequate resourcing and action; encouraging a proactive approach to issues of child safety that places a premium on prevention, through enabling safe communities and environments for children; and building resilience among our children.

3. The opportunity to thrive: safeguarding the health and wellbeing of all children in Australia, which includes promoting and supporting children through early intervention and prevention; and identifying and focusing on the most marginalised and vulnerable children.

4. Engaged citizenship: promoting engaged civics and citizenship through education and awareness-raising.

5. Action and accountability: taking deliberate and proactive steps to protect the wellbeing and rights of children, specifically by collecting comprehensive national data about the wellbeing and human rights of Australia’s children; progressing a national vision for Australia’s children through intergovernmental partnerships and agreements; developing outcome-based reporting and monitoring of government service delivery and policy development; and developing a children’s impact assessment process for law, policy and practice.

I used these themes to guide my priorities, strategic advocacy and engagement with stakeholders throughout the past year. These themes will continue to guide my work into the future. My speaking engagements are listed in Appendix 1 and my meetings with stakeholders are detailed in Appendix 2.

1.2 Children’s rights in early childhood education and care In my report last year, I noted the limited knowledge that many children and young people, as well as adults, have about their rights.

I think that the Big Banter and similar new initiatives are fantastic ideas, getting the message to more young people, telling them that we do have rights, and that we are able to use them.

Quote from a young person during the Big Banter, 2013

Children’s Rights Report 2014 • 15

One of the ways that I have addressed this during 2014 has been in my work with Early Childhood Australia (ECA). ECA is a national peak early childhood advocacy organisation. It was established in 1938. It advocates on all issues relating to the education and care of children from birth to eight years of age. ECA’s membership includes around 4,500 early childhood services, academics, individual educators and students.

The early childhood years are critical for laying the foundations for the sound development of a child. The United Nations Committee on the Rights of the Child has outlined developmental reasons why early childhood is a critical period for the realisation of children’s rights. These reasons include that children:

• experience the most rapid period of growth and change during the human lifespan, in terms of their maturing bodies and nervous systems, increasing mobility, communication skills and intellectual capacities, and rapid shifts in their interests and abilities

• form strong emotional attachments to their parents and other caregivers, from whom they seek and require nurturance, care, guidance and protection, in ways that are respectful of their individuality and growing capacities

• establish their own important relationships with children of the same age, as well as younger and older children. Through these relationships they learn to negotiate and coordinate shared activities, resolve conflicts, keep agreements and accept responsibility for others

• actively make sense of the physical, social and cultural dimensions of the world they inhabit, learning progressively from their activities and their interactions with others, children as well as adults

• form the basis for their physical and mental health, emotional security, cultural and personal identity and developing competencies in their earliest years.2

Young children’s experiences of growth and development vary according to their individual nature, as well as according to gender, living conditions, family organisation, care arrangements and education systems. Their experiences of growth and development are also powerfully shaped by cultural beliefs about their needs and proper treatment, and about their active role in family and community.3

The importance of early childhood for the health and wellbeing of children and future adults has been recognised by federal, state and territory governments in the National Early Childhood Development Strategy.4 This national strategy is a response to evidence about the importance of early childhood development and the benefits, including cost-effectiveness, of ensuring that all children experience a positive early childhood. 5

Quality early childhood education and care is one important component of effective early childhood development and can play a role in enhancing children’s learning and socialisation as well as acting as a strong protective measure.

The Australian Early Years Learning Framework provides guidance for early childhood education and care for children in Australia. It states that ‘early childhood educators will reinforce in their daily practice the principles laid out in the United Nations Convention on the Rights of the Child’.6

As a member of the National Advisory Group for the Statement of Intent on Children’s Rights in Early Childhood Education and Care, I have worked with ECA to develop a Statement of Intent on Children’s Rights in Early Childhood Education and Care. The draft Statement of Intent outlines concrete steps that early childhood educators can take to reinforce children’s rights in their daily practice. A copy of the draft Statement of Intent is contained in Appendix 3.

The draft Statement of Intent identifies priority areas for action. It is a very practical tool designed to help early childhood educators understand Australia’s obligations to children, and to realise children’s rights in their services. For example, it structures each priority according to what it means for children, for professionals working with young children, for ECA and for me. Resources will also be identified and developed to support teachers, educators, families and children to implement the identified areas for action under the Statement of Intent.

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Consultations with children in early childhood education and care are being led by ECA, and the views of these children will be incorporated in areas for action under the finalised Statement of Intent.

In drafting the Statement of Intent, a number of observations made by children about their rights during last year’s Big Banter consultation were included. Feedback on the draft Statement of Intent is also being sought from those who work in the early childhood education and care sector.

The final Statement of Intent will be released in late 2014, to coincide with the 25th anniversary of the CRC.

I would like to take this opportunity to extend my sincere thanks to ECA, and to the members of the ECA National Advisory Group, for their commitment to children’s rights and for all their hard work in developing this important resource.

1.3 Children’s rights and e-safety On 5 September 2013, the Coalition released its pre-election policy to enhance online safety for children and young people, as part of its commitment to establishing measures to improve the safety and wellbeing of children and young people in Australia.7

In December 2013, upon invitation by the Hon Paul Fletcher MP, Parliamentary Secretary to the Minister for Communications, I became a member of the Australian Government’s Online Safety Consultative Working Group (CWG). The CWG was created to assist with the implementation of the Australian Government’s commitment to online safety, by providing advice to Government on online safety issues such as cyberbullying, privacy breaches, and exposure to illegal online content.

Everyone has the right to be respected, safe and free from violence, harassment and bullying. A life free from violence and from cruel, degrading and inhuman treatment is a fundamental human right.8 Bullying and harassment can lead to violations of a range of other human rights. These rights include:

• The highest attainable standard of physical and mental health.9 Bullying can impact negatively on physical and mental health causing harm in the form of physical injuries, stress-related illnesses, depression and other health issues. The United Nations Committee on the Rights of the Child recognises cyberbullying as a form of mental violence.10 Mental violence is often described as psychological maltreatment, mental abuse, verbal abuse and emotional abuse or neglect.11

• Freedom of expression and to hold opinions without interference.12 Bullying can impact on a child’s or young person’s freedom to express her/his feelings or opinions, as he/she may no longer feel safe to do so.

• A child’s or young person’s right to leisure and play.13 Bullying often occurs where children and young people play and socialise, such as in school playgrounds and on social networking sites. All children and young people have the right to participate in leisure activities in a safe environment.

• The right to education.14 15 A child or young person who is experiencing bullying or cyberbullying can feel unsafe and unwelcome at school and this can impact on their capacity to positively achieve and develop in the school environment.

• A child’s or young person’s right to privacy.16 Children or young people who experience cyberbullying can often have their personal information put online or sent by phone for everyone to see without their knowledge, which may result in humiliation and distress.

Chapter 1: My work to promote children’s rights during 2013-2014

Children’s Rights Report 2014 • 17

This is not an exhaustive list. These examples serve to indicate the range of rights that can be violated by bullying and cyberbullying in particular. Taking a human rights approach to tackling bullying and online safety allows us to identify and address the harm to a victim’s rights and encourages all of us to respect the rights of others. As a nation, we have a responsibility to protect the rights of children and young people as they develop and grow into adulthood.

I think that children under a certain, valid and mature age should NOT be permitted to go on social media websites, such as face book and twitter because they are still children, yet they are flicking through inappropriate photos or videos of themselves or others. It’s just not right! Students in my class are mainly all on social media websites, this is completely unheard of because they take photos in class, on the oval or during lunchtime, either without the teacher seeing or without other students knowing, it’s unfair because the victim is oblivious to the damage that could be done on those websites. Some photos could include invading of privacy, nudity or inappropriate comments such as swearing.

Quote from a young person during the Big Banter, 2013

In early 2014, the Australian Government Department of Communications released a Discussion Paper for public consultation, Enhancing Online Safety for Children.17 The Commission made a submission to this public consultation. This can be located at: http://www.communications.gov.au/online_safety_and_security/cyber_ safety/discussion_paper_enhancing_online_safety_for_children/submissions_to_the_public_consultation_on_ enhancing_online_safety_for_children.

The Australian Government is working to have legislation ready to introduce into Parliament by the end of 2014, and will start the process of selecting a Children’s e-Safety Commissioner. The Children’s e-Safety Commissioner will take a national leadership role in online safety for children and young people.

Fundamentally, I am of the view that education and increasing public awareness is critical to enhancing online safety for children and young people. This preventative approach should use research findings to educate and inform about the prevalence of particular risks, and the specific contexts in which they arise. This type of knowledge will assist families and communities in early detection and intervention.

The importance of prevention and early intervention for the online safety of children and young people was recently reinforced by the Child Rights International Network (CRIN), in its 2014 policy paper, Access denied: Protect rights - unblock children’s access to information:

children can and will find ways around restrictions, so if we really want to protect children, we need to support them to think critically and make safe choices based on honest and objective information and discussion. Where restrictions do exist, they should be transparent, adhere to all children’s rights and be determined with input from civil society and children themselves.18

Indeed, most children and young people who I speak with understand the risks in the cyber world, are selective in how they engage with it, and are well versed in how to protect themselves in this space.

Children and young people also increasingly see digital citizenship as fundamental to their wellbeing. A 2014 global study by the Young and Well Cooperative Research Centre strongly supports this finding. 19 This research interviewed 148 children and young people from 16 countries about their perceptions on their rights in the digital age. The study reported that while children and young people are concerned about how their digital practices might impinge on their own rights, and on the rights of other children and young people, they ‘overwhelmingly experience digital media as a powerful and positive influence in their everyday lives…crucial to their rights to information, education and participation’.20

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Research published by the Australian Communications and Media Authority (ACMA) in February 2014, involving 1,001 parents, 396 children aged 8-11 years and 605 young people aged 12-17 years, found that:

• Children and young people were most likely to turn to their parents first if they needed to enquire about a potential cyber-safety issue, despite community perceptions and anecdotal evidence suggesting otherwise.

• 78% of children and young people reported that their likely sources of cyber-safety information sources would be parents or other trusted adults; 38% reported turning to a teacher; 31% reported turning to friends; 22% reported using search engines such as Google; 18% reported turning to siblings; 8% got information from school information sessions; 3% got information from school newsletters; 2% reported getting information from onsite advertisements; and 2% got information from television or radio.21

These results show that the percentage of children and young people turning to their parents for assistance was the most common response for each age group. This deceased as children and young people got older. ACMA acknowledges that this finding highlights the importance of reaching parents as a key target audience for cyber-safety resources.22

The research also indicated that parents became aware of cyber-safety as follows:

• 48% through news or current affair shows • 47% through friends and family • 46% through newsletters from their child’s school • 32% through talking to their child • 27% through a government website • 21% through face to face information sessions through their child’s school • 15% through online advertisements • 15% through something at their child’s school • 9% through a cyber-safety website • 8% through an internet service provider or telephone service • 3% through Facebook • 2% through stories in magazines or newsletters • 11% indicated that they had not heard about cyber-safety through any means.23

Having this type of information is crucial in terms of appropriately targeting education and public awareness campaigns.

Future research should continue to elicit the views of children, young people and their parents, but should also evaluate the various educational and public awareness programs, including filtering and other technologies used to minimise and control risks.

This will help to make better informed choices as to what risks should be prioritised, what programs and methods will be most effective in combating those risks and how resources can be effectively targeted.

Livingstone and Smith, who reviewed available research between 2008 and 2013 on harms experienced by child users of online and mobile technologies, argue that ‘much needed, and still little developed, is a body of research that conducts independent evaluations of existing interventions so as to learn from mistakes and share best practice’.24 They also point out that in the last decade ‘multiple disciplines [are] combining forces to raise awareness, produce research evidence, and initiate multi-stakeholder efforts to mitigate harm’.25

The Discussion Paper, Enhancing Online Safety for Children, stated that the Department of Communications ‘will review the proposed scheme three years after implementation’.26 I welcome this commitment to review the proposed scheme. Guidelines on data collection, including measurable objectives and performance indicators, should be defined from the onset with public reporting procedures clearly articulated.

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1.4 Children’s rights and privacy During the year, I provided input to the Australian Law Reform Commission’s Inquiry into Serious Invasions of Privacy in the Digital Era. Our discussions focused on the importance of incorporating the views of children and young people in its report to the Australian Government about privacy.

Article 16 of the CRC states:

1. No child shall be subjected to arbitrary or unlawful interference with his or her privacy, family, or correspondence, nor to unlawful attacks on his or her honour and reputation.

2. The child has the right to the protection of the law against such interference or attacks.27

I developed resources to elicit the views of children and young people about privacy in the contemporary world. These include a privacy survey and a set of scenarios targeted to younger children, and separate resources targeted to older children and young people.

The materials set out what the CRC states about children’s rights to privacy, noting, in some cases, these rights are so important that they should be protected by the law. I asked children and young people to comment on laws, rules and protocols that would help protect their privacy. Some examples of this included:

• someone goes into your home or space without being asked • you have been watched without you knowing • your photos or words have been sent on to others or changed • private information about you is misused, sent on to someone else or made public.

I designed these resources to be used by teachers and youth leaders in their classrooms or youth services. With the appropriate consents from parents and carers, I asked teachers and youth leaders to provide the views of children and young people to me. I have provided the feedback that I received from children and young people, to date, to the Australian Law Reform Commission to assist in its Inquiry.

Feedback from some of the primary school children who participated included:

Privacy means that you should be worrying about your stuff, not other people’s… I believe that home is the best for your privacy.

Privacy means to me about the safety of little kids under the age of 18. Kids being watched walking home.

I think privacy means that you can do things, talk to other people and go to other places without people listening or watching.

Our teachers don’t talk about it very much, so most kids don’t respect other people’s privacy.

Not being put on chat sites without permission, not having photos taken of you.

Some of the early feedback from this work has been very interesting. Children, especially younger children, believe privacy is important, and most are certain about what it means in the physical world, for example, not letting strangers interfere with your person or property. However, generally the views of children and young people showed that they were not clear about why and when it was important to protect their own privacy and to respect the privacy of others, what laws exist, and what action could be taken to enhance and safeguard privacy. This points to a much greater need to educate children and young people about what privacy looks like in the contemporary world.

Feedback from using these resources is also assisting me in determining whether this model of consultation has ongoing potential as a way to engage with children and young people on issues that affect them.

I encourage schools and youth services to utilise my privacy resources, which are available at https://www. humanrights.gov.au/childrens-rights/privacy-resources.

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1.5 National Inquiry into children in immigration detention During 2014, the Commission undertook a national Inquiry into children in closed immigration detention. The purpose of this Inquiry was to investigate the ways in which life in immigration detention affects the health, wellbeing and development of children, and to assess whether laws, policies and practices relating to children in immigration detention meet Australia’s international human rights obligations, with particular attention to the:

• appropriateness of facilities in which children are detained • impact of the length of detention on children • measures to ensure the safety of children • provision of education, recreation, maternal and infant health services • separation of families across detention facilities in Australia • guardianship of unaccompanied children in detention in Australia • assessments conducted prior to transferring children to be detained in ‘regional processing

countries’ • progress that has been made during the 10 years since the Commission’s 2004 report: A last resort? National Inquiry into Children in Immigration Detention.28

The terms of reference for the Inquiry make specific reference to the role of the National Children’s Commissioner in providing technical assistance and advice to the Inquiry.29

During April and May 2014, I travelled with the Commission’s Inquiry team to assist in conducting interviews with children and families held in:

• Wickham Point Alternative Place of Detention • Bladin Alternative Place of Detention • Darwin Airport Lodge Alternative Place of Detention • Melbourne Immigration Transit Accommodation • Inverbrackie Alternative Places of Detention.

A member of the Children’s Rights policy team travelled with the Inquiry team to Christmas Island to assist with the interviewing process.

The final report of the Inquiry will be transmitted to the Attorney-General in late 2014, and will be tabled in federal Parliament soon after.

1.6 Children’s rights and participation Encouraging the meaningful participation of children and young people in the decisions and processes that affect them is a priority that is deeply embedded in my duties as National Children’s Commissioner.

Respect for the views of the child is one of the four guiding principles of the CRC. It is provided for in article 12 of the CRC, which states:

1. States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.

2. For this purpose the child shall in particular be provided the opportunity to be heard in any judicial and administrative proceedings affecting the child, either directly, or through a representative or an appropriate body, in a manner consistent with the procedural rules of national law.30

Article 12 of the CRC is a strong statement of Australia’s obligations to children and young people, to ensure their full and meaningful participation.

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Over the past year, I have held consultations with children and young people of varying ages and backgrounds. Each of these consultations provided me with an invaluable opportunity to speak directly with children and young people about the issues that affected them, what was most important to them, as well as the extent to which they knew about children’s rights. Some of my consultations are listed in Appendix 4.

In talking to children and young people about human rights, and their rights in particular, it has become clear to me that rights knowledge is both empowering and safeguarding for children and young people. It strengthens their capacity, agency and capabilities, and engenders respect for the rights of others. It also builds their expectations that adults will help to protect their rights, and that they are able to raise concerns if their rights, or the rights of other children or young people, are breached.

A growing body of researchers and practitioners are involved in projects that promote child participation in the Australian context. This is a movement in which I am heavily invested and strongly support.

In March 2014, I participated in the launch of the research report, Putting the Pieces in Place: Children, Communities and Social Capital in Australia.31 This research was completed by Dr Sharon Bessell from the Australian National University and Emeritus Professor Jan Mason from the University of Western Sydney, in partnership with The Benevolent Society and the National Association for Prevention of Child Abuse and Neglect (NAPCAN). It explored what 1,008 children aged 8-12 years thought about their communities, how they experienced ‘community’ on a daily basis and what vision they had for their communities.

The findings provide important insights into communities from a child’s standpoint, and how they might be improved. They also demonstrate children’s capacity to engage in detailed discussion about such issues. The most important things for them in their communities are: relationships, safety, physical places (including home and inclusive spaces) and resources.32 Many children reported being treated rudely or dismissively, some spoke of being disconnected from their community, many wanted more time with their parents, and a number did not feel safe.33 This mirrored what children and young people told me last year during the Big Banter.

The research demonstrates the value of undertaking research with children and provides a strong platform from which to improve the experiences of both adults and children in neighbourhoods and communities.

In April 2014, I had the pleasure of joining a forum hosted by Southern Cross University’s Centre for Children and Young People, as part of their Collaborative Research Network initiative. This forum brought together eminent researchers in the area of child participation. Research undertaken by the Centre for Children and Young People, led by Professor Anne Graham, spans a wide range of issues that impact children and young people’s rights and wellbeing; including disability, family law, loss and grief, teacher learning, out-of-home care, consumerism, technology, relationships, belonging and connection, abuse and neglect, childhood cultures, play, transition to school, climate change and environment.

Respecting the human dignity of children and young people is fundamental to the work of the Centre for Children and Young People. Of particular note is its project on Ethical Research Involving Children to be launched in late 2014, which includes a print-based compendium and website of resources to guide ethical research with children and young people.34

In August 2014, I was pleased to be involved in the launch of a book written by Ms Pauline Harris and Mr Harry Manatakis, Children as Citizens: Engaging with the child’s voice in educational settings,35 which is framed around the notion of the child as a valued citizen. This book canvassed the views of 350 South Australian children aged 8-12 years. It challenges us to think about how we can better facilitate the ‘hundred languages of children’,36 in ways that build authentic and sustained engagement with them.

This book’s development was supported by the University of South Australia and the South Australian Department of Education, reflecting the state’s commitment to being a child-friendly state and community following the lead of UNICEF Australia’s Child Friendly Cities initiative.37

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It is my vision that every community, and every institution across the nation, takes up the challenge to be child safe and child centred. Hearing directly from children and young people, and genuinely engaging with them, is a core principle of the CRC, and respect for this right is central to respecting the other rights children and young people have.

On a positive note, Footprints in Time: the Longitudinal Study of Indigenous Children (LSIC)38 agreed to include and pilot the question ‘What makes you most happy?’ with its remote, regional and urban pilot samples in August to September 2013. This was the same question that I asked as part of the Big Banter. The LSIC Steering Committee was impressed with how the question worked within the survey and I am pleased to report that it will be included in the survey with the older cohort of children (up to 686 children) in 2014 and the younger cohort (up to 943 children) in 2017 when they are roughly the same age. LSIC has agreed to provide me with the final information gathered in 2015. This will help me to make sure that the views of children and young people are represented in my work.

1.7 Development of child-friendly materials

Child-friendly version of the 2013 Children’s Rights Report

In April 2014, I published a child-friendly version of my 2013 Children’s Rights Report.39 The child-friendly report is a short, easy-to-read summary of the contents of my report to Parliament. I wanted children and young people to be able to access easily the findings of my report. I consulted with children and young people during its development.

The child-friendly report is available via the Commission website and in hardcopy. It has been distributed directly to children and young people, teachers and children’s advocates.

I will also publish a child-friendly version of the 2014 Children’s Rights Report.

Child-friendly version of the United Nations Committee on the Rights of the Child’s Concluding Observations

In 2012, the United Nations Committee on the Rights of the Child, which monitors how Australia meets its obligations to the CRC, issued its Concluding Observations on Australia’s progress.40

During 2014, I worked with UNICEF Australia and Plan International Australia on developing a child-friendly version of the 2012 Concluding Observations by the United Nations Committee on the Rights of the Child. There are two versions, one for younger children and one for older children and young people. Children and young people were consulted during the development of these publications. They will be launched late in 2014.

1.8 Human rights education in schools The importance of human rights education is recognised in a number of human rights treaties, including the CRC. Human rights education is both a right in itself, as well as a way of protecting human rights.

Human rights education gives all children and young people a foundation to build a culture of respect for human rights. This provides both knowledge about human rights and the laws that protect all people, and helps children and young people to gain the skills needed to promote, defend and apply human rights in daily life.

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The Commission is currently working on a new school initiative to provide children and young people with a critical understanding of their rights and responsibilities. This initiative involves the development of a suite of resources that are linked to the National School Curriculum. The resources will focus on the topics of anti-racism and disability, and will be linked to the History, Geography and Health and Physical Education curricula. The launch of these resources will take place in late 2014.

The Commission has also developed a mapping resource for teachers called Human Rights Examples for the Australian Curriculum.41 This mapping resource is designed as a guide for teachers to provide human rights related examples that are consistent with key learning area content descriptions. Each human rights example is mapped by key learning area, year level, code and content description so teachers can easily identify possible human rights content for their programs.

In addition to this, the Commission has worked in partnership with ABC Splash to create an interactive educational website called Choose Your Own Statistics. The content of this website has been closely mapped to the Australian Curriculum for Mathematics and is designed to help children and young people in Years 5 to 8 gain a better understanding of important human rights issues in Australian society. Through the use of infographics and interactive graphs, children and young people can explore a range of human rights topics and the statistical data underpinning each topic. The website will also be launched later this year.

1.9 Submissions In my reporting period, the Commission made seven submissions relating to children’s rights and wellbeing:

• Royal Commission into Institutional Responses to Child Sexual Abuse Issues Paper 3: Child Safe Organisations (11 October 2013) • Royal Commission into Institutional Responses to Child Sexual Abuse Issues Paper 4: Preventing Sexual Abuse of Children in Out-of-Home Care (8 November 2013) • Senate Legal and Constitutional Affairs Legislation Committee • Inquiry into the Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill (February 2014) • Department of Communications Consultation into Enhancing Online Safety for Children

(5 March 2014) • Senate Inquiry into grandparents who take primary responsibility for their grandchildren (20 March 2014) • House of Representatives Standing Committee on Indigenous Affairs Inquiry into Harmful Use of

Alcohol in Aboriginal and Torres Strait Islander Communities (April 2014) • Productivity Commission Inquiry into childcare and early childhood learning (5 May 2014).

1.10 Membership of advisory groups and ambassadorships In the reporting period, I have been a member of the following:

• National Advisory Group for the Statement of Intent on Children’s Rights in Early Childhood Education and Care since April 2014.

• Bourke Justice Reinvestment Strategic Advisory Group to assist in designing and steering the justice reinvestment and collective impact process in Bourke over the next two years since May 2014. I have been a Justice Reinvestment Champion since May 2013.

Inquiry into the Criminal Code

Amendment (Misrepresentation of Age to a Minor) Bill (February 2014)

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• Advisory Group formed to provide advice, input and assistance to the Preventing Anxiety and Victimisation through education (PAVe) Project.42 The purpose of the project, which is being jointly funded by the National Health and Medical Research Council, Australian Government Department of Education, and Macquarie University, is to assist schools in reducing bullying behaviour through the development of social and emotional learning of students, building positive peer relationships, and empowering students to cope successfully with difficult situations. 43 The PAVe project is being conducted in selected primary schools throughout New South Wales and Western Australia from late 2014 until 2016. More than 5,000 students in grades 3-6, from approximately 100 schools, will take part in the project. I have been a member since December 2013.

• Foster and Kinship Care Spokesperson since 2013. This role brings attention to the thousands of children and young people who are unable to live at home on either a temporary or permanent basis, and need a loving family to care for them.

• National Ambassador of Children’s Week 2014 since May 2014. Each year the National Children’s Week Council of Australia determines an article of the CRC to be the focus for Children’s Week celebrations and activities. The theme for 2014 is article 12 of the CRC, the child’s right to speak and be heard.

In July 2014, in line with my examination of intentional self-harm and suicidal behaviour in children and young people, I accepted an offer by the Centre of Research Excellence in Suicide Prevention to become one of its industry partners. This partnership involves working as part of an Australia-wide research community group, to consider how research on suicide in Australia can be better understood and translated.

1.11 Reporting on the actions taken in response to the recommendations in the Children’s Rights Report 2013 The Children’s Rights Report 2013 was tabled in Parliament in December 2013. In my 2013 report, I made six recommendations. I indicated that I would report on the actions taken by the Australian Government in response to these recommendations in my 2014 report.44 The Attorney-General responded formally to my 2013 recommendations in April 2014.45

Recommendation 1

That the Australian Government respond formally to the Concluding Observations of the United Nations Committee on the Rights of the Child on Australia’s fourth report of progress under the Convention on the Rights of the Child and its Optional Protocols. The response should indicate how it intends to progress addressing the recommendations, and timelines and benchmarks for their implementation.

The Attorney-General informed me that there was no formal requirement to respond to the Concluding Observations of the United Nations Committee on the Rights of the Child on Australia’s fourth report of progress, and that Australia’s next report to the United Nations Committee on the Rights of the Child will detail how Australia has implemented the 2012 Concluding Observations. The Government convened a roundtable discussion about the Concluding Observations in December 2012 which the Government has noted is intended to inform future policy development.

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More than two years have passed since the United Nations Committee on the Rights of the Child issued its Concluding Observations to Australia, and Australia’s next report to the United Nations Committee on the Rights of the Child is not due until 15 January 2018. It is my view that the wellbeing of Australia’s children and young people would be significantly enhanced if the Australian Government responded to the Concluding Observations with a plan to monitor, prioritise and implement the recommendations made by the United Nations Committee on the Rights of the Child. I will continue to engage in constructive dialogue with the Attorney-General in relation to this.

Recommendation 2

That the Australian Government accedes to the Optional Protocol to the Convention on the Rights of the Child on a Communications Procedure (OPCP) and ratifies the Optional Protocol to the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT).

The OPCP establishes a communications mechanism to allow for children and young people, and their representatives, to bring breaches of their rights to the attention of the United Nations Committee on the Rights of the Child.46 Communications can only be considered if all domestic channels have been exhausted. Such mechanisms are already available to adults in respect to a range of treaties and conventions. Australia’s ratification of OPCP would significantly enhance the capacity for children and young people to have their voices and concerns heard, prompt improvements in domestic compliance and redress systems and ensure that these are accessible and known to children and young people. At the time of writing this report, 46 countries had become signatories to OPCP.

The OPCAT is an international agreement aimed at preventing torture and cruel, inhuman or degrading treatment or punishment.47 It was adopted in 2002, and entered into force in 2006. It builds on the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT), and helps states parties to meet their obligations under CAT. The key aim of OPCAT is to prevent the mistreatment of people in detention. Children and young people in Australia can be at risk of being mistreated in a range of secure settings, where they may be deprived of their liberty. Such settings may include juvenile justice centres, psychiatric units and immigration detention facilities.

Under OPCAT, states parties agree to international inspections of places of detention by the United Nations Subcommittee on the Prevention of Torture (SPT), and are required to establish an independent National Preventative Mechanism (NPM) to conduct inspections of all places of detention and monitor the treatment of children and adults in these places. As at July 2014, 73 countries had ratified OPCAT. Australia has signed but not ratified OPCAT.

The Attorney-General indicated to me that the Australian Government had not yet formed a formal position on OPCP and OPCAT.

I hope that the Australian Government, as a matter of priority, will develop a formal view on OPCP and OPCAT, given their importance in protecting the rights and welfare of children and young people both in Australia and around the world.

Recommendation 3

That the Australian Government finalises its review of Australia’s reservations and withdraws its reservation under article 37(c) of the Convention on the Rights of the Child which relates to the obligation to separate children from adults in prison.

The Attorney-General stated that state and territory governments were reluctant to remove Australia’s reservation to article 37(c). The Attorney-General also stated that new detention facilities would need to be constructed in geographically remote areas in order to separate children from adults in detention, and this would be a costly undertaking.

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I note that Australia has previously defended its reservation to article 37(c) in its reports to the United Nations Committee on the Rights of the Child, claiming that it may not be feasible to separate children from adults in detention and at the same time enable children to maintain contact with their families, given Australia’s geography and demography.48 49 The United Nations Committee on the Rights of the Child rejected this reasoning in its 2005 and 2012 Concluding Observations on Australia,50 51 stating that Australia’s reservation to article 37(c):

is unnecessary since there appears to be no contradiction between the logic behind it and the provisions of article 37(c) of the Convention. The Committee further reiterates its view that the concerns expressed by the State party in its reservation are well addressed by article 37(c), which provides that every child deprived of liberty shall be separated from adults ‘unless it is considered in the best interests of the child not to do so’ and that the child ‘shall have the right to maintain contact with his or her family’.52

It is my view that Australia’s reservation to article 37(c) is not justifiable. I will continue to advocate that Australia withdraws its reservation to article 37(c).

Recommendation 4

That the Australian Institute of Health and Welfare (AIHW) extends its current cohort of Australian children in A picture of Australia’s children from 0 to 14 years to 0 to 17 years, consistent with the Convention on the Rights of the Child definition of the child.

The Attorney-General stated that extending the cohort to children and young people aged 0-17 years would present significant practical challenges and require the collection of additional data. The Attorney-General referred me to the Key National Indicators of Youth Health and Wellbeing that provides data on people aged 12-24 years, albeit covering different indicators and data sets.

In 2014, the Australian Government Department of Health ceased funding for A picture of Australia’s children. A new smaller report containing pure data without narrative will replace it.53

I am strongly of the view that the Australian Government should review its decision to cease funding for A picture of Australia’s children, and extend the cohort of children and young people covered to include the age range 0-17 years. If this decision cannot be reversed, I would at least propose that the cohort of children and young people aged 0-17 years is included in the smaller report containing data, especially given that the data exists but is simply not analysed in this way.

Recommendation 5

That the Australian Government establishes relevant data holdings and analytics covering all the key domains of children’s rights outlined in the Convention on the Rights of the Child, including comparable data across jurisdictions, which the National Children’s Commissioner can use to monitor the enjoyment and exercise of human rights by children in Australia.

In his response to this recommendation, the Attorney-General pointed out to me that the Australian Government remains committed to collaborating with state and territory governments via its cross-jurisdictional Early Childhood Data Subgroup, to implement further improvements to data collection and enhance research capability into the future. He indicated that this should provide the building blocks for data linkage capability across sectors, including health, early childhood and schools, which in turn will allow multi-dimensional research as well as longitudinal analysis.

The jurisdictional challenges that come with our federated structure have led to an often incoherent narrative about the status and wellbeing of our children and young people. The ABS Census and a range of health and wellbeing data is not presented in ways that relate to the policy development needs of children and young people relative to their age and developmental stages. Further, data about children and young people is collected differently across states and territories. This means that it cannot be used reliably to draw

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comparisons. Some of the basic information required to monitor the wellbeing of Australia’s children and young people is not available. Too often, the administrative datasets which are available reflect the operations of various programs rather than measures of actual wellbeing. Many researchers and policy analysts I speak to express similar frustrations regarding the data that is collected about children and young people, and how it is analysed and made available.

During my reporting period, I sought advice from AIHW on what would be required to implement this recommendation. In May 2014, AIHW estimated that it would require 4-5 months of scoping work, followed by data analysis at a cost of approximately $150,000.

As the National Children’s Commissioner, I do not have the funds to progress this. I approached a number of Australian Government Departments for assistance but, to date, no funding could be sourced. This is a worthwhile project and one that I will continue to advocate and seek resources for. In particular, I consider it imperative that Australia is able to adequately report on its progress against the provisions of the CRC when it next appears before the United Nations Committee on the Rights of the Child in 2018. Having an adequate and comprehensive set of wellbeing indicators for children and young people will form a critical part of any such report.

Recommendation 6

That the Australian Government includes in its regular monitoring and evaluation of national policy reforms and initiatives, a component that reports on how it is giving effect to the articles of the Convention on the Rights of the Child.

The Attorney-General stated that this would require an additional layer of reporting outside the periodic reporting to the United Nations Committee on the Rights of the Child, which would be a resource intensive exercise cutting across multiple jurisdictions and multiple programs and policies.

Australia has many policy initiatives at the national level that focus on children and young people, and there are many more at the state and territory levels. In the absence of a national plan for Australia’s children and young people, the coordination of major national policy initiatives becomes an important consideration.

The United Nations Committee on the Rights of the Child noted ‘the lack of a clear mechanism to link the implementation of these plans’ in its Concluding Observations of Australia in 2012.54 While many of these policy initiatives may cite the relevance of other frameworks and plans in their work, it is not clear how they actually work or intend to work in an integrated way to give effect to their interdependence. One possible way to create a mechanism to link the implementation of national policy initiatives to the CRC would be for national policy reforms and initiatives to include, in their ongoing monitoring and evaluation processes, a component that reports on how they are giving effect to the articles of the CRC. Ultimately, it would be possible to coordinate these responses into a consolidated report that could indicate how the rights of children and young people are being given effect at a national level. Without this, it is difficult to know how children’s rights are being progressed in Australia.

Since I tabled my first statutory report to Parliament in December 2013, I have been working to facilitate my membership on the National Framework for Protecting Australia’s Children 2009-2020. In August 2014, I participated in a roundtable with the Department of Social Services to discuss work priorities and how to progress the National Framework. I am pleased that the Department of Social Services considers it a priority to improve the National Minimum Data Sets to build the evidence base and listen to the voices of children and young people in out-of-home care through the development of a survey, which will inform the 2015 National Report on the Views of Children and Young People in out-of-home care.55 I thank the Minister for Social Services, the Hon Kevin Andrews MP, for his commitment to engage with me in the progression of the National Framework and the development of its Third Three-Year Action Plan.56 I look forward to engaging formally with the Department of Social Services throughout the remainder of my term to help progress, and bring a child rights focus to, the National Framework.

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1 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/15/Add.268 (2005). At http://tbinternet. ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2f15%2fAdd.268&Lang=en (viewed 1 October 2014).

2 Committee on the Rights of the Child, General Comment No. 7 - Implementing Child Rights in Early Childhood, UN Doc CRC/C/ GC/7/Rev.1 (2006), p 3, para 6. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC %2fGC%2f7%2fRev.1&Lang=en (viewed 1 October 2014).

3 Committee on the Rights of the Child, General Comment No. 7 - Implementing Child Rights in Early Childhood, UN Doc CRC/C/ GC/7/Rev.1 (2006), p 3, para 6. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC %2fGC%2f7%2fRev.1&Lang=en (viewed 1 October 2014).

4 Council of Australian Governments, Investing in the Early Years - A National Early Childhood Development Strategy (2009). At https://www.coag.gov.au/node/205 (viewed 1 October 2014). 5 Council of Australian Governments, Investing in the Early Years - A National Early Childhood Development Strategy (2009), p 4. At https://www.coag.gov.au/node/205 (viewed 1 October 2014). 6 Australian Government, The Early Years Learning Framework for Australia (2009), p 5. At https://education.gov.au/early-years-

learning-framework (viewed 1 October 2014). 7 The Liberal Party and The Nationals, The Coalition’s Policy to Enhance Online Safety for Children (2013). At http://www.liberal.org. au/our-policies (viewed 1 October 2014). 8 See for example, Convention on the Rights of the Child, 1989, art 19; Universal Declaration of Human Rights, 1948, arts 5 and

7; International Covenant on Civil and Political Rights,1966, arts 7 and 26; Convention on the Rights of Persons with Disabilities, 2006, art 16; Committee on the Elimination of Discrimination Against Women, General Recommendation No. 19 - Violence Against Women (1992), paras 4, 17 and 14. At http://www.un.org/womenwatch/daw/cedaw/recommendations/recomm. htm#recom19 (viewed 1 October 2014); Committee on the Rights of the Child, General Comment No. 13 - The Right of the Child to Freedom from all Forms of Violence, UN Doc CRC/C/GC/13 (2011), para 12. At http://tbinternet.ohchr.org/_layouts/ treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fGC%2f13&Lang=en (viewed 1 October 2014). 9 See for example, Convention on the Rights of the Child, 1989, art 24; Universal Declaration of Human Rights, 1948, art 25;

International Covenant on Economic, Social and Cultural Rights, 1966, art 12(1). 10 Committee on the Rights of the Child, General Comment No. 13 - The Right of the Child to Freedom from all Forms of Violence, UN Doc CRC/C/GC/13 (2011), para 21(g). At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=C

RC%2fC%2fGC%2f13&Lang=en (viewed 1 October 2014). 11 Committee on the Rights of the Child, General Comment No. 13 - The Right of the Child to Freedom from all Forms of Violence, UN Doc CRC/C/GC/13 (2011), para 21. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CR

C%2fC%2fGC%2f13&Lang=en (viewed 1 October 2014). 12 Universal Declaration of Human Rights, 1948, art 19; International Covenant on Civil and Political Rights,1966, art 19. 13 Convention on the Rights of the Child, 1989, art 31. 14 Universal Declaration of Human Rights, 1948, art 26; International Covenant on Economic, Social and Cultural Rights, 1966, art

13(1); Convention on the Rights of the Child, 1989, art 29. 15 Committee on the Rights of the Child, General Comments No. 1 - The Aims of Education, UN Doc CRC/GC/2001/1 (2001), para 8. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fGC%2f2001%2f1&Lang=en

(viewed 1 October 2014). 16 Convention on the Rights of the Child, 1989, art 16. 17 Australian Government Department of Communications, Enhancing Online Safety for Children, Public Consultation on Key

Election Commitments (2014), p 19. At http://www.communications.gov.au/funding_and_programs/cyber_safety/discussion_ paper_enhancing_online_safety_for_children (viewed 1 October 2014). 18 Child Rights International Network, Access Denied: Protect Rights - Unblock Children’s Access to Information (2014), p 3. At https://www.crin.org/sites/default/files/access_to_information_final_layout.pdf (viewed 1 October 2014). 19 A Third, D Bellerose, U Dawkins, E Keltie and K Pihl, Children’s Rights in the Digital Age: A Download from Children Around the

World Young and Well Cooperative Research Centre (2014). At http://www.uws.edu.au/__data/assets/pdf_file/0003/753447/ Childrens-rights-in-the-digital-age.pdf (viewed 1 October 2014). 20 A Third, D Bellerose, U Dawkins, E Keltie and K Pihl, Children’s Rights in the Digital Age: A Download from Children Around the World Young and Well Cooperative Research Centre (2014), p 10. At http://www.uws.edu.au/__data/assets/pdf_file/0003/753447/

Childrens-rights-in-the-digital-age.pdf (viewed 1 October 2014). 21 Australian Communications and Media Authority, Connected Parents in the Cybersafety Age, June 2013 Snapshot (2014), p 24. At http://www.cybersmart.gov.au/About%20Cybersmart/Research/ACMA%20research.aspx#connected (viewed 1 October 2014). 22 Australian Communications and Media Authority, Connected Parents in the Cybersafety Age, June 2013 Snapshot (2014), p 2. At

http://www.cybersmart.gov.au/About%20Cybersmart/Research/ACMA%20research.aspx#connected (viewed 1 October 2014). 23 Australian Communications and Media Authority, Connected Parents in the Cybersafety Age, June 2013 Snapshot (2014), p 2. At http://www.cybersmart.gov.au/About%20Cybersmart/Research/ACMA%20research.aspx#connected (viewed 1 October 2014). 24 S Livingstone and P Smith, ‘Annual Research Review: Harms experienced by child users of online and mobile technologies: the

nature, prevalence and management of sexual and aggressive risks in the digital age’ (2014) 55(6) Journal of Child Psychology and Psychiatry 635, p 647. 25 S Livingstone and P Smith, ‘Annual Research Review: Harms experienced by child users of online and mobile technologies: the nature, prevalence and management of sexual and aggressive risks in the digital age’ (2014) 55(6) Journal of Child Psychology

and Psychiatry 635, p 645.

Chapter 1: Endnotes

Children’s Rights Report 2014 • 29

26 Australian Government Department of Communications, Enhancing Online Safety for Children, Public Consultation on Key Election Commitments (2014), p 19. At http://www.communications.gov.au/funding_and_programs/cyber_safety/discussion_ paper_enhancing_online_safety_for_children (viewed 1 October 2014).

27 Convention on the Rights of the Child, 1989, art 16. 28 Australian Human Rights Commission, National Inquiry into Children in Immigration Detention 2014, http://www.humanrights.gov. au/our-work/asylum-seekers-and-refugees/national-inquiry-children-immigration-detention-2014 (viewed 1 October 2014). 29 Australian Human Rights Commission, National Inquiry into Children in Immigration Detention 2014, https://www.humanrights.

gov.au/our-work/asylum-seekers-and-refugees/national-inquiry-children-immigration-detention-2014 (viewed 1 October 2014). 30 Convention on the Rights of the Child, 1989, art 12. 31 S Bessell and J Mason, Putting the Pieces in Place: Children, Communities and Social Capital in Australia (2014). At http://cpc.

crawford.anu.edu.au/pdf/2014/publications/Children-Communities-and-Social-Capital-Report-FINAL-Colour-March-2014.pdf (viewed 1 October 2014). 32 S Bessell and J Mason, Putting the Pieces in Place: Children, Communities and Social Capital in Australia (2014), p 13. At http:// cpc.crawford.anu.edu.au/pdf/2014/publications/Children-Communities-and-Social-Capital-Report-FINAL-Colour-March-2014.pdf

(viewed 1 October 2014). 33 S Bessell and J Mason, Putting the Pieces in Place: Children, Communities and Social Capital in Australia (2014), p 14. At http:// cpc.crawford.anu.edu.au/pdf/2014/publications/Children-Communities-and-Social-Capital-Report-FINAL-Colour-March-2014.pdf

(viewed 1 October 2014). 34 Centre for Children and Young People, Ethical Research Involving Children, http://ccyp.scu.edu.au/index.php/127 (viewed 1 October 2014). 35 P Harris and H Manatakis, Children as Citizens: Engaging with the Child’s Voice in Educational Settings (1st ed, 2014). 36 P Harris and H Manatakis, Children as Citizens: Engaging with the Child’s Voice in Educational Settings (1st ed, 2014), p 35. 37 UNICEF Australia, Child Friendly Cities, http://www.unicef.org.au/Discover/Australia-s-children/Child-Friendly-Cities.aspx (viewed

1 October 2014). 38 Australian Government, Footprints in Time: the Longitudinal Study of Indigenous Children (LSIC), http://www.dss.gov.au/about-fahcsia/publications-articles/research-publications/longitudinal-data-initiatives/footprints-in-time-the-longitudinal-study-of-

indigenous-children-lsic (viewed 1 October 2014). 39 Australian Human Rights Commission, What does the Children’s Rights Report 2013 say? (2014). At http://www.humanrights.gov. au/publications/what-does-children-s-rights-report-2013-say (viewed 1 October 2014). 40 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/AUS/CO/4 (2012). At http://www2.

ohchr.org/english/bodies/crc/docs/co/CRC_C_AUS_CO_4.pdf (viewed 1 October 2014). 41 Australian Human Rights Commission, Human Rights Examples for the Australian Curriculum (2014). At http://www.humanrights. gov.au/publications/rightsed-human-rights-education-resources-teachers (viewed 1 October 2014). 42 Macquarie University Centre for Emotional Health, Preventing Anxiety and Victimisation through education (PAVe), http://www.

centreforemotionalhealth.com.au/pages/PAVe.aspx (viewed 1 October 2014). 43 Macquarie University Centre for Emotional Health, Preventing Anxiety and Victimisation through education (PAVe), http://www. centreforemotionalhealth.com.au/pages/PAVe.aspx (viewed 1 October 2014). 44 Australian Human Rights Commission, Children’s Rights Report 2013, p 9. At https://www.humanrights.gov.au/publications/

childrens-rights-report-2013 (viewed 1 October 2014). 45 Attorney-General, Letter to the National Children’s Commissioner, 28 April 2014. 46 Optional Protocol to the Convention on the Rights of the Child on a Communications Procedure, opened for signature

28 February 2012, A/HRC/RES/17/18 (entered into force 14 April 2014). 47 Optional Protocol to the Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, opened for signature 18 December 2002, A/RES/57/199 (entered into force 22 June 2006). 48 Committee on the Rights of the Child, Second and third periodic reports of Australia due in 1998 and 2003, CRC/C/129.Add.4

(2004), para 467. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2f129%2fAd d.4&Lang=en (viewed 1 October 2014). 49 Committee on the Rights of the Child, Fourth periodic report of Australia due in 2007, CRC/C/AUS/4 (2011), para 12. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fAUS%2f4&Lang=en

(viewed 1 October 2014). 50 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/15/Add.268 (2005), para 7. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2f15%2fAdd.268&Lang=en

(viewed 1 October 2014). 51 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/AUS/CO/4 (2012), para 9. At http://www2.ohchr.org/english/bodies/crc/docs/co/CRC_C_AUS_CO_4.pdf (viewed 1 October 2014). 52 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/AUS/CO/4 (2012), para 9.

At http://www2.ohchr.org/english/bodies/crc/docs/co/CRC_C_AUS_CO_4.pdf (viewed 1 October 2014). 53 Australian Institute of Health and Welfare, Email to Australian Human Rights Commission, 11 September 2014. 54 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/AUS/CO/4 (2012), para 15.

At http://www2.ohchr.org/english/bodies/crc/docs/co/CRC_C_AUS_CO_4.pdf (viewed 1 October 2014). 55 Minister for Social Services, Letter to the National Children’s Commissioner, 25 September 2014. 56 Minister for Social Services, Letter to the National Children’s Commissioner, 25 September 2014.

30

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

30

Children’s Rights Report 2014 • 31

The National Children’s Commissioner with a child from Marrickville West Primary School, New South Wales

32

Section 46MB(1)(d) of the Australian Human Rights Commission Act 1986 (Cth) (the AHRC Act) gives me power to examine existing and proposed Commonwealth enactments to ascertain whether they recognise and protect the human rights of children in Australia.

In my report to Parliament last year I welcomed the introduction of the Human Rights (Parliamentary Scrutiny) Act 2011, which established the Parliamentary Joint Committee on Human Rights (PJCHR) and the requirement for all new Bills introduced to Parliament to be assessed for compatibility with human rights. In the Children’s Rights Report 2013, I surveyed the comments made by the PJCHR to ascertain how the human rights of children and young people were taken into account by the Statements of Compatibility with Human Rights accompanying Bills introduced to Parliament during my reporting period. This year I used the same survey process to do this. Where the Australian Human Rights Commission examined Bills in more detail and made submissions about these Bills, I have included a summary of our position.

I note that for the purpose of the PJCHR and Statements of Compatibility with Human Rights, human rights are defined as the rights and freedoms contained in the seven core human rights treaties to which Australia is a party:

• International Convention on the Elimination of All Forms of Racial Discrimination • International Covenant on Economic, Social and Cultural Rights • International Covenant on Civil and Political Rights • Convention on the Elimination of All Forms of Discrimination Against Women • Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment • Convention on the Rights of the Child • Convention on the Rights of Persons with Disabilities.1

I consider the requirement for Statements of Compatibility with Human Rights to accompany all new Bills and the establishment of the PJCHR to be a very significant enhancement of the role of Parliament in human rights scrutiny. I note too that the United Nations Committee on the Rights of the Child in its Concluding Observations about Australia welcomed the adoption of these measures.2

The United Nations Committee on the Rights of the Child welcomes as positive the adoption of the Human Rights (Parliamentary Scrutiny) Act 2011, which requires that prior to being passed all the State party’s legislation be subject to a compatibility assessment, with the human rights and freedoms, recognised or declared, in the seven core international human rights instruments to which Australia is party.3

I thank the previous PJCHR members of the 43rd Parliament for their work to elevate the recognition and protection of human rights, and I welcome the new PJCHR members of the 44th Parliament and thank them for their work to date.

2.1 Bills introduced during my reporting period 212 Bills were introduced to Parliament during my reporting period of 1 July 2013 to 30 June 2014. In relation to 168 of these 212 Bills, compatibility with children’s rights was not raised as an issue in the accompanying Statements of Compatibility with Human Rights or the PJCHR. The following comments relate to the remaining 44 Bills.

Children’s Rights Report 2014 • 33

2.1.1 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were promoted

10 Bills had accompanying Statements of Compatibility with Human Rights which stated children’s rights were promoted. The comments of the PJCHR about these 10 Bills did not always accord with the statement of compatibility.

The PJCHR commented that one of the Bills, the Migration Amendment (Regaining Control Over Australia’s Protection Obligations) Bill 2013, would limit children’s rights and the statement of compatibility did not justify how the limitation served a legitimate, rational and proportionate objective.4

In relation to three of the 10 Bills, the PJCHR commented that compatibility with human rights was unclear. The PJCHR sought further information from the relevant Member of Parliament about these three Bills.

Additional comments about the 10 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were promoted are included below.

Date of introduction Bill Additional comments

13/11/2013 Parliamentary

Proceedings Broadcasting Amendment Bill 2013

The Bill sought to relax restrictions prohibiting the re-broadcasting of Parliamentary proceedings, specifically to ensure that Parliamentary footage could be used for the purpose of satire or ridicule.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged and that the Bill promotes the right to freedom of expression ‘as it allows Parliamentary proceedings to be re-broadcast in a wider range of circumstances’.5

The PJCHR commented that the Bill did not appear to give rise to human rights concerns.6

The Senate referred the Bill for inquiry and report, to which the Australian Human Rights Commission submitted that:

…the re-broadcasting of parliamentary proceedings for the purposes of satire or ridicule fall within the right to freedom of expression protected by article 19 of the ICCPR. Any restrictions on the re-broadcasting of these proceedings must therefore be necessary and proportionate to the aims pursued by such restrictions. The Commission cannot envisage a sufficient justification for a blanket prohibition on re-broadcasting parliamentary proceedings for the purposes of satire or ridicule.7

34

Date of introduction Bill Additional comments

13/11/2013 (continued)

Parliamentary Proceedings Broadcasting Amendment Bill 2013

On 12 February 2014 the Senate Standing Committees on Environment and Communications reported that new resolutions relating to the broadcasting of Parliamentary proceedings were passed, and that the new resolutions no longer require Parliamentary footage not to be used for satire or ridicule.8 The Senate Committee recommended that the Bill not be passed.9

04/12/2013 Migration

Amendment (Regaining Control Over Australia’s Protection Obligations) Bill 2013

The Bill sought to repeal complementary protection provisions and reinstate administrative processes to deal with complementary protection claims.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted.

The PJCHR commented that the Bill engaged the rights of children and families, including the right of children to have their best interests taken as a primary consideration, the right to family reunification, the rights of children deprived of their family environment, and the rights of refugee children.10 The PJCHR further commented that the Bill would limit children’s rights.11 The PJCHR also commented that it had concerns about family and children’s rights due to the discretionary nature of the arrangements.12

The PJCHR commented that any limitation on rights must be justified by demonstrating that the Bill’s measures are aimed at achieving a legitimate objective, rationally connected to the objective, and proportionate to that objective.13 The PJCHR further commented that the Statement of Compatibility with Human Rights accompanying the Bill did not meet these requirements.14

The Senate referred the Bill for inquiry and report, to which the Australian Human Rights Commission submitted that:

• The repeal of the statutory complementary protection framework may lead to non-compliance with Australia’s non-refoulement obligations.

• If the complementary protection provisions are repealed, the Minister may apply a test in assessing applications for complementary protection that is inconsistent with Australia’s non-refoulement obligations.

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 35

Date of introduction Bill Additional comments

04/12/2013 (continued)

Migration Amendment (Regaining Control Over Australia’s Protection Obligations) Bill 2013

• Reliance on the Minister’s non-compellable discretionary powers is likely to lead to delays, inefficient processing of claims, and inconsistent decision making.15

The Australian Human Rights Commission recommended that the Bill not be passed.16

On 18 March 2014 the Senate Legal and Constitutional Affairs Legislation Committee recommended that the Bill be passed subject to the Department of Immigration and Border Protection releasing:

…consultation drafts of the guides and supporting material it intends to use as part of the administrative assessment of complementary protection claims if the Bill is passed and actively consults with stakeholders in finalising those guides and supporting materials.17

12/12/2013 Criminal Code

Amendment (Misrepresentation of Age to a Minor) Bill 2013

The Bill sought to make it a criminal offence for a person over 18 to intentionally misrepresent their age in online communications with someone they believe to be under the age of 18.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted.

The PJCHR commented that the measures contained in the Bill had previously been introduced in the 43rd Parliament.18 The PJCHR commented that the measures appear to limit the right to freedom of expression, the right to privacy, and possibly the right to freedom of association, but that these limitations were aimed at the legitimate objective of seeking to protect children.19

The PJCHR commented that it would seek further information from Senator Xenophon to clarify why it is necessary to have a separate offence of misrepresenting one’s age without an intention to commit an offence and how the Bill is compatible with the right to be presumed innocent.20

36

Date of introduction Bill Additional comments

12/12/2013 (continued)

Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill 2013

The Senate referred the Bill for inquiry and report, to which the Australian Human Rights Commission submitted that the Bill not be passed because:21

• The Bill would result in the duplication of existing offences.

• The Bill would criminalise behaviour which is not inherently criminal.

• The Bill’s protective purpose could alternatively be achieved through education and increasing public awareness, including through educating children and the general public about existing laws and penalties, and about risk detection and intervention.22

The Senate Legal and Constitutional Affairs Legislation Committee report is due on 4 December 2014.

27/02/2014 Fair Work

Amendment Bill 2014

The Bill sought to implement a number of recommendations made in the report of the Fair Work Act Review Panel in 2012.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted.

The PJCHR commented that it would seek further information from the Minister for Employment on whether the measures contained in the Bill are compatible with various rights, including the right to bargain collectively.23

06/03/2014 Social Security

Amendment (Caring for People on Newstart) Bill 2014

The Bill sought to provide additional financial assistance to Newstart and Youth Allowance recipients.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted.

The PJCHR commented that the general right to social security was promoted.24

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 37

Date of introduction Bill Additional comments

19/03/2014 Agricultural and

Veterinary Chemicals Legislation Amendment (Removing Re-approval and Re-registration) Bill 2014

The Bill sought to remove requirements for mandatory periodic re-registering of agvet chemicals.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted.

The PJCHR commented that the right to health may be limited to the extent that the reduced opportunity for evaluation of substances that may be unsafe or unhealthy may lead to adverse health impacts or environmental conditions.25

The PJCHR commented that it would seek further information from the Minister for Agriculture as to whether the removal of the re-registration requirement is compatible with the right to health and a healthy environment.26

19/03/2014 Classification

(Publications, Films and Computer Games) Amendment (Classification Tools and Other Measures) Bill 2014

The Bill sought to implement a number of recommendations of the Australian Law Reform Commission about the classification of films, computer games and other material.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted.

The PJCHR commented that the Bill did not appear to give rise to human rights concerns.27

26/05/2014 Australian Education

Amendment (School Funding Guarantee) Bill 2014

The Bill sought to require the Minister for Education to be satisfied that a state or territory will not reduce or has not reduced its education budget before federal school funding is provided to states and territories.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted.

The PJCHR commented that the Bill did not appear to give rise to human rights concerns.28

38

Date of introduction Bill Additional comments

26/05/2014 Migration

Amendment (Ending the Nation’s Shame) Bill 2014

The Bill sought to afford specific rights, which are currently denied under legislation, to non-citizens who travel to or are brought to Australia.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted and that the Bill would rectify current breaches of Australia’s obligations under the CRC.29

The PJCHR commented that the Bill did not appear to give rise to human rights concerns.30

18/06/2014 Migration

Amendment (Protecting Babies Born in Australia) Bill 2014

The Bill sought to ensure that a child who is born in Australia is not classified to have ‘entered Australia by sea’, and is therefore not an ‘unauthorised maritime arrival’ subject to transfer to Australia’s offshore detention centres.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were promoted and that the Bill positively engaged the right of the child to not be arbitrarily deprived of his or her liberty.31

The PJCHR commented that the Bill did not appear to give rise to human rights concerns.32

The Senate referred the Bill for inquiry and report, to which the Australian Human Rights Commission submitted that:

• The amendments proposed are consistent with article 37(b) of the CRC which provides that no child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time.33

The Australian Human Rights Commission recommended that the Bill be passed.34

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 39

2.1.2 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were not engaged and the PJCHR commented about potential incompatibility

Seven Bills had accompanying Statements of Compatibility with Human Rights which stated children’s rights were not engaged. The PJCHR commented on the potential incompatibility of the measures contained in the Bills with human rights, including the right to an adequate standard of living, the right to social security, the right to education, the right to be free from arbitrary detention, and the right to health. Some additional comments about these seven Bills are included below.

Date of introduction Bill Additional comments

13/11/2013 Minerals Resource

Rent Tax Repeal and Other Measures Bill 2013

The Bill sought to repeal the mineral resources rent tax.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented on the compatibility of measures relating to the superannuation guarantee and low-income superannuation contribution with the right to an adequate standard of living and the right to social security.35

The PJCHR further commented on whether measures to cease the income support bonus and schoolkids bonus would be compatible with human rights, given there may be a disproportionate impact on disadvantaged individuals, children and families experiencing hardship.36

The PJCHR commented that to demonstrate whether a limitation of human rights is permissible, legislation proponents must provide reasoned evidence-based explanations of why proposed measures are necessary in pursuit of a legitimate objective.37

21/11/2013 Higher Education

Support Amendment (Savings and Other Measures) Bill 2013

The Bill sought to remove the upfront payment discount and voluntary repayment bonus for HECS-HELP debts, and to reduce previously budgeted funding for universities by implementing an efficiency dividend.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that while it may be arguable that any retrogression or limitation on the right to education could be justifiable, without information about the context in which the decision was made and what choices were available to government, compatibility with human rights is not clear.38

40

Date of introduction Bill Additional comments

12/12/2013 Migration

Amendment Bill 2013

The Bill sought to make it a requirement for the grant of a protection visa that the applicant not be deemed a security risk by the Australian Security Intelligence Organisation.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that the Bill may give rise to human rights concerns if a refugee was deemed a security risk and indefinitely detained. 39

19/03/2014 Corporations

Amendment (Streamlining of Future of Financial Advice) Bill 2014

The Bill sought to reduce compliance costs imposed on the financial services industry.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that the measures contained in the Bill may give rise to human rights concerns and noted that the Bill is being considered by the Senate Finance and Public Administration Legislation Committee.40

19/03/2014 Independent

National Security Legislation Monitor Repeal Bill 2014

The Bill sought to abolish the Office of the Independent National Security Legislation Monitor (the Monitor).

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it is unable to conclude that the measures contained in the Bill would be compatible with human rights, given the Monitor’s role to oversee intelligence services and consider human rights obligations.41 The PJCHR further commented that it would give further consideration to the human rights compatibility of the Bill in the future.42

20/03/2014 Regulatory

Powers (Standard Provisions) Bill 2014

The Bill sought to establish a framework of standard monitoring and investigation powers for government regulators.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 41

Date of introduction Bill Additional comments

20/03/2014 (continued)

Regulatory Powers (Standard Provisions) Bill 2014

The PJCHR commented that it was unable to conclude that the measures in the Bill would be compatible with human rights because compatibility would depend on the application of the powers, which would require enacting legislation and therefore a case by case assessment of compatibility with human rights.43

15/05/2014 Australian National

Preventive Health Agency (Abolition) Bill 2014

The Bill sought to abolish the Australian National Preventive Health Agency (ANPHA) to remove overlapping responsibilities between it and the Department of Health.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that, while the purpose of the Bill is to better coordinate and re-allocate the activities of ANPHA, any consequent reduction in effective health activities could result in a limitation of the right to health.44

42

2.1.3 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were not engaged and the PJCHR sought further information

11 Bills had accompanying Statements of Compatibility with Human Rights which stated children’s rights were not engaged. The PJCHR commented that it sought further information from the relevant Member of Parliament about the Bills in order to assess compatibility with human rights. Further comments about these 11 Bills are included below.

Date of introduction Bill Additional comments

13/11/2013 Clean Energy

(Income Tax Rates and Other Amendments) Bill 2013

The Bill sought to repeal personal income tax cuts that were legislated to commence on 1 July 2015.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it sought further information from the Treasurer on whether the measures contained in the Bill are compatible with the right to an adequate standard of living.45

The PJCHR later commented that it was unable to assess whether the proposed changes would be compatible with human rights because insufficient information was provided about the impact of the measures contained in the Bill, particularly on those earning lower incomes.46

11/12/2013 Criminal Code

Amendment (Harming Australians) Bill 2013

The Bill sought to enable the retrospective application of new offences so that they would apply to acts which occur at any time, including before the commencement of the law.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it sought further information from Senator Xenophon as to whether the retrospective application of the measures contained in the Bill would be compatible with article 15 of the International Covenant on Civil and Political Rights.47

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 43

Date of introduction Bill Additional comments

12/12/2013 Tax Bonus for

Working Australians Repeal Bill 2013

The Bill sought to make sure that no further stimulus payments of $950 could be made by the Commissioner of Taxation.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that the right to social security and the right to an adequate standard of living may be engaged.48

The PJCHR commented that it sought further information from the Treasurer as to whether the measure would have a particular impact on vulnerable and marginalised groups on low incomes, and if so how the measure would be reasonable and proportionate to the government’s objective of managing and prioritising fiscal needs. 49

The PJCHR later commented that the further information from Treasury did not provide a detailed and evidence-based explanation justifying the measure.50

26/02/2014 Social Security

Legislation Amendment (Green Army Programme) Bill 2014

The Bill sought to prevent recipients of the Green Army allowance aged 17-24 years from receiving any other social security benefit or pension, and to legislate that participants would not be considered workers or employees for the purposes of various Commonwealth laws.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it would seek further information from the Minister for Social Services as to whether the measures contained in the Bill would be compatible with the general right to social security and the general right to work.51 52

44

Date of introduction Bill Additional comments

27/02/2014 Tertiary Education

Quality and Standards Agency Amendment Bill 2014

The Bill sought to implement recommendations arising from the Review of Higher Education Regulation in 2013, including the removal of the Tertiary Education Quality and Standards Agency’s (TEQSA) quality assessment function.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it would seek further information from the Minister for Education as to whether the measures contained in the Bill would be compatible with the right to education and how quality standards in tertiary education will continue to be maintained in the absence of the quality assessment function.53

19/03/2014 Australian Charities

and Not-for-profits Commission (Repeal) (No. 1) Bill 2014

The Bill sought to repeal the Australian Charities and Not-for-profits Commission, but not until a second Bill would be enacted to replace the Commission.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it is unable to assess the human rights compatibility of the Bill until the second Bill is introduced with the details of arrangements replacing the Commission.54

19/03/2014 Paid Parental Leave

Amendment Bill 2014

The Bill sought to remove the requirement for employers to provide government-funded parental leave pay to their eligible long-term employees as employees would be paid directly by the Department of Human Services.55

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it sought further information from the Minister for Small Business as to whether the measures contained in the Bill would be compatible with the rights of children in relation to family life under article 8 of the CRC.56

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 45

Date of introduction Bill Additional comments

27/03/2014 Live Animal

Export (Slaughter) Prohibition Bill 2014

The Bill sought to prohibit the export of live-stock for slaughter.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that prohibiting export may have an adverse impact on employment opportunities in certain Australian industries.57 The PJCHR further commented that it sought further information from Senator Rhiannon as to whether the measures contained in the Bill would be compatible with the rights to work and rights at work.58

27/03/2014 Student Identifiers

Bill 2014

The Bill sought to introduce a unique student identifier for individuals undertaking nationally recognised vocational education and training.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that it sought further information from the Minister for Education as to the compatibility of the measures contained in the Bill with the right to privacy.59

29/05/2014 Australian

Citizenship Amendment (Intercountry Adoption) Bill 2014

The Bill sought to extend citizenship rights to children who are adopted in Australia from countries that are not party to the Hague Convention on the Protection of Children and Co-operation in Respect of Intercountry Adoption (the Hague Convention).

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that the Hague Convention establishes a common regime, including minimum standards and appropriate safeguards, for ensuring that intercountry adoptions are performed in the best interests of the child, with a focus on combatting the sale of children and human trafficking. 60

46

Date of introduction Bill Additional comments

29/05/2014 (continued)

Australian Citizenship Amendment (Intercountry Adoption) Bill 2014

The PJCHR commented that the Bill seeks to allow the acquisition of Australian citizenship by a person adopted outside of Australia by an Australian citizen in accordance with a bilateral arrangement between Australia and another country.61

The PJCHR further commented that the Bill does not specify what standards or safeguards, like those provided for in the Hague Convention, would apply to intercountry adoptions under a bilateral agreement.62

The PJCHR commented that it sought further information from the Minister for Immigration and Border Protection as to whether the measures contained in the Bill would be compatible with the child’s right to have their best interests taken as a primary consideration and the specific protections for intercountry adoptions contained in article 21 of the CRC and the Hague Convention.63

04/06/2014 Trade Support

Loans Bill 2014

The Bill sought to introduce a voluntary loan scheme for concessional income-contingent loans of up to $20,000 over four years to certain apprentices.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were not engaged.

The PJCHR commented that because the Bill would replace the existing ‘Tools for Your Trade Program’, the PJCHR expected that the Bill would provide an assessment of whether the repeal of those arrangements may limit or remove human rights protections.64 The PJCHR commented that it sought further information from the Minister for Industry as to whether the measures contained in the Bill would be compatible with the general right to education.65

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 47

2.1.4 Bills with accompanying Statements of Compatibility with Human Rights which stated children’s rights were engaged and any limitation was reasonable and proportionate

Eight Bills had accompanying Statements of Compatibility with Human Rights which stated children’s rights were engaged and any limitation was reasonable and proportionate. The PJCHR commented that it sought further information from the relevant Member of Parliament about the measures contained in the Bills in order to assess compatibility with human rights. Additional comments about these eight Bills are included below.

Date of introduction Bill Additional comments

20/11/2013 Social Services and

Other Legislation Amendment Bill 2013

The Bill sought to amend a range of social security measures, including child care rebate payments, family tax benefits, child support amendments, and amendments to payments relating to the birth of a baby.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged, including the right to social security recognised in article 26 of the CRC, but that any limitation on children’s rights was reasonable and proportionate.66

The PJCHR commented that it would seek further information from the Minister for Social Services on whether the measures contained in the Bill that would limit the right to social security were for a legitimate objective, rationally connected to that objective and proportional.67

The PJCHR also commented that details and justifications of any potential limitations on human rights should be provided in accordance with the framework adopted by the PJCHR, and that general assurances of reasonableness and proportionality are inadequate.68

27/03/2014 Migration Legislation

Amendment Bill (No. 1) 2014

The Bill sought to prevent individuals from applying for a further visa if a previous application has been refused, even if the first and subsequent application was made by a minor, which is defined as a person under 18 years of age.69

The Statement of Compatibility with Human Rights which accompanied the Bill stated the child’s right to have their best interests taken as a primary consideration and the child’s right to live with their parents was engaged, and that the Bill is consistent with Australia’s non-refoulement obligations in relation to minors.70

48

Date of introduction Bill Additional comments

27/03/2014 (continued)

Migration Legislation Amendment Bill (No. 1) 2014

The PJCHR commented that the Bill could result in a breach of Australia’s non-refoulement obligations,71 and limit the right of the child to an effective remedy.72 The PJCHR commented that the Bill should be amended to provide for an independent merits review of decisions to deny subsequent protection visa applications by children under 18 years of age.73

The PJCHR also commented that it sought further information from the Minister for Immigration and Border Protection as to whether the measures contained in the Bill would be compatible with the obligation to consider the best interests of the child,74 the right of the child to contribute to, or be heard in, judicial and administrative proceedings,75 and the right to equality and non-discrimination.76

05/06/2014 Family Assistance

Legislation Amendment (Child Care Measures) Bill 2014

The Bill sought to maintain the indexation pause on the child care rebate limit and the current child care benefit income thresholds.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged.

The PJCHR commented that it sought further information from the Minister for Education as to whether the measures contained in the Bill would be compatible with the right to social security, the right to an adequate standard of living and the right to work.77

18/06/2014 Social Services and

Other Legislation Amendment (2014 Budget Measures No. 1) Bill 2014

The Bill sought to change a number of Australian Government payments, including student payments and certain family tax benefit payments.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged.

The PJCHR commented that it sought further information from the Minister for Social Services as to whether the measures contained in the Bill would be compatible with the right to equality and non-discrimination,78 the right to social security,79 and the right to an adequate standard of living.80

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 49

Date of introduction Bill Additional comments

18/06/2014 Social Services and

Other Legislation Amendment (2014 Budget Measures No. 2) Bill 2014

The Bill sought to change a number of social security payments, including student payments, relocation scholarship assistance for students and family tax benefits.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged.

The PJCHR commented that it sought further information from the Minister for Social Services as to whether the measures contained in the Bill would be compatible with the right to social security, the right to an adequate standard of living and the right to education.81

23/06/2014 Minerals Resource

Rent Tax Repeal and Other Measures Bill 2013 [No. 2]

The Bill sought to repeal a number of measures including the schoolkids bonus.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged.

The PJCHR commented that it sought further information from the Treasurer as to whether the measures contained in the Bill would be compatible with the general right to social security and the right to an adequate standard of living.82

25/06/2014 Family Assistance

Legislation Amendment (Child Care Measures) Bill (No. 2) 2014

The Bill sought to maintain the current child care benefit income thresholds, rather than have them increase.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged.

The PJCHR commented that it sought further information from the Minister for Education as to whether the measures contained in the Bill would be compatible with the right to social security, the right to an adequate standard of living and the right to work.83

50

Date of introduction Bill Additional comments

25/06/2014 Migration

Amendment (Protection and Other Measures) Bill 2014

The Bill sought to introduce a range of new measures affecting the rights of asylum seekers.

The Statement of Compatibility with Human Rights accompanying the Bill stated children’s rights were engaged.

The PJCHR commented that it sought further information from the Minister for Immigration and Border Protection as to the compatibility of the following measures contained in the Bill with human rights:

• Making it the responsibility of asylum seekers to ‘specify all particulars of his or her claim’ and ‘to provide sufficient evidence to establish the claim’,84 and the interaction of this measure with the right to equality and non-discrimination,85 and the child’s right to have their best interests taken as a primary consideration.86

• Restricting applications for protection visas to members of the same family unit, and its interaction with the child’s right to have their best interests taken as a primary consideration.87

• Measures potentially restricting the right to a fair trial and fair hearing rights.88

The PJCHR commented that the following measures contained in the Bill are likely to be incompatible with human rights, including the child’s right to have their best interests taken as a primary consideration:

• Requiring the Refugee Review Tribunal to draw an unfavourable inference with regard to evidence or claims raised at the review stage.89 90

91

• Power to refuse visa applications for failure to establish identity, nationality or citizenship.92 93

• Further barriers to permanent protection.94

The PJCHR also commented that introducing a stricter test for determining Australia’s protection obligations would likely be incompatible with human rights and Australia’s non-refoulement obligations.95

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 51

2.1.5 Bills with accompanying Statements of Compatibility with Human Rights which contested the requirement to provide a human rights impact assessment

Eight Bills were appropriations bills and sought to authorise government expenditure from the Consolidated Revenue Fund to give effect to government policy. The eight Bills had accompanying Statements of Compatibility with Human Rights which contested the requirement to provide a human rights impact assessment. The PJCHR acknowledged that the Minister for Finance holds the view that it is not practical or appropriate to provide a human rights impact assessment for appropriations bills.96 The PJCHR commented that ‘where there is a sufficiently close connection between a particular appropriations bill and the implementation of legislation, policy or programs that may give rise to human rights compatibility issues, the statement of compatibility for that bill should provide an assessment of human rights that may be engaged’.97

Date of introduction Bill Additional comments

13/02/2014 Appropriation

(Parliamentary Departments) Bill (No. 2) 2013-2014

The Bills sought to authorise government expenditure from the Consolidated Revenue Fund to give effect to government policy.

The PJCHR commented that it sought further information from the Minister for Finance as to whether the current budgetary processes expressly take account of human rights factors, and the PJCHR commented that the Minister for Finance advised that:

The approach of requiring human rights impact assessment to be incorporated in portfolio budget statements, suggested in your committee’s report, is also neither practicable nor appropriate.

This is also true in relation to whether complex budgetary processes can expressly take account of human rights factors. Taking that approach would entrench an extensive drafting exercise and the need to obtain detailed assessments from all agencies across the Australian Government.

That said, however, the budgetary processes do, by their nature, require an assessment of all factors that might relate to the relevant policies, including environmental, legal, economic, social and moral factors. Human rights factors are also part of these many factors taken into account.98

The PJCHR commented that it welcomes the opportunity to continue to progress towards practical and substantive human rights assessments of appropriations bills.99

13/02/2014 Appropriation Bill

(No. 3) 2013-2014

13/02/2014 Appropriation Bill

(No. 4) 2013-2014

52

Date of introduction Bill Additional comments

13/05/2014 Appropriation

(Parliamentary Departments) Bill (No. 1) 2014-2015

The Bills sought to authorise government expenditure from the Consolidated Revenue Fund to give effect to government policy.

The Statement of Compatibility with Human Rights which accompanied the Bills stated ‘Appropriation Acts do not create rights and nor do they, importantly, impose any duties’.100

The PJCHR commented that ‘where there is sufficiently close connection between a particular appropriations bill and the implementation of legislation, policy or programs that may give rise to human rights compatibility issues, the statement of compatibility for that bill should provide an assessment of human rights that may be engaged’.101

The PJCHR also commented that it acknowledges that ‘the Minister for Finance holds the view that appropriations bills present particular difficulties given their technical nature, and because they generally include appropriations for a wide range of programs and activities across many portfolios’.102

13/05/2014 Appropriation Bill

(No. 2) 2014-2015

13/05/2014 Appropriation Bill

(No. 5) 2013-2014

13/05/2014 Appropriation Bill

(No. 6) 2013-2014

2.2 Conclusion The PJCHR expects a statement of compatibility to provide a detailed and evidence-based explanation of the impact a Bill may have on human rights.103 The PJCHR sought further information from the relevant Member of Parliament about the compatibility of 22 Bills with human rights. The PJCHR sought further information because the accompanying statement of compatibility did not clearly meet the PJCHR’s assessment expectations of human rights compatibility, namely:

• Whether the proposed changes in the Bill are aimed at achieving a legitimate objective. • Whether there is a rational connection between the possible limitation of human rights and that objective. • Whether the possible limitation of human rights is a reasonable and proportionate measure for

the achievement of that objective.104

For example, on 29 May 2014 the Prime Minister, the Hon Tony Abbott MP, introduced to Parliament the Australian Citizenship Amendment (Inter-country Adoption) Bill 2014 (Cth). The purpose of the Bill is to extend citizenship rights to a person adopted outside Australia by an Australian citizen under a bilateral arrangement between Australia and other countries that are not party to the Hague Convention on the Protection of Children and Co-operation in Respect of Inter-country Adoption (the Hague Convention).

The Statement of Compatibility with Human Rights accompanying the Bill did not raise compatibility with children’s rights as an issue. The PJCHR commented that this assessment was ‘based on an unduly restricted view of both the scope of Australia’s human rights obligations, and the circumstances in which they apply’ given the specific protections for children in relation to inter-country adoption under article 21 of the CRC. 105

Chapter 2: Examining whether Commonwealth legislation recognises and protects child rights

Children’s Rights Report 2014 • 53

The PJCHR commented that it sought further information from the Minister for Immigration and Border Protection as to whether the Bill is compatible with the best interests of the child and the specific protections for inter-country adoption under article 21 of the CRC and the Hague Convention.106 I note that on 17 June 2014 the Senate referred the Bill for inquiry, and on 27 August 2014 the Senate Standing Committee on Legal and Constitutional Affairs made the following recommendations:

Recommendation 1: The Committee recommends, subject to the two subsequent recommendations, that the Bill be passed.

Recommendation 2: The Committee recommends that the child protection principles set out in the Hague Convention, particularly the overarching requirement that the best interests of the child be the paramount consideration in inter-country adoption processes, be explicitly articulated in Australia’s bilateral arrangements and, where relevant, in the related legislation and regulations.

Recommendation 3: While not directly relevant to the Committee’s terms of reference, the Committee strongly urges Commonwealth, state and territory governments to ensure that adequate resourcing and priority is provided for follow up monitoring and support to ensure that it fully addresses Australia’s obligations to adoptees throughout the adoption cycle, regardless of whether adoptions take place under the Hague Convention or under bilateral arrangements.107

The PJCHR later commented that the Bill is likely to be incompatible with Australia’s international human rights obligations under the CRC, and that the further information provided by the Minister for Immigration and Border Protection was insufficient to support a conclusion that the Bill is compatible with article 21 of the CRC.108

This example highlights the need for parliamentarians to consider children’s rights in the early stages of policy and law making processes. Bills introduced to Parliament concerning children’s lives must contain a detailed and evidence-based assessment of how children’s rights will be affected. The PJCHR was effective in its role to scrutinise the Bill for compatibility with Australia’s international human rights obligations. Ultimately, the Senate Committee took the PJCHR’s comments into account and recommended that the principles set out in the Hague Convention and the requirement for the child’s best interests to be the paramount consideration be included in bilateral arrangements for inter-country adoption and related legislation.

I strongly encourage all parliamentarians to prioritise and meaningfully assess the compatibility of the Bills that they introduce to Parliament with the rights of children and young people.

54

1 Human Rights (Parliamentary Scrutiny) Act 2011 (Cth), section 3(1). 2 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/AUS/CO/4 (2012), para 4(a). At http://www2.ohchr.org/english/bodies/crc/docs/co/CRC_C_AUS_CO_4.pdf (viewed 30 July 2014). 3 Committee on the Rights of the Child, Concluding observations: Australia, UN Doc CRC/C/AUS/CO/4 (2012), para 4(a).

At http://www2.ohchr.org/english/bodies/crc/docs/co/CRC_C_AUS_CO_4.pdf (viewed 30 July 2014). 4 PJCHR, 4th Report, 3-6 March 2014, p 54-55, 58, 61-62. 5 PJCHR, 1st Report, 12 November-5 December 2013, p 80. 6 PJCHR, 1st Report, 12 November-5 December 2013, p 80. 7 Australian Human Rights Commission, Senate Environment and Communications Legislation Committee, December 2013, p 3.

At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Environment_and_Communications/Parliamentary_ Proceedings_Broadcasting_Amendment_Bill_2013/Submissions (viewed 25 July 2014). 8 Senate Standing Committees on Environment and Communications, Parliamentary Proceedings Broadcasting Amendment Bill 2013, p 3. At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Environment_and_Communications/

Parliamentary_Proceedings_Broadcasting_Amendment_Bill_2013/Report/index (viewed 28 July 2014). 9 Senate Standing Committees on Environment and Communications, Parliamentary Proceedings Broadcasting Amendment Bill 2013, p 3. At http://www.aph.gov.au/DocumentStore.ashx?id=a15b1ad8-0084-4763-a6ff-f580709e703d&subId=31824

(viewed 28 July 2014). 10 PJCHR, 4th Report, 3-6 March 2014, p 52. 11 PJCHR, 4th Report, 3-6 March 2014, p 53. 12 PJCHR, 4th Report, 3-6 March 2014, p 62. 13 PJCHR, 4th Report, 3-6 March 2014, p 54-55, 58, 61-62. 14 PJCHR, 4th Report, 3-6 March 2014, p 54-55, 58, 61-62. 15 Australian Human Rights Commission, Submission to the Senate Legal and Constitutional Affairs Legislation Committee, January

2014, p 4. At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/Mirgration_ Amendment_bill/Submissions (viewed 25 July 2014). 16 Australian Human Rights Commission, Submission to the Senate Legal and Constitutional Affairs Legislation Committee, January 2014, p 3. At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/Mirgration_

Amendment_bill/Submissions (viewed 28 July 2014). 17 Senate Legal and Constitutional Affairs Legislation Committee, Migration Amendment (Regaining Control Over Australia’s Protection Obligations) Bill 2013 [Provisions], pages 16 and 18. At http://www.aph.gov.au/Parliamentary_Business/Committees/

Senate/Legal_and_Constitutional_Affairs/Mirgration_Amendment_bill/Report/index (viewed 28 July 2014). 18 PJCHR 2nd Report, 9-12 December 2013, p 37. 19 PJCHR 2nd Report, 9-12 December 2013, p 37-38. 20 PJCHR 2nd Report, 9-12 December 2013, p 38. 21 Australian Human Rights Commission, Submission to the Senate Legal and Constitutional Affairs Legislation Committee,

February 2014, p 5. At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/ Criminal_Code_Amendment_Misrepresentation_of_Age_to_a_Minor_Bill_2013/Submissions (viewed 28 July 2014). 22 Australian Human Rights Commission, Submission to the Senate Legal and Constitutional Affairs Legislation Committee, February 2014, p 5. At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/

Criminal_Code_Amendment_Misrepresentation_of_Age_to_a_Minor_Bill_2013/Submissions (viewed 28 July 2014). 23 PJCHR, 7th Report, 13-29 May 2014, p 26. 24 PJCHR, 4th Report, 3-6 March 2014, p 32. 25 PJCHR, 8th Report, 2-19 June 2014, p 59. 26 PJCHR, 8th Report, 2-19 June 2014, p 59. 27 PJCHR, 5th Report, 17-20 March 2014, p 27. 28 PJCHR, 7th Report, 13-29 May 2014, p 3. 29 Explanatory Memorandum, Migration Amendment (Ending the Nation’s Shame) Bill 2014 (Cth), 2. 30 PJCHR, 7th Report, 13-29 May 2014, p 29. 31 Explanatory Memorandum, Migration Amendment (Protecting Babies Born in Australia) Bill 2014 (Cth), 3. 32 PJCHR, 8th Report, 2-19 June 2014, p 22. 33 Australian Human Rights Commission, Submission to the Senate Standing Committee on Legal and Constitutional Affairs,

August 2104, p 3. At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/ Protecting_Babies/Submissions (viewed 19 September 2014). 34 Australian Human Rights Commission, Submission to the Senate Standing Committee on Legal and Constitutional Affairs, August 2104, p 3. At http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/

Protecting_Babies/Submissions (viewed 19 September 2014). 35 PJCHR, 8th Report, 2-19 June 2014, p 51. 36 PJCHR, 8th Report, 2-19 June 2014, p 52. 37 PJCHR, 8th Report, 2-19 June 2014, p 53. 38 PJCHR, 3rd Report, 11-27 February 2014, p 60. 39 PJCHR 2nd Report, 9-12 December 2013, p 75. 40 PJCHR, 5th Report, 17-20 March 2014, p 44.

Chapter 2: Endnotes

Children’s Rights Report 2014 • 55

41 PJCHR, 8th Report, 2-19 June 2014, p 44. 42 PJCHR, 8th Report, 2-19 June 2014, p 44. 43 PJCHR, 5th Report, 17-20 March 2014, p 20. 44 PJCHR, 7th Report, 13-29 May 2014, p 4. 45 PJCHR, 8th Report, 2-19 June 2014, p 34. 46 PJCHR, 8th Report, 2-19 June 2014, p 34. 47 PJCHR, 4th Report, 3-6 March 2014, p 40. 48 PJCHR 2nd Report, 9-12 December 2013, p 78. 49 PJCHR 2nd Report, 9-12 December 2013, p 77. 50 PJCHR, 8th Report, 2-19 June 2014, p 59. 51 PJCHR, 3rd Report, 11-27 February 2014, p 12. 52 PJCHR, 3rd Report, 11-27 February 2014, p 13. 53 PJCHR, 3rd Report, 11-27 February 2014, p28. 54 PJCHR, 5th Report, 17-20 March 2014, p 2. 55 PJCHR, 8th Report, 2-19 June 2014, p 54. 56 PJCHR, 5th Report, 17-20 March 2014, p 14. 57 PJCHR, 6th Report, 24-27 March 2014, p 19. 58 PJCHR, 6th Report, 24-27 March 2014, p 19. 59 PJCHR, 7th Report, 13-29 May 2014, p 56. 60 PJCHR, 8th Report, 2-19 June 2014, p 9. 61 PJCHR, 8th Report, 2-19 June 2014, p 8. 62 PJCHR, 8th Report, 2-19 June 2014, p 10. 63 PJCHR, 8th Report, 2-19 June 2014, p 10. 64 PJCHR, 9th Report, 23-26 June 2014, p 101. 65 PJCHR, 9th Report, 23-26 June 2014, p 101. 66 PJCHR, 1st Report, 12 November-5 December 2013, p 63. 67 PJCHR, 1st Report, 12 November-5 December 2013, p 57. 68 PJCHR, 1st Report, 12 November-5 December 2013, p 68. 69 Migration Act 1958 (Cth) s 5 (definition of “minor”). 70 Explanatory Memorandum, Migration Legislation Amendment Bill (No. 1) 2014 (Cth),12-15. 71 PJCHR, 7th Report, 13-29 May 2014, p 32. 72 PJCHR, 7th Report, 13-29 May 2014, p 33. 73 PJCHR, 7th Report, 13-29 May 2014, p 34. 74 PJCHR, 7th Report, 13-29 May 2014, p 37. 75 PJCHR, 7th Report, 13-29 May 2014, p 38. 76 PJCHR, 7th Report, 13-29 May 2014, p 41. 77 PJCHR, 8th Report, 2-19 June 2014, p 18-21. 78 PJCHR, 9th Report, 23-26 June 2014, p 72. 79 PJCHR, 9th Report, 23-26 June 2014, p 76,-78, 80-81, 86. 80 PJCHR, 9th Report, 23-26 June 2014, p 76-78, 80-81. 81 PJCHR, 9th Report, 23-26 June 2014, p 83-99. 82 PJCHR, 9th Report, 23-26 June 2014, p 62. 83 PJCHR, 9th Report, 23-26 June 2014, p 31-33. 84 PJCHR, 9th Report, 23-26 June 2014, p 39, para 1.178. 85 PJCHR, 9th Report, 23-26 June 2014, p 53, para 1.247. 86 PJCHR, 9th Report, 23-26 June 2014, p 47, para 1.217. 87 PJCHR, 9th Report, 23-26 June 2014, p 50, para 1.232. 88 PJCHR, 9th Report, 23-26 June 2014, p 55, para 1.255. 89 PJCHR, 9th Report, 23-26 June 2014, p 44, para 1.199. 90 PJCHR, 9th Report, 23-26 June 2014, p 54, para 1.250. 91 PJCHR, 9th Report, 23-26 June 2014, p 48, para 1.223. 92 PJCHR, 9th Report, 23-26 June 2014, p 46, para 1.208. 93 PJCHR, 9th Report, 23-26 June 2014, p 49, para 1.227. 94 PJCHR, 9th Report, 23-26 June 2014, p 51, para 1.237. 95 PJCHR, 9th Report, 23-26 June 2014, p 43, para 1.193. 96 PJCHR, 8th Report, 2-19 June 2014, p 32. 97 PJCHR, 8th Report, 2-19 June 2014, p 33. 98 PJCHR, 8th Report, 2-19 June 2014, p 6. 99 PJCHR, 8th Report, 2-19 June 2014, p 7. 100 PJCHR, 8th Report, 2-19 June 2014, p 7. 101 PJCHR, 8th Report, 2-19 June 2014, p 7. 102 PJCHR, 8th Report, 2-19 June 2014, p 7.

56

103 Parliamentary Joint Committee on Human Rights, Parliament of Australia, Practice Note 1 (2012), p 2. At http://www.aph.gov.au/ Parliamentary_Business/Committees/Joint/Human_Rights/Guidance_Notes_and_Resources (viewed 30 July 2014). 104 Parliamentary Joint Committee on Human Rights, Parliament of Australia, Practice Note 1 (2012), p 2. At http://www.aph.gov.au/ Parliamentary_Business/Committees/Joint/Human_Rights/Guidance_Notes_and_Resources (viewed 30 July 2014). 105 PJCHR, 8th Report, 2-19 June 2014, p 10. 106 PJCHR, 8th Report, 2-19 June 2014, p 10. 107 Senate Standing Committee on Legal and Constitutional Affairs, Parliament of Australia, Report on the Australian Citizenship

Amendment (Intercountry Adoption) Bill 2014 (2014), p vii. At http://www.aph.gov.au/Parliamentary_Business/Committees/ Senate/Legal_and_Constitutional_Affairs/Intercountry_Adoption_Bill/Report (viewed 29 August 2014). 108 PJCHR, 10th Report, 7-17 July 2014, p 143.

Chapter 2: Endnotes

58

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age 58

Children’s Rights Report 2014 • 59

A selection of photos from roundtables throughout Australia about intentional self-harm, with or without suicidal intent

60

Section 46MB(1)(c) of the Australian Human Rights Commission Act 1986 (Cth) (the AHRC Act) provides that the National Children’s Commissioner may:

...undertake research, or educational or other programs, for the purpose of promoting respect for the human rights of children in Australia, and promoting the enjoyment and exercise of human rights by children in Australia.

Utilising this function, I have examined intentional self-harm and suicidal behaviour in children and young people aged 0-17 years.

Intentional self-harm and suicidal behaviour in children and young people is a serious issue in Australia and overseas.1 2

Too many precious young lives are lost or damaged by intentional self-harm and suicide. It has profound impacts on families and communities, both at the time and for many years on.

When one member of a family is distressed, the whole family feels pain.

Family members can react in different ways to a child or young person in this situation, including feelings of despair, anger, guilt, shame, sadness and grief.

Families have told me they want to be able to do more to help their children in distress, and children and young people want to be able to reach out to people they trust, including family members. I hope that by conducting this examination I have gone some way to highlighting what is happening for our children and young people, and to shine a light on the kinds of supports children, young people and families need to better prevent and respond to intentional self-harm with or without suicidal intent.

3.1 What do we know about intentional self-harm, with or without suicidal intent, in children and young people? The Australian Bureau of Statistics (ABS) has reported that intentional self-harm is the leading cause of death among Australian children and young people aged 15-24 years,3 with 214 deaths by males and 110 by females in 2012.4

For those aged 15-19 years, intentional self-harm accounted for 21.9% of deaths in males5 and 32.6% in females.6 Six males7 and eight females8 under 15 years of age died due to intentional self-harm.

Prior to 2013, ABS had not separately published data about deaths due to intentional self-harm in children and young people under 15 years of age.

Work conducted in the United Kingdom in 2004,9 and cited by headspace, the National Youth Mental Health Foundation,10 estimates that the number of children and young people who have engaged in intentional self-harm is between 40-100 times greater than the number of children and young people who die due to intentional self-harm.

Given the estimated level of non-suicidal self-harm in children and young people, it is concerning that our surveillance systems may not be detecting the actual number of children and young people engaging in this behaviour.

The Australian Institute of Health and Welfare (AIHW) has reported that, in 2011-12, intentional self-harm was the cause of 2,855 hospital separations for males aged 15-24 years.11 In the same time period, there were 7,154 hospital separations involving females aged 15-24 years.12 There were 690 hospital separations due to intentional self-harm for females aged 5-14 years.13 No data was provided for males.14

Children’s Rights Report 2014 • 61

A separation is defined as an episode of care for an admitted patient. 15 An admitted patient completes an episode of care either by being discharged, dying, transferring to another hospital or changing type of care.16 In the remainder of this report, separations are referred to as hospitalisations.

In 2013, Kids Helpline, Australia’s national telephone crisis and counselling service for those aged 5-25 years, facilitated 9,649 counselling sessions with children and young people who were assessed by the counsellor as having current thoughts of suicide.17 Kids Helpline also responded to 15,948 contacts from children and young people aged 5-25 years who were assessed to have self-injury and self-harming behaviour.18

Research suggests that a growing number of children and young people are engaging in intentional self-harm and are not seeking help.19 20 However, the extent and cause of this poor help-seeking behaviour is unknown.

It is clear that some children and young people are disproportionately affected by intentional self-harm and suicidal behaviour.

These groups include Aboriginal and Torres Strait Islander children and young people, children and young people who are sexuality diverse, transgender, gender diverse and intersex, children and young people in out-of-home care, children and young people with disability, children and young people from culturally and linguistically diverse backgrounds, and children and young people living in rural and remote areas of Australia.

The ABS reports that Aboriginal and Torres Strait Islander males and females aged 15-24 years were 5.2 times more likely to die due to intentional self-harm than other children and young people in the same age range.21 22 The AIHW reports that 60 Aboriginal and Torres Strait Islander children and young people under 18 years of age died due to intentional self-harm during the period 2007-2011, compared to 143 non-Indigenous children and young people.23

The AIHW notes that this data only includes New South Wales, Queensland, Western Australia, South Australia and the Northern Territory as only these five jurisdictions are considered to have adequate identification of Indigenous deaths in their registration systems for the reporting period.24 Since 2010, the Close the Gap Campaign Steering Committee has reported there is lack of reliable data in some areas to show whether the gap in Indigenous health and life expectancy is closing.25

During 2013, I attended the launch of the report, Growing Up Queer, released by the Young and Well Cooperative Research Centre.26 This report identified intentional self-harm and suicide as a significant issue for children and young people who are sexuality diverse, transgender, gender diverse and intersex.27

1,032 children and young people aged 16-23 years participated in an online national survey as part of this report. 41% of participants had thought about self-harm and/or suicide, 33% had harmed themselves, and 16% had attempted suicide.28

At 30 June 2013, there were 40,549 children and young people in out-of-home care in Australia.29 Of these, 13,952 were Aboriginal and Torres Strait Islander children and young people.30 Research suggests there are higher rates of intentional self-harm and suicidal behaviour for children and young people in out-of-home care compared to the general population.

One Australian study involving 326 children and young people aged 6-17 years living in home-based foster care, found that 6.7% of the 13-17 year old children and young people reported a suicide attempt that required medical treatment within the last 12 months.31

Children and young people with disability can also be at an increased risk of intentional self-harm and suicidal behaviour. A US study found that 30-64% of children and young people with an intellectual disability develop comorbid mental health disorders, a rate of around 3-4 times that of their peers, including higher rates of depression, anxiety and psychosis.32 Children and young people with co-occurring chronic physical and mental health conditions are also said to have higher probabilities of self-harm, suicidal ideation, and suicide attempts when compared with healthy peers.33 Research also suggests an association between chronic pain and suicidality in children and young people.34

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Children and young people from culturally and linguistically diverse backgrounds are described as being particularly vulnerable. While there is limited data about the prevalence of intentional self-harm and suicidal behaviour within multicultural communities, the stresses of migration, settlement in a new country and low language proficiency can increase mood and anxiety disorders. 35

Children and young people in rural and remote areas of Australia experience unique challenges. Ratios for death due to intentional self-harm among young men are particularly high, with some estimates finding that it occurs at almost twice the rate as in metropolitan areas.36 37

According to Suicide Prevention Australia, underemployment, lack of infrastructure, including health and education services, restricted social and career opportunities, drought, and cultural stoicism may contribute to the distress of young people in rural Australia.38 Children and young people with mental health needs often experience a lack of services and access to information in rural Australia.39

3.2 An identified need for further investigation Reflecting on what was known about intentional self-harm and suicidal behaviour in children and young people in Australia, I became acutely aware of the gaps in our knowledge base.

Disaggregated data, at a national level, is generally not available for children and young people, under the age of 18 years, who are engaging in intentional self-harm and suicidal behaviour. The ABS, AIHW and Kids Helpline publish national data using broad age ranges: 5-14 years; 5-24 years; and 15-25 years.

These age ranges combine data about children and young people who are functioning at different developmental stages. The two later age ranges also mix those who are legally defined as minors with those who are legally defined as adults. The circumstances facing those under 18 years of age and those over 18 years of age vary considerably.

Additionally, the age ranges do not align with the 0-17 year age range used in reporting by the child death review bodies across the different jurisdictions.

In my 2013 report to Parliament, I outlined the paucity of data in Australia about the wellbeing of children and young in a range of critical domains. The dearth of information in the area of intentional self-harm and suicidal behaviour has implications for policy development, the design of interventions and for the evaluation of the effectiveness of these interventions.

As far back as February 2010, the National Committee for Standardised Reporting on Suicide recognised that suicide statistics in Australia were characterised by underreporting and inconsistency across the regions.40 In 2010 they stated that inadequate data about suicide:

has implications for policy development, monitoring and evaluation and can lead to misinformed and misdirected prevention, intervention and postvention activities. Critically for suicide prevention initiatives, this may result in inadequate resource allocation and neglect of at-risk groups and regions.41

Four years later, little appears to have changed with respect to the availability of disaggregated data relating to Australian children and young people engaging in intentional self-harm and suicidal behaviour.

The United Nations Committee on the Rights of the Child specifically asks for disaggregated data on the death of children and young people under 18 years of age who die due to intentional self-harm.42 As a party to the Convention on the Rights of the Child (CRC), Australia provides periodic reports to the Committee on the Rights of the Child every five years. These periodic reports examine how Australia is meeting its obligations under the CRC. Australia is due to provide its next periodic report to the Committee on the Rights of the Child in 2018.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

young

people

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Since 2010, two inquiries into suicide have been conducted at the national level:

• Senate Inquiry: The Hidden Toll: Suicide in Australia (2010)43 • House of Representatives Inquiry into Early Intervention Programs aimed at Reducing Youth Suicide (2011).44

Other reports have been published at state and territory levels,45 46 including those prepared by the various child death review bodies that regularly review the deaths of all children and young people in their jurisdictions.

While acknowledging the value of these inquiries and reports, I was conscious that children and young people, and their advocates, had specifically raised issues relating to intentional self-harm and suicidal behaviour with me during my national listening tour in 2013. They asked me to examine, at a national level, how the human rights of children and young people engaging in intentional self-harm and suicidal behaviour could be better protected.

Intentional self-harm and suicidal behaviour in children and young people was also brought to my attention through the Australian Human Rights Commission (the Commission) BackMeUp competitions, which were run in 2012 and 2013. The BackMeUp competitions asked children and young people to create videos that promoted bystander action to combat cyberbullying. Some entries alluded to intentional self-harm and suicidal behaviour. The Commission’s guidelines for the competition clearly stated that videos including depictions of methods of self-harm would not be uploaded for public viewing, consistent with advice provided by headspace. Where this occurred, children and young people were referred to mental health support hotlines.

The Commission reported in its 2013 Snapshot Report, Asylum seekers, refugees and human rights, that between 1 January 2013 and 14 August 2013, there were 50 incidents of actual self-harm and 49 incidents of threatened self-harm at Pontville Alternative Place of Detention involving unaccompanied minors.47 I visited those children and young people held in Pontvillle Alternative Place of Detention in April 2013. I am pleased that Pontville Alternative Place of Detention has since been closed. However, I am aware of reports of intentional self-harm by children and young people in other Australian immigration detention facilities.

For the reasons that I have outlined, and consistent with my statutory function under section 46MB1(c) of the AHRC Act, I decided to undertake a national examination.

3.3 Why is intentional self-harm, with or without suicidal intent, a child rights issue? Intentional self-harm and suicidal behaviour relates to Australia’s obligations under the CRC:

Article 6(1) States Parties recognise that every child has the inherent right to life.

Article 6(2) States Parties shall ensure to the maximum extent possible the survival and development of the child.

Article 19 States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.

Such protective measures should, as appropriate, include effective procedures for the establishment of social programmes to provide necessary support for the child and for those who have the care of the child, as well as for other forms of prevention and for identification, reporting, referral, investigation, treatment and follow-up of instances of child maltreatment described heretofore, and, as appropriate, for judicial involvement.

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Article 23(1) States Parties recognise that a mentally or physically disabled child should enjoy a full and decent life, in conditions, which ensure dignity, promote self-reliance and facilitate the child’s active participation in the community.

Article 24(1) States Parties recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.

Article 25 States Parties recognise the right of a child who has been placed by the competent authorities for the purposes of care, protection or treatment of his or her physical or mental health, to a periodic review of the treatment provided to the child and all other circumstances relevant to his or her placement.

Associated with intentional self-harm and suicidal behaviour are experiences of homelessness; imprisonment; substance misuse; physical and mental health problems; out-of-home care; child abuse and neglect; domestic violence; peer victimisation; increased rates of family breakdown; and sexual abuse.48 These experiences are connected with breaches of other children’s rights, including:

Article 27(1) State Parties recognise the right of every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development.

Article 33 States Parties shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances.

Article 37 States Parties shall ensure that:

(a) No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment. Neither capital punishment nor life imprisonment without possibility of release shall be imposed for offences committed by persons below eighteen years of age;

(b) No child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time;

(c) Every child deprived of liberty shall be treated with humanity and respect for the inherent dignity of the human person, and in a manner, which takes into account the needs of persons of his or her age. In particular, every child deprived of liberty shall be separated from adults unless it is considered in the child’s best interest not to do so and shall have the right to maintain contact with his or her family through correspondence and visits, save in exceptional circumstances;

(d) Every child deprived of his or her liberty shall have the right to prompt access to legal and other appropriate assistance, as well as the right to challenge the legality of the deprivation of his or her liberty before a court or other competent, independent and impartial authority, and to a prompt decision on any such action.

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Article 39 States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment, which fosters the health, self-respect and dignity of the child.

The United Nations Committee on the Rights of the Child issues General Comments on specific articles of the CRC, which provide an interpretation of children’s rights.

General Comment No. 13 on the Right of the Child to Freedom from all Forms of Violence makes specific reference to suicide and self-harm as health consequences resulting from exposure to violence and maltreatment.49

General Comment No. 13 includes self-inflicted injuries, suicidal thoughts, suicide attempts and actual suicide in its definition of self-harm. 50

In General Comment No. 13 the Committee on the Rights of the Child indicates that suicide among adolescents is of particular concern to it.51 It argues that counselling support should be available to children and young people who are engaging in self-harm, including 24-hour toll-free child helplines with trained personnel.52 It specifies that all interventions must be supportive and not punitive in any way. 53 The United Nations guidelines for periodic reports to the Committee on the Rights of the Child specifically asks for information on measures taken to prevent suicide and other relevant issues affecting the right to life, survival and development of children and young people.54

3.4 How I conducted my examination Over a six month period, I ran national consultations, with a public submission process, roundtables, analysis of key data, and engagement with children and young people at risk through supported processes.

Overview

140 written submissions were received from individuals, government, private and non-government organisations (see Appendix 5).

12 roundtables were held and 154 people participated (see Appendix 6).

There were nine individual consultations (see Appendix 7).

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3.4.1 Data requests

Death and hospitalisation data are a significant and important input to health and social policy formulation, planning, research and analysis.55 56

National data about death and hospitalisations due to intentional self-harm are collected by ABS and AIHW respectively. The National Coronial Information System (NCIS) is an electronic database of coronial information that contains case details from coronial files of most states and territories since 1 July 2000. Queensland coronial files were made available from 1 January 2001. The function of NCIS is to develop and maintain a high quality information service for coroners, policy makers and researchers to benefit the community by contributing to a reduction in preventable death and injury.57

As part of my investigation into intentional self-harm and suicidal behaviour, I sourced data from NCIS, ABS and AIHW. I was charged on a cost recovery basis for all data.

The NCIS agreed to provide data by six age ranges: 0-3 years; 4-9 years; 10-11 years; 12-13 years; 14-15 years; and 16-17 years. This data was disaggregated by Indigenous status, state or territory of residence, mechanism of intentional self-harm and incident location of intentional self-harm. The NCIS also provided data about the time when the incident of intentional self-harm was recorded to have occurred.

The ABS agreed to provide data by two age ranges: 5-14 years and 15-17 years. This data was disaggregated by sex, state and territory of residence and mechanism of intentional self-harm. The ABS also provided data about all children and young people aged 5-17 years disaggregated by Indigenous status and area of usual residence by capital city and the remainder of the state or territory.

The AIHW agreed to provide data by three age ranges: 3-9 years; 10-14 years; and 15-17 years. This data was disaggregated by sex, area of usual residence by major cities, regional Australia and remote Australia, mechanism of intentional self-harm and incident location of intentional self-harm. The AIHW also provided data about all children and young people aged 3-17 years disaggregated by Indigenous status and socioeconomic status by area of residence.

3.4.2 Accessing the experiences of children and young people

Hearing directly from children and young people about their experiences is critical to my work. In the case of this examination, I wanted to hear from children and young people in a way that was safe and did not traumatise them in any way. I accessed the voices and stories of children and young people affected by intentional self-harm and suicidal behaviour through partnerships with organisations working directly with them as this was the safest, most confidential and sensitive way of hearing from children and young people.

Through these partnerships, a number of children and young people provided me with their stories directly. I have included some of their stories throughout this chapter. Some were over 18 years of age and were no longer engaging in intentional self-harm or suicidal behaviour. Parents and carers of children and young people also told me their stories through their submissions.

I wish to thank the courageous children and young people, and their families, who shared their stories with me.

The Kids Helpline supplied me with a detailed report of 6,703 contacts from children and young people aged 5-17 years, who directly stated that suicide was their main concern. The Kids Helpline also reported 4,380 contacts from children and young people who directly stated that self-injury and self-harm was their main concern. These contacts were made during 2012 and 2013.

In addition to this, Kids Helpline gave me a qualitative analysis of 50 contact notes for counselling provided to children and young people in relation to suicide issues, and 84 contact notes for counselling provided in relation to self-injury and self-harm issues.

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The Kids Helpline submission stated that:

Given the importance of these issues to Australian children, this organisation has prepared a detailed analysis of its experiences in supporting children to both inform the National Children’s Commissioner’s deliberations and to ensure that the voice of young people is heard.58

Data provided in the Kids Helpline submission is based on the experiences and views of children and young people who are actively seeking help. This contrasts with most other data sources that report on children and young people who are either in recovery, hospitalised or who have died due to intentional self-harm.

I sincerely thank Ms Tracy Adams, Chief Executive Officer, and Mr John Dalgleish, Manager of Strategy and Research, at Kids Helpline for generously providing this data about children and young people aged 0-17 years. It is my hope that this previously unpublished data may be used by researchers and policy makers to better support the rights of children and young people engaging in intentional self-harm and suicidal behaviour.

With respect to engaging with the views of children and young people, I am pleased to report that Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) has recently included items of suicidal behaviour and non-suicidal self-harm in its survey completed by children and young people. The LSAC has followed the development of 10,000 children, young people and families from all parts of Australia since 2004. The questions that it asks are provided in Table 1. The LSAC told me that it views these questions as critically important and intends to continue to include them in future waves of LSAC.59

Table 1: Questions asked by Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC)

Sometimes people feel like hurting themselves.

1. During the past 12 months have you…

a. thought about hurting yourself on purpose in any way? (e.g. by taking an overdose of pills, or by cutting or burning yourself)? b. hurt yourself on purpose in any way (e.g. by taking an overdose of pills, or by cutting or burning yourself)?

2. During the past 12 months did you…

a. ever seriously consider attempting suicide? b. make a plan about how you would attempt suicide?

3. During the past 12 months, how many times did you actually attempt suicide?

0. 0 times 1. 1 time 2. 2 or 3 times 3. 4 or 5 times 4. 6 or more times

Did any attempt result in an injury, poisoning or overdose that had to be treated by a doctor or nurse? 

1. Yes 2. No

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Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) which includes two groups of Aboriginal and/or Torres Strait Islander children who were aged 6 to 18 months (B cohort) and 3½-5 years (K cohort) when the study began in 2008, informed me that its Steering committee is currently considering questions on self-harm and suicide ideation to be included in its future work.

The LSIC explained that the questions are planned for its K cohort when the children are 11 years old. It informed me that some parents and carers who have been interviewed in previous years have mentioned suicide when asked about life events. The LSIC indicated that it was especially interested in protective factors and in exploring prevention strategies and the development of coping skills.  Additionally, LSIC told me that it was concerned about contagion and it would be trying to ensure that it had some questions about happenings at a community level.60

The work being conducted by LSAC and LSIC is commendable and their recent efforts in the area of suicidal behaviour and non-suicidal self-harm have the potential to contribute much to an area where too much remains unknown.

3.4.3 Call for written submissions

On 22 April 2014, I called for written submissions from individuals, government, private and non-government organisations about some key areas of interest. These included:

• Why children and young people engage in intentional self-harm and suicidal behaviour.

• The incidence and factors contributing to contagion and clustering involving children and young people.

• The barriers which prevent children and young people from seeking help.

• The conditions necessary to collect comprehensive information, which can be reported in a regular and timely way and used to inform policy, programs and practice. This may include consideration of the role of Australian Government agencies, such as the Australian Bureau of Statistics and the Australian Institute of Health and Welfare.

• The impediments to the accurate identification and recording of intentional self-harm and suicide in children and young people, the consequences of this, and suggestions for reform.

• The benefit of a national child death and injury database, and a national reporting function.

• The types of programs and practices that effectively target and support children and young people who are engaging in the range of intentional self-harm and suicidal behaviours. Submissions about specific groups are encouraged, including children and young people who are Aboriginal and Torres Strait Islanders, those who are living in regional and remote communities, those who are gender variant and sexuality diverse, those from culturally diverse backgrounds, those living with disabilities, and refugee children and young people seeking asylum. De-identified case studies are welcome.

• The feasibility and effectiveness of conducting public education campaigns aimed at reducing the number of children who engage in intentional self-harm and suicidal behaviour.

• The role, management and utilisation of digital technologies and media in preventing and responding to intentional self-harm and suicidal behaviour among children and young people.

I received 140 written submissions, which are listed in Appendix 5. The submissions can be viewed online at https://www.humanrights.gov.au/publications/childrens-rights-report-2014.

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I thank everyone who took the time to make a written submission.

3.4.4 Roundtables and individual consultations

From 13 May 2014 to 11 September 2014, I held roundtables with experts in intentional self-harm and suicidal behaviour in all capital cities across Australia. I also held a roundtable in Alice Springs. In addition, I conducted two targeted roundtables; one focused on data and research issues and the other on Aboriginal and Torres Strait Islander children and young people.

The Aboriginal and Torres Strait Islander Social Justice Commissioner, Mr Mick Gooda, co-chaired the roundtable that focused on Aboriginal and Torres Strait Islander children and young people. Commissioner Gooda also co-chaired the roundtables that were held in Western Australia and the Northern Territory. The contribution made by Commissioner Gooda enabled Aboriginal and Torres Strait Islander people to have a strong presence in my roundtables. I sincerely thank Commissioner Gooda for his invaluable support.

I also held a roundtable with the Royal Children’s Hospital Mental Health Community Reference Group. I thank Mr Harry Gelber OAM for facilitating this opportunity.

In order to stimulate discussion, up to two experts presented at each roundtable. I would like to thank all those who presented. Appendix 6 includes a list of participants and expert presenters who attended the national roundtables.

I had 9 consultations with individuals. These are included in Appendix 7.

I would like to thank all those who participated in roundtables and individual consultations.

I would also like to acknowledge the significant contribution made by DLA Piper in hosting a number of my roundtables and transcribing the discussions that took place. Appendix 8 includes a list of DLA Piper staff who participated in this investigation.

Additionally, I would like to thank those State and Territory Children’s Commissioners/Guardians who hosted some of my roundtables and who participated in my examination.

Staff at the Commission worked tirelessly throughout, and in particular I wish to thank Dr Susan Nicolson, Mr Loki Ball and Ms Jennifer Ross.

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My examination of intentional self-harm and suicidal behaviour in children and young people aged between 0-17 years was welcomed by a cross-section of government and non-government bodies as well as academics and individuals.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Jesuit Social Services: What has been missing is sustained political will and community understanding and commitment to tackling this important issue. We welcome this Commissioner’s inquiry and hope that it leads to meaningful and sustained action to prevent further unthinkable tragedies from occurring.

National LGBTI Health Alliance is pleased to make a submission on intentional self-harm and suicidal behaviour in children and young people. We appreciate the explicit inclusion of young people of all sexual orientations and genders in this investigation. We also encourage the future inclusion of intersex children and young people in such investigations.

Hunter Institute of Mental Health believes this review is an important step towards preventing self-harm and suicidal behaviour in children and young people.

Australian Bureau of Statistics continues to seek opportunities to enhance the availability and content of relevant data which supports suicide prevention work, and values the opportunity to make a submission to the National Children’s Commissioner’s examination of how children and young people under the age of 18 years can be better protected from intentional self-harm and suicidal behaviour.

Royal Australian and New Zealand College of Psychiatrists (RANZCP) welcomes the opportunity to provide feedback into the National Children’s Commissioner’s examination into intentional self-harm and suicidal behaviour among children under 18 years. The RANZCP welcomes this inquiry particularly in view of the release of recent statistics that suicide continues to be a leading cause of death among children and young people.

Northern Territory Council of Social Services welcomes the opportunity to contribute to the National Children’s Commissioner’s examination of intentional self-harm and suicidal behaviour in children. We welcome the opportunity to comment on this distressing subject, and are heartened that the National Children’s Commissioner considers this as a matter of great importance.

Youth Affairs Council of WA (YACWA) is thankful for the opportunity to submit to this critically important examination. Self-harm and suicide is at epidemic levels in Australia, with mental health illness impacting greatly throughout our communities. However, these are not at all new phenomena, with many inquiries and reports conducted both at a state, national and international level. Without immediate action, we will continue to see the lives of many young people in Australia lost as stigma, lack of services and a lack of funding prevent them from accessing help. The true impact of this examination will not be in the revealing of new information, but in the changes we see to the lives of young people at risk of self-harm and suicidal behaviour, through change to the way we support their needs.

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3.5 Key findings My primary finding is that too much continues to be unknown and this is impeding us from predicting and preventing injury and death in children and young people due to intentional self-harm.

Despite previous inquiries, efforts relating to children and young people in this area are fragmented and lack a sound evidence base. In relation to suicidal behaviour, the Australian National Coalition for Suicide Prevention stated:

We do not have a clear picture of suicide in this country and until we have access to that information we are limited in how we can affect change.61

The picture about intentional self-harm is even less clear.

Establishing a national research agenda for children and young people in the area of intentional self-harm and suicidal behaviour could serve as a focus and a means to coordinate some of the excellent work already being undertaken by those in this field.

3.5.1 Definitional challenges and research considerations

Many different terms are used to define intentional self-harm and suicidal behaviour. It is evident that:

there is no uniform set of terms, definitions, and classifications for the range of thoughts, communications, and behaviours that are related to self-injurious behaviours, with or without the intent to die.62

The distinctions between the terms used are not well understood, are not agreed upon, and are not clear.

For example, some use the term self-harm broadly and do not differentiate between self-harm with suicidal intent, non-suicidal self-injury and self-harm episodes with unclear intent.63 They argue that:

suicidal intent is fluid and its assessment remains unreliable and that a professional judgement about suicidal intent may be different from that stated by the young person.64

Some of those who hold this view maintain:

self-harm in adolescents is likely to be associated with a spectrum of suicidal and purely non-suicidal groups at each end of the spectrum and the majority of adolescents reporting mixed or unstable intent.65

While others distinguish intentional self-harm with suicidal intent from intentional self-harm without suicidal intent, the definitions used vary and so the reliability and validity of findings are compromised. 66 Research from the UK and Europe tends to use the broader definition while research from the US is inclined to differentiate between them.67

At this point, I would like to highlight the fact that some submissions and participants in the roundtables used the term ‘self-harm’ when referring to ‘non-suicidal self-harm’ and used the term ‘suicidal behaviour’ when referring to ‘self-harm with suicidal intent’. Others used the term ‘self-harm’ to include ‘self-harm with suicidal intent’ as well as ‘self-harm without suicidal intent’. Some substituted the term ‘self-harm’ with the term ‘self-injury’.

These definitional issues present significant challenges for those working in the field. For example, researchers cannot easily compare their study populations and research findings and clinicians have difficulty in translating research findings into practical applications. 68

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Professor Nock, an eminent researcher in this area, points out that:

over the past several years, there has been a great deal of discussion, and some debate, in the scientific and clinical community regarding what terms we should use to describe self-harm behaviours and how we should define them…future efforts are needed to operationalise these constructs even more clearly and specifically. 69

In Australia and internationally, many professionals use the American Diagnostic and Statistical Manual of Mental Disorders (DSM)70 as the authoritative guide71 for diagnosing mental disorders, including for children and young people. In 2013, the fifth revision of the DSM included, ‘Suicidal Behaviour Disorder’ and ‘Non-suicidal Self-Injury’ as conditions for further study.

The proposed criteria are provided in Table 2. It is argued that using these common definitions and criteria could:

increase the reliability and validity of findings from the studies in the area… increase consistency across studies and…further facilitate research progress.72

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Table 2: Criteria proposed by American Diagnostic and Statistical Manual of Mental Disorders-5

Proposed Criteria for Suicidal Behavior Disorder73

A. Within the last 23 months, the individual has made a suicide attempt. Note: A suicide attempt is a self-initiated sequence of behaviors by an individual who, at the time of initiation, expected that the set of actions would lead to his or her own death. The “time of initiation” is the time when a behavior took place that involved applying the method.

B. The act does not meet criteria for non-suicidal self-injury - that is, it does not involve self-injury directed to the surface of the body undertaken to induce relief from a negative feeling/cognitive state or to achieve a positive mood state.

C. The diagnosis is not applied to suicidal ideation or to preparatory acts. D. The act was not initiated during a state of delirium or confusion. E. The act was not undertaken solely for a political or religious objective.

Specify if:

Current: Not more than 12 months since the last attempt. In early remission: 12-24 months since the last attempt.

Proposed Criteria for Non-suicidal Self-Injury74

D. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent). Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the individual’s repeated engagement in a behavior that the individual knows, or has learned, is not likely to result in death.

E. The individual engages in the self-injurious behavior with one or more of the following expectations:

1. To obtain relief from a negative feeling or cognitive state. 2. To resolve an interpersonal difficulty. 3. To induce a positive feeling state.

Note: The desired relief or response is experienced during or shortly after the self-injury, and the individual may display patterns of behavior suggesting a dependence on repeatedly engaging in it.

C. The intentional self-injury is associated with at least one of the following:

1. Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act. 2. Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control. 3. Thinking about self-injury that occurs frequently, even when it is not acted upon.

D. The behavior is not socially sanctioned (e.g., body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting.

E. The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning.

F. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (e.g., psychotic disorder, autism spectrum disorder, intellectual disability, Lesch-Nyhan syndrome, stereotypic movement disorder with self-injury, trichotillomania [hair-pulling disorder], excoriation [skin-picking] disorder).

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When the DSM-5 was raised in the context of my roundtables, some misgivings were expressed. This related to the categorical approach taken in the DSM-5 and the narrowness of the proposed criteria and its cut-off points, with the end result being that ‘you either have it or you don’t’.

In the roundtables, there was clearly a preference for a more dimensional approach to diagnostic classification where clinicians are not restricted by such concrete thresholds.

This view has been gradually gaining international momentum in the area of psychiatry where:

after decades of categorical approaches to psychiatric disorder through the DSM, science is considering a shift toward integrating new dimensional applications with the current categorical approaches.75

To some extent, the DSM-5 has recognised this shift and while all disorders remain in categories, it has, for some disorders on a spectrum, added measures related to degrees of severity.76 The degree to which the DSM-5 has done this for its proposed criteria for Suicidal Behavior Disorder and Non-suicidal Self-Injury appears questionable.

While apprehensive about the proposed criteria provided in the DSM-5, the participants at roundtables and many who made submissions were clearly of the view that it was important to examine non-suicidal self-harm as a condition outside of a suicide perspective.

Conceptually this separation has been difficult in the past given that the risk of suicide in adolescents has been shown to increase by approximately 10-fold where there is a history of intentional self-harm, with or without suicidal intent.77

However, as pointed out in the submission made by the Royal Australasian College of Physicians, ‘not all self-harm is related to suicide risk’.78

The Hunter Institute of Mental Health makes the important point that:

self-harm and suicide are distinct and separate acts. However the relationship between the two is complex… Self-harm is different from suicidal behaviour, but some people who self-harm are also suicidal or can become suicidal.79

The Rosemount Good Shepherd Youth and Family Services submission emphasises the need to clearly differentiate between non-suicidal self-harm and suicidal behaviour.80 The Phoenix Centre reinforces this in its submission when it states:

it is essential that stakeholders have a shared understanding of terminology. Self-harm and suicidal behaviour are phenomena with differing characteristics. Confusion arises when “self-harm” and “suicide” are used synonymously.81

The NSW Department of Education and Communities notes that:

a range of behaviours and motivations (including ambiguous motivations) are captured by the terms “intentional self-harm” and “suicidal behaviour” and this confounds agreement on the reasons why children and young people may engage in this type of behaviour.82

The Youth Affairs Council of Western Australia told me:

the reasons why young people engage in self-harm and suicidal behaviour are complex. It is important that we recognise differences between the two behaviours.83

The Australian Psychological Society argued:

it is critical to define the two terms. Specifically, one must understand whether a young person engages in these types of behaviours with the intent to die (suicidal intent) or whether the behaviour serves a different purpose.84

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 75

headspace pointed out:

the terms “intentional self-harm” and “suicidal behaviour” are not consistently defined within the literature, and are therefore not necessarily understood in the same way across different contexts or service settings. headspace views the difference between self-harm and suicidal behaviour as the intent behind the behaviours. In the vast majority of cases, self-harm is a strategy used to cope with underlying distress and not a suicide attempt.85

The Child and Youth Mental Health Service, Children’s Health Queensland Hospital argued:

there can be confusion regarding the overlap between the concepts of self-harm and suicide, let alone what they each constitute. If there is to be more accurate identification and recording of these behaviours, it would be helpful to promote a shared understanding of their scope across sectors supporting children and young people.86

International researchers in this area, Muehlenlamp, Claes, Havertape and Plener assert that:

essential qualitative and phenomelogical differences do distinguish suicidal from non-suicidal self-injurious behaviour so continuing to differentiate self-injury with and without suicidal intent is essential to building precise understandings of these behaviours as well as how non-suicidal self-injurious behaviours relate to and influence suicidality. 87

Clearly these definitional issues must be resolved. Addressing definitional issues should form an essential part of any national research agenda that is focused on children and young people who are engaging in non-suicidal self-harm and suicidal behaviour.

It was pointed out to me that conducting research in the area of suicidal behaviour and non-suicidal self-harm has challenges that are not present when conducting research in other areas such as depression, anxiety or psychosis. It is possible in these other areas to directly observe the symptoms in real-time whereas it is not possible to do this for suicidal behaviour and non-suicidal self-harm.88

Information is usually collected retrospectively. Some argue ‘future research is needed to capture such thoughts and behaviours and study the individuals as they actually occur in real-time’.89 With advancing technology, this may be possible.

To some extent the information collected online and over the phone by Kids Helpline is already moving towards this. As pointed out by Child Helpline International:

Child helplines provide children with unique opportunities to express their thoughts, feelings, and needs and to seek help in their own terms, without fear or inhibition. Trusted by children, child helplines help to keep children safe and to receive respect, nurturance and support. They do this through their own direct responses and by using the knowledge given to them by children to advocate on their behalf.90

Another issue raised with me was the dearth of research that actually involved the direct participation of children and young people.

There is a perception that it is unsafe to include children and young people engaging in non-suicidal self-harm and suicidal behaviour in research about them. This often leads to their exclusion from research studies.91 This exclusion is based on the belief that it can lead to increased risk.

However, as Orygen Youth Health Research Centre emphasised to me, recent studies:

have demonstrated that participation in research related to suicide prevention appears to have no iatrogenic effects among participants. Therefore continuing to build an evidence base specifically relating to the safety of engaging young people in research is an important step towards overcoming the current absence of evidence.92

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Many submissions also raised the need for youth friendly services that have the resources, skills and capacity to respond to children and young people engaging in non-suicidal self-injury and suicidal behaviour.93

headspace pointed out the need for:

a youth friendly approach that prioritises young people’s participation in their own treatment as well as in service development and quality improvement.94

It is important that future research develops better knowledge about how to provide youth friendly services, and services are evaluated in terms of their accessibility to children and young people.

Summary - definitional challenges

There is inconsistent use of terms and definitions relating to intentional self-harm with or without suicidal intent. The distinctions between the terms used are not well understood, are not agreed upon, and are not clear. Researchers cannot easily compare their study populations and research findings, and clinicians have difficulty in translating research findings into practical applications.

It is necessary to distinguish between non-suicidal self-harm and suicidal behaviour. Non-suicidal self-harm is different to suicidal behaviour. Differentiating between them is essential to building precise understandings about them.

Directly involving children and young people in research about intentional self-harm, with or without suicidal intent, is essential.

3.5.2 Why do children and young people engage in non-suicidal self-harm and suicidal behaviour?

Death due intentional self-harm

In my examination there was a significant focus on suicidal behaviour. This is consistent with international research, which indicates, ‘the vast majority of research on self-injurious behaviours has focused on suicidal, rather than non-suicidal, self-injury’.95 As a result, we have some ‘valuable data on the epidemiology of suicidal behaviours’.96

Many of the submissions outlined the distal risk factors for suicidal behaviour in children and young people. Distal factors are those that predispose a child or young person to risk. These included:

• mental health problems • alcohol and drug abuse • child abuse, including physical and sexual abuse • adverse family experiences, including poverty, domestic violence, parent with alcohol or drug

dependency, parent in gaol, parent with a mental illness, person known to the child who died due to intentional self-harm • previous suicide attempt(s) • communicated suicidal intent • intentional self-harm, with or without suicidal intent.97

As we know, the different forms of child abuse, including sexual, physical, emotional, neglect, and family and domestic violence, can co-occur and be cumulative in nature.98 Cumulative harm ‘is experienced by a child as a result of a series or pattern of harmful events and experiences that may be historical, or ongoing, with the strong possibility of the risk factors being multiple, inter-related and co-existing over critical developmental periods’.99

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 77

The vulnerability and consequent need for assessment is increased for children and young people who are exposed to multiple risk factors and who experience a lack of key protective factors.100

Specific concerns about the relationship between domestic and family violence and suicidal behaviour were brought to my attention at roundtables and through the submissions.

The Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council told me that data collected over the past three years in the NPY region of Central Australia showed that, ‘domestic and family violence is the most significant factor that is contributing to these incidents, along with prior exposure to suicide in close family members’.101

The National Children’s and Youth Law Centre identified domestic violence in all reported suicide attempts to its service in the last 18 months.102 The NSW Government submission specifically called for further exploration of this possible risk factor.103

The submission made by Orygen Youth Health Research Centre reasoned that proximal risk factors are often the ‘tipping point’ for those who are exposed to one or more distal risk factors. They suggested that:

these can include negative or adverse life events including relationship difficulties, interpersonal losses or conflict with parents or peers, bullying (including cyberbullying), substance abuse, availability of means, excessive worrying or rumination and certain types of media reporting.104

The Young and Well Cooperative Research Centre reinforced this in its submission, stating that:

the act of suicide and indeed suicidal behaviour is complex and is often the result of a culmination of individual-socio-environmental-genetic risk factors coupled with adversity across the lifespan.105

It was made clear to me that the understanding of these risk factors was predominantly based on research with older adolescents, with only limited research about suicidal behaviour in pre-pubertal children.106

This leaves the differences between children and adolescents who die due to intentional self-harm less well understood.

As understanding is central to prevention, it is necessary to know if children and adolescents who die due to intentional self-harm share common risk factors or whether their risk factors are different.107 This also applies to non-suicidal self-harm.

Intentional self-harm, without suicidal intent

In terms of non-suicidal self-harm, Bentley, Nock and Barlow maintain:

despite growing interest in this perplexing phenomenon, much remains unknown about why non-suicidal self injury occurs, including fundamental features of its etiology and underlying mechanisms. In addition, no evidence-based interventions that directly target this maladaptive behavior currently exist.108

Submissions provided to me and those participating in the roundtables held similar views and voiced the need for more research in this particular area.

The submission by the Young and Well Cooperative Research Centre explained how:

[the] reasons for intentional self-harm are not well understood and clinical expertise often describes self-harming behaviour in the context of self-management, that is it can be used as a tool for escape, a way to transfer mental frustrations into physical manifestations, a coping mechanism for feelings of failure or guilt, or simply as a way for people to “feel again”.109

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Orygen Youth Health Research Centre made the point that ‘longitudinal evidence is lacking and caution should be exercised when interpreting the risk factors associated with self-harm’.110

Others, while recognising this, offered their understandings of possible risk factors.

For example, the Rosemount Good Shepherd Youth and Family Services submission posited that non-suicidal self-harm provides temporary release from intense feelings such as anxiety, depression, stress, emotional numbness, sense of failure, self-loathing, low self-esteem and perfectionism.111

beyondblue stated that:

many young people describe self-harm as a way of coping with feeling numb or intense pain, distress or unbearable negative feelings, thoughts or memories. They are trying to change how they feel by replacing their emotional pain or pressure with physical pain. Some people harm themselves because they feel alone, and hurting themselves is the only way they feel real or connected; while others self-harm to punish themselves due to feelings of guilt or shame or to “feel again”. Some young people who self-harm are experiencing depression and/or anxiety.112

The NSW Department of Family and Community Services suggested:

self-harm is often used to try and control difficult and overwhelming feelings or to gain some kind of relief from emotional pain. It may also be used to express anger, to feel “something” (if you’re feeling numb) or to communicate a need for help. People who self-harm may have been experiencing a range of problems such as difficulty getting along with family members or friends, feeling isolated or bullied by someone, a relationship break-up, current or past physical, sexual or emotional abuse or neglect, loss of someone close such as a parent, sibling or friend and/or serious or ongoing illness or physical pain.113

The Kids Helpline analysed the case notes of 84 randomly selected online and phone contacts from children and young people under 18 years of age who contacted the service between May 2013 and May 2014. Of the 84 contacts, all were coded as engaging in current self-injury and self-harm or wanting assistance with their self-injuring and self-harming behaviour. The analysis of the case notes revealed a range of situational risk factors with emotional distress being the most common, followed by diagnosed mental and physical health concerns.114 The results of the thematic analysis are outlined in Table 3.

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Children’s Rights Report 2014 • 79

Table 3: Thematic analysis of immediate concerns - current self-injury and self-harm in young people under 18 years of age May 2013 to May 2014115

Situational risk factors of young people who contact Kids Helpline with issues of current self-injury and self-harm Online contacts

Phone contacts

Emotional distress (overwhelmed, confusion, existential concerns, feeling unloved, lonely, not coping with change, anger issues, current suicidal thoughts, past suicide attempts, or past suicidal ideation)

46.5% 35%

Diagnosed mental and physical health concerns 22% 28%

Grief and loss (such as death of family member, end of a friendship or other relationship) 8% 14%

Physical/emotional abuse (including sexual abuse, child abuse, bullying) 12% 7%

Family conflict (including breakdown in relationship with parents/ siblings, extended family, parents separating, father living away from home/country)

8% 10%

School pressures 3%

Body image issues (weight, weight gain) 2.5% 3%

As my examination of the issues progressed, I became increasingly aware that while there is a growing body of knowledge about the risk factors that increase the likelihood of suicidal behaviour and non-suicidal self-injury, ‘much less is known about how or why they do so’.116

Jesuit Social Services pointed out in its submission to me ‘there have been relatively few explanations for how these complex risk factors interact’.117 For example, we do not know whether non-suicidal self-harm develops as a result of multiple interrelated risk factors or only one or two predominant vulnerabilities, or whether specific combinations of risk factors can accurately predict non-suicidal self-harming behaviour. 118

Understanding the multiplicity of risk factors for intentional self-harming and suicidal behaviour in children and young people is central to effectively targeting and supporting them.119

Building knowledge about this must be a focus of future research. This ‘will help us to start to make sense of the many risk factors that have been identified, and will yield the most clinically useful information’. 120

It is important to point out that the nature of the research conducted will have to change to do this. Currently, ‘most studies examine bivariate, linear associations between individual risk factors and self-harm’.121 Research that simultaneously considers multiple risk factors is required.122

While many submissions and discussions at my roundtables focused on risk factors, there was also some dialogue about protective factors and how risk factors can be moderated by the presence of protective factors.123

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There are a range of protective factors associated with reducing non-suicidal self-harm and suicidal behaviour, including:

• parent connectedness • connections to other non-parental adults • closeness to caring friends • academic achievement • school safety • neighbourhood safety • awareness of and access to local health services.124 125

The Kids Helpline provided me with some of its data on protective factors for children and young people engaging in self-injury and self-harm. It analysed protective factors identified by children and young people between May 2013 and May 2014. These children and young people identified the importance of ‘support received from health professionals, school staff, family and friends’.126 The Kids Helpline emphasised that ‘the involvement of others in assisting the young person to manage their self-injury and self-harm is a significant protective factor’. 127

While the identification of protective factors is valuable, it is essential to better understand the impact of the different protective factors, how they are interrelated, whether some are more predominant than others, or whether specific combinations offer more protection.

Consistent with the issues relating to risk factors, there is little empirical evidence about this. Exploration of these issues should form part of a research agenda that pertains specifically to children and young people.

Summary - why do children and young people engage in non-suicidal self-harm and suicidal behaviour?

Research has predominantly focused on intentional self-harm with suicidal intent compared with non-suicidal self-harm. As a result, we know more about intentional self-harm with suicidal intent leading to death than we do about non-suicidal self-harm.

Risk and protective factors are identified for both. These are primarily based on research involving older adolescents. It is necessary to know if children and young people share common risk factors, or whether their risk factors are the same.

Research is required to improve understanding of the impact of different risk and protective factors, how they are interrelated, whether some are more predominant than others, or whether specific combinations offer more protection.

Domestic and family violence was raised as a risk factor requiring further research.

3.5.3 Clusters and contagion

Throughout my examination, I asked about the incidence and factors contributing to clustering and contagion involving children and young people.

Participants at the roundtables and those who made submissions commented on the inconsistent uses of, and definitions of, the terms ‘contagion’ and ‘clustering’ across the field.

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Children’s Rights Report 2014 • 81

The Child Death and Serious Injury Review Committee South Australia asserted in its submission that:

If epidemiologically robust answers to questions about clustering and contagion are sought, then definitions of what is meant by clustering and contagion need to be provided.128

It seems the terms are often used loosely with little attention given to the different meanings that can be attached and associated with them.

It was also made clear to me that the issues of contagion and clustering for death due to intentional self-harm and non-suicidal self-harm should be treated separately.

(i) Contagion and clustering involving death due to intentional self-harm

headspace defines suicide contagion as:

the process whereby one suicide or suicidal act within a school community, or geographic area increases the likelihood that others will attempt or die by suicide. Suicide contagion can lead to a suicide cluster where a number of connected suicides occur following an initial death.129

Direct or indirect exposure to another suicide has been shown to be a prerequisite of cluster membership.130

The submission by the Black Dog Institute emphasised that ‘suicide clusters remain a rare event’.131 This was reinforced by headspace,132 Menzies School of Health Research,133 Child Death and Serious Injury Review Committee South Australia,134 Queensland Commission for Children and Young People and Child Guardian,135 and Orygen Youth Health Research Centre.136

Acknowledging the rarity of suicidal clusters is important because:

communities may be vulnerable to concluding there is a suicide cluster if two suicides occur by chance in a population that has not experienced a suicide for some time, or has not been aware of occasional suicides occurring in previous years.137

Some coroners attending my roundtables pointed out that communities may perceive themselves to be experiencing a suicidal cluster even when the evidence does not support this. It is important to address this because ‘the perception of suicide clustering in itself may increase the risk of imitation and contagion’.138

Having said this, it is important to recognise that death due to intentional self-harm for Aboriginal and Torres Strait Islander children and young people is more likely to occur in clusters.139

It is also probable that these children and young people were exposed to multiple sources of risk. The submission made by Menzies School of Health Research, which focused predominately on death due to intentional self-harm in Indigenous communities, pointed out that:

While general exposure to suicide in communities creates the conditions for modelling and imitation of suicidal behaviour among young people, it is suggested that the rapid escalation of suicide rates among youth and preadolescent children already exposed to some degree of neglect or trauma may be most powerfully influenced by the frequency of suicide threats and attempts within families and households, and of suicide completions in families and within related social networks.140

The Menzies School of Health Research calls for more research in this area.

Participants at the roundtables, and those who made submissions, mainly focused on point clusters where ‘an unusually high number of suicides occur in a small geographical area or institution and over a relatively brief period of time’.141

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When determining the existence of clusters, some focused on identifying and exploring the relationships between those who had died through their case histories, while others used geo-statistical techniques to test statistically if cases were sufficiently close in space and time. 142

Disparity was evident in terms of how many deaths, and their temporal proximity, constituted a cluster.143 Some specified the number of cases should be two or more, 144 while others specified three or more. 145 Time intervals varied. These definitional issues make it difficult when comparing findings.

Despite this, both these approaches have contributed to increasing our understanding of the risk factors for death due to intentional self-harm in a cluster. Overall, the risk factors for cluster suicide are not dissimilar from those associated with individual adolescent suicide.146

This means they are not particularly helpful in assisting to identify those children and young people who may be most at risk of becoming part of a suicide cluster. Empirical evidence is lacking in terms of the ‘psychological mechanisms underlying the spatio-temporal clustering of suicides (point clusters)’.147 It is suggested that psychological mechanisms may include contagion, imitation, suggestion, social learning theory, and assortative relating, but it is argued that:

there is no firm evidence that these mechanisms operate in cluster formation. It would seem reasonable to infer that multiple mechanisms operate together, and that the main mechanism is different for different settings and populations. Which mechanism, if any, is dominant in any particular cluster is unknown.148

Some very recent research,149 published in August 2014, has started to identify some socio-demographic and contextual characteristics of suicide clusters from national and regional analyses of suicide clusters using NCIS data for all suicides in Australia between 2004 and 2008.

It used all available variables in the NCIS dataset that earlier research had indicated could be associated with the risk of suicide. These were sex, age, marital status, employment status, Indigenous status, method of suicide and state or territory of residence of each suicide case. The study noted that variables such as exposure to a peer’s suicide, diagnosis of psychiatric illnesses and history of suicide attempt are contained in NCIS case files but not currently available in the NCIS dataset. The study used only the information in the dataset.

Conducting similar research on children and young people under 18 years of age using the NCIS dataset and case files is critical if we are going to increase our understanding of the mechanisms that may trigger suicide clustering in children and young people.

A focus on children and young people is essential because, as the Australian Institute for Suicide Research and Prevention reinforced to me, ‘children and adolescents differ in terms of physical, sexual, cognitive, and social development and warrant separate consideration’.150

As the Royal Australian and New Zealand College of Psychiatrists pointed out:

the nature of the stressors vary according to age; children and younger adolescents describe familial stress, whereas older adolescents typically describe peer-related stressors.151

Two other cluster types were acknowledged in the roundtables but were not addressed to the same extent as point clusters.

One was mass clusters, which are ‘media-related phenomena where suicides occur during a restricted time period following, and linked to, the broadcasting or publishing of actual or fictional suicides’. 152 The Mindframe National Media Initiative provides a range of resources and guidelines for the media reporting of death by suicide in Australia. Additionally, guidance is provided by the Australian Press Council’s Standards.

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Children’s Rights Report 2014 • 83

The Coronial Council of Victoria informed me in its submission that it favours the approach advocated by the Mindframe guidelines, stating ‘the Council does not recommend any changes to current policy on media reporting’.153 It indicated that this view is shared by ABS, the Brisbane Coroner, Chief Coroner of the ACT, Queensland Commission of Children and Young People and Child Guardian, Dr Michael Dudley from the University of New South Wales, Queensland Police Service, Dr Andrew Stocky, Associate Professor Susan Walker of Queensland University of Technology and Member of the WHO-FIC Mortality Reference Group, and Western Australian Ombudsman.154

The third cluster type mentioned involved ‘geographical but not temporal clustering of suicides’.155 For example, deaths due to intentional self-harm at railway stations with close proximity to mental health inpatient facilities. This cluster type was only raised at my Victorian roundtable.

In my call for submissions and at roundtables, I asked for comment about the impact of media and digital technologies.

I was consistently told that these were very important issues in the context of point clusters. Some coroners and police who attended my roundtables pointed out that, in some cases, deaths due to intentional self-harm were reported on social media before they had been able to complete their preparatory work and had informed family members of the death.

The submission by Hunter Institute of Mental Health emphasised:

the effects of media, digital technologies, and contagion are important factors in the self-harm and suicide of young people alongside significant contributors such as genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors.156

Professor Jane Pirkis pointed out:

research into suicide among online communities is lacking, largely, I think, because it is very difficult to do… It certainly seems plausible that suicide clusters could exist in online communities.157

The Child Death and Serious Injury Review Committee in South Australia informed me that:

Death scene investigations do not routinely collect information about the use of social media by young people. We have been told that it is expensive and time consuming to access and analyse this information, for example the messaging between young people prior to an event or their use of facebook and other social media. For these reasons we find it difficult to comment on the role, management and utilisation of social media in prevention as we are not yet certain of the extent of the use of social media or of the ways in which it influences a young person’s decision to suicide. 158

The Young and Well Cooperative Research Centre stated in its submission that:

Increasingly with the advent of social media, and the concept of a networked 24/7 society, it is clear that we need to rethink the role of “media guidelines” and think more broadly about guidelines for social networks… A vital component to this conversation is an understanding that factors contributing to contagion and clustering are complex, as are the reasons behind the suicide and self-harm behaviours of young people.159

The Black Dog Institute reinforced that:

urgent research is needed, using new technologies and approaches to understand “contagion” and to investigate how connectiveness can be used to lower risk and to promote safe communities.160

The complexity of the issues was reinforced to me through a submission provided to me by a parent:

The completed suicide of a 14-year-old girl (who I shall refer to as Alice)…resulted in an enormous ripple effect throughout the community where it seemed that an enormous proportion of the youth aged between 12 and 18 had some connection to Alice.

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This connection was made, often, through social media, where young people were either “friends” with Alice or had friends or siblings who were in turn “friends” of Alice or her 2 teenaged siblings (who each attended different local schools). Most of these “friends” had never met Alice as such, but either before (and often after) her death, they were able to access a glimpse at her life through access to her Facebook/Myspace/ other social media profile. This created a sense of closeness and connection that was not real, in the way that we adults would see it.

But for young people, these connections do feel real and indeed, in many ways they are real. The distress at Alice’s death and the widespread sharing of her means of suicide may have triggered suicidal thoughts or sharpened suicidal plans in others.

On the other hand Alice’s death did generate enormous community discussion, at both formal and informal levels, about the causes of her death, the presentation of mental illness in youth, possible triggers and of course the catastrophic impact on her family and her friends. The ubiquitous use of social media platforms means that this will always be a challenge when a young person suicides.

We need to work with young people to understand what opportunities might exist via these fora to help young people and to protect them from harm.161

The Australian Interactive Media Industry Association (AIMIA) Digital Policy Group - Cyber-Safety Sub Group made a submission to my examination. The AIMIA Digital Policy Group represents 460 organisations in the Australian digital industry, including Facebook, Google, Twitter, Microsoft, eBay and Yahoo!7. The submission outlines the various policies, tools and infrastructures that particular organisations are implementing to manage content about non-suicidal self-harm and suicidal behaviour. It also provides information about connecting users to support services that may be of assistance to them.

It was evident from the submission, and also from other submissions, that AIMIA Digital Policy Group is working with key organisations such as headspace, beyondblue, and the Young and Well Cooperative Research Centre to receive information about current issues facing children and young people and also to give information about the relevant safety policies and tools that are available.

I welcome this collaborative approach and encourage it to continue. However, I am concerned that not enough is being done to evaluate the awareness that children and young people have of these policies and procedures. It would be pertinent to undertake research that explores the extent to which children and young people are aware of the policies and procedures and how this type of information can be most effectively disseminated to them.

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Children’s Rights Report 2014 • 85

(ii) Postvention services following death due to intentional self-harm

Following a death due to intentional self-harm, postvention services are said to be essential for those children and young people who have been exposed to it.

Case study provided by Jesuit Social Services about postvention and intervention162

A 15 year old was referred to Support After Suicide following a phone call from her school counsellor. Her father had taken his own life a year earlier and she was depressed, was self-harming by cutting and was at risk of suicide.

She wanted to meet other young people who had lost a parent to suicide as she was feeling isolated and alienated from her peers in school. She attended the Adventures camp program on several occasions and was able to keep in contact with the other young people on a private group page of the Support After Suicide Facebook page.

She requires ongoing support due to issues with depression, family conflict and in response to bullying at school. Also, the relationship with her father was complex as before he died he was physically and emotionally abusive to her and her mother.

Supporting her has involved one-to-one counselling which has focussed on the grief and trauma of her father’s death, family counselling to assist in the development of supportive relationships and communication, and a case manager arranging contact with other young people bereaved by suicide.

There have been times when there was an increased risk of self-harm and suicide. Providing understanding and support has been crucial in minimising the risk. She has needed to feel understood, connected as opposed to isolated, alone and misunderstood. It has required a high level of expertise to respond appropriately to her.

headspace is funded by the Australian Government Department of Health to provide schools with support in dealing with the aftermath of a death due to intentional self-harm.

headspace recommends a number of strategies to reduce the risk of suicide contagion in a school or community.163 These include:

• identification and monitoring of young people at increased risk • appropriate support and treatment for young people at risk including initial one-to-one support for distressed students as well as ongoing treatment by mental health clinicians • appropriate reporting of suicide in the media • well considered provision of information that is age and culturally appropriate, including:

» clear, concise and timely provision of information so that inaccurate information and distress are minimised » factual information, without unnecessary detail, to be provided as soon as possible » information should be provided to small groups, with close friends and family being told

individually prior to this.

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While these strategies would seem responsive to the immediate circumstances, there is no empirical evidence that they actually facilitate positive outcomes. As far back as 1993, Professor Hazell, who participated in one of my roundtables, noted that:

while there has been considerable enthusiasm for the implementation of postvention programs, particularly in the school setting, such programs have yet to undergo systematic evaluation of their efficacy in preventing imitative suicide.164

The systematic evaluation of postvention programs has not progressed in over 20 years. There is still no solid evidence base documenting the effectiveness of postvention services.

A review of the literature on postvention strategies delivered to children and young people in response to suicide clusters concluded that, with so few evaluations of postvention responses, it was difficult to draw firm conclusions about the effectiveness of these strategies on the reduction of suicide risk or death due to intentional self-harm.165

The general lack of evaluation of programs, strategies and services was also raised in the Evaluation Report of the National Suicide Prevention Program, published in 2014.166 The report noted that a lack of outcome data made it difficult for projects to demonstrate their effectiveness.

The headspace submission informed me that:

a rigorous evaluation of School Support is currently being undertaken. This is exploring: awareness of and perceived need for the service; satisfaction with School Support written resources; satisfaction with postvention support provided by the service; impact on knowledge, awareness and skills; and the effectiveness of gatekeeper training provided by the service.167

I am told that the timeframe for providing this evaluation has been brought forward and is due to be completed by the end of 2014. I look forward to the publication of this evaluation by headspace and hope that it will contribute not only to our Australian context but also internationally.

I also want to draw attention to the fact that some children and young people are disengaged from school.

The Northern Territory Council of Social Service reinforced this in its submission, pointing out that:

There is a need to adapt school based interventions to community settings, such as in Aboriginal communities, recreational centres, community centres, etc. to ensure that the information reaches young people who are not in school anymore.168

This was also raised by the Northern Territory Department of Health who told me that:

Young people are often not engaged with school or any ongoing activities; this can be due to fatigue, lack of resources (clothes, shoes, lunch food, books), lack of support from family and resulting lack of interest and as a result are transient during the day and difficult to locate. 169

The review of the literature on postvention strategies delivered to children and young people in response to suicide clusters identified some ‘promising’ strategies, including:

• the development of a community response plan • educational/psychological debriefings • provision of both individual and group counselling to affected peers • screening of high-risk individuals • responsible media reporting of suicide clusters • promotion of health recovery within the community to prevent further suicides.

In 2012, the Australian Government produced a set of guidelines that provide assistance to communities who wish to develop and implement community response plans to suicide clusters.170 The extent to which community plans are being developed and evaluated is unknown.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 87

Evaluation of postvention services must be on the national research agenda for children and young people. Without this evidence base, it will continue to be difficult to identify what works to reduce deaths due to intentional self-harm. It will also decrease the likelihood of ineffective interventions being funded and implemented.171

(iii) Contagion involving non-suicidal self-harm

It is widely assumed that non-suicidal self-harm is contagious,172 and this may be true. However, as pointed out to me by the Royal Australian and New Zealand College of Psychiatrists, ‘empirical evidence is lacking for the incidence and mechanisms leading to clustering of adolescent self-harm’.173 This view was consistent across roundtables and submissions.

A recent review of studies, reporting an association of social contagion and non-suicidal self-harm among adolescents and young adults, outlined some of the limitations of existing research, including:

• small sample sizes • limited to all male or all female participants • failure to report racial and ethnic demographic information • lack of standardised assessment or no assessment of non-suicidal self-harm • staff/researcher determination of intent of self-harm behaviour • lack of information regarding initial onset of non-suicidal self-harm outside of the study context • limited generalisability due to occurrence of contagion in specific unit/facility of interest, and inability

to infer causality from exposure to non-suicidal self-harm and initiation of non-suicidal self-harm behaviour • non-suicidal self-harm definitional differences • cross-sectional study designs that hinder determination of causality • examination of social contagion factors as a secondary versus primary focus • lack of studies focused on initial onset of non-suicidal self-harm (i.e., retrospective vs. prospective designs) • lack of diversity (e.g., racial/ethnic, socioeconomic status, sexual orientation) among participants • self-report measures used for assessment of non-suicidal self-harm and exposure to non-suicidal self-harm.174

Rosemount Good Shepherd Youth and Family Services told me that while it can be argued that there is a contagion effect with regard to exposure to non-suicidal self-harm, some of those who respond to peers, media, and popular culture could be identified as having risk factors prior to exposure. 175

Available research reflects this view when it suggests that exposure to peer non-suicidal self-harm ‘may put vulnerable adolescents (e.g., persons with comorbid conditions) at particular risk for perceiving the behavior as an effective coping strategy, especially because adolescents often identify with similar peers’.176

A submission I received from an adult with a history of non-suicidal self-harm commented on this issue:

I’m dubious about the idea of self-harm as contagious, just because it is so personal. Since I was 14, I’ve covered up my scars with long sleeves and/or cosmetics. Even though I’m now open about the fact I have a mental illness amongst friends, only my husband and clinicians are aware of my history of self-harm. It’s the most shameful part of my experience of mental illness. The shame arises from the fact that often when self-harm comes up in conversations it is referred to as “silly” or is trivialised as being a private school girls on tumblr thing. I don’t want to subject myself to that level of judgment, even though I do feel able to tell others about my paranoid delusions.177

Discussions at some of my roundtables focused on children and young people who connect online and communicate about non-suicidal self-harm. The consensus reached about this was that further research is required about the online communicability of non-suicidal self-harm, including examination of the processes by which communications initiate, reinforce, and/or help to extinguish non-suicidal self-harm.178

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One young person told me that:

I found tremendous support on online forums. We would help each other commit to cutting less often and just share our stories and frustrations for the day. It was nice to know that there were people out there who understood, which put me in good stead when I did eventually get help at age 20.179

While the Hunter Institute of Mental Health informed me that there was limited research addressing media reporting of non-suicidal self-harm, it advocated reference to the codes of practice and guidelines used for reporting death due to intentional self-harm. It also provided some guidance that specifically used the term ‘self-harm’. In essence, this guidance reflected the existing content in the codes of practice and guidelines used for reporting death due to intentional self-harm.

Professor Graham Martin, who attended my Brisbane roundtable and who also made a submission, told me that non-suicidal self-harm must be taken more seriously as an ‘entity’, with research funding specifically allocated to large scale examinations.180 Given how little is actually known in this area, I agree with the views of Professor Martin.

Summary - clustering and contagion

There is inconsistent use of, and definitions of, the terms ‘contagion’ and ‘clustering’ across the field. The issues of contagion and clustering for death due to intentional self-harm and non-suicidal self-harm should be treated separately.

Despite perceptions about the frequency and existence of suicide clusters, suicide clusters are very rare. Empirical evidence is lacking in terms of the psychological mechanisms underlying suicide clusters.

There is still no solid evidence base documenting the effectiveness of postvention strategies. It is difficult to draw firm conclusions about how effective these strategies are in terms of reducing death due to intentional self-harm.

Empirical evidence is lacking for the incidence and mechanisms leading to clustering of intentional self-harm, with or without suicidal intent.

More research about children and young people who connect online and communicate about non-suicidal self-harm is required in relation to the online communicability of intentional self-harm, with or without suicidal intent, including examinations of the processes by which communications initiate, reinforce, and/or help to extinguish non-suicidal self-harm.

3.5.4 Barriers that prevent children and young people from seeking help

Those attending my roundtables and those who made submissions were generally in agreement about the types of barriers that prevent children and young people from seeking help.

Barriers were identified in terms of those experienced by the child or young person, those shaped by parents and carers, and those imposed by system constraints. Some participants and submissions cited help-negation as a barrier.181 The ACT Health and Education and Training Directorate pointed out to me, ‘there is considerable stigma attached to help-seeking behaviours’.182

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 89

Stated barriers experienced by children and young people included:

• feelings of embarrassment and guilt • fear of the response from parents and/or the source of help • concerns about the confidentiality of information shared and not wanting parents to know • fear about stigma and being judged in an unfavourable light • concern about cost of services/treatments • previous negative experiences accessing services • inexperience with independently seeking help and limited awareness of available support services • not identifying intentional self-harm, with or without suicidal intent, as a serious problem.

Language barriers can also be problematic for children and young people seeking assistance. The Jesuit Social Services highlighted in its submission that English is a second language for many young people in remote communities.183

The Northern Territory Council for Social Services pointed out:

while many Aboriginal children and young people in remote settings are able to converse in two or three different Aboriginal languages they might find it difficult to communicate in English. Explaining mental health concepts in English and not being able to converse in a familiar language can potentially be alienating and stressful and lead to misunderstandings, misidentification and wrong diagnosis of the symptoms and impact negatively on the subsequent intervention.184

This was highlighted at my roundtable in Alice Springs by the NPY Women’s Council who shared with me an impressive guide developed to help Aboriginal children and young people talk about mental health. The guide, called the Words for Feelings Map, depicts characters experiencing a range of adverse feelings and links English and Aboriginal words to express them. The Words for Feelings Map has been created in two languages, Ngaanyatjarra and Pitjantjatjara. I have included a copy of the Pitantjatjara version. I hope this guide will encourage children and young people to talk about their feelings and seek help when they need to. A more comprehensive word list is available at www.npywc.org.au/ngangkari.

Language barriers were also raised in the context of children and young people from culturally and linguistically diverse backgrounds (CALD). A number of submissions reported that confidential phone counselling and the use of interpreters is crucial in the provision of services for children and young people from CALD backgrounds. Children and young people prefer telephone interpreters for confidentiality reasons.185 This is especially important where communities are small and groups are connected. The Kids Helpline reported that phone counselling was the preferred method of contact for CALD children and young people under 18 years of age seeking help for non-suicidal self-harm or suicidal behaviour.186

CALD children and young people also face numerous other individual, cultural, and service-related barriers when seeking help for non-suicidal self-harm and suicidal behaviour. This includes cultural and community stigma, a shortage of culturally appropriate early intervention and mental health response services, as well as poor mental health literacy due to the lack of suitable information for children and young people and their families.187

The Phoenix Centre told me that their clients may not share their distress with their parents for a range of reasons. These reasons included, personal sharing between parent and child may not be culturally appropriate; family issues such as intergenerational conflict or unrealistic expectations may be contributing to the child’s or young person’s distress; and a reluctance to add to the psychological distress and burdens of the family.188

A number of submissions noted that intellectual disability in itself may be a barrier for some children and young people when seeking help and guidance. The submission by the ACT Community Services Directorate cited intellectual disability as a possible ‘barrier for children and young people who have difficulty in identifying and communicating the nature and extent of their feelings and mental health needs’.189

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Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Words for Feelings Map

Children’s Rights Report 2014 • 91

The ACT Community Services Directorate also highlighted a lack of screening measures for suicidal behaviour for children and young people with intellectual disabilities, making ‘assessments of needs and service accessibility more difficult where children and young people have limited comprehension and language skills’.190

Mention was made about the developmental stage of some young people where self-reliance and autonomy are foremost.191 A survey of 1,032 Australian children and young people aged 14-25 years found that believing ‘I should and/or could solve my problems alone’ was a strong barrier to seeking mental health care.192

Help-negation was also recognised as a barrier to help-seeking. Research by Wilson and Deane describes help-negation as:

help-avoidance or withdrawal that has been found in samples of adolescents who are currently experiencing clinical and subclinical levels of suicidal thoughts (e.g., Wilson et al. 2005a), depressive symptoms (e.g., Wilson et al. 2007), and symptoms of general psychological distress (e.g., Wilson 2010). In each study, adolescents with higher symptom levels are also those with lower intentions to seek help from health-care professionals, family, and friends, and higher intentions to seek help from no one.193

A submission by Dr Mareka Frost, on research conducted at Griffith University in 2011, suggested that:

the more significant the extent of a young person’s self-harm, the lower their intentions to seek help for self-harm. This effect occurred primarily for help-seeking from family and friends, who typically act as gatekeepers to care for young people under the age of 18. As such, this is a key barrier to help-seeking for young people in this age range.194

Support for these findings is becoming increasingly common in the literature. 195 Suggested ways to respond to help-negation include:

• education about the help-negation process, which may assist young people to seek help early by increasing their awareness that a desire to withdraw from others may signal a need to seek help • assisting young people to increase their emotional competency and feel more confident in expressing their problems and concerns to others may also assist them to seek appropriate and

timely help • improving the ability of informal supports to respond to non-suicidal self-harm and suicidal behaviour may increase help-seeking • increased education regarding help-negation for individuals who support young people may highlight

the need to be more proactive in providing help.196

While these particular strategies have been proposed in the context of help-negation, it could be argued that they are also applicable when addressing other barriers.

In its submission, headspace highlighted some factors that have also been shown to facilitate help-seeking in children and young people. These include:

• good knowledge of mental health problems and awareness of the need for help • past positive experiences of help-seeking by the child or young person • social support and encouragement to access help • good relationships with service staff and trust that information will be treated confidentially. 197

Barriers associated with parents included:

• limited awareness of available support services • worries about cost of services/treatments • non-consent to treatment due to stigma attached with receiving services/treatments • failure to understand the significance of the difficulties being experienced by their child • lack of capacity to assist due to their own physical or mental health issues and parental lack of time.

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The Menzies School of Health Research highlighted the lack of capacity among families and communities to identify and respond to escalating non-suicidal self-harm and suicidal behaviour, in the context of other pressing social and economic issues.198

Barriers as a result of system constraints included:

• lack of appropriate and culturally sensitive support services • limited capacity of support services where there are waiting lists and motivation to seek support may have decreased by the time an appointment is available • limited appointment times outside school or work hours • restricted accessibility to support services due to location, transport and hours of operation • inundated school counsellors who can only prioritise crisis cases.

Concerns were also raised about the types of responses children and young people received when presenting at accident and emergency departments of hospitals.

There was consensus that staff in these departments were generally not trained or equipped to deal with children and young people engaging in non-suicidal self-harm and suicidal behaviour.

Often children and young people were perceived as ‘attention-seeking’, ‘wasting professionals’ time’, or ‘nuisances’.199

In its submission to my examination, the Black Dog Institute, while recognising that there was limited research in this particular area, cited research completed in 2014 that suggests:

medical staff are likely to hold stigmatising views and that medical students have been shown to have high levels of stigma and suboptimal levels of knowledge, and their attitudes worsen through their medical training.200

Limited access to mental health professionals within accident and emergency departments was also identified as a problem at the roundtables. A set of Guidelines for the Management of Deliberate Self Harm in Young People were developed by the Australasian College for Emergency Medicine and the Royal Australian and New Zealand College of Psychiatrists in 2000.201 The extent to which these guidelines have been adopted or how they impact on practice is unknown. This is an area that requires follow-up and evaluation. Where children and young people present to an accident and emergency department, there is a genuine opportunity to connect with them and facilitate follow-up intervention.

The Menzies School of Health Research submission informed me that:

Even when children and young people do seek help, there is often very little or no follow up available and very little coordination between services resulting in a reduction in the effectiveness of the help that is available.202

A submission made to me by a young person under 18 years of age raised this issue:

i am 16 (nearly 17), and i have self-harmed for nearly 3 years. from what i have learned in these three years, is there is no real “cure” for it. i have attempted suicide dozens of times to no avail, and have spent time in the mental ward a few times. doctors have not really had a chance to sit down and look at the problems, so it seems, because some will make asinine attempts to deter self harmers or suicidal adolescents, by saying how stupid they are acting and how much hurt they are causing to their families. we are treated as though we have no understanding of the “real” world, and that our mind just cant see how wrong it is to do what we do, or think how we think, when really, our minds just dont care anymore. most of us have lost hope in being “cured”, because we know that it will always be there, whenever we come into a bad situation, calling our names (not to confuse us with having schizophrenia)(maybe we do), and a lot of self harmers think the coping strategies given are unhelpful, and kind of make us feel like we are being made to look under developed. we know that we should think happier thoughts (those with depression) but we can’t just change ourselves because you bring up the idea!203

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Children’s Rights Report 2014 • 93

A study by the Menzies School of Health Research on hospital admissions in the Northern Territory showed that Indigenous people accounted for over half of the hospital admissions due to intentional self-harm between the period 2000-2012, and that Indigenous children and young people aged 0-14 years were three times more likely to be admitted during that period than non-Indigenous children and young people.204

The Menzies School of Health Research concluded that further research is required ‘to investigate the types of contact that people at risk of suicide do have with professional help and where the missed opportunities for prevention lie’.205

Conjoint Professor Greg Carter, who attended my research roundtable, described jurisdictions that direct non-suicidal self-harm cases to one hospital within a region where expert care and treatment can be provided. Professor Carter explained that his unit in Newcastle Mater Misericordiae Hospital works in this way, and as far back as 1997 an evaluation of this model showed some positive results.206

This type of model has the capacity to gather valuable epidemiological data that can be used to inform practice. It allows data to be collected on presentations of intentional self-harm with or without suicidal intent, as well as repeat presentations, and the linkage of these presentations to deaths due to intentional self-harm.

This model has the potential to contribute much to our understanding of intentional self-harm with or without suicidal intent. Some participants at my roundtables told me that children and young people treated for non-suicidal self-harm and suicidal behaviour were often discharged into the community without follow-up, despite evidence that during the hours and days immediately after discharge the child or young person can be at high risk.

I was also told about the need for teacher training to promote early detection and intervention. School is an important site for early universal interventions, as the opportunities for prevention can diminish in adolescence where school attendance often decreases.

The report by the House of Representatives Standing Committee on Health and Ageing on early intervention programs aimed at reducing youth suicide in 2011 recommended that teachers receive mandatory training on mental health awareness, including specific training to develop their capacity to recognise and assess suicidal risk.207 It was pointed out to me that while the Australian Government agreed to this in principle, mandatory training was not pursued.

I was provided with some examples of where schools had voluntarily started to do this. For example, in 2014, Rosemount Good Shepherd Youth and Family Services launched the Self-Harm Workshop for Educators that has been designed to promote a better understanding of non-suicidal self-harm as it presents within a school context.208 This provides teachers with practical strategies to work collaboratively with these students and their families to ensure they receive appropriate support from external mental health professionals. It sits alongside a full day course for educators entitled Mental Health and Young People. Both courses are in keeping with the MindMatters framework, the national mental health initiative for secondary schools. I commend Rosemount Good Shepherd Youth and Family Services for its initiative in this area.

An individual submission by Ms Toni Falk, who conducted a research project into secondary teachers’ perceptions of adolescent non-suicidal self-injury as part of a post-graduate diploma in psychology in 2012, told me:

Despite not feeling well-equipped, when students disclose their wounds, teachers feel duty-bound to intervene, regardless of their level of skill. Therefore, providing staff with training and support is essential if teachers are to be enabled to intervene in the most careful, informed and constructive manner.209

In its submission, Rosemount Good Shepherd Youth and Family Services provided the transcript of an interview with a person who engaged in intentional self-harm as a teenager.

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Interview provided by Rosemount Good Shepherd Youth and Family Services with a person who intentionally self-harmed as a teenager. This person is now 28 years old.210

INTERVIEWER: Young people self-harm to cope with overwhelming emotion or control the feeling of being out of control how do you relate to that?

YOUNG PERSON: I know that for me I didn’t quite understand what was going on, it was more about putting words to feelings that I couldn’t name, not words I guess, but actions to feelings that I couldn’t explain.

Yeah, and all the issues you go through when you’re a teenage, it all seems so, they’re really intense and it all seems so much more powerful when you look back on those years, and yeah, it’s definitely about trying to manage emotions and control things that seem to be out of control.

INTERVIEWER: Some people would see self-harm as attention seeking or as being manipulative, I wondered how you would respond to that:

YOUNG PERSON: Someone once told me that it’s not attention seeking, its attention needing. Now whenever I hear someone say its attention seeking, I think well, maybe its not actually seeking, maybe they do actually need some attention and support because nobody does that sort of stuff if they are getting adequate support and there is somebody actually helping them out with what they need. And, as for manipulating, that’s the oldest one in the book really, it comes across as manipulative because a young person might go up to a person and tell one person and then they might tell another person, or they might put it on display, but it’s more about them saying “I am in so much pain that I don’t know how to ask for help. I don’t know how to tell you before I do it that I need help.” I remember I used to say “well, if you don’t do this, then I’m gonna hurt myself”, and it wasn’t so much that what they were doing would make me hurt myself, it was that I didn’t know how to manage those feelings and that’s the only way that I could explain it. So, it comes across as that, but that’s not actually the primary intention, it just ends up like that sometimes.

INTERVIEWER: So, did you actually tell someone about your self-harming or did people notice?

YOUNG PERSON: I started very young, I started when I was ten and it was a year and a half or two years before somebody actually found out and I ended up telling the school counsellor and of course, she told my parents. I know that when my mum found out that she was really really shocked. Neither of my parents knew what to do with that kind of behaviour and I didn’t know how to explain it to them in a way that would calm them down as well.

INTERVIEWER: In terms of teachers in schools, how do you think they should respond if a young person tells them they’re self-harming?

YOUNG PERSON: Be compassionate and respectful that the young person deserves some sort of privacy, so it’s not like, they shouldn’t broadcast it around the school. At the same time, they need to be getting that young person some kind of support. Um, offering to go with them to the school counsellor, perhaps sit with them during that meeting. If they’ve trusted that teacher enough to disclose that or to open up about self-harm with them, then that teacher really needs to follow through until that young person has enough support. And, it’s not that that teacher need to be the sole port of call, it’s that they can say, I can’t actually help you with the psychological things, but I can be there for moral support.

INTERVIEWER: Mmm, that’s a very good distinction actually to make.

YOUNG PERSON: Yes.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 95

INTERVIEWER: So, can I ask you, who or what helped you manage that self-harming behaviour?

YOUNG PERSON: Um, it took a long time for me to get proper help, and I know that from getting inadequate assistance when I was younger, it took longer for me to actually get the right help and for me to continue to seek out the right sort of help. The people for me that made a difference, were those that didn’t judge, They just took day by day and said “ok, that’s just, you know, a slip up, we’ll move on to the next one” rather than saying “that’s it, we’re going to punish you now.” The amount of times that I was punished for a behaviour that I was already punishing myself for things that I hated about myself and that I felt guilty about, having somebody else do that it was like, well, now you’re just making me feel like I want to actually do it again. Um, also having someone that I could talk to and trust enough that they would do what needed to be done, but hear me out first. So, say if I needed to, say if my parents needed to find out, or if I needed medication or any of those sorts of things, saying well, “this is what I’m thinking of and this is what I’d like to do, how do you feel about doing that or going ahead with it?” Because, anything that was done behind my back, I was like, well, how can I trust you? How can I believe that you are going to be there and bat in my corner and support me?

INTERVIEWER: So, do you have any other thoughts about how schools have been helpful in terms of this issue?

YOUNG PERSON: Yeah, it’s got to be a collaborative approach, you know with teachers and school counsellors and you know, maybe there’s an external therapist that gets involved, the parents; everybody working together to ensure that that young person is supported during school hours and out of school hours. Um, and not using punishments I guess, like detentions and suspensions, like I said before, because I know that my school used suspension as a way of managing my behaviour because it was too disturbing for other students and they didn’t actually address what was going on for me, or provide that support and I think if a young person is going through so much turmoil in their life, then they need that support to be able to manage while they’re going to school or perhaps they do need time off or whatever’s going on for that individual young person, rather than having a blanket rule.

INTERVIEWER: Sure. I think you’ve given us some amazing insights really, are there any final comments you’d like to make?

YOUNG PERSON: Um, not really.

INTERVIEWER: Ok, well thanks XX I think there are some wonderful learnings there for teachers and for school communities

The Menzies School of Health Research submission pointed out to me ‘In most communities, schools are under-resourced and ill-equipped to respond to suicidal behaviour and the underlying risks’.211

The Menzies School of Health Research is currently trialling Youth Life Skills, a new strength-based approach to emotional learning and development for students at Maningrida Community Education College, in Arnhem Land.212 This program is being developed for middle years students, as well as for young people who are not attending school. It is also developing an evaluation methodology that is suitable for remote settings, with school programs being designed to align with the health and physical education learning area of the Australian Curriculum.213

Repeatedly, I was told that finding effective ways to encourage children and young people to access appropriate help or support for early signs and symptoms of difficulties must be a priority in any research agenda.214

headspace stated in its submission to me:

If the barriers to help-seeking can be addressed, young people experiencing emotional distress are more likely to access help earlier when difficulties first arise. This can help pr event more serious long-term problems from developing, including deliberate self-harm and suicidal behaviours, which may then be more difficult to treat or require more intensive interventions. 215

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I am pleased to report that Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) has recently commenced asking children and young people questions about who and where they could seek help.

The questions that the LSAC asks are provided in Table 4.

Table 4: Questions asked by Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC)

Below is a list of people who you might seek help or advice from if you were experiencing a personal or emotional problem.

Have you sought help for personal or emotional problems from any of these in the last 12 months?

You can select more than one. (If you are not using a mouse, press space bar between responses.)

1. Boyfriend or girlfriend 2. Friend (not related to you) 3. Parent / step-parent 4. Brother or sister 5. Other relative / family member 6. Teacher (year advisor, classroom teacher) 7. Other school staff (e.g. school counsellor, nurse, chaplain) 8. Family doctor / GP 9. Mental health professional (e.g. psychologist, psychiatrist) 10. Unrelated adult (18 years or over) 11. Phone help line (e.g. Lifeline, Kids Helpline) 12. Internet 13. Someone else not listed above 14. I have not sought help from anyone 15. I have not had any emotional or personal problems (in the last 12 months)

How likely is it that you would seek help from the following people, if you had a personal or emotional problem during the next 4 weeks?

a. Boyfriend or girlfriend b. Friend (not related to you) c. Parent / step-parent d. Brother or sister e. Other relative / family member f. Teacher (year advisor, classroom teacher) g. Other school staff (e.g. school counsellor, nurse, chaplain) h. Family doctor / GP I. Mental health professional (e.g. psychologist, psychiatrist) j. Unrelated adult (18 years or over) k. Phone help line (e.g. Lifeline, Kids Helpline) l. Internet m. Someone else not listed above

If no answer to above:

So we just want to confirm…

would you seek help from anyone if you had a personal or emotional problem during the next 4 weeks?

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 97

This type of information will be very helpful in terms of identifying where supports should be facilitated. As Australian researchers point out:

The last decade has seen a flurry of productive help-seeking research and program development, but we are a long way from ‘being there yet’. We must continue to conduct rigorous help-seeking research that aims to better understand the science of help-seeking.216

Summary - barriers that prevent children and young people from seeking help

Barriers were identified in terms of those experienced by the child or young person, those shaped by parents and carers, and those imposed by system constraints.

Particular barriers exist in relation to certain groups of children and young people.

The effect of help-negation reduces the willingness of children and young people to seek help.

Children and young people often receive poor response from accident and emergency departments.

Further research is required to investigate the types of contact that children and young people have with professionals and where the missed opportunities for prevention lie.

3.5.5 Supporting children and young people who are engaging in intentional self-harm, with or without suicidal intent

One of the key areas explored in the literature, the call for submissions and in the expert roundtables was the characteristics of programs and practices that effectively target and support children and young people, both engaging in or at risk of engaging in intentional self-harm, with or without suicidal intent.

(i) A public health model

The 2014 World Health Organisation report on Preventing Suicide: A Global Imperative provides a comprehensive overview of suicide prevention activities around the world.217 This report does not specifically focus on children and young people. The report was developed using a global consultative process ‘based on systematic reviews of data and evidence together with inputs from partners and stakeholders’.218 The report identified a global imperative to prioritise suicide prevention in public health and policy agendas.

The report outlines the current situation in suicide prevention in terms of what is known and what has been achieved.219 It particularly notes the importance of the interplay between ‘biological, psychological, social, environmental and cultural factors in determining suicidal behaviours’.220 Twenty-eight countries, including Australia, have national suicide prevention strategies, which utilise a multisectoral response to suicide prevention.221 Such strategies generally cover a range of complementary actions from surveillance, means restrictions, media guidelines, stigma reduction, public awareness raising, skills development and research.222 The report identifies the key factors in successful national strategies as:

• making suicide prevention a multisectoral priority, with partnerships across health, education, employment, judiciary, housing, social welfare and other sectors • tailoring for diversity with goals, objectives and interventions customised to specific contexts • establishing best practices by using evidence based interventions, evaluating pilot projects

and targeting programs • allocating adequate resources • planning and collaborating with key stakeholders, such as through the creation of a national

planning group • evaluating findings and disseminating the results. 223

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Australia lacks a strategic and coordinated approach that articulates and resources the full suite of interventions required. This is despite the existence of the National Suicide Prevention Strategy, the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and a range of other national policy initiatives focused on the wellbeing of children and young people.

The Australian Government advocates a public health model, where promotion, prevention and early intervention are priorities.224 However, the Australian National Coalition for Suicide Prevention in its response to the 2014 World Health Organisation report on Preventing Suicide: A Global Imperative, suggested that:

In reality, the strategic approach to suicide prevention in Australia is piecemeal, uncoordinated and overly biased on activities falling under the remit of the Department of Health, especially mental health. This must change if we are to significantly reduce the tragedy of suicide. Reducing suicidal behaviour should be seen as a key outcome across a wide range of areas including drug and alcohol, homelessness, domestic violence, family and relationships, justice, employment, veterans and immigration.225

The Black Dog Institute introduced its submission by stating that:

suicide is both a medical and a public health issue, and that solutions to lowering suicide rates in Australia require an approach that targets both individual mental health risk factors and broader societal factors. A new idea is emerging globally that suicide can be reduced through a “systems” approach operating across all systems. “Systems” include schools, community groups, hospitals, emergency departments, workplaces, and emergency services. These services must act in unison, simultaneously and in localised areas.226

(ii) National and local coordination

The Queensland Mental Health Commission supported the need for coordination in its submission to me, stating that:

to achieve the breadth and depth of the interventions necessary across the spectrum, integrated policy responses are required, supported through engagement and integration within and across policy sectors at all points of planning rather than at the implementation stage or not at all as is commonly the situation.227

The Queensland Mental Health Commission also observed:

there continues to be an over-emphasis on actions and interventions at the individual level, particularly in terms of crisis or illness responses. That is, primarily a mental illnesses approach rather than a broader and integrated approach.228

There are a wide range of highly competent professionals working in this area, including government departments, non-government organisations, academics, researchers, and clinicians. Despite the best intentions of all parties, it is not clear how they always work together in an integrated and collaborative way.

My concerns about this were reinforced in a number of submissions. For example, the NSW Ombudsman advised me:

there are many government and non-government organisations undertaking work in this area, and it is not always evident whether, and how well, the activities are co-ordinated to minimise duplication of effort and maximise efficacy. 229

The Queensland Commission for Children and Young People and Child Guardian suggested:

mechanisms to promote alignment with and enhance suicide prevention activities across all tiers of government as well as the non-government sector are a priority.230

A number of states and territories have child and adolescent mental health teams which provide services to children and young people in outreach or clinical settings. It was clear from submissions and discussions that the respective roles and responsibilities and referral pathways between the various government and non- government mental health and other health services were not always well articulated or understood.231

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The Menzies School of Health Research commented on poor coordination between services:

Health clinics tend to treat injuries with referral to mental health services on the basis of a clinical diagnosis. [However] the determinants of suicide amongst Indigenous children and young people are social - for example, only one case in our study population had a clinical diagnosis - and many health services in remote settings do not offer social and emotional wellbeing services.

Even when children and young people do seek help, there is often very little or no follow-up available and very little coordination between services resulting in a reduction in the effectiveness of the help that is available.232

The Royal Australasian College of Physicians noted that many paediatricians still report a lack of confidence when dealing with children and young people engaging in intentional self-harm, with or without suicidal intent, and suggested that:

models of care be developed that integrate across paediatric and mental health care services to develop pathways for referral and collaborative management.233

The Rosemount Good Shepherd Youth and Family Services provided me with the views of a person who had engaged in self-harming behaviour as a teenager:

Yeah, it’s got to be a collaborative approach, you know with teachers and school counsellors and you know, maybe there’s an external therapist that gets involved, the parents; everybody working together to ensure that that young person is supported during school hours and out of school hours. Um, and not using punishments I guess, like detentions and suspensions, like I said before, because I know that my school used suspension as a way of managing my behaviour because it was too disturbing for other students and they didn’t actually address what was going on for me, or provide that support and I think if a young person is going through so much turmoil in their life, then they need that support to be able to manage while they’re going to school or perhaps they do need time off or whatever’s going on for that individual young person, rather than having a blanket rule.234

(iii) Evaluating interventions and building the evidence base

The absence of conclusive evidence about the types of programs and practices that work for children and young people was frequently mentioned in submissions and at roundtables.

This lack of evidence base existed across the continuum of intervention responses from resilience building programs to clinical treatments. Orygen Youth Health Research Centre stated in its submission that, whilst much is known about the epidemiology of youth suicide and self-harm, less evidence exists relating to preventative approaches, both in clinical and general population settings’.235

Some research suggests that further investigation into cognitive behaviour therapy based interventions and attachment based family therapy interventions may be warranted as these interventions have shown some promise.236

The submission by the The Child and Youth Mental Health Service, Children’s Health Queensland Hospital commented on the general lack of research regarding interventions for non-suicidal self-harm in children and young people, citing a literature review completed in 2012.237 This review concluded that:

Despite an increased interest in non-suicidal self-injury in the literature, few psychotherapeutic treatments have been designed and evaluated specifically for non-suicidal self-injury . Of grave concern is that no treatments have been designed and evaluated specifically for non-suicidal self-injury among adolescents. The dearth of interventions for non-suicidal self-injury among adolescents may be due to the relatively recent interest and recognition of the problem of non-suicidal self-injury among this age group, and may improve with the adoption of non-suicidal self-injury as a psychiatric disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.238

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The submission by the Royal Australian and New Zealand College of Psychiatrists commented on the lack of evidence about the effectiveness of interventions, stating that ‘Disappointingly most interventions developed to prevent the recurrence of self-harm to date appear to have been no more effective than treatment as usual (which is of itself often limited)’.239

(iv) Responding to and preventing intentional self-harm, with or without suicidal intent

Gatekeeper training programs were discussed in numerous submissions made to me.240 Gatekeeping programs ‘aim to equip lay members of the public, as well as various professionals that may encounter at risk individuals, with the key skills needed to recognise those at risk, perform a basic intervention and then assist those they identify in seeking professional help.’241

Gatekeepers can include teachers and other school staff, police officers, paramedics, firefighters, general practitioners, youth workers, mental health workers, community nurses, emergency department staff, spiritual and religious leaders, parents and young people. This type of training can be delivered universally as well as selectively.

Orygen Youth Health Research Centre pointed out to me that gatekeeper training has been ‘a focus of the national approach to suicide prevention for some time’.242 However, Orygen Youth Health Research Centre also indicated to me that to date:

no research has examined the effects of this type of intervention on actual outcomes for young people, for example changes in rates of help-seeking and improved outcomes following help-seeking.243

The Menzies School of Health Research told me ‘there is almost no reported evidence of its effectiveness in reducing risk factors in young people’.244 Clearly determining the effectiveness of gatekeeper training programs on the outcomes for children and young people should be prioritised in evaluations of these programs and also in future research.

Building resilience is an important part of any public health model. This was highlighted as critical in many submissions I received, including from Menzies School of Health Research,245 United Synergies and the National Standby Suicide Bereavement Response Service,246 Early Childhood Australia,247 Royal Australian and New Zealand College of Psychiatrists,248 and Mental Health First Aid Australia.249

Given compulsory school education, schools were identified as environments where universal early intervention programs focused on mental health could be embedded as part of the culture and curriculum. Current examples include MindMatters, KidsMatter and KidsMatter Early Childhood initiatives. These three initiatives provide a universal early intervention framework to promote mental health from pre-school to Year 12.

MindMatters is a national mental health promotion initiative for secondary schools that addresses some of the risk and protective factors for suicide. It has high levels of uptake and acceptance across Australian schools.250 The curriculum materials focus on issues such as resilience, loss and grief, bullying and harassment, understanding of mental illness and reduction of stigma.251 It was initially introduced to a selection of schools in 2000. MindMatters is currently being updated by beyondblue, with a target of reaching 1,500 secondary schools by 2016.252 However, the Final Report of the Evaluation of Suicide Prevention Activities released in January 2014 found that, ‘the evaluation reports produced to date (from 2006 to 2012) do not address the effectiveness or efficiency of MindMatters’. 253 Given its widespread use, it is essential that MindMatters is effectively evaluated.

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KidsMatter is a national primary school mental health promotion, prevention and early intervention initiative.254 KidsMatter is currently being implemented in 2,000 primary schools. It uses a whole-school approach and aims to improve the mental health and wellbeing of primary school students, reduce mental health difficulties amongst students and achieve greater support for students experiencing mental health difficulties. 255 KidsMatter was developed in response to recognising the vulnerabilities and risks of younger children. The early years are a period of rapid brain development when neural circuits and brain architecture are established. The KidsMatter Evaluation Final Report concluded that:

The outcomes of the KidsMatter trial are consistent with an emerging body of national and international literature that a “whole school” approach can be protective for students, promoting a positive shift in mental health for the whole school population, and helping to enhance academic and social competencies through more positive interactions between all members of the school community.256

Having said this, ‘the observed impacts varied in size and were not evident in all aspects of KidsMatter’.257 Furthermore, ‘evidence of potential limitations and of possibilities for increasing the effectiveness of KidsMatter also emerged’.258 This highlights the need for further and more rigorous evaluation.

KidsMatter Early Childhood is a preschool and long day care mental health promotion, prevention and early intervention initiative. It was first trialled in 2010 and is now operating in 225 early childhood settings in Australia. The KidsMatter Early Childhood Evaluation Report made similar findings to that of the KidsMatter Evaluation Final Report.259 It also noted that further work is required to better understand the long‐term impact of professional learning on staff knowledge, attitudes and behaviour. Future evaluation must be undertaken.

beyondblue works with Early Childhood Australia, the Australian Psychological Society and the Principals Australia Institute to deliver the KidsMatter suite of initiatives. An example of universal early intervention is provided in the case study below.

Case study provided by Early Childhood Australia illustrating the importance of early intervention in the early years260

A four year old child started worrying about his childcare day as soon as he woke. His mum had to work so had no options but to persevere with the enrolment. The educators worked with him and his mum to create a strong relationship, including making a book of photographs of preferred playthings at the centre, his preferred friends and his educators. The educators also created a visual routine so he knew exactly what time his mum would return. They also made sure that he knew he could access the ‘quiet area’ inside whenever he needed time alone. His mum negotiated with her work so he could phone her if he needed to. These strategies worked well for him and after three months, he no longer needed the additional supports.

A number of other mental health, resilience, and relationship programs are being trialled or used in Australian schools:

• SenseAbility is a strengths based e-learning program developed by beyondblue for children and young people aged 12-18 years that includes modules developed to enhance and maintain emotional and psychological resilience. To date around 66% of all Australian schools have ordered the program.261

• Building Respectful Relationships is a Victorian education based resource targeted at adolescents that provides teaching and learning activities around the themes of gender, power, sexual intimacy, respect and personal responsibility.262

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• Love Bites is a school based domestic and family violence and sexual assault prevention program aimed at children and young people aged 14-16 years. Over 100,000 high school students across Australia have participated in the program.263

• KoolKIDS is a self-regulatory intervention developed by the University of Queensland and University of Western Australia to equip children and young people aged 7-10 years to understand their strengths and emotions and develop friendship and empathy skills. It is currently being evaluated by a consortium led through Macquarie University.264

• SAFEMinds is a new learning and resource package developed by headspace in partnership with the Victorian Department of Education and Early Childhood. It combines a range of targeting training packages and a resources toolkit to enhance the capacity of schools to identify children and young people with early signs of mental health issues, intervene in informed and sensitive ways and to make appropriate referrals.265

These are a selection of the many programs available to promote the health and wellbeing of children and young people. A number of other programs were highlighted, such as those using sport as an engagement platform to promote wellbeing.

It is imperative that all programs are properly evaluated before being introduced more broadly in schools or the community, and that their capacity to complement and build on other existing programs is properly assessed.

Some submissions also supported the introduction of specific non-suicidal self-harm education to school settings. Rosemount Good Shepherd Youth and Family Services argued that:

Similar to sex education not leading to promiscuity; providing information and responding to questions on non-suicidal self-injury does not cause undue distress among young people, even those already identified as potentially requiring support.266

One young person who made a submission to my examination told me:

There seems to be a fear if you discuss mental health on an open level, more mental health problems are going to arise in students. This is not necessarily the case. I feel it has more to do with how the material is presented.267

(v) Online programs and digital technology

Helplines offer a very important service and have the capacity to reach large numbers of children and young people. Children and young people are also able to use these services anonymously.

There are a number of helplines in Australia that children and young people can access either by phone or online, such as Kids Helpline and ReachOut.

Digital technologies are becoming more and more critical for support service delivery and intervention. Digital communication can assist remote health clinics to respond to those children and young people who are at risk, and to follow-up and review those cases where possible.268

Online support services enable children and young people to access some form of assistance at any time, and from any location, thus reducing reliance on office-based services. A number of submissions cited online services as being integral to the health and wellbeing of children and young people in rural communities. headspace, for instance, states that the development of their eheadspace program in 2010 was a reflection of the need to offer appropriately accessible services:

utilising web and telephone-based technology to extend the reach of evidence-based services to those young people who are unable or unwilling to access office-based services, including particularly vulnerable groups such as those in regional and remote communities.269

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eheadspace is currently providing assistance to around 1,200 young people per month.270 Two thirds of those young people had not previously accessed mental health services.271

The Young and Well Cooperative Research Centre in its submission referred to its development of the Online Wellbeing Centre, which has:

created a virtual space for young people to access a personalised, ongoing recommendation service for tech-based tools and apps, and is currently being trialled through the Young and Well Towns Project with young people living in the rural region of Murray Bridge in South Australia.272

This project aims to explore the barriers to treatment being experienced by young people living outside of major cities in Australia, and presents a method of engagement that builds local community capacity by exploring how technologies can be used to enhance the service offering.

It was noted in a submission from Dr Mareka Frost from Griffith University that:

Online services may connect young people with professional help online or act as a proximal step to offline help-seeking by providing young people with information, skills, support, intervention or referrals which assist them to access help offline. 273

Dr Frost went on to indicate that from the sample of 1,463 children and young people involved in the study:

over 60% of young people reported either a desire for information online that would help them to immediately talk to family, friends or a professional about their self-harm or a desire to access support online to begin with, but to eventually speak to someone offline about their self-harm. It is important to note, however , that one third of young people wished to receive all the help that they required through the internet.274

This study shows that children and young people have clear ideas about what they need from online services. Consultation with children and young people regarding the development of online and offline support services is critical.

The national Growing Up Queer study showed that 98% of young people in the study had access to the internet, 49% saw the internet as a place where they could connect with trusted others, and 78% used the internet as a source of information about sexual and gender identity.275

Having said this, at the time of the study, only 24% of young people used the internet to access support services, pointing to greater potential to utilise this medium.276 Participants in the study reported that face-to-face contact in a ‘safe space’ was critical to overcoming the physical and social isolation felt by sexually diverse and gender questioning young people.277

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Summary - supporting children and young people who are engaging in intentional self-harm, with or without suicidal intent

The Australian Government advocates a public health model, where promotion, prevention and early intervention are priorities. However, Australia lacks a strategic and coordinated approach that articulates and resources the full suite of interventions required to reduce non-suicidal self-harm and suicidal behaviour in children and young people.

There is an absence of conclusive evidence about the types of programs and practices that work for children and young people.

Evaluating the effectiveness of gatekeeper training on the outcomes for children and young people should be prioritised.

It is imperative that all programs are properly evaluated before being introduced more broadly in schools or the community, and that their capacity to complement and build on other existing programs is properly assessed.

Online programs, digital technologies and helplines are important services as they have the capacity to reach large numbers of children and young people. The effectiveness of these interventions should be evaluated, taking into account the views of children and young people.

3.5.6 Groups of children and young people with particular vulnerabilities

Some children and young people are disproportionately affected by non-suicidal self-harm and suicidal behaviour. I asked in my call for submissions specifically about children and young people who are Aboriginal and Torres Strait Islanders, those who are living in regional and remote communities, those who are sexuality diverse, transgender, gender diverse and intersex, those from culturally diverse backgrounds, those living with disabilities, and refugee children and young people seeking asylum.

The needs of these particular groups of children and young people, as well as those living in out-of-home care, were raised in my roundtables, in individual consultations and in submissions to my examination, including the need for targeted programs and interventions for these particular groups of children and young people.

(i) Aboriginal and Torres Strait Islanders

Death due to intentional self-harm among Aboriginal and Torres Strait Islander children and young people is significantly higher when compared with those from non-Indigenous backgrounds. This is particularly evident in younger children.278 279

Participants at my roundtables and submissions to my examination advised me that the reasons for the overrepresentation of Aboriginal and Torres Strait Islander children and young people in statistics about intentional self-harm with or without suicidal intent were complex and multifactorial in nature.

The 2014 Elders’ Report into Preventing Indigenous Self-Harm and Youth Suicide collated the voices of 28 Elders from different areas in the Northern Territory, Western Australia and Queensland, providing their perspectives on the key driving issues and effective practices in reducing non-suicidal self-harm and suicidal behaviour among Aboriginal and Torres Strait Islander children and young people.

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Aboriginal and Torres Strait Islander Social Justice Commissioner, Mr Mick Gooda, stated:

What makes this Report different from other mainstream investigations into these issues is that the solutions come from the people. They have not been watered down, marginalised or interpreted by outside “experts” or governments.280

In this report, Professor Pat Dudgeon, a Bardi woman of Western Australia and Commissioner with the National Mental Health Commission, described the key drivers behind the high rates of non-suicidal self-harm and suicidal behaviour among Aboriginal and Torres Strait Islander children and young people as:

the brutal history of colonisation, the inter-generational trauma left by Stolen Generations policy, and ongoing racism, combined with the everyday realities in many Aboriginal communities, such as unemployment, poverty, overcrowding, social marginalisation, and higher access to alcohol and drugs.281

These issues were raised in a number of my roundtables as well as in submissions made to my examination.

The NPY Women’s Council, which works in an area covering 350,000 square kilometres of the remote cross border of Western Australia, South Australia and the Northern Territory in Central Australia, reported that boredom, hopeless prospects, and a lack of significant role models impact on the health and wellbeing of children and young people. It stated that:

Hopelessness and despair as well as known use of volatile substances add to the recipe for why children and young people engage in suicidal behaviour in the region.282

The Northern Territory Council of Social Service reinforced to me that death due to intentional self-harm must be seen:

in the context of poverty and disadvantage that many Aboriginal people experience, and particularly for those living in remote communities, where systematic community control, inappropriate services, difficulty accessing services, language and other barriers exist.283

The Menzies School of Health Research 2011 report, Suicide of Children and Youth in the NT 2006-2010, analysed the coronial files for 18 cases of death due to intentional self-harm and hanging deaths by misadventure from 2006 to 2010, by children and young people under the age of 18 years in the Northern Territory. Of the 18 cases analysed, 17 related to the deaths of Aboriginal and Torres Strait Islander children and young people.284

The report found that the majority of children and young people in the study had experienced neglect or abuse within the family context from their early years.285 Familial transmission of suicide risk, particularly involving parental and sibling suicide, along with early experiences of trauma and substance abuse within communities, was strongly linked to suicide attempts in children and young people.286

The Northern Territory Child and Youth Mental Health Service receives referrals from all children and young people aged 0-17 years who present to the Alice Springs Hospital with a suicide attempt or suicidal ideation. It reported that, in the period from 2011 to 2014, between 69% and 75% of referrals to them for ‘self-harm behaviour or intent’ were identified as Aboriginal children or young people, 287 and that the most common presentation for these children and young people was:

suicidal behaviour and threats of suicide in the context of drug and alcohol use, relational conflict and usually as an impulsive act to express or gain attention of those around.288

Some children and young people also presented with suicidal behaviours or thoughts in the context of ongoing depression or chronic levels of stress, while others (although less common in and around Alice Springs) presented with self-harming behaviour as an expression of their distress without the intention to suicide.289 Those children and young people in the most common category were reported as frequently living in overcrowded and substandard housing, exposed to domestic violence and drug and alcohol abuse, not attending school and likely to have chronic health concerns.290

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The information provided to me left me in no doubt about the risk factors for Indigenous children and young people. I know that state and territory governments and the federal government have made significant investments over recent years to address these issues. Despite this, the Kimberley Aboriginal Law and Cultural Centre (KALACC) pointed out, ‘suicide rates in the Kimberley are no lower today than when KALACC wrote to Coroner Alistair Hope back in early 2007’.291

The submission by AIHW indicated that there are very few Australian or international evaluations on the impact of Indigenous-specific suicide prevention programs on suicide rates. 292 The AIHW recommended that more evaluations of suicide prevention programs are needed to help better inform policymakers and service providers about what works for Indigenous suicide prevention.293

The KALACC particularly welcomed my examination because it specifically asked for submissions about specific groups of children and young people. It stated that:

this is a welcome stance, because not only does it recognise that there are a range of demographic groups within Australia society which are at higher risk of suicide, but it also goes part of the way towards shifting consideration of suicidal behaviour away from a focus on individual persons and towards consideration of communities or sub-communities… to understand the phenomenon, the focus needs to be on the community, not on the individual child or young person.294

The KALACC suggested we should be asking why the rates of death due to intentional self-harm are high in some Aboriginal communities and not in others. This point was also made at a number of roundtables.

The 2014 Elders’ Report into Preventing Indigenous Self-Harm and Youth Suicide highlights the situation of Indigenous communities in Canada, which suggests that communities with strong connections to culture experience few or no suicides.295

Mr Wayne Bergmann, former CEO of the Kimberley Land Council, Western Australia reports:

There are clear examples in Canada where communities as a whole have taken responsibility to address youth self-harm. By taking greater control in decision-making, these communities have less alcohol abuse, less suicide, higher employment, higher rates of school attendance, and a healthier and happier society. That’s where the real answers lie, in empowering Aboriginal people to address community issues.296

Mr Max Dulumunmun Harrison of Yuin, New South Wales claimed that:

the way forward is to adopt a “community centred” approach to healing that is led by local Elders and which involves building community and cultural strength as a foundation for helping Indigenous youth be stronger, more resilient and more positive about their future.297

In his foreword to the 2014 Elders’ Report into Preventing Indigenous Self-Harm and Youth Suicide, Commissioner Gooda stated that:

having access to traditional knowledge and culture strengthens and reinforces a positive sense of identity, it provides young people a cultural foundation and helps protect them from feelings of hopelessness, isolation and being lost between two worlds.298

The Victorian Commission for Children and Young People, where Mr Andrew Jackomos is Commissioner for Aboriginal Children and Young People, pointed out to me that despite the lack of lack evidence about what works for Indigenous children and young people, some key program requirements have been identified in the Victorian Aboriginal Suicide Prevention and Response Action Plan, 2010-2015.299 These key requirements include the need for:

• programs to be developed by and for the communities for which they are intended • programs to foster empowerment • Indigenous Australians to be involved in the consultation, programming, delivery and control of services.300

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The submission made to me by KALACC cited the Fitzroy Crossing Regional Partnership Agreement Consultation Findings Report, which stated that:

Resilience-based factors that strengthen and protect Aboriginal health and wellbeing have been identified as: connection to land, culture, spirituality, ancestry and family and community. Aboriginal communities have a clear desire to lead their own healing initiatives, based on the value of life, culture and community.301

The importance of language and culture in building identity and resilience in Aboriginal children and young people was reported to be one of the most critical protective factors in the 2014 Elders’ Report into Preventing Indigenous Self-Harm and Youth Suicide, with Walmajarri Elder, Mr Joe Brown of Fitzroy Crossing noting:

We tell these lads their skin group, that’s who they are and how they fit together in the community. Language is important. They’ve got to know this so they know their culture and who they are. If they lose language and connection to culture they become a nobody inside and that’s enough to put anyone over the edge.302

The submission by KALACC told me that the Yiriman Project of Western Australia is an example of how this is being achieved.303 The Yiriman Project was established in 2000 and initially implemented in Jarlmadangah Burru Aboriginal Community. The program is currently based out of Fitzroy Crossing, Western Australia under the auspices of KALACC.

Yiriman is an intergenerational, ‘on-Country’ cultural program, conceived and developed directly by Elders from four Kimberly language groups: Nyikina; Mangala; Karajarri; and Walmajarri. It aims is to ‘build stories in young people’ and keep them alive and healthy by reacquainting them with ‘country’. These four groups have similar cultural, geographical, language and kinship ties across a vast region of traditional lands stretching from the coastline south of Broome, inland to the desert areas south and just east of Fitzroy Crossing, Western Australia.

A review and evaluation of the Yiriman Project by Dr Dave Palmer of Murdoch University described it as:

one of the country’s most impressive stories of local people’s attempts to deal with the central and pressing public policy challenge of securing the future for Indigenous young people living in remote communities.304

This report also indicated that traditional evaluation methods were not suited to projects of this kind.305 The submission by KALACC informed me that despite such reinforcement, governments are not open to supporting programs such as Yiriman.306 It attributes this to culturally based methodologies being marginalised and regarded as peripheral.307

Future research, with community engagement, into the Yiriman Project should be undertaken. The Yiriman Project is inter-generational involving not only relationships between young and old members of the community but also the generation in between these two groups who ‘provide oversight, often taking part in the more physical activities, and often carrying out the instructions of the senior people’.308 This way of working is more suited to longitudinal evaluation where the longer-term outcomes can be used to build an evidence base.

Another program, which has been reported positively, is the Family Wellbeing Program. It was developed in the 1990s by a group of Indigenous leaders. It is a 150-hour program for Indigenous people, developed specifically for local Queensland communities. The Lowitja Institute advises that this program is:

enriched with material from complementary philosophies and empowerment principles and seeks to empower participants through personal transformation that involves harmonising physical, emotional, mental and spiritual aspects of life and applying this to practical, day-to-day living.309

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Evaluation reports of the Family Wellbeing Program, across a range of settings, suggest that many of the program’s participants:

learned to deal with emotions and avoid conflict, and found more peace in their lives. They were able to analyse situations more carefully, take better care of themselves, give and demand more in their relationships, and participate more actively.310

(ii) Children and young people living in rural and remote areas

A recent analysis undertaken by the Australian Institute for Suicide Research and Prevention, using information from the Queensland Child Death Register, found that children and young people who lived in remote areas were significantly more likely to die due to intentional self-harm than by other external causes, when compared to children and young people who lived in metropolitan areas.311

This finding was supported by the Young and Well Cooperative Research Centre’s first National Survey, yet to be published, which indicates that 49% of children and young people in inner regional areas and 46% in rural and remote areas had experienced ‘moderate to very high levels of psychological distress’.312

Numerous submissions highlighted the lack of available support services in rural and remote communities, issues of staff shortages and staff housing shortages, and a lack of training for staff to deliver evidence-based services.313 Those services that do exist may not necessarily reflect the needs or wants of the particular community.

Jesuit Social Services noted in its submission:

In communities where we work, people have said that they want targeted, culturally safe, suicide prevention activities and that a one-size fits all model will not work for r emote communities... Community based wellbeing programs that have been shown to work are those that focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing.314

The Northern Territory Council of Social Service reinforced the need for services to be built with the community in mind. It argued that:

while this may take more time than top down implementation, without this approach it is likely that services will be ineffective and waste further valuable resources and time.315

Unfortunately, a lack of funding to commit to research projects that specifically target youth mental health, self-harm and suicide in rural and remote areas has resulted in research undertaken in metropolitan areas being used in rural and remote settings.316 As Dr Sarah Lutkin noted:

Funding, policy and programs are often based on data from more populated areas, while models of service are applied to smaller communities with limited flexibility. 317

The Youth Affairs Council of Western Australia pointed out that the gradual depopulation of rural and remote communities can be a barrier to young people who may be seeking support due to limited availability of essential services.318

The Menzies School of Health Research argued that there is a lack of social and emotional wellbeing services available to children and young people in remote communities, with few or no follow-up services available to them.319

When investing in services, it is necessary to be mindful of the limited infrastructure available in some very remote locations. This, as Menzies School of Health Research acknowledged, may require investment in ‘community resources and programs linked to health and education with an effort to optimise the effectiveness of visiting, mobile services’.320

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(iii) Children and young people who are sexuality diverse, transgender, gender diverse and intersex

At some roundtables and also in some submissions, it was reinforced to me that many children and young people who are sexuality diverse, transgender, gender diverse and intersex are especially vulnerable to non-suicidal self-harm and suicidal behaviour.

The submission by Twenty10 incorporating the GLCS NSW and the University of Western Sydney (Twenty10) stated that, despite an overall decline in deaths due to intentional self-harm in Australian young people since the mid-1990s, the prevalence of suicide attempts, suicidal ideation and non-suicidal self-harm in young people who are sexuality diverse, transgender, gender diverse and intersex remains stubbornly high.321

Little is known about the prevalence of non-suicidal self-harm and suicidal behaviour in intersex children and young people.

The submission by Twenty10 suggested that these children and young people are at heightened risk.322 Organisation Intersex International Australia told me that children and young people who are intersex face particular risks related to cultural, familial and medical attitudes that focus on intersex bodies conforming to social norms.323 In particular, surgical and other medical interventions that aim to erase intersex differences can have profound consequences on the physical and mental health of intersex children and young people.324 Twenty10 emphasised:

• the trauma associated with medical examinations, treatment, and surgical interventions • the physical difficulties linked with unnecessary childhood genital surgery, including impairment causing genital sensitivity, scarring, urinary issues and chronic pain • negative body image and problems with sexual intimacy associated with genital difference • a dissonance between ‘surgically assigned’ sex at infancy and gender identity.325

It is important to point out that sexual orientation, gender identity and/or intersex status do not elevate risk per se, but rather ongoing negative experiences and discrimination can increase the risks.

Some of the risk factors for non-suicidal self-harm and suicidal behaviour experienced by children and young people who are sexuality diverse, transgender, gender diverse and intersex include discrimination, verbal and physical abuse, and victimisation and bullying.326

Twenty10 highlighted the multiple layers of risk factors impacting on sexuality diverse, transgender, gender diverse and intersex children and young people and how these intersectionalities may, in turn, influence patterns of non-suicidal self-harm and suicidal behaviour. For example, risk factors can be compounded for children and young people who also identify as Aboriginal or Torres Strait Islander, are from culturally or linguistically diverse backgrounds, or who have a disability.327

Intra-family homophobia and transphobia is also a serious risk factor. Family rejection often increases the isolation and despair for children and young people who are sexuality diverse, transgender, gender diverse and intersex. Supportive family relationships have been found to be protective factors against non-suicidal self-harm and suicidal behaviour in children and young people.328

Additionally, homophobia and transphobia often occurs in the school environment. The Writing Themselves In 3 report found that students who had experienced either verbal or physical abuse were 55% more likely to self-harm or attempt suicide.329 In the Growing up Queer study, peers were found to be the most frequent perpetrators of homophobia and transphobia. Homophobia and transphobia perpetrated by teachers is said to have the greatest impact on the lives and wellbeing of children and young people.330

Homophobia and transphobia in schools frequently leads to multiple school moves and disrupted learning, or dropping out of school entirely. School policies, practices and curricula must be inclusive of all young people’s lives and experiences.

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Twenty10 pointed out to me that heterosexism, homophobia and transphobia can contribute to social isolation, poorer mental health outcomes, substance misuse, and other sociocultural and economic problems and conditions, which in turn increase the risk of non-suicidal self-harm and suicidal behaviour.331

These issues are further compounded by the social and physical developments that occur within adolescence, major life transitions, identity exploration, relationships, and a growing need for autonomy.332

(iv) Children and young people from culturally and linguistically diverse backgrounds

As previously mentioned, there is limited data about the prevalence of non-suicidal self-harm and suicidal behaviour within multicultural communities. However, it is suggested that some children and young people from culturally and linguistically diverse (CALD) backgrounds are vulnerable to environmental risk factors that impact negatively on their mental health.

In its submission, the Centre for Multicultural Youth identified traumatic experience prior to immigration, the stresses of migration, separation from families and communities, settlement in a new country, being ‘caught’ between cultures, low language proficiency, higher levels of social disadvantage and unemployment as issues faced in CALD communities.333

Some children and young people from CALD backgrounds also experience racism at school and in the broader community, which can lead to feelings of isolation and trigger pre-migration trauma.334

There is strong evidence to suggest that children and young people from migrant and refugee backgrounds access mental health services at a lower rate than other Australian born children and young people, although their need for such services may be as great or greater.335

The Kids Helpline made the point in its submission that its service experienced an underrepresentation of young males with CALD backgrounds engaged in help-seeking activities about suicide and self-harm.336

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Case study provided by The Phoenix Centre, a member agency of the Forum of Australian Services for Survivors of Torture and Trauma (FASSTT) and auspiced by the Migrant Resource Centre Southern Tasmania.337

A 12 year old Afghani boy who has been in Australia for three years disclosed to his peers that he had been cutting himself and had taken a rope with the intention of hanging himself. His peers spoke to a trusted EAL (English as an Additional Language) teacher. The teacher spoke to the school social worker who spoke to him. He said that he did not want to speak to anyone from the school. He agreed, however, to be visited at school by a counsellor from the Phoenix Centre, acceptable to him because of its association with the Migrant Resource Centre, with which he was familiar. Hi also insisted that his parents and siblings not be informed about his situation or that he was receiving counselling. He did not wish to upset his parents who were already upset by his older brother’s behaviour.

The counsellor conducted a suicide assessment which indicated that the client was not in immediate danger. The incident with the rope had occurred several months ago and there had been no similar incidents since then. The client described the context in which this incident occurred. The client said he had difficulty controlling his emotions; as he said, his emotions went ‘whoosh’. He would break items nearby, hit out at others, flick light switches on and off, scream and shout. The suicidal behaviour occurred after such an episode of emotional dysregulation, following an argument with his siblings about access to a computer game. His mother intervened, seemingly in favour of his siblings. He ran outside and into the garage where he saw a rope which he threw over a beam. He stood there with the rope around his neck. He thought about if he hanged himself how badly that would impact on his parents. He thought about a favourite teacher at school and how upset she would be if he killed himself. Feeling ashamed, he hid the rope, went inside and did not speak about the incident until he disclosed it to two classmates.

He spoke about the suicidal behaviour when two classmates saw scratches on his arms. He was feeling lonely and confirmed that he had been scratching himself and told them about the incident with the rope. He explained to the counsellor that he did not scratch himself often but did so when he had no one to be with at school. He would feel alone and upset and would scratch himself with scissors. He felt ashamed about doing this. He said it did not hurt and he wasn’t sure why he did it.

He and the counsellor worked first on a safety plan: how to keep safe if he felt suicidal again. The counsellor provided psycho-education around suicidal behaviour, e.g. that many people attempt suicide because they are looking for a solution to their pain rather than wishing to end their lives, about impulsivity which is an issue for young people because developmentally they may not be able to grasp the finality of death. The counsellor explored the many reasons why young people might self-harm, identifying it as a maladaptive coping mechanism and looking at other positive coping strategies to use when feeling overwhelmed.

The counsellor created an opportunity for him to talk about the experiences he and his family had had before coming to Australia. He chose not to disclose the details of his experience, only saying that it had been “hard” and that there were aspects of his old life that he missed. He spoke about friends who were still in the refugee camp.

He and the counsellor looked at the impacts of trauma on the developing brain in an age appropriate way, and how the brain could establish new pathways, so that he wouldn’t go “whoosh” so often. He learnt to identify emotions, to recognise triggers, body signs for emotions, anger management techniques, and mindfulness techniques such as deep breathing or imagining a calming space which he could go to when feeling distressed.

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His priority was to make friends so that issue was explored, using strengths based approach.

The counsellor worked with him for six months, seeing the client during term on a weekly basis. During that time, he reported no further self-harm or suicidal behaviour. He made friends, one of them “Australian”, and had been supported by staff to join one of the school soccer teams. He and the counsellor worked on goal setting, providing a future orientation. He made the goal that he wanted to become a sports teacher.

As part of the exit strategy, the counsellor encouraged him to speak with the School Social worker who had referred him whenever he felt in need of support, or contact the counsellor again if in need for further assistance. The counsellor showed him websites that he might find useful: Reach Out, RUOK, Kids Helpline, Youth Beyond Blue, and Bite Back. Other key elements of his recovery included a supportive and inclusive school environment and his spiritual beliefs. He identified participation in the Moslem faith as a source of comfort and strength, feeling very proud when he received a certificate for fasting during Ramadan for the first time.

(v) Children and young people living with disability

Children and young people with disabilities are defined as those with ‘long-term physical, mental, intellectual or sensory impairments, which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others’.338

In 2009, AIHW reported that there were 288,300 Australian children and young people aged 0-14 years with some form of disability, with 163,600 of these children and young people living with severe or profound core activity limitation.339 Corresponding data for children and young people with disabilities aged 15-17 years, in line with the CRC definition of the child, is currently unavailable. 340

The ACT Community Services Directorate advised me ‘children and young people with a severe or profound disability, or who have learning disabilities, are at a higher risk of self-harming behaviour or attempting suicide.’341

The submission by the Royal Australasian College of Physicians suggested children and young people with learning and developmental disabilities are particularly vulnerable to mental health problems, including depression, and can face difficulties engaging with complex health service systems and recommendations. 342

The Australian Psychological Society indicated, in its submission, factors such as chronic illness and physical disability ‘are associated with suicidal ideation or attempts, even after controlling for other risk factors’.343 Other research has also suggested an association between chronic pain and suicidality in children and young people.344

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) pointed out to me that siblings of children and young people with disabilities or chronic illnesses are at risk of developing behavioural, mental and physical health problems that, if unaddressed, can increase the risk of longer-term mental health problems.345

Siblings Australia reiterated the concerns of RANZCP.346 Siblings Australia conducted a study on the experiences of siblings, children and young people with disability in 1999, which found that:

whilst some [siblings] could certainly identify a range of positives, like developing compassion and patience and embracing diversity and a sense of social justice, many also identified the costs to both their physical and mental health. Impacts included depression, anxiety, OCD, eating disorders, social phobia, self-harm, sleep problems and very low self-esteem. Some siblings also talked of previous suicide attempts.347

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The results of a 2008 research project undertaken by the Australian Institute of Family Studies, found that both siblings and parents of children and young people with disabilities had higher than average rates of depression, regardless of whether or not they play an active caring role.348

Given that children and young people with disabilities are at particular risk of non-suicidal self-harm and suicidal behaviour, increased awareness regarding the potential risks, and the implementation of early intervention and prevention strategies to reduce these risks, is essential.349

The Young and Well Cooperative Research Centre noted that children and young people with physical, learning or psychological disabilities, or chronic illnesses, may not be able to socially interact in the same way as their peers.350 Access to the internet, and online communicative technologies, in such instances, may serve as important mechanisms for supporting the mental health and wellbeing of those children and young people who might otherwise be socially isolated. Educational campaigns and services must therefore be designed with the abilities and needs of particular groups of children and young people in mind.351

One example of an effective online communication tool for children and young people with disabilities is The Lab, a project that Young and Well Cooperative Research Centre jointly undertook with Project Synthesis.352 According to Young and Well Cooperative Research Centre, The Lab connects young people with Asperger’s Syndrome directly with settings where information technology specialists work and study, so that participants can learn new technology and software skills, improve social interaction skills, and meet new friends who also have Asperger’s Syndrome.353

The results from The Lab indicate increased health and wellbeing in the participants, in addition to higher social engagement, cessation of harmful behaviour and the development of technical skills.354

In order to accurately identify best practice approaches for the development of effective prevention and treatment programs for children and young people with a disability, more research and data collection must be undertaken at the national level.

(vi) Asylum-seeking children and young people

Several of the submissions that I received outlined how young asylum seekers face an accumulation of risk factors including previous trauma, separation from family with little or no prospect of reunification, persecution in countries of refuge, dangerous voyages by boat, long periods of time spent in detention centres, continuing uncertainty about visa status and fear of being sent back to danger.355

Some asylum seekers under 18 years of age are born in refugee camps, where basic necessities are scarce, sexual and domestic violence is present, education is disrupted and inadequate, and many witness self-harm and suicide.356

Research has shown that the mental health impacts on asylum seekers held in detention can continue to affect them after they have been released into the community.357

The detrimental mental health impact of prolonged detention is well documented, including in previous reports by the Australian Human Rights Commission (the Commission). The 2004 National Inquiry into Children in Immigration Detention by the Commission found that children and young people who are detained for long periods in immigration detention facilities are at high risk of serious mental harm,358 and that at the severe end of the spectrum some made suicide attempts and began to self-harm, such as by cutting themselves, sewing their lips together, or swallowing shampoo.359

Between January 2013 and March 2014, there were 128 reported actual self-harm incidents amongst children and young people in closed immigration detention facilities in Australia.360 The average length of time that a child or young person spent in an immigration detention facility in Australia as at 31 March 2014 was 231 days.361

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As mentioned in Chapter 1, given the ongoing concerns about children and young people in immigration detention, the Commission undertook another National Inquiry into Children in Immigration Detention in 2014.

Submissions to the National Inquiry into Children in Immigration Detention 2014, which are available on the Commission’s website, have noted the detrimental impact of immigration detention on children and young people, including self-harm and suicidal ideation and the lack of appropriate mental health services.362

(vii) Children and young people living in out-of-home care

A number of the submissions I received cited placements in out-of-home care as a key risk factor associated with non-suicidal self-harm and suicidal behaviour.363

Children and young people in out-of-home care have often faced serious disadvantage early in their lives. As Orygen Youth Health Research Centre pointed out in its submission ‘many have multiple and complex needs before, during and after living in care, including higher rates of mental health and substance use disorders and suicide, and greater risks of homelessness and delinquency’.364

The submission made to me by Menzies School of Health Research stated:

many young persons at risk of suicide have been raised in adverse circumstances, with poor quality or disrupted parental care, in some cases amounting to maltreatment and abuse. Many of them will have been the subject of actions by child protection services in early childhood and later in life.365

Early Childhood Australia reported how:

family and parental factors, such as history of parental or family suicide, depression, anxiety, substance abuse, violence, sexual abuse, trauma, harsh parenting style, disruption in development of relationships and secure attachment, divorce or separation place children at risk of poor mental health.366

In its submission, Orygen Youth Health Research Centre suggested that the prevalence of suicidal behaviour in this population appears to increase when young people leave out-of-home care.367 A 2007 study reported that 71% of young people had thought about, or acted on, suicidal thoughts and almost half had attempted suicide either before, or up to five years after, leaving care. 368

The submission by Menzies School of Health Research advocates targeting high-risk parents, identified through the child protection system, to potentially improve the quality of parenting and family environments in early childhood.369 This would necessarily involve investigation into the:

contribution of early childhood adversity to suicide outcomes in order to target child protection intervention and for improvements in prevention targeting early childhood and the ongoing functioning of families.370

It is imperative that prevention and support programs tailored for children and young people in out-of-home care placements are developed. This should involve actively listening to the voices of children and young people in out-of-home care settings, and providing culturally appropriate therapeutic and other supports, as an integral part of case planning and management, both during and post-care.

The ACT Community Services Directorate is presently developing an out-of-home care strategy for 2015-2020 that proposes ‘the introduction of regular comprehensive wellbeing assessments of children and young people in care’.371 This is a positive step in terms of listening to, and empowering, children and young people in these settings.

Orygen Youth Health Research Centre is currently conducting a ripple study on improving mental health for children and young people in out-of-home care aged 12-17 years.372 It is assessing:

whether a mental health intervention that enhances the therapeutic care roles and capacities of their carers will improve: (i) the consistency and quality of out-of-home care for all young people in the sector, and (ii) access to early intervention when indicated for prevention and treatment of mental illness.373

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I look forward to the results of this important study.

(viii) Pharmacological concerns

I received a number of submissions that questioned the appropriateness of prescribing retinoid and psychotropic medications to children and young people.

Some of these were from parents who maintained that their child only became suicidal, and died due to intentional self-harm, as a result of the medication.

I am interested in what information is captured about these deaths, how it is recorded, and how it is reported.

I am aware that the Royal Australian and New Zealand College of Psychiatrists is currently leading the development of guidelines for the treatment of self-harm, including for young people with first episode psychosis.374 This is an area that definitely requires further work and investigation.

Summary - groups of children and young people with particular vulnerabilities

Aboriginal and Torres Strait Islander children and young people, those who are living in regional and remote communities, those who are sexuality diverse, transgender, gender diverse and intersex, those from culturally diverse backgrounds, those living in out-of-home care, those living with disabilities, and refugee children and young people seeking asylum may be particularly vulnerable to non-suicidal self-harm and suicidal behaviour.

Research investigating their particular risks should be undertaken. It is essential to understand the impact of the different risk factors, how they are interrelated, and whether some are more predominant than others.

It is also important for research to examine the effects and impacts of different protective factors on their wellbeing.

3.5.7 The context of the data that I was able to source for my examination

I provide this contextual information because it outlines the conditions under which data was provided and highlights the current impediments to the accurate identification and recording of non-suicidal self-harm and suicidal behaviour in children and young people.

(i) Coding of deaths and hospitalisations due to intentional self-harm

The International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) has been used by ABS since 1997375 to code incidents of death and episodes of hospitalisation due to purposely self-inflicted poisoning or injury, including attempted suicide.

The International Statistical Classification of Diseases and Related Health Problems, 10th, Australian Modification (ICD-10-AM) was developed by the National Centre for Classification in Health. The classification is used for the coding of diagnoses and external causes of injury and poisoning (including self-inflicted injury or poisoning) in admitted patient records in the National Hospital Morbidity Database (NHMD). The NHMD is collated by AIHW from records provided annually by states and territories. States and territories receive these data from public and private hospitals. The ICD-10-AM classification has been used in AIHW reports since 1999.

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The NCIS uses its own codeset that is largely based on the International Classification of External Causes of Injuries, Version 1.2 (ICECI) but has been modified for use in Australia to code incidents of death. 376 The ICECI codeset has not been updated since 2004 and is less detailed than the NCIS codeset.

As a first step, NCIS assigns the intent coding to each case based on the coronial finding. This intent coding, along with other relevant coding, is then reviewed by ABS, which assigns the ICD-10 codes based on the information provided by NCIS. Subsequently, ABS feeds the ICD-10 codes back to NCIS, with NCIS adding the codes to the NCIS cases.

Neither the ICD-10 codes nor the classification system used by NCIS distinguish between intentional self-harm with suicidal intent and intentional self-harm without suicidal intent. Conflating intentional self-harm with suicidal intent and intentional self-harm without suicidal intent makes it hard to construct an accurate picture of what is actually occurring.

The NCIS pointed out to me that:

[it] provides exclusively information on “intentional self-harm”, not on “suicide”. The terms are not always accurately distinguished, however every act of “suicide” will classify as an act of “intentional self-harm”. As a result, the NCIS chooses to provide a wider scope, which allows researchers to narrow down their criteria to cases, which are relevant to them.377

(ii) Constraints on data availability

Obtaining disaggregated data required significant negotiation. Primarily the reason given for this was due to the comparatively small number of children and young people involved and the need to protect their identities.

The Census and Statistics Act 1905 (Cth) gives ABS authority to collect data for statistical purposes. Under this Act, information supplied to ABS cannot be published or disseminated in a manner that is likely to enable the identification of a particular person or organisation. This Act contains provisions obliging past and present employees of ABS to maintain the secrecy of data collected. A fine of up to $20,400 or a penalty of two years imprisonment, or both, applies to an unauthorised disclosure of information collected under this Act.

The AIHW’s main functions relate to the collection and production of health-related and welfare-related information and statistics, and are specified in section 5 of the Australian Institute of Health and Welfare Act 1987 (Cth). The AIHW operates under a strict privacy regime which has its basis in section 29 of this Act. Personal information held by the AIHW is also protected by the Privacy Act 1988 (Cth).

The NCIS is governed by a Board of Management, including coronial, public health and national justice representatives. Administrative support is provided by the Victorian Department of Justice. While there is no specific legislation that NCIS is bound by, NCIS operates under a Licence Agreement between it and each of the nine Australian and New Zealand coronial jurisdictions that provide coronial information.

As part of this Licence Agreement, Schedule B (Data Release Principles) specifies that statistical data shall only be released by NCIS according to the following principles:

• The Statistical Data must be non-identifying, and be an accurate and comprehensive representation of the data held in NCIS.

• The Statistical Data should be consistent with the NCIS Data Quality Principles to ensure data quality and reliability.

• Statistical Data that specifically identifies the frequency of deaths in a jurisdiction must be approved for release by the State/Chief Coroner of that jurisdiction (or a nominated delegate) prior to provision to the Requesting Party.

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Schedule C (Information Privacy Release Principles) of the Licence Agreement is based on schedules of the Information Privacy Act 2000 (Vic) and describes the circumstances in which the coronial information may be used. Schedule C of the Licence Agreement includes eight exemption clauses. Two exemption clauses of Schedule C of the Licence Agreement include that an organisation must not use or disclose personal information about an individual for a purpose (the secondary purpose) other than the primary purpose of collection unless ‘the use or disclosure is necessary for research, or the compilation or analysis of statistics, in the public interest, other than for publication in a form that identifies any particular individual’, or ‘the organisation reasonably believes that the use or disclosure is necessary to lessen or prevent a serious threat to public health, public safety, or public welfare’.

I note the comment made by NCIS about my request for data:

The release of data of such a sensitive nature at this level of detail is quite ground breaking for us. All coronial jurisdictions, while cautious about the release of data, recognise the potential benefit to the community of evidence-based information when addressing very complex issues. While preparing this report we have had some very good discussions with the jurisdictions with very positive results.378

In an attempt to work respectfully within these privacy and confidentiality constraints, an aggregated time period of five years was negotiated with ABS and NCIS who provided data for the period 2007 to 2012. The AIHW provided data using the aggregated time period of 2007-2008 to 2012-2013.

There is a time delay in data available from ABS and NCIS due to cases being under coronial investigation and therefore not concluded. The NCIS only provides data on concluded/closed cases.379

The ABS indicated in its submission that ‘there can be significant time delays (generally of up to three years) before coronial cases are closed and findings made’. 380

In an attempt to address this time delay issue, ABS includes open cases in its data by using information from NCIS which is available before coronial investigations have concluded. The ABS then re-codes open cases 12 and 24 months later as part of a revisions process so that as new information becomes available it is coded by ABS.

In real terms, this means that the latest data released by ABS in March 2014 includes 2012 preliminary data, 2011 revised data and 2010 final data. The ABS reported in its submission, and also at the research roundtable, that in a recent review ‘only 1.4% of preliminary codes needed to be changed during the revisions process because of a disparity with a coronial finding’. 381

The time delay in data availability was raised as an issue in numerous submissions. The Orygen Youth Health Research Centre particularly commented on the difficulties of ‘accessing data in a timely manner’. 382 It impedes the capacity for those who work in this area to be able to respond to issues as they are emerging. The Youth Affairs Council of Western Australia,383 National Aboriginal and Torres Strait Islander Leadership in Mental Health,384 Coronial Council of Victoria,385 and Royal Australian and New Zealand College of Psychiatrists386 also raised this as an issue.

The inclusion of open and closed cases in the ABS data387 may account for the difference in the number of deaths due to intentional self-harm provided to me by ABS and NCIS, 393 and 333 respectively. The ABS recorded 60 more deaths due to intentional self-harm than NCIS in the same period. The data provided by NCIS may be an underestimation of the actual number of deaths in children and young people under 18 years of age due to cases of relevance not being included as they are still under coronial investigation.388

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The need for highly disaggregated information for specific research purposes is clearly understood by those agencies involved in the collection and dissemination of cause of death data. The ABS has been working closely with the Registrars of Births, Deaths and Marriages and state and territory coroners to determine a suitable mechanism for the dissemination of a national unit record file. Negotiation of a sustainable process for the dissemination of unit record data is challenging because of the need to comply with multiple federal and jurisdictional legislation. The sensitive nature of the dataset has necessitated the development of strong data management practices and a rigorous application process to provide adequate protections and ensure appropriate use of the data. However, an agreement between data custodians has been reached and an application process for access to this dataset is now open and is being managed by the Australian Coordinating Registry based in Queensland.

The availability of unit record data is especially important in regards to research on death due to intentional self-harm among children and young people. This dataset could provide access to particular social and demographic characteristics captured at the time of death as well as the cause of death, mechanism of death, age, sex, usual residence, Indigenous status, place of death and country of birth.

It could also provide researchers with information on other conditions identified by a doctor or coroner as being present at the time of death. This unit record information could, in certain circumstances, enable linkage with other datasets, opening possibilities to more fully understand the circumstances of those who have died due to intentional self-harm.

(iii) Underestimation of death due to intentional self-harm

Participants at my roundtables, and some of those who made submissions, raised the underestimation of deaths due to intentional self-harm from under-reporting as a consequence of coroners not making a finding about intent.

The Coronial Council of Victoria told me:

Issues of capacity are particularly likely to arise for children and young people. Whether or not children can formulate concepts of the finality of death is controversial but it is clear that self-harming behaviour by children and young people, which sometimes leads to death, is a significant problem. 389

The Queensland Commission of Children and Young People informed me:

The under-reporting of youth suicide has been a contributing factor to an under-appreciation of childhood suicide. The sensitive nature of suicide has historically been a rationale for not publicly reporting its occurrence in Australia. However, this is no longer valid, as accurate data on the prevalence of youth suicide can not only reduce misinformation amongst media and community stakeholders, but also improve research into prevention and postvention responses for at-risk young people.390

The Royal Australian and New Zealand College of Psychiatrists argued that:

The issue of intent is a complex one…what this has created is a “hidden” group of child suicides, only just now coming to our knowledge through state based data databases (e.g. Queensland and WA). The dilemma is that if a problem is hidden and not publically acknowledged, then there is no public will to find and fund strategies to prevent such suicides.391

In the past, the prevailing view was that children and young people lacked the capacity to understand the consequences and irreversibility of their actions. However, this view appears to be changing with many now agreeing that some children and young people do have this capacity.

The Menzies School of Health Research pointed out to me:

It should not be taken for granted that the consequences of suicide and the absoluteness of death are not unknown to young Aboriginal people so frequently exposed to death, mourning and the permanent absence of people lost to suicide.392

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Currently, no jurisdiction in Australia requires a coroner to make a specific determination about intent. Reluctance to make a determination is often attributed to not wanting to cause the family further trauma given the stigma associated with death due to intentional self-harm.

This issue was raised by the Senate Community Affairs References Committee in The Hidden Toll: Suicides in Australia report of 2010, and it continues to be on the agenda of the National Committee for Standardised Reporting on Suicide.

The NCIS recommended the amendment of coronial legislation in each jurisdiction to require a determination of intent in its submission to the The Hidden Toll: Suicides in Australia Inquiry in 2010. This has not happened.

The NCIS told me that it recognises that the determination of an intent of either suicide or intentional self-harm is a complex issue for coroners, but it would help NCIS to capture all cases of relevance and code them correctly if there was standardised reporting of intentional self-harm and if coroners were obliged to determine intent.

Many cases that may be of relevance are coded as undetermined intent if a coroner does not make a determination on intent. This is a complex aspect of coronial investigation but there is a danger of under representation due to the way NCIS is forced to code cases where the intent is not determined.

The Coronial Council of Victoria is currently advocating for a legislative amendment in the Victorian coronial jurisdiction that will require coroners to make a finding of intention.

The Council has also asked the Victorian Attorney-General to:

raise the issue of standardisation of coronial legislation and/or coronial systems in Australia in the Standing Council on Law, Crime and Community Safety and propose that changes be implemented in parallel in all Australian jurisdictions.393

I support this recommendation.

Standardising the input that coroners receive from primary sources, such as police, was also raised in my roundtables. Again, this was a subject that received significant attention in the The Hidden Toll: Suicides in Australia Inquiry in 2010.

Following on from the Senate Inquiry, a National Police Form template was developed. However, as pointed out to me by the Coronial Council of Victoria, only four of the eight jurisdictions are using a version of it and only the Australian Capital Territory and Tasmania have implemented electronic transfer to NCIS.394

Moving towards using a standardised national reporting form should be a priority in all jurisdictions. The NCIS told me that the non-standard collection of information by Police when reporting a death was problematic and could be assisted by the uniform adoption of a National Police Form, providing more consistent identification of suspected suicide deaths to pathologists and coroners, as well as collecting standard information surrounding the background of the deceased, and reasons for the suspicion of suicide.

Several jurisdictions have implemented a more extensive police form which incorporates many of the fields contained within the standardised form, as well as fields which are specific to their own data collection requirements.395

The Menzies School of Health Research suggested to me that:

To assist coroners in their task of weighing up the likelihood of suicide deaths by school-aged children and young people, the reporting proforma used by police in investigating and recording information about the deceased could be extended to include a separate section for people aged 18 and under. This could include a standard set of questions relevant to this age group and the types of information to be routinely sought from schools, children and families, and health practitioners and services.396

This is an excellent suggestion and one that I advocate should be implemented.

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Participants at the Australian Capital Territory roundtable and submissions from the Australian Capital Territory raised the issue of poorly completed death certificates.

The ACT Children and Young People Death Review Committee believes that:

one of the major impediments to the accurate identification of suicidal behaviours in childr en and young people is the quality and accuracy of the death certificates being completed by the doctors involved in the child or young person’s death.397

It attributes this to doctors not wishing to upset surviving family members given the stigma associated with this cause of death, relatively inexperienced doctors being responsible for completing the death certificate, and doctors not taking enough time to complete the death certificate accurately and in enough detail.

It suggests better training of doctors in this area and changes to the questions on death certificate forms, so that doctors are required to provide more detailed and accurate information.

Improving the quality of information recorded on death certificates may warrant the development of specific practice guidelines for medical practitioners about how to complete death certificates where suicide is suspected. As ABS notes:

Medical practitioners have a vital role to play in the production of high quality mortality data, by ensuring complete accurate and detailed information is recorded on the certificate. 398

Women’s Health Victoria recommended that hospital settings and coroners offices be supported with tools to better identify non-suicidal self-harm and suicidal behaviour.399 I agree with the recommendation made to me by Women’s Health Victoria.

Some participants in my roundtables, and some submissions, raised the challenges of accurate data collection on deaths due to intentional self-harm in rural and remote communities. Reasons for this included:

• suicides being inaccurately reported as accidents • witnesses speaking English as a second language • hesitation to report deaths due to intentional self-harm or attempted deaths due to intentional self-harm for cultural reasons

• the transient nature of some remote communities.400

The submission by the Northern Territory Council of Social Service argued:

There must be trusting relationships formed between service providers and Aboriginal people over a period of time before people feel safe enough to share personal information.401

Some submissions highlighted concerns about the accurate identification and recording of data relating to children and young people who are sexuality diverse, transgender, gender diverse and intersex.402

Transgender Victoria pointed out to me that:

a major barrier for trans people is many might never disclose they are questioning their gender identity before taking their life. We may simply never know how many such situations really exist. Another is that trans and gender diverse people are often made invisible due to reporting systems based on male/female that do not allow for respectful disclosure re gender identity.403

The absence of representative data on intersex children and young people makes it impossible to accurately record non-suicidal self-harm and suicidal behaviour in this group.404

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 121

(iv) Underestimation of intentional self-harm with or without suicidal intent

The AIHW indicates in its most recent publication about hospitalisations for injury and poisoning that only a small proportion of incident injury cases result in admission to a hospital, and that for each hospital admission, many more cases present to emergency departments and are not admitted, or are seen by a general practitioner, or do not receive medical treatment.405

This has serious implications in terms of accurate identification and recording of prevalence, incidence, motivating factors, prevention and treatment. The Western Australian Commission for Children and Young People reinforced this and told me:

the vast majority of young people who self-harm do not present for hospital treatment at all and therefore the…data is most likely an underrepresentation of the actual number of young people intentionally self-harming.406

The AIHW also pointed out that:

In very young children, ascertaining whether an injury was due to intentional self-harm can be difficult and may involve a parent or caregiver’s perception of the intent…The age at which self-inflicted acts can be interpreted as intentional self-harm is not well defined and is the subject of debate. 407

The Rosemount Good Shepherd Youth and Family Services told me:

We are finding clients have been self-harming from as young as 10 or below and often in Year 6. If data is to be used to achieve the best outcomes, this data will need to examine a younger cohort of students.408

(v) The benefit of a national child death and injury database and a national reporting function

In my call for submissions, I asked about the benefits of having a national child death and injury database, and a national reporting function.

Many participants at my roundtables, and submissions which addressed this issue, supported the establishment of a national child death and injury database. Organisations including beyondblue,409 Black Dog Institute,410 Australian Psychological Society,411 Menzies School of Health Research,412 Youth Affairs Council of Western Australia,413 Public Health Association Australia,414 Young and Well Cooperative Research Centre,415 United Synergies and the National Standby Suicide Bereavement Response Service,416 The Royal Australian and New Zealand College of Psychiatrists (RANZCP),417 Child and Youth Mental Health Service, Children’s Health Queensland,418 NSW Government,419 the Australian Institute of Health and Welfare,420 National Children’s and Youth Law Centre,421 and the Victorian Commission for Children and Young People422 advocated for the development of a national child death and injury database.

The ABS commented on the need to ensure that the data gap driving the push for a national database was well understood to fully inform any cost benefit analysis of such an initiative. 423 In addition, ABS commented on the importance of bringing together coherent information from multiple sources to maximise the usefulness and interpretability of the database as an information source.424

The AIHW emphasised that:

More comprehensive data on suicides and attempted suicides is needed to better facilitate better planning of support, prevention and early intervention services. A notable gap exists in reporting the number of suicide-related contacts by ambulance services, mental health crisis teams and the police. A gap also exists in terms of reporting on the services they provide.425

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As the Australian Psychological Society argued:

the role of various authorities must be clearly documented and agreed to (schools, police, family/carers, health professionals, at both State and Commonwealth levels). In particular, the reporting requirements for each authority need to be reliably implemented in order to minimise children and youth falling through the gaps.426

The Victorian Commission for Children and Young People proposed the development of standardised data sets including:

• the method of self-harm or suicide attempt (including railway suicide attempts) • the age of the child or young person • the cultural and/or religious group with which the child or young person identified • whether the child or young person had an asylum seeker or refugee background • whether the child or young person was of Aboriginal or Torres Strait Islander background • whether the child or young person was involved with child protection at the time, or had been

previously • whether the child or young person was in out-of-home care, and if so, what type • whether the child or young person was involved with youth justice at the time, or had been

previously • whether the child or young person had been involved with mental health services, or had been previously • whether the child or young person was subject to permanent care or adoption • whether the child or young person was in immigration detention (held or community), located on

the Australian mainland or an alternative, or had been previously • whether the child or young person was an unaccompanied minor, and if so, whether classified as a ward or non-ward • whether the child or young person identified as gender diverse or sexuality variant (or alternatively

using LGBTIQ classification groups). 427

The Australian Institute for Suicide Research and Prevention reinforced the need to collect a range of demographic, psychosocial, psychiatric information.428

Twenty10 told me:

sexual orientation and gender identity should be included when collecting data for purposes such as coronial records and reports prepared by police to assist coroners, as well as in other health contexts, where appropriate and relevant. Inclusion of intersex status in these contexts should also be explored, in partnership with intersex communities.429

This was reinforced by the Australian National Coalition for Suicide Prevention in its response to the 2014 World Health Organisation report on Preventing Suicide: A Global Imperative when it stated:

national data is not centrally and routinely collected on identification as lesbian, gay, bisexual, transgender, intersex and other sexuality and gender diverse.430

The Australian and New Zealand Child Death Review and Prevention Group (ANZCDR&PG) has commenced some work in relation to the development of a national child death database.431 It is working with AIHW on this.432 Representatives from each Australian state and territory and New Zealand are members of ANZCDR&PG. The ANZCDR&PG pointed out to me that:

although each jurisdiction has its own legislation, functions, roles and requirements for reporting, there is consensus among the ANZCDR&PG members that a national child death database and national child death reporting is essential for consistent, statistically sound data to provide the evidence for prevention activities and the full range policy development. Current comparisons of causes and rates of child deaths across the jurisdictions, although completed annually and generally comparable, are not standardised or consistent.433

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 123

The Menzies School of Health Research noted in its submission that the establishment of such a database should be accompanied by a uniform national standard for identifying and reporting causes of death and injury that is specific to children and young people. 434

While the benefits of establishing a national child death and injury database are acknowledged, aligning the legislation, functions and requirements for reporting across all the jurisdictions will require extensive coordination and resourcing.

I encourage ANZCDR&PG, in conjunction with AIHW, to continue its work in this area, and for the Australian Government to provide funds to ABS to pursue its work on data linkage for children and young people in the event that this work is cleared to proceed.

Summary - issues relating to data

Data about death and hospitalisation due to intentional self-harm does not distinguish between intentional self-harm with suicidal intent and intentional self-harm without suicidal intent. This makes it hard to construct an accurate picture of what is actually occurring.

Confidentiality and privacy requirements limit the availability of data about death and hospitalisation due to intentional self-harm.

The availability of data is delayed due to the length of coronial investigations, which can take two years or more to finalise.

The availability of unit record data is especially important in regards to research on non-suicidal self-harm, suicidal behaviour and death due to intentional self-harm among children and young people. This dataset would provide access to particular social and demographic characteristics captured at the time of death including cause of death, mechanism of death (in the case of intentional self-harm deaths), age, sex, usual residence, Indigenous status, place of death and country of birth.

There is an underestimation of deaths due to intentional self-harm as a consequence of coroners not making a finding about intent.

Use of a National Police Form would provide more consistent identification of suspected suicide deaths to pathologists and coroners, and capture information surrounding the background of the deceased, and reasons for the suspicion of suicide.

It is important to accurately identify and record data relating to children and young people who are sexuality diverse, transgender, gender diverse and intersex.

Only a small proportion of cases involving intentional self-harm, with or without suicidal intent, result in admission to a hospital, and for each hospital admission, many more cases present to emergency departments and are not admitted, not seen by a general practitioner, or do not receive medical treatment.

While the benefits of establishing a national child death and injury database are acknowledged, aligning the legislation, functions and requirements for reporting across all the jurisdictions will require extensive coordination and resourcing.

The ANZCDR&PG, in conjunction with AIHW, has commenced some work on the development of a national child death database.

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3.6 What did the data from NCIS, ABS, AIHW and Kids Helpline tell me?435

3.6.1 NCIS data about death due to intentional self-harm

Number of deaths, sex, Indigenous status, age

The data that I sourced from NCIS showed me that 333 children and young people aged 4-17 years died due to intentional self-harm between 1 January 2007 and 31 December 2012. Approximately 64% were male and 36% were female. There was an average of 55.5 deaths due to intentional self-harm reported on an annual basis.

Of the 333 children and young people who died due to intentional self-harm, approximately 20% were identified as Aboriginal, less than 1% were identified as Torres Strait Islander, less than 1% were identified as both Aboriginal and Torres Strait Islander, 11% were identified as being unknown in terms of Indigenous status and 69% identified neither as Aboriginal nor Torres Strait Islander.

Of the males, 19% were Aboriginal, 12% were unknown and 69% were neither Aboriginal nor Torres Strait Islander.

Of the females, 21% were Aboriginal, 9% were unknown and 70% were neither Aboriginal nor Torres Strait Islander.

Of those children and young people who were identified as Aboriginal, 2% were in the 4-9 year age range, 2% were in the 10-11 year age range, 9% were in the 12-13 year age range, 38% were in the 14-15 year age range and 49% were in the 16-17 year age range.

Of those who were neither Aboriginal nor Torres Strait Islander, less than 1% were in the 4-9 year age range, none were in the 10-11 year age range, 3% were in the 12-13 year age range, 30% were in the 14-15 year age range and 67% were in the 16-17 year age range.

Of those whose Indigenous status was unknown, 3% were in the 12-13 year age range, 33% were in the 14-15 year age range and 64% were in the 16-17 year age range.

Jurisdictional information

The jurisdictional data from NCIS provided the total number of deaths in each state and territory.

The NCIS asked me to point out that these are only frequencies. In order to achieve appropriate comparisons between states and territories, population numbers should be taken into consideration because an increase in frequency could be impacted by an increase in population rather than by an increase in incident.

Of the 333 children and young people who died due to intentional self-harm, 22% were from New South Wales, 17% were from Victoria, 31% were from Queensland, 5% were from South Australia, 14% were from Western Australia, 2% were from Tasmania, 6% were from the Northern Territory and 2% were from the Australian Capital Territory.

Of the children and young people in New South Wales, 69% were male and 31% were female. 3% were in the 12-13 year age range, 38% were in the 14-15 year age range and 59% were in the 16-17 year age range.

Of those in Victoria, 64% were male and 36% were female. 3% were in the 12-13 year age range, 29% were in the 14-15 year age range and 67% were in the 16-17 year age range.

Of those in Queensland, 63% were male and 37% were female. 1% were in the 4-9 year age range, 2% were in the 10-11 year age range, 7% were in the 12-13 year age range, 27% were in the 14-15 year age range and 63% were in the 16-17 year age range.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 125

Of those in South Australia, 71% were male and 29% were female. 6% were in the 4-9 year age range, 29% were in the 14-15 year age range and 65% were in the 16-17 year age range.

Of those in Western Australia, 63% were male and 37% were female. 2% were in the 10-11 year age range, 2% were in the 12-13 year age range, 33% were in the 14-15 year age range and 63% were in the 16-17 year age range.

Of those in Tasmania, 71% were male and 29% were female. 14% were in the 12-13 year age range, 29% were in the 14-15 year age range and 57% were in the 16-17 year age range.

Of those in the Northern Territory, 55% were male and 45% were female. 5% were in the 12-13 year age range, 40% were in the 14-15 year age range and 55% were in the 16-17 year age range.

Of those in the Australian Capital Territory, 57% were male and 43% were female. 29% were in the 14-15 year age range and 71% were in the 16-17 year age range.

Mechanisms involved in death due to intentional self-harm

(i) Hanging

Of the 333 children and young people who died due to intentional self-harm, 81%, or 270 deaths, were by hanging. Of these 63% were male and 37% were female. 19% of deaths due to intentional self-harm by hanging occurred between midnight and 4am, 7% occurred between 4am and 8am, 11% occurred between 8am and noon, 17% occurred between noon and 4pm, 20% occurred between 4pm and 8pm, and 22% occurred between 8pm and midnight. Unknown time accounted for 3%.

Of the 270 children and young people who died due to intentional self-harm by hanging, 41% used rope, string or twine. Of these, 65% were male and 35% were female. No children died using rope, string or twine in the 4-9 year age range. 1% were in the 10-11 year age range, 3% were in the 12-13 year age range, 26% were in the 14-15 year age range and 70% were in the 16-17 year age range.

19% used a cord of a household appliance or an extension cord. Of these, 66% were male and 34% were female. No children died using a cord of a household appliance or an extension cord in the 4-9 year age range or the 10-11 year age range. 4% were in the 12-13 year age range, 34% were in the 14-15 year age range and 62% were in the 16-17 year age range.

9% used a belt, braces, suspenders or sash. Of these, 56% were male and 44% were female. No children died using a belt, braces, suspenders or sash in the 4-9 year age range. 8% were in the 10-11 year age range, 4% were in the 12-13 year age range, 32% were in the 14-15 year age range and 56% were in the 16-17 year age range.

7% used a dog leash. Of these, 50% were male and 50% were female. No children died using a dog leash in the 4-9 year age range or the 10-11 year age range. 6% were in the 12-13 year age range, 33% were in the 14-15 year age range and 61% were in the 16-17 year age range.

5% used a necktie or scarf. Of these, 31% were male and 69% were female. 8% were in the 4-9 year age range, none were in the 10-11 year age range, 8% were in the 12-13 year age range, 46% were in the 14-15 year age range and 38% were in the 16-17 year age range.

3% used a pressured hose or pipe. Of these, 71% were male and 29% were female. No children died using a pressured hose or pipe in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 29% were in the 14-15 year age range and 71% were in the 16-17 year age range.

2% used bedding or bedclothes. Of these, 83% were male and 17% were female. No children died using bedding or bedclothes in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 17% were in the 14-15 year age range and 83% were in the 16-17 year age range.

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2% used a strap or webbing. Of these, 50% were male and 50% were female. No children died using a strap or webbing in the 4-9 year age range or the 10-11 year age range. 17% were in the 12-13 year age range, 50% were in the 14-15 year age range and 33% were in the 16-17 year age range.

2% used a chain. All of these children and young people were male. No children died using a chain in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 25% were in the 14-15 year age range and 75% were in the 16-17 year age range.

1% used cloth or material. Of these, 33% were male and 67% were female. No children died using cloth or material in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 67% were in the 14-15 year age range and 33% were in the 16-17 year age range.

1% used a shirt, blouse, t-shirt, trousers, slacks, jacket, coat or outerwear. Of these, 67% were male and 33% were female. No children died using a shirt, blouse, t-shirt, trousers, slacks, jacket, coat or outerwear in the 4-9 year age range or the 10-11 year age range. 33% were in the 12-13 year age range, 33% were in the 14-15 year age range and 33% were in the 16-17 year age range.

1% used a shoelace or shoe buckle. All of these children and young people were female. No children died using a shoelace or shoe buckle in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 67% were in the 14-15 year age range and 33% were in the 16-17 year age range.

I note that 8% of the deaths due to intentional self-harm by hanging were categorised as ‘other’. All primary objects involved in a hanging death with a prevalence of less than three were summarised in the ‘other’ category. These instances include, but not exclusively, the involvement of draperies, curtains, cleaning appliance hoses or fixtures, clothesline, cables, and toy sports equipment.

(ii) Struck by a moving object

Of the 333 children and young people who died due to intentional self-harm, 5% died by being struck by a moving object. Of these, 69% were male and 31% were female.

No children died by being struck by a moving object in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 38% were in the 14-15 year age range and 62% were in the 16-17 year age range.

13% of deaths due to intentional self-harm by being struck by a moving object occurred between midnight and 4am, none occurred between 4am and 8am, 13% occurred between 8am and noon, 6% occurred between noon and 4pm, 44% between 4pm and 8pm and 25% between 8pm and midnight.

81% of these deaths involved being struck by a train. Of these, 69% were male and 31% were female. 46% were in the 14-15 year age range and 54% were in the 16-17 year age range.

19% of these deaths involved being struck by a heavy truck not elsewhere classified , including a range of heavy transport vehicles but not including semi-trailers. Of these, 67% were male and 33% were female. All were in the 16-17 year age range.

(iii) Intentional self-harm fall

Of the 333 children and young people who died due to intentional self-harm, 4% died from an intentional self-harm fall. Of these, 69% were male and 31% were female.

No children died due to an intentional self-harm fall in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 31% were in the 14-15 year age range and 69% were in the 16-17 year age range.

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Children’s Rights Report 2014 • 127

8% of deaths due to an intentional self-harm fall occurred between midnight and 4am, 23% occurred between 4am and 8am, 15% occurred between 8am and noon, 15% occurred between noon and 4pm, 23% between 4pm and 8pm, and 8% between 8pm and midnight. Unknown time accounted for 8%.

23% of these deaths involved a balcony or roof. Of these, 33% were male and 67% were female. All were in the 16-17 year age range.

23% of these deaths involved a bridge. Of these, 67% were male and 33% were female. 33% were in the 14-15 year age range and 67% were in the 16-17 year age range.

23% of these deaths involved a cliff. Of these, 67% were male and 33% were female. All were in the 16-17 year age range.

I note that 31% of the deaths due to intentional self-harm falls were categorised as ‘other’. All primary objects involved in intentional self-harm falls with a prevalence of less than three were summarised in the ‘other’ category. These instances include, but not exclusively, the involvement of other specified building components or fittings and windows.

(iv) Firearms

Of the 333 children and young people who died due to intentional self-harm, 4% died by a firearm. Of these, 77% were male and 23% were female.

No children died due to intentional self-harm by firearm in the 4-9 year age range or the 10-11 year age range. 8% were in the 12-13 year age range, 46% were in the 14-15 year age range and 46% were in the 16-17 year age range.

15% of deaths due to intentional self-harm by firearm occurred between midnight and 4am, 31% occurred between 4am and 8am, 23% occurred between 8am and noon, 15% occurred between noon and 4pm, none between 4pm and 8pm, and 15% between 8pm and midnight.

62% of these deaths involved a rifle . Of these, 75% were male and 25% were female. 13% were in the 12-13 year age range, 50% were in the 14-15 year age range and 38% were in the 16-17 year age range.

23% of these deaths involved a shotgun. Of these, 67% were male and 33% were female. 33% were in the 14-15 year age range and 67% were in the 16-17 year age range.

15% of these deaths involved an unspecified firearm or related item .

(v) Pharmaceutical substance for human use

Of the 333 children and young people who died due to intentional self-harm, 2% died by a pharmaceutical substance for human use (PSHU).

This category includes prescription and illicit drugs. The involvement of a prescription drug does not suggest whether the drug of interest was prescribed to the deceased or if they got hold of it by diverted means. Of these deaths, 71% were male and 29% were female.

No children died due to intentional self-harm by PSHU in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range. 43% were in the 14-15 year age range and 57% were in the 16-17 year age range.

14% of deaths due to intentional self-harm by PSHU occurred between midnight and 4am, 14% occurred between 4am and 8am, none occurred between 8am and noon, none occurred between noon and 4pm, 14% between 4pm and 8pm, and 43% between 8pm and midnight. Unknown time accounted for 14%.

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71% of those who died used multiple substances. They were all male. 40% were in the 14-15 year age range and 60% were in the 16-17 year age range.

29% used a single substance.

Illicit drugs were used in one death whereas all the other incidents involved prescription drugs only.

Alcohol was not involved in any of the deaths due to intentional self-harm by PSHU.

(vi) Plastic bag asphyxia

Of the 333 children and young people who died due to intentional self-harm, 2% died by plastic bag asphyxia.

Of these, 50% were male and 50% were female. No children died due to intentional self-harm by plastic bag asphyxia in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range.

33% were in the 14-15 year age range and 67% were in the 16-17 year age range. 17% of deaths due to intentional self-harm by plastic bag asphyxia occurred between midnight and 4am, none occurred between 4am and 8am, 17% occurred between 8am and noon, 17% occurred between noon and 4pm, 33% between 4pm and 8pm, and 17% between 8pm and midnight.

All instances of plastic bag asphyxia involved a plastic bag as the primary object.

(vii) Motor vehicle exhaust poisoning

Of the 333 children and young people who died due to intentional self-harm, 1% died by motor vehicle exhaust poisoning.

Of these, all were male and all were in the 16-17 year age range. 33% of deaths due to intentional self-harm by motor vehicle exhaust poisoning occurred between midnight and 4am, none occurred between 4am and 8am, 33% occurred between 8am and noon, 33% occurred between noon and 4pm, none between 4pm and 8pm, and none between 8pm and midnight.

(viii) Other mechanisms

Of the 333 children and young people who died due to intentional self-harm, 1% died from stabbing involving a knife, 1% by carbon monoxide poisoning by burning charcoal in a closed environment and less than 1% from drowning in the open sea or ocean. The number of deaths due to these individual mechanisms of intentional self-harm is less than three and so further breakdown by sex and age cannot be provided.

Incident location of intentional self-harm

(i) Home

Of the 333 children and young people who died due to intentional self-harm, 76% died due to intentional self-harm which occurred at home. Of these, 62% were male and 38% were female.

The home was the incident location of intentional self-harm in all of the deaths in the 4-9 year age range and all of the deaths in the 10-11 year age range.

It accounted for 86% in the 12-13 year age range, 79% in the 14-15 year age range and 73% in the 16-17 year age range.

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Children’s Rights Report 2014 • 129

16% of deaths due to intentional self-harm occurring at home occurred between midnight and 4am, 9% occurred between 4am and 8am, 12% occurred between 8am and noon, 18% occurred between noon and 4pm, 19% between 4pm and 8pm, and 23% between 8pm and midnight. Unknown time accounted for 3%.

(ii) Countryside

7% of deaths were due to intentional self-harm occurring in the countryside. Of these, 67% were male and 33% were female. No deaths in the 4-9 year age range or the 10-11 year age range were due to intentional self-harm occurring in the countryside.

The countryside accounted for the incident location of intentional self-harm in 14% of deaths in the 12-13 year age range, 4% in the 14-15 year age range and 9% in the 16-17 year age range.

17% of deaths due to intentional self-harm occurring in the countryside occurred between midnight and 4am, none occurred between 4am and 8am, 13% occurred between 8am and noon, 25% occurred between noon and 4pm, 38% between 4pm and 8pm, and 4% between 8pm and midnight. Unknown time accounted for 4%.

(iii) Transport area

5% of deaths were due to intentional self-harm occurring in a transport area. A transport area includes underground stations, railway stations, railway lines and streets or roads.436

Of these deaths, 69% were male and 31% were female. No deaths in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range were due to intentional self-harm occurring in a transport area. A transport area accounted for the incident location of intentional self-harm in 6% of deaths in the 14-15 year age range and 5% in the 16-17 year age range.

19% of deaths due to intentional self-harm occurring in a transport area occurred between midnight and 4am, none occurred between 4am and 8am, 13% occurred between 8am and noon, 6% occurred between noon and 4pm, 44% between 4pm and 8pm, and 19% between 8pm and midnight.

(iv) Recreational area, cultural area or public building

4% of deaths were due to intentional self-harm occurring in a recreational area, cultural area or public building. Of these, 77% were male and 23% were female. No deaths in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range were due to intentional self-harm occurring in a recreational area, cultural area or public building. 8% were in the 14-15 year age range and 92% in the 16-17 year age range.

46% of deaths due to intentional self-harm occurring in a recreational area, cultural area or public building occurred between midnight and 4am, 8% occurred between 4am and 8am, 15% occurred between 8am and noon, none occurred between noon and 4pm, 8% between 4pm and 8pm, and 23% between 8pm and midnight.

(v) Public highway, freeway, street or road

3% of deaths were due to intentional self-harm occurring on a public highway, freeway, street or road. Of these, 70% were male and 30% were female.

No deaths in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range were due to intentional self-harm occurring on a public highway, freeway, street or road. 40% were in the 14-15 year age range and 60% in the 16-17 year age range.

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10% of deaths due to intentional self-harm occurring on a public highway, freeway, street or road occurred between midnight and 4am, 20% occurred between 4am and 8am, 20% occurred between 8am and noon, 10% occurred between noon and 4pm, 10% between 4pm and 8pm, and 20% between 8pm and midnight. Unknown time accounted for 10%.

(vi) Farm or other place of primary production

1% of deaths were due to intentional self-harm occurring on a farm or other place of primary production. Of these, 75% were male and 25% were female.

No deaths in the 4-9 year age range, the 10-11 year age range or in the 12-13 year age range were due to intentional self-harm occurring on a farm or other place of primary production. 25% were in the 14-15 year age range and 75% in the 16-17 year age range.

No deaths due to intentional self-harm occurring on a farm or other place of primary production occurred between midnight and 4am, 25% occurred between 4am and 8am, 25% occurred between 8am and noon, none occurred between noon and 4pm, 50% between 4pm and 8pm, and none between 8pm and midnight.

(vii) Educational area

1% of deaths were due to intentional self-harm occurring in a school or educational area. Of these, 67% were male and 33% were female. All deaths were in the 14-15 year age range.

33% of deaths due to intentional self-harm occurring in a school or educational area occurred between midnight and 4am, none occurred between 4am and 8am, none occurred between 8am and noon, 33% occurred between noon and 4pm, none between 4pm and 8pm, and none between 8pm and midnight. Unknown time accounted for 33%.

(viii) Other

I note that 3% of the deaths were due to intentional self-harm occurring in a location categorised as ‘other’. All locations of intentional self-harm with a prevalence of less than three were summarised in the ‘other’ category. These instances include, but not exclusively, commercial non-recreational areas, medical service areas, and industrial or construction areas.

3.6.2 ABS data about death due to intentional self-harm

The data I sourced from ABS showed me that 393 children and young people aged 5-17 years died due to intentional self-harm between 2007 and 2012. The ABS pointed out to me that the data continued to be under a revision process and included both open as well as closed coronial cases.

Data cells with small values were randomly assigned to protect the confidentiality of individuals. Data was presented in five-year groupings due to the relatively small number of deaths each year. This also aids in reducing the volatility associated with annual figures. Data was provided about Indigenous status for New South Wales, Queensland, South Australia, Western Australia and the Northern Territory only. Identification of persons as Indigenous varies between jurisdictions, and these five jurisdictions have been found to have both sufficient levels of identification and sufficient numbers of death to support mortality analysis.

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Children’s Rights Report 2014 • 131

Number of deaths, sex, age

Of the 69 deaths in the 5-14 year age range, 54% were male and 46% were female. 84% of deaths in the 5-14 year age range were due to intentional self-harm by hanging.

Of the 324 deaths in the 15-17 year age range, 66% were male and 34% were female. 79% of deaths in the 15-17 year age range were due to intentional self-harm by hanging.

Across the total number of children and young people who died due to intentional self-harm, 64% were male and 36% were female.

Jurisdiction, sex, Indigenous status

Of the 83 deaths in New South Wales, 19% were in the 5-14 year age range and 81% were in the 15-17 year age range. Of these, 11% were Indigenous, 87% were non-Indigenous and 1% had an unknown Indigenous status. 51% of deaths in New South Wales were in greater Sydney and 49% were in the rest of New South Wales. Of the deaths in greater Sydney, 64% were male and 36% were female. Of the deaths in the rest of New South Wales, 71% were male and 29% were female.

Of the 112 deaths in Queensland, 16% were in the 5-14 year age range and 84% were in the 15-17 year age range. Data cells with small values were randomly assigned to protect the confidentiality of individuals so percentages relating to Indigenous status cannot be specified. The ABS data indicated that 27 deaths were by Indigenous children and young people, 78 deaths were by non-Indigenous children and young people, and 4 deaths were by children and young people with an unknown Indigenous status. The data from ABS about Indigenous status does not account for 4 deaths in Queensland. 32% of deaths in Queensland were in greater Brisbane and 69% were in the rest of Queensland. Of the deaths in greater Brisbane, 61% were male and 39% were female. Of the deaths in the rest of Queensland, 66% were male and 34% were female.

Of the 19 deaths in South Australia, 11% were in the 5-14 year age range and 89% were in the 15-17 year age range. Data cells with small values were randomly assigned to protect the confidentiality of individuals so percentages relating to Indigenous status and region of usual residence cannot be specified. The ABS data indicated that 1 death was by an Indigenous child and 15 deaths were by non-Indigenous children and young people. The data from ABS about Indigenous status does not account for 3 deaths in South Australia.

Of the 52 deaths in Western Australia, 13% were in the 5-14 year age range and 87% were in the 15-17 year age range. Of these, 31% were Indigenous, 63% were non-Indigenous and 6% had an unknown Indigenous status. 58% of deaths in Western Australia were in greater Perth and 42% were in the rest of Western Australia. Of the deaths in greater Perth, 63% were male and 37% were female. Of the deaths in the rest of Western Australia, 59% were male and 41% were female.

Of the 25 deaths in the Northern Territory, 24% were in the 5-14 year age range and 76% were in the 15-17 year age range. All of these deaths were by Indigenous children and young people. Data cells with small values were randomly assigned to protect the confidentiality of individuals so percentages relating to region of usual residence cannot be specified.

Of the 8 deaths in Tasmania, 38% were in the 5-14 year age range and 63% were in the 15-17 year age range. Data cells with small values were randomly assigned to protect the confidentiality of individuals so percentages relating to region of usual residence cannot be specified.

Of the 87 deaths in Victoria, 18% were in the 5-14 year age range and 82% were in the 15-17 year age range. 61% of deaths in Victoria were in greater Melbourne and 39% were in the rest of Victoria. Of the deaths in greater Melbourne, 55% were male and 45% were female. Of the deaths in the rest of Victoria, 71% were male and 29% were female.

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With respect to the Australian Capital Territory, data cells with small values were randomly assigned to protect the confidentiality of individuals. This means that percentages relating to deaths in age ranges or area of usual residence cannot be specified.

I note the data provided to me by ABS about Indigenous status is based on five jurisdictions as the quality of Indigenous identification in mortality data is only considered acceptable in New South Wales, Queensland, South Australia, Western Australia and the Northern Territory.437

Mechanisms involved in death due to intentional self-harm

(i) Hanging

Of the 393 children and young people who died due to intentional self-harm, 80%, or 315 children and young people died by hanging. Of these, 63% were male and 37% were female. 18% were in the 5-14 year age range and 82% were in the 15-17 year age range.

(ii) Falls

4% died from intentional self-harm by falls. Of these, 67% were male and 33% were female. 7% were in the 5-14 year age range and 93% were in the 15-17 year age range.

(iii) Firearms

4% died from intentional self-harm by firearms . Data cells with small values were randomly assigned to protect the confidentiality of individuals so percentages relating to sex and age range cannot be specified.

(iv) Poisoning

4% died from intentional self-harm by poisoning. Data cells with small values were randomly assigned to protect the confidentiality of individuals so percentages relating to sex and age range cannot be specified.

(v) Drowning

Less than 1% died from intentional self-harm by drowning. Data cells with small values were randomly assigned to protect the confidentiality of individuals so percentages relating to sex and age range cannot be specified.

(vi) Other mechanisms

8% died due to intentional self-harm by other mechanisms. The category included the potential for deaths by explosive material, by smoke, fire and flames, by steam, hot vapours and hot objects, by blunt object, by jumping or lying before a moving object, and by unspecified means. Of these, 65% were male and 35% were female. 16% were in the 5-14 year age range and 84% were in the 15-17 year age range.

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Children’s Rights Report 2014 • 133

3.6.3 AIHW data about hospitalisation for intentional self-harm

Number of hospitalisations, sex, Indigenous status, age

Data I sourced from AIHW showed me that there were 18,277 hospitalisations for intentional self-harm in children and young people aged 3-17 years between 2007-2008 and 2012-2013. Of these 18,277 hospitalisations, 80% were for females and 20% were for males.

7% of hospitalisations involved Indigenous children and young people and 93% involved other Australians. ‘Indigenous’ includes hospitalisations where Indigenous status was reported as Aboriginal but not Torres Strait Islander, Torres Strait Islander but not Aboriginal, and Aboriginal and Torres Strait Islander. ‘Other Australians’ includes hospitalisations for which Indigenous status was not reported. Of the 1,248 hospitalisations for Indigenous children and young people, 1% were in the 3-9 year age range, 28% were in the 10-14 year age range and 72% were in the 15-17 year age range. Of the 17,029 hospitalisations for other Australians, less than 1% were in the 3-9 year age range, 20% were in the 10-14 year age range and 80% were in the 15-17 year age range.

Area of usual residence by Indigenous status, age and sex

Of the 1,248 hospitalisations involving Indigenous children and young people, 34% lived in major cities, 47% lived in regional areas and 19% lived in remote areas. ‘Regional’ includes inner regional Australia and outer regional Australia. ‘Remote’ includes remote Australia and very remote Australia.

Of the 17,029 hospitalisations for other Australian children and young people, 64% lived in major cities, 34% lived in regional areas and 2% lived in remote areas.

3,690 episodes, or 20% of all hospitalisations, involved male children and young people. Of these, 58% were males living in major cities, 37% were males living in regional areas and 4% were males living in remote areas. Of hospitalisations for males living in major cities, less than 1% were in the 3-9 year age range, 16% were in the 10-14 year age range and 84% were in the 15-17 year age range. Of hospitalisations for males living in regional areas, 1% were in the 3-9 year age range, 17% were in the 10-14 year age range and 82% were in the 15-17 year age range. Of hospitalisations for males living in remote areas, 1% were in the 3-9 year age range, 28% were in the 10-14 year age range and 71% were in the 15-17 year age range.

14,587 episodes, or 80% of all hospitalisations, involved female children and young people. Of these, 63% were females living in major cities, 34% were females in regional areas and 3% were females in remote areas. Of hospitalisations for females living in major cities, less than 1% were in the 3-9 year age range, 21% were in the 10-14 year age range and 79% were in the 15-17 year age range. Of hospitalisations for females living in regional areas, less than 1% were in the 3-9 year age range, 23% were in the 10-14 year age range and 79% were in the 15-17 year age range. Of hospitalisations for females living in remote areas, 1% were in the 3-9 year age range, 25% were in the 10-14 year age range and 74% were in the 15-17 year age range.

Socioeconomic status of area of residence

Data on hospitalisations involving children and young people was disaggregated using the Index of Relative Socio-economic Disadvantage (IRSD). The IRSD is a general socio-economic index that summarises a range of information about the economic and social conditions of people and households within an area. Unlike the other indexes, this index includes only measures of relative disadvantage. A low score on this index indicates a high proportion of relatively disadvantaged people in an area.438 Each of the quintiles, or the five economic groups, represents approximately 20% of the national population.

Of the 18,277 hospitalisations involving children and young people, 23% were in the lowest socioeconomic group, 22% were in the second lowest group, 21% were in the third lowest group, 18% were in the fourth lowest group and 16% were in the fifth lowest group.

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Of the 1,248 hospitalisations involving Indigenous children and young people, 40% were in the lowest socioeconomic group, 27% were in the second lowest group, 20% were in the third lowest group, 8% were in the fourth lowest group and 5% were in the fifth lowest group.

Hospitalisations for intentional self-poisoning

Of the 18,277 hospitalisations involving children and young people, 82% were due to intentional self-poisoning. Of these, 18% were for males and 82% were for females. Of the hospitalisations for intentional self-poisoning, less than 1% were in the 3-9 year age range, 21% were in the 10-14 year age range and 79% were in the 15-17 year age range. The data provided by AIHW included 10 categories of intentional self-poisoning.

Of the 7,644 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and anti-rheumatics, 13% were for males and 87% were for females. Of these, less than 1% were in the 3-9 year age range, 21% were in the 10-14 year age range and 78% were in the 15-17 year age range.

Of the 4,979 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs not elsewhere classified , 22% were for males and 78% were for females. Of these, less than 1% were in the 3-9 year age range, 18% were in the 10-14 year age range and 82% were in the 15-17 year age range.

Of the 1,279 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances , 21% were for males and 79% were for females. Of these, 1% were in the 3-9 year age range, 25% were in the 10-14 year age range and 74% were in the 15-17 year age range.

Of the 395 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to narcotics and psychodysleptics (hallucinogens) not elsewhere classified , 23% were for males and 77% were for females. Of these, less than 1% were in the 3-9 year age range, 12% were in the 10-14 year age range and 88% were in the 15-17 year age range.

Of the 340 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances , 26% were for males and 74% were for females. Of these, none were in the 3-9 year age range, 29% were in the 10-14 year age range and 71% were in the 15-17 year age range.

Of the 139 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system, 22% were for males and 78% were for females. Of these, no hospitalisations were in the 3-9 year age range, 26% were in the 10-14 year age range and 74% were in the 15-17 year age range.

Of the 110 hospitalisations involving children and young people due to alcohol, 42% were for males and 58% were for females. Of these, none were in the 3-9 year age range, 22% were in the 10-14 year age range and 78% were in the 15-17 year age range.

Of the 55 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours, 29% were for males and 71% were for females. Of these, 2% were in the 3-9 year age range, 44% were in the 10-14 year age range and 55% were in the 15-17 year age range.

Of the 48 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to pesticides, 33% were for males and 67% were for females. Of these, none were in the 3-9 year age range, 29% were in the 10-14 year age range and 71% were in the 15-17 year age range.

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Children’s Rights Report 2014 • 135

Of the 42 hospitalisations involving children and young people due to intentional self-poisoning by and exposure to other gases and vapours, 57% were for males and 43% were for females. Of these, none were in the 3-9 year age range, 26% were in the 10-14 year age range and 74% were in the 15-17 year age range.

Hospitalisations for other mechanisms of intentional self-harm

(i) Sharp object

Of the 2,262 hospitalisations involving children and young people due to intentional self-harm by sharp object, 26% were for males and 74% were for females. Of these, less than 1% were in the 3-9 year age range, 21% were in the 10-14 year age range and 79% were in the 15-17 year age range.

(ii) Hanging, strangulation and suffocation

Of the 552 hospitalisations involving children and young people due to intentional self-harm by hanging, strangulation and suffocation, 50% were for males and 50% were for females. Of these, 2% were in the 3-9 year age range, 26% were in the 10-14 year age range and 72% were in the 15-17 year age range.

(iii) Jumping from a high place

Of the 49 hospitalisations involving children and young people resulting from intentional self-harm by jumping from a high place, 45% were for males and 55% were for females. Of these, 2% were in the 3-9 year age range, 14% were in the 10-14 year age range and 84% were in the 15-17 year age range.

(iv) Smoke, fire and flames

Of the 48 hospitalisations involving children and young people due to intentional self-harm by smoke, fire and flames , 38% were for males and 62% were for females. Of these, none were in the 3-9 year age range, 23% were in the 10-14 year age range and 77% were in the 15-17 year age range.

(v) Jumping or lying before a moving object

Of the 35 hospitalisations involving children and young people due to intentional self-harm by jumping or lying before a moving object, 54% were for males and 46% were for females. Of these, no hospitalisations were in the 3-9 year age range, 14% were in the 10-14 year age range and 86% were in the 15-17 year age range.

(vi) Blunt object

Of the 32 hospitalisations involving children and young people due to intentional self-harm by blunt object, 38% were for males and 62% were for females. Of these, 3% were in the 3-9 year age range, 19% were in the 10-14 year age range and 78% were in the 15-17 year age range.

(vii) Crashing of motor vehicle

Of the 27 hospitalisations involving children and young people due to intentional self-harm by crashing of motor vehicle, 56% were for males and 44% were for females. All hospitalisations were in the 15-17 year age range.

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(viii) Drowning and submersion

Of the 12 hospitalisations involving children and young people due to intentional self-harm by drowning and submersion, 17% were for males and 83% were for females. Of these, none were in the 3-9 year age range, 17% were in the 10-14 year age range and 83% were in the 15-17 year age range.

(ix) Steam, hot vapours and hot objects

Of the 12 hospitalisations involving children and young people due to intentional self-harm by steam, hot vapours and hot objects, 50% were for males and 50% were for females. All hospitalisations were in the 15-17 year age range.

(x) Handgun discharge

There was one hospitalisation for intentional self-harm by handgun discharge in a male child.

(xi) Other specified means

Of the 132 hospitalisations involving children and young people due to intentional self-harm by other specified means , 49% were for males and 51% were for females. Of these, 4% were in the 3-9 year age range, 28% were in the 10-14 year age range and 68% were in the 15-17 year age range.

(xii) Unspecified means

Of the 84 hospitalisations involving children and young people due to intentional self-harm by unspecified means, 24% were for males and 76% were for females. Of these, no hospitalisations were in the 3-9 year age range, 23% were in the 10-14 year age range and 77% were in the 15-17 year age range.

Incident location of intentional self-harm

(i) Home

53% of all hospitalisations, or 9,635 episodes, involving children and young people were due to intentional self-harm occurring at home. Of these, 20% were for males and 80% were for females. Less than 1% were in the 3-9 year age range, 22% were in the 10-14 year age range and 78% were in the 15-17 year age range.

(ii) Unspecified place of occurrence/not reported

37% of all hospitalisations, or 6,707 episodes, involving children and young people were due to intentional self-harm occurring in an ‘unspecified place of occurrence/not reported’ . Of these, 20% were for males and 80% were for females. Less than 1% were in the 3-9 year age range, 18% were in the 10-14 year age range and 81% were in the 15-17 year age range.

(iii) School, other institution and public administrative area

5% of all hospitalisations, or 995 episodes, involving children and young people were due to intentional self-harm occurring at a school, other institution and public administrative area. Of these, 18% were for males and 82% were for females. Less than 1% were in the 3-9 year age range, 23% were in the 10-14 year age range and 76% were in the 15-17 year age range.

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(iv) Residential institution

2% of all hospitalisations, or 332 episodes, involving children and young people were due to intentional self-harm occurring in a residential institution. Of these, 28% were for males and 72% were for females. Less than 1% were in the 3-9 year age range, 25% were in the 10-14 year age range and 75% were in the 15-17 year age range.

(v) Other specified place of occurrence

2% of all hospitalisations, or 278 episodes, involving children and young people were due to intentional self-harm occurring in an ‘other specified place of occurrence’ . Of these, 26% were for males and 74% were for females. There were no hospitalisations involving the 3-9 year age range, 24% were in the 10-14 year age range and 76% were in the 15-17 year age range.

(vi) Street or highway

1% of all hospitalisations, or 152 episodes, involving children and young people were due to intentional self-harm occurring on a street or highway. Of these, 45% were for males and 55% were for females. There were no hospitalisations involving the 3-9 year age range, 13% were in the 10-14 year age range and 87% were in the 15-17 year age range.

(vii) Trade and service area

1% of all hospitalisations, or 160 episodes, involving children and young people were due to intentional self-harm occurring in a trade and service area. Of these, 23% were for males and 77% were for females. There were no hospitalisations in the 3-9 year age range, 16% were in the 10-14 year age range and 84% were in the 15-17 year age range.

(viii) Sports and athletics area

Less than 1% of all hospitalisations, or 12 episodes, involving children and young people were due to intentional self-harm occurring at a sports and athletics area. Of these, 33% were for males and 67% were for females. There were no hospitalisations in the 3-9 year age range, 17% were in the 10-14 year age range and 83% were in the 15-17 year age range.

(ix) Industrial and construction area

Less than 1% of all hospitalisations, or four episodes, involving children and young people were due to intentional self-harm in an industrial and construction area. Of these, 75% were for males and 25% were for females. There were no hospitalisations in the 3-9 year age range, 25% were in the 10-14 year age range and 75% were in the 15-17 year age range.

(x) Farm

Less than 1% of all hospitalisations, or two episodes, involving children and young people were due to intentional self-harm occurring on a farm. All of these hospitalisations were for females. There were no hospitalisations in the 3-9 year age range, 50% were in the 10-14 year age range and 50% were in the 15-17 year age range.

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3.6.4 Kids Helpline data about children and young people seeking help

The Kids Helpline is Australia’s only national 24/7, confidential support and counselling service specifically for children and young people aged 5-25 years. It offers counselling support via phone, email and a real-time web platform.

For the purpose of my examination, Kids Helpline prepared a detailed analysis of the information that it collected during 2012 and 2013 relating to children and young people aged 5-17 years.

Through the submission made by Kids Helpline to this examination, I was able to access the voices of children and young people aged 5-17 years. The Kids Helpline collects information directly stated by children and young people to the service.439

Contacts from children and young people aged 5-17 years relating to suicide

During 2012 and 2013, Kids Helpline responded to 80,142 contacts from children and young people aged 5-17 years that involved the provision of counselling.440 14% of these, or 11,180 contacts, were assessed by counsellors as involving a child or young person with current thoughts of suicide.441 Of these 11,180 contacts, 5,451 were in 2012 and 5,729 were in 2013.442

As well as recording the assessment by counsellors about contacts from children and young people, Kids Helpline also records the issues directly stated by children and young people at the point of contact. During 2012 and 2013, Kids Helpline responded to 10,033 contacts from children and young people aged 5-17 years who directly stated that suicide was one of their main concerns.443

In 6,703 contacts, suicide was directly stated as the main concern.444 Of these 6,703 contacts, 3,190 were in 2012 and 3,513 were in 2013. The Kids Helpline indicated that the increase in the proportion of contacts from 2012 to 2013, where suicide was directly stated as the main concern, was statistically significant, p < .05.445

Of the 6,703 contacts from children and young people who directly stated that suicide was their main concern, 54.44%, or 3,649 contacts, were recorded as having suicide as the only concern discussed.446 45.46%, or 3,054 contacts, were recorded as having suicide as the main concern along with additional concerns.447

The additional concerns where suicide was the main concern are shown in Table 5. I note that the number of additional concerns, 3,606, is greater than the number of contacts recorded as having additional concerns, 3,054. This is due to it being possible to record multiple concerns for each individual contact.

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Children’s Rights Report 2014 • 139

Table 5: Number and type of coexisting concerns discussed when suicide is the main concern for children and young people under 18 years448

2012 2013

Additional Concern Number Additional Concern Number

Mental health 480 Mental health 409

Self-injury and self-harm 369 Self-injury and self-harm 396

Child-parent relationships 268 Child-parent relationships 240

Relationships with friends and peers 152 Emotional wellbeing 207

Emotional wellbeing 143 Bullying 116

Bullying 124 Relationships with friends and peers 92

Grief 96 Self-image 89

Relationship with partner 84 Grief 65

Physical abuse 79 Physical abuse 62

Other family relationships 76 Other family relationships 59

Reasons for contact

Of the 6,703 contacts during 2012 and 2013 from children and young people who directly stated that suicide was their main concern, 73.42% of contacts in 2012 and 75.01% of contacts in 2013 were about suicidal thoughts and fears.459 Where sex was recorded and suicide was stated as the main concern, 71.8% of contacts from males and 74.56% of contacts from females were about suicidal thoughts and fears.450

15.58% of contacts in 2012 and 13.64% in 2013 were about concerns for another person:451

• Where sex was recorded and suicide was stated as the main concern, 17.08% of contacts from males and 14.21% of contacts from females were about concerns for another person.452

• The Kids Helpline indicated that the higher proportion of contacts from males compared with females about concerns for another person was statistically significant, p <.05.453

• The Kids Helpline also indicated that the overall decrease in the proportion of contacts from 2012 to 2013 about concerns for another person was statistically significant, p <.05.454

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7.93% of contacts in 2012 and 6.60% in 2013 were about immediate intention:455

• Where sex was recorded and suicide was stated as the main concern, 8.48% of contacts from males and 7.08% of contacts from females were about immediate intention.456 • The Kids Helpline indicated that the decrease in the proportion of contacts from 2012 to 2013 about immediate intention was statistically significant, p <.05.457

2.38% of contacts in 2012 and 3.96% in 2013 were about a current attempt at the time of contact:458

• Where sex was recorded and suicide was stated as the main concern, 1.55% of contacts from males and 3.44% of contacts from females were about a current attempt at the time of contact.459 • The Kids Helpline indicated that the higher proportion of contacts from females compared with males about a current attempt at the time of contact was statistically significant, p <.05.460 • The Kids Helpline also indicated that the increase in the proportion of contacts from 2012 to 2013

about a current attempt at the time of contact was statistically significant, p <.05.461

0.69% of contacts in 2012 and 0.79% in 2013 were about seeking information.470 Where sex was recorded and suicide was stated as the main concern, 1.08% of contacts from males and 0.71% of contacts from females were about seeking information.463

The reasons for children and young people aged 5-17 years contacting Kids Helpline where suicide was the main concern are shown in Table 6.

Table 6: Reasons for children and young people aged under 18 years contacting about suicide as their main concern in 2012 and 2013464

Reason for Contact 2012 2013

Number % Number %

Seeking information 22 0.69% 28 0.79%

Concerned about another person 497 15.58% 479 13.64%

Suicidal thoughts or fears 2,342 73.42% 2,635 75.01%

Immediate intention 253 7.93% 232 6.60%

Current attempt at the time of contact 76 2.38% 139 3.96%

Total 3,190 100% 3,513 100%

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Children’s Rights Report 2014 • 141

Sex and age

The sex of the child or young person was recorded in 6,600 of the 6,703 contacts during 2012 and 2013 from children and young people who directly stated that suicide was their main concern.465 Of these contacts, where sex was recorded, 87.32%, or 5,763 contacts, were from females and 12.68%, or 837 contacts, were from males:466

• Female children and young people who directly stated that suicide was their main concern were in the 7-17 year age range.467 93.86% of contacts from females were in the 13-17 year age range.468 • Males were in the 6-17 year age range.469 Contacts from males increased with age.470 • The average age of females and males was 14.97 years at the time of contacting Kids Helpline.471

Of the contacts from females who directly stated that suicide was their main concern, 52.87% contacted Kids Helpline online and 47.13% by phone.472 The Kids Helpline indicated that the higher proportion of online contacts by females compared with males was statistically significant, p <.05.473

Of the contacts from males, 33.09% contacted Kids Helpline online and 66.91% by phone.474 The Kids Helpline also indicated that the higher proportion of phone contacts by males compared with females was statistically significant, p <.05.475

Location by year, age, sex, mode of contact

Data about the location of the child or young person was recorded in 3,174 of the 6,703 contacts during 2012 and 2013 from children and young people who directly stated that suicide was their main concern.476

Of these contacts where location data was recorded, 62.73%, or 1,991 contacts, were from children and young people in capital cities.477 8.76%, or 278 contacts, were from other metropolitan areas:478

• Contacts from children and young people in capital cities and other metropolitan areas were in the 9-17 year age range.479 • Of these contacts, where sex was recorded, 89.35% were from females and 10.65% were from males.480 • 7.42% made contact by phone and 62.58% made contact online.481 • The Kids Helpline indicated that a higher proportion of contacts came from males in capital cities

and other metropolitan areas compared with rural centres and areas. This was said to be statistically significant, p <.05.482 • The Kids Helpline also indicated that a higher proportion of contacts were online from children and young people in capital cities and other metropolitan areas compared with rural centres and areas.

This was said to be statistically significant, p <.05.483

27.25%, or 865 contacts, were from rural centres and areas:484

• Contacts from children and young people in rural centres and areas were in the 8-17 year age range.485 • Of these contacts, where sex was recorded, 93.48% were from females and 6.52% were from males.486 • 42.08% made contact by phone and 57.92% made contact online.487 • The Kids Helpline indicated that there was a higher proportion of contacts from females compared

with males in rural centres and areas and this was statistically significant, p <.05.488 • The Kids Helpline also indicated that there was a higher proportion of contacts by phone from children and young people in rural centres and areas compared with contacts from capital cities

and other metropolitan areas and this was statistically significant, p <.05.489

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1.26%, or 40 contacts, were from remote centres and areas:490

• Contacts from children and young people in remote centres and areas were in the 13-17 year age range.491 • Of these contacts, where sex was recorded, 90% were from females and 10% were from males.492 • 32.5% made contact by phone and 67.5% made contact online.493 • Although the number of contacts is small, Kids Helpline indicated that the increase in the proportion

of contacts from 2012 to 2013 by children and young people in remote centres and areas was statistically significant, p <.05.494

Indigenous children and young people

Of the 6,703 contacts during 2012 and 2013 from children and young people who directly stated that suicide was their main concern, 129 contacts were from children and young people who identified as Aboriginal and four contacts were from children and young people who identified as both Aboriginal and Torres Strait Islander.495

Of these 133 contacts, the sex of the child or young person was recorded in 130 contacts.496 97.69%, or 127 contacts, were from females and 2.31%, or three contacts, were from males.497

Aboriginal and Torres Strait Islander children and young people who directly stated that suicide was their main concern were in the 12-17 year age range,498 with 90.55% of contacts in the 14-16 year age range.499

71.43% made contact by phone and 28.57% made contact online.500

Data about the location of the child or young person was recorded in 89 of the 133 contacts during 2012 and 2013:501

• 77.53%, or 69 contacts, were from Aboriginal and Torres Strait Islander children and young people in capital cities and other metropolitan areas.502 • 21.35%, or 19 contacts, were from rural towns.503 • 1.12%, or one contact, was from a remote area.504

Of the 133 contacts during 2012 and 2013 from Aboriginal and Torres Strait Islander children and young people who directly stated that suicide was their main concern:

• 83.46%, or 111 contacts, were about suicidal thoughts and fears.505 • 7.52%, or 10 contacts, were about immediate intention.506 • 5.26%, or seven contacts, were about concerns for another person.507 • 3.01%, or four contacts, were about a current attempt at the time of contact.508 • 0.75%, or one contact, was about seeking information.509

Children and young people with a culturally and linguistically diverse background

Of the 6,703 contacts during 2012 and 2013 from children and young people who directly stated that suicide was their main concern, 5.26%, or 353 contacts, were from children and young people who identified as being from a culturally and linguistically diverse background.510

Of these 353 contacts, the sex of the child or young person was recorded in 350 contacts.511 81.71%, or 286 contacts, were from females and 18.29%, or 64 contacts, were from males.512

The 353 contacts from children and young people who identified as being from a culturally and linguistically diverse background who directly stated that suicide was their main concern were in the 9-17 year age range,513 with 80.45% of contacts in the 14-17 year age range.514

55.81% made contact by phone and 44.19% made contact online.515

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 143

Data about the location of the child or young person was recorded in 161 of the 353 contacts during 2012 and 2013:516

• 79.50%, or 128 contacts, were from children and young people in capital cities and other metropolitan areas.517 • 14.29%, or 23 contacts, were from children and young people in rural towns.518 • 6.21%, or 10 contacts, were from children and young people in remote areas.519

Of the 353 contacts during 2012 and 2013 from children and young people who identified as being from a culturally and linguistically diverse background who directly stated that suicide was their main concern:

• 76.20%, or 269 contacts, were about suicidal thoughts and fears.520 • 11.33%, or 40 contacts, were about concerns for another person.521 • 8.78%, or 31 contacts, were about immediate intention.522 • 2.55%, or nine contacts, were about a current attempt at the time of contact.523 • 1.13%, or four contacts, were about seeking information.524

Contacts with children and young people aged 5-17 years relating to self-injury and self-harm

Of the 80,142 contacts during 2012 and 2013 from children and young people aged 5-17 years which involved the provision of counselling,525 23% of these, or 18,737 contacts, were assessed by counsellors as involving a child or young person who self-injures and self-harms.526 Of these 18,737 contacts, 9,451 were in 2012 and 9,286 were in 2013.527

As well as recording the assessment by counsellors about contacts from children and young people, Kids Helpline also records the issues directly stated by children and young people at the point of contact. During 2012 and 2013, Kids Helpline responded to 8,117 contacts from children and young people aged 5-17 years who directly stated that self-injury and self-harm was one of their main concerns.528

In 4,380 contacts, self-injury and self-harm was directly stated as the main concern.529 Of these 4,380 contacts, 2,112 were in 2012 and 2,268 were in 2013.530

Of the 4,380 contacts from children and young people who directly stated that self-injury and self-harm was their main concern, 49.43%, or 2,165 contacts, were recorded as having self-injury and self-harm as the only concern discussed.531 50.57%, or 2,215 contacts, were recorded as having self-injury and self-harm as the main concern along with additional concerns.532

The additional concerns where self-injury and self-harm was the main concern are shown in Table 7. I note that the number of additional concerns, 2,541, is greater than the number of contacts recorded as having additional concerns, 2,215. This is because multiple concerns can be recorded for individual contacts.

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Table 7: Number and type of coexisting concerns discussed when self-injury and self-harm is the main concern for children and young people under 18 years533

2012 2013

Additional Concern Number Additional Concern Number

Suicide 275 Suicide 238

Mental health 258 Mental health 228

Child-parent relationships 205 Emotional wellbeing 186

Emotional wellbeing 192 Child-parent relationships 152

Relationships with friends and peers 116 Bullying 96

Self-image 82 Relationships with friends and peers 89

Bullying 73 Self-image 80

Grief 50 Body image 53

Other family relationships 47 Relationship with partner 43

Relationship with partner 43 Other family relationships 35

Reasons for contact

Of the 4,380 contacts during 2012 and 2013 from children and young people who directly stated that self-injury and self-harm was their main concern, 39.16% of contacts in 2012 and 40.30% of contacts in 2013 were about talking through consequences and/or alternative coping strategies:534

• Where sex was recorded and self-injury and self-harm was stated as the main concern, 30.9% of contacts from males and 40.63% of contacts from females were about talking through the consequences and/or alternative coping strategies.535

• The Kids Helpline indicated that there was a lower proportion of contacts concerned with talking through the consequences and/or alternative coping strategies from children and young people in capital cities and other metropolitan areas compared with those in rural centres and areas. The Kids Helpline stated that this was statistically significant, p <.05.536

36.03% of contacts in 2012 and 32.67% in 2013 were about getting help to resist thoughts and urges to injure.537 Where sex was recorded and self-injury and self-harm was stated as the main concern, 32.56% of contacts from males and 34.41% of contacts from females were about getting help to resist thoughts and urges to injure.538

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 145

12.45% of contacts in 2012 and 15.12% of contacts in 2013 were made by children and young people who stated that they were concerned about another person:539

• Where sex was recorded and self-injury and self-harm was stated as the main concern, 23.92% of contacts from males and 12.89% of contacts from females were about concerns for another person.540

• The Kids Helpline indicated that a higher proportion of contacts about concerns for another person were made by children and young people in capital cities and other metropolitan areas compared with those in rural centres and areas. The Kids Helpline stated that this was statistically significant, p <.05.541

6.2% of contacts in 2012 and 6% in 2013 were about concerns other people had for a child or young person who was engaging in self-injury and self-harm behaviour.542 Where sex was recorded and self-injury and self-harm was stated as the main concern, 4.98% were contacts from males and 6.25% were contacts from females.543

3.41% of contacts in 2012 and 4.01% in 2013 were about concerns where injury at the time of contact required medical assistance.544 Where sex was recorded and self-injury and self-harm was stated as the main concern, 2.99% of contacts were from males and 3.74% were from females.545

2.75% of contacts in 2012 and 1.90% in 2013 were about seeking information.546 Where sex was recorded and self-injury and self-harm was stated as the main concern, 4.65% of contacts from males and 2.08% of contacts from females were about seeking information.547

The reasons for children and young people aged 5-17 years contacting Kids Helpline where self-injury and self-harm was the main concern are shown in Table 8.

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Table 8: Reasons for children and young people aged under 18 years contacting about self-injury and self-harm in 2012 and 2013548

Reason for Contact 2012 2013

Number % Number %

Seeking information 58 2.75% 43 1.90%

Concerned about another person 263 12.45% 343 15.12%

Contacting to help resist thoughts and urges to injure 761 36.03% 741 32.67%

Talking through consequences and/or alternative coping strategies 827 39.16% 914 40.30%

Others are concerned about client’s self-injuring and self-harming behaviour 131 6.20% 136 6.00%

Concerned that injury at the time of contact requires medical assistance 72 3.41% 91 4.01%

Total 2,112 100% 2,268 100%

Sex and age

The sex of the child or young person was recorded in 4,288 of the 4,380 contacts during 2012 and 2013 from children and young people who directly stated that self-injury and self-harm was their main concern.549 Of these contacts, where sex was recorded, 92.98%, or 3,987 contacts, were from females and 7.02%, or 301 contacts, were from males:550

• Female and male children and young people who directly stated that self-injury and self-harm was their main concern were in the 9-17 year age range.551

• 92.78% of contacts from females and 94.35% of contacts from males were in the 13-17 year age range.552

• The average age of females was 14.73 years at the time of contacting Kids Helpline, and the average age of males was 15.06 years.553

Of the contacts from females who directly stated that self-injury and self-harm was their main concern, 59.22% contacted Kids Helpline online and 40.78% by phone.554

Of the contacts from males, 44.85% contacted Kids Helpline online and 55.15% by phone.555 The Kids Helpline indicated that there was a higher proportion of online contacts from females compared with males which was statistically significant, p <.05.556 The Kids Helpline also stated that there was a higher proportion of phone contacts from males than females which was statistically significant, p <.05.557

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 147

Location by year, age, sex, mode of contact

Data about the location of the child and young person was recorded in 2,100 of the 4,380 contacts during 2012 and 2013 from children and young people who directly stated that self-injury and self-harm was their main concern.558

Of these contacts where location data was recorded, 62.86%, or 1,320 contacts, were from children and young people in capital cities.559 6.62%, or 139 contacts, were from other metropolitan areas:560

• Contacts from children and young people in capital cities and other metropolitan areas were in the 9-17 year age range.561 • Of these contacts, where sex was recorded, 91.86% were from females and 8.14% were from males.562 • 29.61% made contact by phone and 70.39% made contact online.563 • The Kids Helpline indicated that the decrease in the proportion of contacts from 2012 to 2013 by

children and young people in capital cities and other metropolitan areas was statistically significant, p <.05.564 • The Kids Helpline also indicated that the higher proportion of contacts from males in capital cities and other metropolitan areas compared with those in rural centres and areas, was statistically

significant, p <.05.565 • The Kids Helpline further indicated that the higher proportion of contacts online from children and young people in capital cities and other metropolitan areas compared with rural centres and areas,

was statistically significant, p <.05.566

29.86%, or 627 contacts, were from rural centres and areas:567

• Contacts from children and young people in rural centres and areas were in the 9-17 year age range.568 • Of these contacts, where sex was recorded, 96.94% were from females and 3.06% were from males.569 • 36.04% made contact by phone and 63.96% made contact online.570 • The Kids Helpline indicated that the increase in the proportion of contacts from 2012 to 2013 by

children and young people in rural centres and areas was statistically significant, p <.05.571 • The Kids Helpline also indicated that there was a higher proportion of contacts from females in rural centres and areas compared with capital cities and other metropolitan areas. The Kids Helpline

stated that this was statistically significant, p <.05.572 • The Kids Helpline further indicated that the higher proportion of contacts by phone from children and young people in rural centres and areas compared with capital cities and other metropolitan areas,

was statistically significant, p <.05.573

0.67%, or 14 contacts, were from remote centres and areas:574

• Contacts from children and young people in remote centres and areas were in the 13-17 year age range.575 • Of these contacts, where sex was recorded, all were from females.576 • 28.57% made contact by phone and 71.43% made contact online.577 • Although the number of contacts was small, Kids Helpline indicated that the increase in the

proportion of contacts from 2012 to 2013 by children and young people in remote areas was statistically significant, p <.05.578

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Indigenous children and young people

Of the 4,380 contacts during 2012 and 2013 from children and young people who directly stated that self-injury and self-harm was their main concern, 41 contacts were from children and young people who identified as Aboriginal and four contacts were from children and young people who identified as both Aboriginal and Torres Strait Islander.579

Of these 45 contacts, the sex of the child or young person was recorded in 44 contacts.580 95.45%, or 42 contacts, were from females and 4.55%, or two contacts, were from males.581

Aboriginal and Torres Strait Islander children and young people who directly stated that self-injury and self-harm was their main concern were in the 12-17 year age range.582

64.44% made contact by phone and 35.56% made contact online.583

Data about the location of the child or young person was recorded in 23 of the 45 contacts during 2012 and 2013:584

• 91.3%, or 21 contacts, were from Aboriginal and Torres Strait Islander children and young people in capital cities and other metropolitan areas.585 • 8.7%, or two contacts, were from rural towns.586 • No contacts were recorded from children and young people in remote areas.

Of the 45 contacts during 2012 and 2013 from Aboriginal and Torres Strait Islander children and young people who directly stated that self-injury and self-harm was their main concern:

• 46.67%, or 21 contacts, were about contacting to help resist thoughts and urges to injure.587 • 40%, or 18 contacts, were about talking through consequences and/or alternative coping strategies.588 • 13.33%, or six contacts, were about the concerns other people had in relation to the self-injuring

and self-harming behaviour of the child or young person contacting Kids Helpline.589

Children and young people with culturally and linguistically diverse backgrounds

Of the 4,380 contacts during 2012 and 2013 from children and young people who directly stated that self-injury and self-harm was their main concern, 4.56%, or 200 contacts, were from children and young people who identified as being from a culturally and linguistically diverse background.590

Of these 200 contacts, the sex of the child or young person was recorded in 198 contacts.591 89.9%, or 178 contacts, were from females and 10.1%, or 20 contacts, were from males.592

The 200 contacts from children and young people who identified as being from a culturally and linguistically diverse background and who directly stated that self-injury and self-harm was their main concern were in the 10-17 year age range.593

62% made contact by phone and 38% made contact online.594

Data about the location of the child or young person was recorded in 109 of the 200 contacts during 2012 and 2013:595

• 81.65%, or 89 contacts, were from children and young people in capital cities and other metropolitan areas.596 • 18.35%, or 20 contacts, were from children and young people in rural towns.597 • No contacts were recorded from children and young people in remote areas.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 149

Of the 200 contacts during 2012 and 2013 from children and young people who identified as being from a culturally and linguistically diverse background and who directly stated that self-injury and self-harm was their main concern:

• 42%, or 84 contacts, were about contacting to help resist thoughts and urges to injure.598 • 36.5%, or 73 contacts, were about talking through consequences and/or alternative coping strategies.599 • 10.5%, or 21 contacts, were about concerns for another person.600 • 6.5%, or 13 contacts, were from other people who were concerned about a child or young person

who was engaging in self-injuring and self-harming behaviour.601 • 4%, or eight contacts, were about concerns where injury at the time of contact required medical assistance.602 • 0.5%, or one contact, was about seeking information.603

3.7 What does the data tell us?

3.7.1 Death due to intentional self-harm

Obtaining this national data has been a very important part of my examination. As noted before, NCIS provided me with national data that has previously not been published. I hope that the release of this data will assist those who are working with and/or involved with children and young people.

The data provided to me by NCIS and ABS confirmed that hanging was the most frequently used mechanism of intentional self-harm leading to death in children and young people across all age ranges. According to NCIS, 89% of children and young people aged 4-13 years died by hanging, 80% of those aged 14-15 years and 81% of those aged 16-17 years died by hanging.

While hanging has been predominantly associated with males, it is now the most common mechanism used by females. While NCIS data showed that males were 1.7 times more likely than females to die by this mechanism, the proportion of females who died by hanging was higher than the proportion of males. 85% of females died by this mechanism compared with 81% of males.

Given the prevalence of hanging, investigating ways to prevent it should be prioritised.

However, this is very challenging. Previously, suicide prevention has focused on restricting access to commonly used methods, such as:

• changing the maximum paracetamol pack size sold by Australian retailers other than pharmacies from 25 to 20 in September 2013 • erecting safety precautions at potential jumping sites • licensing, storage and safe keeping requirements for firearms being prescribed in all states and

territories.

Unfortunately, restricted access to the means for hanging is not possible and the ease of availability to means makes hanging receptive to impulsivity.

The submission by the Child Death and Serious Injury Review Committee of South Australia emphasised:

hanging is a method of “high lethality” and…is almost impossible to “restrict access to means” when these can be pieces of rope, electrical cable, garden hose, shoe laces or handbag and straps.604

The submission by Menzies School of Health Research highlighted the lethality of hanging and the ease of availability.605

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The Royal Australian and New Zealand College of Psychiatrists told me that ‘Young people have a poor understanding of the potential lethality of methods of self-harm’.606

International research suggests:

Prevention strategies should focus on countering perceptions of hanging as a clean, painless and rapid method that is easily implemented. However, care is needed in the delivery of such messages as some individuals could gain information that might facilitate fatal implementation. Detailed research needs to focus on developing and evaluating interventions that can manage this tension…further research is required to verify existing perceptions about hanging and to explore in detail the origins of these and the full range of sources and knowledge that people draw upon and are influenced by when planning a suicide attempt. 607

The NCIS data also showed that 76% of deaths in children and young people were due to intentional self-harm occurring in the home. Increasing the awareness of primary caregivers about risk factors and warning signs is essential. The continued implementation of universal suicide prevention strategies aimed at raising public awareness, encouraging help-seeking behaviour and challenging stigma associated with suicide may assist with this.

The submission by the Black Dog Institute highlighted to me that the community has:

low to moderate levels of suicide literacy, with the greatest deficits in the identification of the signs and symptoms of suicide and the risk factors associated with it.608

The Black Dog Institute also emphasised:

Family and friends have poor knowledge of the signs of suicide and lack knowledge about how and in what circumstances they should act.609

The NCIS data showed that five children died due to intentional self-harm in the 4-11 year age range, 14 died in the 12-13 year age range, 106 died in the 14-15 year age range and 204 died in the 16-17 year age range.

The percentage increase between those in the 4-11 year age range and those in the 12-13 year age range is 180%. The percentage increase between the 12-13 year age range and the 14-15 year age range is 657%. The percentage increase between the 14-15 year age range and the 16-17 year age range is 96%.

The 180% increase between those in the 4-11 year age range and those in the 12-13 year age range happens when many children are transitioning from primary school to secondary school, accompanied by the onset of puberty. The increase of 657% between those who are in the 12-13 year age range and those in the 14-15 year age range occurs when many are entering or experiencing puberty. This is not to impute a definitive biological age to the onset of puberty, which can ‘vary depending on genetic, environmental, and social influences’. 610 However, the data provided by NCIS suggests that the transition between childhood and adolescence may be a time where targeted interventions are warranted.

Developments in neuroscience and functional Magnetic Resonance Imaging suggest there is a second wave of rapid brain development in the middle years of childhood and adolescence.611 Research in this area indicates that the greatest changes to the parts of the brain responsible for functions such as self-control, judgement, emotions and organisation occur between puberty and adulthood.612 This, too, has implications for the kinds of interventions that might be delivered to children and young people during these years.

Typically, in the past, data about death due to intentional self-harm involving those under 15 years of age have been merged together as one group without differentiating between childhood and adolescence. However, as Soole, Kõlves and De Leo argue, ‘Children and adolescents might warrant separate consideration’.613 Indeed, they differ in terms of physical, sexual, cognitive and social development:

Arguably, failure to delineate differences and similarities in suicide-related factors for childhood and adolescence can have scientific and clinical implications, hindering the understanding of child suicide and the development of targeted suicide prevention.614

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 151

Previously, nationally disaggregated data for those under 15 years of age has not been available. The importance of its continued availability cannot be underestimated and must be prioritised.

Most children and young people died by hanging between 8pm and midnight, followed by 4pm and 8pm, noon and 4pm, midnight and 4am, 8am and noon, and 4am and 8am. The time of some deaths was unknown. It is not possible to draw conclusions or predict patterns in relation to these identified time periods as the spread across the time periods was relatively even. Given that children and young people die due to intentional self-harm across all time periods, there is a clear need for twenty-four hour support services.

According to NCIS, 58 children and young people died by mechanisms other than hanging. There was 1 death in the 12-13 year age range by a mechanism other than hanging, 21 deaths in the 14-15 year age, and 36 deaths in the 16-17 year age range by a mechanism other than hanging. As children and young people grow older, more mechanisms become available to them and some of them utilise these other means.

While most die due to intentional self-harm occurring at home, approximately 18% of those aged 14-15 years chose other locations, predominately transport areas. This increased to 24% for those aged 16-17 years, with intentional self-harm leading to death in this age range mainly occurring in the countryside, transport areas and recreational areas, cultural areas or public buildings. The data that I obtained did not cross tabulate the mechanism of intentional self-harm by location. It is important that future work investigates this correlation as it may provide insights to assist in preventing access to means.

Aboriginal and Torres Strait Islanders represent only 3% of Australia’s population,615 yet the data provided to me by ABS shows they accounted for 28.1% of all the recorded deaths in children and young people under 18 years of age due to intentional self-harm.

The data provided to me by NCIS shows that Indigenous children and young people accounted for 80% of deaths in the 4-11 year age, 42.9% of deaths in the 12-13 year age range, 24.5% of deaths in the 14-15 year age range and 15.3% of deaths in the 16-17 year age range.

The significant overrepresentation of Indigenous children and young people requires a comprehensive whole of government response.

In May 2013, the Australian Government National Aboriginal and Torres Strait Islander Suicide Prevention Strategy recognised the need to build the evidence base and disseminate information about effective suicide prevention interventions for Indigenous Australians.616 In June 2013, the Australian Government National Health and Medical Research Council opened a targeted call for research into suicide prevention in Aboriginal and Torres Strait Islander youth, due to the priority and urgency of the need for research in this area.617 In September 2014, four new National Health and Medical Research Council grants, which aim to help intervene in the high rates of Indigenous youth suicide were announced by the Minister for Health, the Hon Peter Dutton MP. This is critical research.

It was not possible for ABS to provide a breakdown by ethnicity, culture, educational attainment, and socio-economic status at the time of my request. However, ABS indicated to me in its submission that it:

has been examining options to deliver this type of information and believes that it will be possible through data linkage. The ABS is actively engaging with relevant data custodians to highlight the value of this type of study and garner agreement on a way forward. Further consultation with other stakeholders is also required as this work is currently unfunded. While there may yet be challenges faced in progressing this study, the potential benefits are clear. 618

In the event that this work is cleared to proceed, I would strongly support funding being made available.

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Some excellent work is currently underway by the Telethon Kids Institute,619 which is using linked data and a life-course approach to understand the developmental pathways to intentional self-harm, with or without suicidal intent, in children and young people. To link the data, the Telethon Kids Institute in Western Australia is collaborating with a number of state government departments, including the Western Australian Departments of Health, Education, Child Protection and Family Support, Corrective Services, Communities, Aboriginal Affairs, Treasury, Housing, Attorney-General, the Disability Services Commission, School Curriculum and Standards Authority, the Mental Health Commission and Police.

The project has established the process of linking together de-identified longitudinal, population-based data collected and stored by these Western Australian government departments with an aim to create a cost-effective research, policy planning and evaluation resource. The findings of this project have not yet been published. I commend this initiative.

3.7.2 Hospitalisation for intentional self-harm

The data provided by AIHW showed that there were 18,277 hospitalisations for intentional self-harm involving children and young people aged 3-17 years between 2007-2008 and 2012-2013. 82% of these hospitalisations were due to intentional self-poisoning.

Of the hospitalisations for intentional self-poisoning, less than 1% were in the 3-9 year age range, 21% were in the 10-14 year age range and 79% were in the 15-17 year age range.

Clearly as children and young people age, their capacity to know about the effects of self-poisoning and to obtain the means to self-poison increases.

As mentioned before, those children and young people who engage in intentional self-harm, with or without suicidal intent, may only experience hospitalisation because they cannot manage their injury without medical intervention. The AIHW reports:

A small proportion of all incident injury cases result in admission to a hospital. For each hospital admission, many more cases present to emergency departments and are not admitted, or are seen by a general practitioner (Harrison & Steenkamp 2002). A larger number of generally minor cases do not receive medical treatment. In addition, a smaller number of severe injuries that quickly result in death go unrecorded in terms of hospital separations, but are captured in mortality data.620

The data that AIHW provided to me only includes those children and young people who experienced hospitalisation. It does not include non-admitted patient care provided in outpatient services or elsewhere.

The data provided by AIHW included 10 categories of intentional self-poisoning. Females were significantly more likely to be hospitalised for intentional self-poisoning. Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics was the most frequently used means, followed by antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs not elsewhere classified, and then by other and unspecified drugs, medicaments and biological substances.

Restricting access to means is known to be an effective suicide prevention strategy. Restricting access to the means used for intentional self-poisoning offers similar potential. While the maximum paracetamol pack size sold by Australian retailers other than pharmacies changed from 25 to 20 (500 mg tablets/capsules/ caplets) in September 2013, it may be that further restrictive measures are required. Treatment for paracetamol overdose usually occurs in Australian hospitals when 10 g (20 tablets) have been consumed.621

In 1998, the UK government introduced legislation that reduced the maximum pack size of all non-effervescent tablets and capsules containing aspirin (acetylsalicylic acid) or paracetamol that can be sold or supplied from outlets other than registered pharmacies from 25 to 16 tablets.622 Further restriction could be considered in Australia. Age identification requirements may also assist in restricting access to means.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 153

Females aged 0-17 years account for 80% of all hospitalisations for intentional self-harm. Proportionally, 82% of these females are hospitalised due to intentional self-poisoning. 87% of these females are hospitalised due to intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics,

Limited research on intentional self-poisoning by female children and young people has been conducted in Australia. A number of international studies support the AIHW data, which shows higher incidences of non-fatal intentional self-poisoning in female compared with male children and young people. These studies also highlight the fact that intentional self-poisoning behaviour in female children and young people predominantly occurs during adolescence.623

The reason for the heightened incidences of non-fatal intentional self-poisoning in female adolescents is not known. Some research suggests that the earlier physical and mental maturation of girls, as well as gender differences in emotional and behavioural problems, may be contributing factors in non-fatal self-harming behaviour among female adolescents.624 More research is required to better understand this gender discrepancy.

3.7.3 Seeking help for intentional self-harm, with or without suicidal intent

The number of contacts made to Kids Helpline was very encouraging as it shows that some children and young people are engaging in help-seeking using phone and online counselling services.

Each year, Kids Helpline seeks the views of children and young people about the quality and effectiveness of the service. In 2013, 778 children and young people participated in an online survey regarding their satisfaction and perceived effectiveness of Kids Helpline. Around 81% of respondents agreed they had increased ideas about how to deal with their problems as a result of their contact. Around 65%, or 381 respondents, stated they felt more able to deal with their problems after the contact.

Sadly, I know that the number of contacts is not representative of the greater number of children and young people who need assistance. The Kids Helpline pointed out to me:

Unfortunately telephone and online counseling providers are unable to meet existing demand. In 2013 Kids Helpline had capacity to respond to only 60% of contacts. Additional financial support to increase the capability of telephone and online counseling services is required.625

Given we know that children and young people utilise these types of services and find them helpful, I strongly encourage the Australian Government to increase its financial support for these services.

The data provided to me by NCIS showed that approximately 64% of deaths due to intentional self-harm were male children and young people. It is concerning to see that there were significantly fewer contacts to Kids Helpline from male children and young people when compared with contacts from females. While contacts by male children and young people did increase with age, the overall number of contacts from males in all age ranges was consistently lower when compared with females. The reluctance of male children and young people to engage is not a new finding. 626

The continued prevalence of poor help-seeking in males shows that we are not being effective in addressing it. Given the substantially higher rates of deaths due to intentional self-harm in males, this situation is disturbing.

Engaging male children and young people in help-seeking is crucial, and concerted effort is needed to address this. Actively targeting male children and young people, and promoting help-seeking as a positive life skill and a sign of strength should be prioritised. Research which focuses on discerning what inhibits and what facilitates help-seeking in male children and young people is needed to assist in overcoming this reluctance.

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The Kids Helpline data also suggested that, proportionally, the contacts from male children and young people were more likely to be about seeking information and discussing their concerns for another person. It is unknown how many of these contacts were actually seeking information for themselves or discussing concerns that really related to their own personal circumstances, as opposed to the circumstances of another person. Knowing more about the underlying features of this could inform the strategies used to engage with male children and young people.

The data provided by Kids Helpline also showed how children and young people, depending on their sex and cultural background, had different preferences in terms of their mode of contact to seek help. Female children and young people tended to make contact online whereas male children and young people predominantly contacted Kids Helpline via phone.

Aboriginal and Torres Strait Islander children and young people, and those from culturally and linguistically diverse backgrounds, also preferred to contact Kids Helpline by phone.

Knowing how children and young people prefer to make contact is essential for tailoring services to their needs. More research that directly involves children and young people is required in this area. The need for direct consultation with children and young people was pointed out to me in a number of submissions. The ACT Children and Young People Death Review Committee stated that:

The Committee believes children and young people need to be spoken to about all aspects of self-harm and suicide, including barriers to seeking assistance. Many of the barriers to seeking assistance identified by adults may not necessarily be what children and young people identify as barriers.627

There was a pattern of concerns in the contacts to Kids Helpline from children and young people:

• Where contact was made about suicide with other concerns, self-injury and self-harm was one of the other main concerns. • Suicidal thoughts and fears were the primary concerns raised by children and young people who identified suicide as their primary concern. • Where contact was made about self-injury and self-harm, one of the other frequently cited concerns

was suicide. • Talking through the consequences and/or alternative coping strategies were the foremost concerns of children and young people who identified self-injury and self-harm as their primary concern.

Regardless of whether the main contact was about suicide or self-injury and self-harm, the leading concerns raised by children and young people were about mental health, child-parent relationships and emotional wellbeing.

This type of information is invaluable and should inform the ways that resources and interventions are developed and targeted to children and young people.628

Focusing on the concerns identified through the contacts by children and young people is important because this may assist us to know how we can effectively meet their needs.

The Northern Territory Council of Social Service told me:

Valuing the contributions young people make to society and ensuring that there are legitimate pathways for young people‘s views to be actively heard will make a marked difference to the overall mental health and incidence of suicide currently experienced.629

The data I received from NCIS, ABS, AIHW and Kids Helpline has been invaluable and has informed some of my recommendations.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 155

3.7.4 Where to from here?

I hope that my examination of non-suicidal self-harm and suicidal behaviour can be a blueprint for identifying some of the issues that can inform the development of a specific national research agenda for children and young people who are engaging in non-suicidal self-harm and suicidal behaviour.

The submission by the Black Dog Institute recommended the development of a ‘new national suicide prevention research agenda for children and young people’.630

The Orygen Youth Health Research Centre made a similar recommendation and pointed out to me:

one of the key things lacking in Australia’s approach to the prevention of suicide and self-harm among young people is a truly strategic approach towards developing a research agenda which can be used to inform best practice.631

The submission by Orygen Youth Health Research Centre also told me:

Australia has numerous organisations with specific expertise in youth suicide prevention, including [Orygen Youth Health Research Centre], headspace, and the Young and Well Cooperative Research Centre that together hold the expertise and infrastructure to lead the way in a collaboration of this nature.632

Currently the Standing Committee on Child and Youth Health is developing the National Child and Youth Strategic Framework (the National Strategic Framework). The National Strategic Framework is an Australian Health Ministers’ Advisory Council funded project and is being progressed through its Community Care and Population Health Principal Committee.

The National Strategic Framework will assist in developing national service strategies that outline roles and responsibilities and establish priorities. The National Strategic Framework could make establishing a national research agenda for children and young people engaging in non-suicidal self-harm and suicidal behaviour a focus area.

Health goals and targets for Australian children and young people were initially developed in 1992. Youth suicide was included in Goal 1, which focused on reducing preventable premature mortality. For 20 years, these strategic goals have guided work to improve the health of children and young people in Australia.

The views of stakeholders are now being sought to help identify the current key issues and necessary priorities to improve the health and wellbeing of children and young people in Australia. A Discussion Paper has been released in conjunction with a survey. Feedback from the survey will inform the first draft of the new National Strategic Framework. Youth suicide is included as a continuing concern in the Discussion Paper.

Intentional self-harm, with or without suicidal intent, is not referred to in the Discussion Paper. Given the evidence of the increasing rates of intentional self-harm, with or without suicidal intent, it would seem reasonable to identify it as an area of emerging concern and include it in the revised goals and targets.

It is anticipated that the new National Strategic Framework will be completed by March 2015. Associate Professor Elisabeth Murphy, as the Co-Chair of the Standing Committee on Child and Youth Health, has asked me to organise a consultation with the Australian Children’s Commissioners and Guardians to assist in identifying key issues and priorities to improve the health and wellbeing of children and young people in Australia. I have also written to the Chair of the Community Care and Population Health Principal Committee to ask about the possibility of me joining a relevant working group for the new National Strategic Framework.

In August 2013, the Coalition’s Policy for Efficient Mental Health Research and Services was released. This policy indicated that, if elected, the Coalition would provide $18 million over four years to Orygen Youth Health Research Centre to establish and operate a National Centre for Excellence in Youth Mental Health.633

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In May 2014, the federal budget allocated $18 million over four years to Orygen Youth Health Research Centre to establish the National Centre for Excellence in Youth Mental Health. In its media release, the Australian Government stated:

once established, the centre will undertake clinical trials; invest in research; provide training, support and information to mental health clinicians and service planners; and develop new ways to treat people.634

At the time that this report went to press, Orygen Youth Health Research Centre was negotiating its contract with the Australian Government in terms of what it would be expected to deliver over the four years. The Orygen Youth Health Research Centre suggested to me that:

the new National Centre of Excellence in Youth Mental health will provide leadership, through activities and resources that increase and improve Australia’s research capacity in youth mental health and provide advice to Government on development and improvement of evidence informed strategies to improve youth mental health services and outcomes with optimal utilisation of resources.635

Given that intentional self-harm and suicide were raised as priorities in the Coalition’s pre-election policy on mental health,636 I am hopeful that non-suicidal self-harm and suicidal behaviours in children and young people will be included as part of the work of the National Centre for Excellence in Youth Mental Health.

The work of the National Centre for Excellence in Youth Mental Health, in conjunction with the new National Strategic Framework for Child and Youth Health, could set the foundations for developing a national research agenda for children and young people engaging in non-suicidal self-harm and suicidal behaviour.

I note that Orygen Youth Health Research Centre mainly focuses on children and young people aged 12-25 years. It will be important that in any national research agenda the interests of children and young people under 12 years of age are also considered by those with the necessary expertise.

As part of my examination, I wrote to the Minister for Health, the Hon Peter Dutton MP, to ask about actions taken by the Australian Government since June 2011 to address the recommendations contained in the reports, The Hidden Toll: Suicide in Australia637 and Before it’s too late.638 I thank the Hon Peter Dutton MP for his comprehensive response and commend the Australian Government for its continued commitment. My letter and his response are contained in Appendix 9. I look forward to meeting with the Hon Peter Dutton MP to discuss my key findings and recommendations.

3.7.5 Summary of key findings

Some of the key findings of my examination include:

• The inconsistent use of terms and definitions to describe the range of thoughts, communications, and behaviours that are related to non-suicidal self-harm, suicidal behaviours and death due to intentional self-harm.

These definitional issues present significant challenges for those working in the field. Researchers cannot easily compare their study populations and research findings, and clinicians have difficulty translating research findings into practical applications. 639 Differentiating self-harm with and without suicidal intent is essential to building precise understandings of these behaviours as well as how non-suicidal self-harm relates to, and influences, suicidality. 640

Neither the ICD-10 codes nor the classification system used by NCIS distinguish between intentional self-harm with suicidal intent and intentional self-harm without suicidal intent. Conflating intentional self-harm with suicidal intent and intentional self-harm without suicidal intent makes it difficult to construct an accurate picture of what is actually occurring.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 157

• Understanding the multiplicity of risk factors is central to effectively targeting and supporting children and young people.641

While there is a growing body of knowledge about the risk factors that increase the likelihood of suicidal behaviour and non-suicidal self-harm, ‘much less is known about how or why’ they engage in these behaviours.642

We do not know whether they develop as a result of multiple interrelated risk factors or only one or two predominant vulnerabilities, or whether specific combinations of risk factors can accurately predict intentional self-harming behaviour with or without suicidal intent.643

Suicidal thoughts and fears were the predominant concerns raised by children and young people who identified suicide as their primary concern. Talking through the consequences and/or alternative coping strategies were the foremost concerns of children and young people who identified self-injury and self-harm as their primary concern.

Building knowledge about this ‘will help us to start to make sense of the many risk factors that have been identified, and will yield the most clinically useful information’. 644 Currently, ‘most studies examine bivariate, linear associations between individual risk factors and self-harm’.645 Research that simultaneously considers multiple risk factors is required.646

Domestic and family violence was raised as a risk factor requiring further research.

• Similarly, while knowledge about possible protective factors is increasing, we do not sufficiently understand the impact of the different protective factors , how they are interrelated, whether some are more predominant than others or whether specific combinations offer more protection.

• There is a dearth of research involving the direct participation of children and young people.

The National Statement on Ethical Conduct in Human Research guides research in this area.647 Recent studies have shown that participation in research related to suicide prevention appears to have no iatrogenic effects among participants.648 Research proposals to Ethics Committees should highlight this.

• Empirical evidence is lacking in terms of the psychological mechanisms underlying suicide clusters.649 Overall, the risk factors for cluster suicide are not dissimilar from those associated with individual adolescent suicide.650 This means they are not particularly helpful in assisting to identify those children and young people who may be most at risk of becoming part of a suicide cluster.

It is suggested that psychological mechanisms may include contagion, imitation, suggestion, social learning theory and assortative relating, but it is argued that ‘there is no firm evidence that these mechanisms operate in cluster formation. It would seem reasonable to infer that multiple mechanisms operate together, and that the main mechanism is different for different settings and populations. Which mechanism, if any, is dominant in any particular cluster is unknown’.651

• There is limited evidence about the incidence and mechanisms leading to clustering of intentional self-harm without suicidal intent.

• There is no solid evidence base documenting the effectiveness of postvention services. A review of the literature on postvention strategies delivered to children and young people in response to suicide clusters concluded that, with so few evaluations of postvention responses, it was difficult to draw firm conclusions about the effectiveness of these strategies on the reduction of suicide risk or death due to intentional self-harm.652

The general lack of evaluation of programs, strategies, and services was also raised in the Evaluation Report of the National Suicide Prevention Program published in 2014.653 The report noted that a lack of outcome data made it difficult for projects to demonstrate their effectiveness.

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• There is insufficient empirical evidence on the effectiveness of gatekeeping training programs on actual outcomes for children and young people.654 The Menzies School of Health Research told me ‘there is almost no reported evidence of its effectiveness in reducing risk factors in young people’.655 Determining the effectiveness of gatekeeper training programs on the outcomes for children and young people should be prioritised in evaluations of these programs and also in future research.

• Where children and young people present to an accident and emergency department, there is a genuine opportunity to connect with them and facilitate follow-up intervention. A set of Guidelines for the Management of Deliberate Self Harm in Young People were developed by the Australasian College for Emergency Medicine and the Royal Australian and New Zealand College of Psychiatrists in 2000. The extent to which these guidelines have been adopted or how they impact on practice is unknown but this is an area that requires follow-up and evaluation.

• Not enough is known about the online communicability of non-suicidal self-harm, including examinations of the processes by which communications initiate, reinforce, and/or help to extinguish non-suicidal self-harm.656

• Poorly completed death certificates impede the accurate identification of intentional self-harm resulting in death by suicide. Some roundtable participants and submissions from the Australian Capital Territory raised this issue.

• Given the prevalence of hanging, investigating ways to prevent it should be prioritised. The data provided to me by NCIS and ABS confirmed that hanging was the most frequently used mechanism of intentional self-harm leading to death in children and young people across all age ranges. According to NCIS, 89% of children and young people aged 4-13 years died by hanging. 80% of those aged 14-15 years and 81% of those aged 16-17 years died by hanging.

While hanging has been predominantly associated with males, it is now the most common mechanism used by females. Previously, suicide prevention has focused on restricting access to commonly used methods. Unfortunately, restricted access to the means for hanging is not possible. Detailed research is required to verify existing perceptions about hanging and to explore in detail how these perceptions influence children and young people when planning a suicide attempt. 657

• Increasing the awareness of primary caregivers about risk factors and warning signs is essential. The NCIS data showed that 76% of deaths in children and young people were due to intentional self-harm occurring in the home.

• The continued implementation of universal suicide prevention strategies aimed at raising public awareness, encouraging help-seeking behaviour and challenging stigma associated with suicide may assist with this. The submission by the Black Dog Institute highlighted to me that the community has ‘low to moderate levels of suicide literacy, with the greatest deficits in the identification of the signs and symptoms of suicide and the risk factors associated with it’. 658 The Black Dog Institute also emphasised that ‘Family and friends have poor knowledge of the signs of suicide and lack knowledge about how and in what circumstances they should act’.659

• Restricting access to the means used for intentional self-poisoning could prevent intentional self-harm in children and young people. The data provided by AIHW showed that there were 18,277 hospitalisations for intentional self-harm in children and young people aged 3-17 years between 2007-2008 and 2012-2013. 82% of these hospitalisations were due to intentional self-poisoning. Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics was the most frequently used means, followed by antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs not elsewhere classified, and then by other and unspecified drugs, medicaments and biological substances. Restricting access to means is known to be an effective suicide prevention strategy.

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Children’s Rights Report 2014 • 159

• Finding effective ways to encourage children and young people to access appropriate help or support for early signs and symptoms of difficulties must be a priority .660

headspace stated:

If the barriers to help-seeking can be addressed, young people experiencing emotional distress are more likely to access help earlier when difficulties first arise. This can help prevent more serious long-term problems from developing, including deliberate self-harm and suicidal behaviours, which may then be more difficult to treat or require more intensive interventions. 661

Some children and young people are seeking help from Kids Helpline. Of the 80,142 contacts during 2012 and 2013 from children and young people aged 5-17 years, which involved the provision of counselling,662 11,180 contacts were assessed by counsellors as involving a child or young person with current thoughts of suicide,663 and 18,737 contacts were assessed by counsellors as involving a child or young person who self-injures and self-harms.664

There were significantly fewer contacts to Kids Helpline made by male children and young people when compared with contacts made by female children and young people.

While contacts by male children and young people did increase with age, the number of contacts remained comparatively low. Engaging male children and young people in help-seeking behaviour is crucial, and concerted effort is needed to address this.

Female children and young people tended to make contact online whereas male children and young people mainly contacted Kids Helpline via phone. Aboriginal and Torres Strait Islander children and young people and those from culturally and linguistically diverse backgrounds also preferred to contact Kids Helpline by phone.

Knowing how children and young people prefer to make contact is essential for tailoring services to their needs. More research that directly involves children and young people is required in this area.

Where contact was made to Kids Helpline about suicide with other concerns, self-injury and self-harm was one of the other main concerns. Where contact was made about self-injury and self-harm, one of the other frequently cited concerns was suicide.

Suicidal thoughts and fears were the predominant concerns raised by children and young people who identified suicide as their primary concern. Talking through the consequences and/or alternative coping strategies were the foremost concerns of children and young people who identified self-injury and self-harm as their primary concern.

Regardless of whether the main contact was about suicide or self-injury and self-harm, the leading concerns raised by children and young people were about mental health, child-parent relationships and emotional wellbeing.

This type of information is invaluable and should inform the ways that resources and interventions are developed and targeted to children and young people.665

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Recommendations I make the following recommendations based on the public health model where:

suicide prevention begins with surveillance to define the problem and to understand it, followed by the identification of risk and protective factors (as well as effective interventions), and culminates in implementation, which includes evaluation and scale-up of interventions and leads to revisiting surveillance and the ensuing steps.666

1. Establish a national research agenda for children and young people engaging in non-suicidal self-harm and suicidal behaviour through the new National Strategic Framework for Child and Youth Health. This should be supported by the soon to be established National Centre for Excellence in Youth Mental Health. This research agenda should prioritise:

• the standardisation of terms and definitions to describe the range of thoughts, communications, and behaviours that are related to intentional self-harm, with or without the intent to die • understanding the multiplicity of risk factors central to effectively targeting and supporting children and young people • understanding the impact of different protective factors, how they are interrelated, whether some

are more predominant than others, or whether specific combinations offer more protection • the direct participation of children and young people in research about intentional self-harm, with or without suicidal intent • understanding the psychological mechanisms underlying suicide clusters • understanding incidence and mechanisms leading to clustering of intentional self-harm without

suicidal intent • evaluating the effectiveness of postvention services • evaluating the effectiveness of gatekeeping training programs on actual outcomes for children

and young people • increasing the awareness of primary caregivers about risk factors and warning signs • investigating ways to restrict access to the means used for intentional self-poisoning in children

and young people • finding effective ways to encourage children and young people to access appropriate help or support for early signs and symptoms of difficulties.

2. Strengthen and develop surveillance of intentional self-harm, with or without suicidal intent, through:

a. The Australian Government funding an annual report on deaths due to intentional self-harm involving children and young people aged 0-17 years using the agreement reached between the Australian Bureau of Statistics; the Registrars of Births, Deaths and Marriages; and state and territory coroners on the dissemination of unit record data.

b. The Australian Institute of Health and Welfare including a section using disaggregated data about hospitalisations for intentional self-harm involving children and young people aged 0-17 years in its regular series on hospitalisations for injury and poisoning in Australia.

c. The Australian and New Zealand Child Death Review and Prevention Group continuing its work in relation to the development of a national child death database, in conjunction with the Australian Institute of Health and Welfare, and providing an annual progress report.

Chapter 3: Intentional self-harm, with or without suicidal intent, in children and young people under 18 years of age

Children’s Rights Report 2014 • 161

3. Collect national data on children and young people who die due to intentional self-harm through:

a. The use of the standardised National Police Form, in all jurisdictions, by 2015. This should include an electronic transfer to the National Coronial Information System. A plan to monitor the outcomes of all jurisdictions using the standardised National Police Form should be developed, and the possibility of incorporating a range of demographic, psychosocial and psychiatric information specific to children and young people should be investigated.

b. The Standing Council on Law, Crime and Community Safety putting the issue of standardisation of coronial legislation and/or coronial systems on its agenda. Standardisation should require that where all state and territory coroners find a death under investigation to be caused by an action of the deceased, the coroner must make a further finding of intent, based on the evidence, to clarify whether the deceased intended to take the action which caused his or her death; the deceased lacked capacity to recognise that his or her action would cause his or her death but death was a reasonably foreseeable consequence of the action; or it is not clear from the evidence whether the deceased intended to cause his or her death.

4. The Royal Australian and New Zealand College of Psychiatrists should review and, where appropriate, update its Guidelines for the Management of Deliberate Self Harm in Young People (2000).

Conclusion Clearly, much remains to be done in the area of intentional self-harm, with or without the intention to die, for children and young people aged 0-17 years.

While we have some understandings, there is too much that we still do not know. This limits our capacity to respond in ways that will prevent children and young people from engaging in non-suicidal self-harm and suicidal behaviour.

Fundamentally, we ‘lack an accurate means of predicting these behaviours and an effective method of preventing them’.667

This is compounded by the complexities inherent in data collection and the restricted access to data that is collected.

Establishing a national research agenda will provide a structure for moving forward. Standardisation of coronial legislation and/or coronial systems in Australia, and all jurisdictions using the standardised National Police Form, will assist with data collection.

I look forward to reporting on the progress of my recommendations in my 2015 report to Parliament.

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1 P McNamara, ‘Adolescent suicide in Australia: Rates, risk and resilience’ (2013) 18(3) Clinical Child Psychology and Psychiatry 351, p 354. 2 D De Leo and K Kolves, Trends and predictors of suicide in Australian children, Australian Research Council Linkage Project (2014). At http://research-hub.griffith.edu.au/display/n20c651b2962cd9c72fab02cec0a62b1b (viewed 1 October 2014). 3 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Table 1.3, Line 40. At http://www.abs.gov.au/

AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 4 Australian Bureau of Statistics, Causes of Death, Australia, 2012, Catalogue Number 3303.0 (2014), Table 1.3, Line 40 5 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Table 11.6, Line 13. At http://www.abs.gov.au/

AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 6 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Table 11.6, Line 32. At http://www.abs.gov.au/ AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 7 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Table 11.1, Line 11. At http://www.abs.gov.au/

AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 8 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Table 11.1, Line 29. At http://www.abs.gov.au/ AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 9 C Fox and K Hawton, Deliberate self-harm in adolescence (2004), p 18. 10 headspace, Self-harm and suicidal behaviours, http://www.headspace.org.au/what-works/research-information/self-harm-and-

suicidal-behaviours#3 (viewed 1 October 2014). 11 Australian Institute of Health and Welfare, Australian hospital statistics 2011-12 (2013). At http://www.aihw.gov.au/publication-detail/?id=60129543133&tab=3 (viewed 1 October 2014). 12 Australian Institute of Health and Welfare, Australian hospital statistics 2011-12, National tables for external causes of

injury or poisoning (part 1) (2013), Tables 3 and 4. At http://www.aihw.gov.au/publication-detail/?id=60129543133&tab=3 (viewed 1 October 2014). 13 Australian Institute of Health and Welfare, Australian hospital statistics 2011-12, National tables for external causes of injury or poisoning (part 1) (2013), Table 4, Line 15. At http://www.aihw.gov.au/publication-detail/?id=60129543133&tab=3

(viewed 1 October 2014). 14 Australian Institute of Health and Welfare, Australian hospital statistics 2011-12, National tables for external causes of injury or poisoning (part 1) (2013), Table 3, Line 15. At http://www.aihw.gov.au/publication-detail/?id=60129543133&tab=3

(viewed 1 October 2014). 15 Australian Institute of Health and Welfare, Hospitals A-Z glossary, http://www.aihw.gov.au/hospitals-glossary, (viewed 1 October 2014). 16 Australian Institute of Health and Welfare, Hospitals A-Z glossary, http://www.aihw.gov.au/hospitals-glossary,

(viewed 1 October 2014). 17 BoysTown (Kids Helpline), Kids Helpline 2013 Overview (2014), p 8. At http://www.kidshelp.com.au/grownups/news-research/ research-reports/kids-helpline-overview.php (viewed 1 October 2014). 18 BoysTown (Kids Helpline), Kids Helpline 2013 Overview (2014), p 8. At http://www.kidshelp.com.au/grownups/news-research/

research-reports/kids-helpline-overview.php (viewed 1 October 2014). 19 K Hawton, K Rodham, E Evans and R Weatherall R, ‘Deliberate self harm in adolescents: self report survey in schools in England’ (2002) 325 British Medical Journal 1207. 20 N Madge, K Hawton, E McMahon, P Corcoran, D De Leo, ‘Psychological characteristics, stressful life events and deliberate self-

harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study’ (2011) 20(10) Eur Child Adolescent Psychiatry 499. 21 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Table 12.4, Line 27. At http://www.abs.gov.au/ AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 22 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Table 12.4, Line 105. At http://www.abs.gov.au/

AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 23 Australian Institute of Health and Welfare, Indigenous child safety (2014), p 7, Table 3.1. At http://www.aihw.gov.au/publication-detail/?id=60129547839 (viewed 1 October 2014). 24 Australian Institute of Health and Welfare, Indigenous child safety (2014), p 25. At http://www.aihw.gov.au/publication-

detail/?id=60129547839 (viewed 1 October 2014). 25 Close the Gap Campaign Steering Committee, Progress and priorities report 2014 (2014), p 36; Close the Gap Campaign Steering Committee, Shadow Report 2013 - on Australian governments’ progress towards closing the gap in life expectancy between

Indigenous and non-Indigenous Australians (2013), p 29; Close the Gap Campaign Steering Committee, Shadow Report 2012 - on Australian governments’ progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians (2012), p 11; Close the Gap Campaign Steering Committee, Shadow Report - on Australian governments’ progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians (2011), p 15; Close the Gap Campaign Steering Committee, Shadow Report - on the Australian Government’s progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians (2010), p 21. At https://www.humanrights.gov.au/close-gap-indigenous-health-campaign (viewed 1 October 2014). 26 K Robinson, P Bansel, N Denson, G Ovenden and C Davies, Growing Up Queer: Issues facing young Australians who are gender

variant and sexuality diverse, Young and Well Cooperative Research Centre (2014). At http://www.youngandwellcrc.org.au/ knowledge-hub/publications/growing-queer/ (viewed 1 October 2014).

Chapter 3: Endnotes

Children’s Rights Report 2014 • 163

27 K Robinson, P Bansel, N Denson, G Ovenden and C Davies, Growing Up Queer: Issues facing young Australians who are gender variant and sexuality diverse, Young and Well Cooperative Research Centre (2014). At http://www.youngandwellcrc.org.au/ knowledge-hub/publications/growing-queer/ (viewed 1 October 2014).

28 K Robinson, P Bansel, N Denson, G Ovenden and C Davies, Growing Up Queer: Issues facing young Australians who are gender variant and sexuality diverse, Young and Well Cooperative Research Centre (2014). At http://www.youngandwellcrc.org.au/ knowledge-hub/publications/growing-queer/ (viewed 1 October 2014); Young and Well Cooperative Research Centre, Submission 121, p V. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

29 Australian Institute of Health and Welfare, Child protection Australia: 2012-13, Child Welfare Series No 58 (2014), p 45. 30 Australian Institute of Health and Welfare, Child protection Australia: 2012-13, Child Welfare Series No 58 (2014), p 51. 31 M Sawyer, J Carbone, A Searle, P Robinson, ‘The mental health and wellbeing of children and adolescents in home-based foster care’ (2007) 186(4) Medical Journal of Australia 181.

32 E Ludi, E Ballard, R Greenbaum, M Pao, J Bridge, W Reynolds and L Horowitz, ‘Suicide Risk in Youth with Intellectual Disabilities: The Challenges of Screening’ (2012) 33(5) Journal of Developmental & Behavioral Pediatrics 431. 33 A Barnes, M Eisenberg and M Resnick, ‘Suicide and self‐injury among children and youth with chronic health conditions’ (2010) 125 Pediatrics 889. 889.http://pediatrics.aappublications.org/content/125/5/889.full (viewed 1 October 2014). 34 D Greydanus, D Patel and H Pratt, ‘Suicide Risk in Adolescents with Chronic Illness: Implications for Primary Care and Speciality

Pediatric Practice: A Review’ (2010) 52(12) Developmental Medicine and Child Neurology 1083, p 1087. 35 Y Stolk, I Minas and S Klimidis, Access to mental health services in Victoria: A focus on ethnic communities (2008). 36 National Rural Health Alliance Inc, Suicide in Rural Australia, Fact Sheet 14 (2009). At http://ruralhealth.org.au/sites/default/files/

fact-sheets/fact-sheet-14-suicide%20in%20rural%20australia_0.pdf (viewed 1 October 2014). 37 Australian Institute of Health and Welfare, A Snapshot of Men’s Health in Regional and Remote Australia, Rural Health Series No 11 (2010). At http://www.aihw.gov.au/publication-detail/?id=6442468343 (viewed 1 October 2014). 38 Suicide Prevention Australia, Position statement: Youth suicide prevention (2010). At http://suicidepreventionaust.org/statement/

youth-suicide-prevention-in-australia/ (viewed 1 October 2014). 39 Suicide Prevention Australia, Position statement: Youth suicide prevention (2010). At http://suicidepreventionaust.org/statement/ youth-suicide-prevention-in-australia/ (viewed 1 October 2014). 40 National Committee for Standardised Reporting on Suicide, Submission to the Senate Community Affairs References Committee

(February 2010), p 4. At http://suicidepreventionaust.org/wp-content/uploads/2012/05/NCSRS-Senate-Submission.pdf (viewed 1 October 2014). 41 National Committee for Standardised Reporting on Suicide, Submission to the Senate Community Affairs References Committee (February 2010), p 4. At http://suicidepreventionaust.org/wp-content/uploads/2012/05/NCSRS-Senate-Submission.pdf

(viewed 1 October 2014). 42 Committee on the Rights of the Child, Treaty-specific guidelines regarding the form and content of periodic reports to be submitted by States parties under article 44, paragraph 1(b), of the Convention on the Rights of the Child, UN Doc CRC/C/58/

Rev.2 (2010), para 6. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?key=92g0+9FnI5fX/ ePqHxWObMdE63qlOjiuLKDV/BafkP+XV86EGNR9fgW9SFw/mAZV&Lang=en (viewed 1 October 2014). 43 The Senate Community Affairs References Committee, The Hidden Toll: Suicide in Australia (2010). At http://www.aph.gov. au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2008-10/suicide/report/index

(viewed 1 October 2014). 44 House of Representatives Standing Committee on Health and Ageing, Before it’s too late: Report on early intervention programs aimed at preventing youth suicide (2011). At http://www.aph.gov.au/parliamentary_business/committees/house_of_

representatives_committees?url=haa/./youthsuicide/report.htm# (viewed 1 October 2014). 45 Queensland Commission for Children and Young People and Child Guardian, Final Report: Reducing Youth Suicide in Queensland (2011). At http://pandora.nla.gov.au/pan/14014/20140630-0820/www.ccypcg.qld.gov.au/resources/publications/Reducing-Youth-

Suicide-in-Queensland-Final-Report.html (viewed 1 October 2014). 46 Legislative Assembly of the Northern Territory, Select Committee on Youth Suicides in the NT, Gone Too Soon: A Report into Youth Suicide in the Northern Territory (2012). At http://www.indigenousjustice.gov.au/db/publications/291071.html

(viewed 1 October 2014). 47 Australian Human Rights Commission, Asylum seekers, refugees and human rights (2013), p 8. At https://www.humanrights.gov. au/publications/asylum-seekers-refugees-and-human-rights-snapshot-report (viewed 1 October 2014). 48 J Devaney, L Bunting, G Davidson, D Hayes, A Lazenbatt and T Spratt, Still Vulnerable: The impact of early childhood experiences

on adolescent suicide and accidental death, Queen’s University Belfast and NSPCC (2013), p 40. At http://www.niccy.org/Publications/policyandresearchreportsandpapers/PolicyandresearchReportsbytheme/keepingsafe/ TheImpactofEarlyChildhoodExperiencesonAdolescentSuicideandAccidentalDeath (viewed 1 October 2014). 49 Committee on the Rights of the Child, General Comment No. 13 - The right of the child to freedom from all forms of violence, CRC/C/GC/13 (2011), pages 7 and 21. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC %2fC%2fGC%2f13&Lang=en (viewed 1 October 2014). 50 Committee on the Rights of the Child, General Comment No. 13 - The right of the child to freedom from all forms of violence, CRC/C/GC/13 (2011), page 11. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC %2fGC%2f13&Lang=en (viewed 1 October 2014).

164

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51 Committee on the Rights of the Child, General Comment No. 13 - The right of the child to freedom from all forms of violence, CRC/C/GC/13 (2011), page 11. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC %2fGC%2f13&Lang=en (viewed 1 October 2014).

52 Committee on the Rights of the Child, General Comment No. 13 - The right of the child to freedom from all forms of violence, CRC/C/GC/13 (2011), page 16, para 43. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CR C%2fC%2fGC%2f13&Lang=en (viewed 1 October 2014).

53 Committee on the Rights of the Child, General Comment No. 13 - The right of the child to freedom from all forms of violence, CRC/C/GC/13 (2011), page 21, para 52. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CR C%2fC%2fGC%2f13&Lang=en (viewed 1 October 2014).

54 Committee on the Rights of the Child, Treaty-specific guidelines regarding the form and content of periodic reports to be submitted by States parties under article 44, paragraph 1(b), of the Convention on the Rights of the Child, UN Doc CRC/C/58/ Rev.2 (2010), para 26. At http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?key=92g0+9FnI5fX/ ePqHxWObMdE63qlOjiuLKDV/BafkP+XV86EGNR9fgW9SFw/mAZV&Lang=en (viewed 1 October 2014).

55 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Introduction. At http://www.abs.gov.au/ausstats/ abs@.nsf/Lookup/3303.0main+features100002012 (viewed 1 October 2014). 56 Australian Institute of Health and Welfare, Australian hospital statistics, http://www.aihw.gov.au/hospitals/australian-hospital-statistics/ (viewed 1 October 2014). 57 National Coronial Information System, What does the NCIS Unit do?, http://www.ncis.org.au/data-collection/what-does-the-ncis-

unit-do/ (viewed 1 October 2014). 58 BoysTown (Kids Helpline), Submission 116, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 59 Section Manager, Longitudinal Study of Australian Children, Email to Australian Human Rights Commission, 10 June 2014. 60 Design Manager, Longitudinal Study of Indigenous Children, Email to Australian Human Rights Commission, 12 June 2014. 61 National Coalition for Suicide Prevention, Response to the World Health Organisation World Suicide Report, One World

Connected: An Assessment of Australia’s Progress in Suicide Prevention, Discussion Paper (2014), p 4. At http://suicidepreventionaust.org/wp-content/uploads/2014/09/NCSP_Australian-Response-to-WHO-World-Suicide-Report_ singlepage.pdf (viewed 1 October 2014). 62 R O’Connor, S Platt, J Gordon, International Handbook of Suicide Prevention (2011), p 9. 63 D Ougrin, T Tranah, E Leigh, L Taylor and J Asarnow, ‘Practitioner Review: Self-harm in adolescents’ (2012) 53(4) Journal of Child Psychology and Psychiatry 337. 64 D Ougrin , ‘Commentary: Self-harm in adolescents: the best predictor of death by suicide? - reflections on Hawton et al’ (2012) 53(12) Journal of Child Psychology and Psychiatry, p 1220-1221. 65 D Ougrin , ‘Commentary: Self-harm in adolescents: the best predictor of death by suicide? - reflections on Hawton et al’ (2012) 53(12) Journal of Child Psychology and Psychiatry, p 1220-1221. 66 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255. 67 D Ougrin, T Tranah, E Leigh, L Taylor and J Asarnow, ‘Practitioner Review: Self-harm in adolescents’ (2012) 53(4) Journal of Child Psychology and Psychiatry 337. 68 R O’Connor, S Platt, J Gordon, International Handbook of Suicide Prevention (2011), p 10. 69 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255. 70 American Psychiatric Association, Diagnostic and statistical manual of mental disorders (5th ed, 2013). 71 American Psychiatric Association, DSM-5 Development, www.dsm5.org/about/pages/default.aspx (viewed 1 October 2014). 72 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255, p 256. 73 American Psychiatric Association, Diagnostic and statistical manual of mental disorders (5th ed, 2013), p 801. 74 American Psychiatric Association, Diagnostic and statistical manual of mental disorders (5th ed, 2013), p 803. 75 M Lopez, W Compton, B Grant and J Breiling, ‘Dimensional approaches in diagnostic classification: a critical appraisal’ (2007) 16(S1) International Journal of Methods in Psychiatric Research 16(S1), p 6. At www.dsm5.org/Research/Documents/Lopez_ Dimensions.pdf (viewed 1 October 2014). 76 American Psychiatric Association, DSM-5’s Integrated Approach to Diagnosis and Classifications (2013). 77 D Ougrin, T Tranah, E Leigh, L Taylor and J Asarnow, ‘Practitioner Review: Self-harm in adolescents’ (2012) 53(4) Journal of Child Psychology and Psychiatry 337. 78 Royal Australasian College of Physicians, Submission 109, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 79 Hunter Institute of Mental Health, Submission 93, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 80 Rosemount Good Shepherd Youth and Family Services, Submission 45, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014 81 The Phoenix Centre, Submission 115, p 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 82 NSW Government, Submission 134, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 83 Youth Affairs Council of Western Australia, Submission 118, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 84 Australian Psychological Society, Submission 91, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

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85 headspace, Submission 89, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 86 Child and Youth Mental Health Service, Children’s Health Queensland, Submission 131, p 8. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. 87 J Muehlenlamp, L Claes, L Havertape and P Plener, ‘International prevalence of adolescent non-suicidal self-injury and deliberate

self-harm’ (2012) 6(10) Child and Adolescent Psychiatry and Mental Health, p 6. 88 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255, p 256. 89 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent

Psychology 255, p 256. 90 Child Helpline International, The Voices of Children and Young People (2013), p III. At http://www.childhelplineinternational.org/ resources/news/global-pd-new-york/ (viewed 1 October 2014). 91 Orygen Youth Health Research Centre, Submission 82, p 7. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 92 Orygen Youth Health Research Centre, Submission 82, pages 8 and 77-80. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 93 Youth Affairs Council of Western Australia, Submission 118, p 12. At www.humanrights.gov.au/publications/childrens-rights-

report-2014; Hobsons City Council, Submission 46. At www.humanrights.gov.au/publications/childrens-rights-report-2014; Australian Institute of Family Studies, Submission 49, Attachment C, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014; Youth Insearch Foundation, Submission 76, p 14. At www.humanrights.gov.au/publications/childrens-rights-report-2014;Orygen Youth Health Research Centre, Submission 82, p 14. At www.humanrights.gov.au/publications/childrens-rights-report-2014; headspace, Submission 89, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 94 headspace, Submission 89, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 95 M Nock, The Oxford Handbook of Suicide and Self-Injury (2014), p 2. 96 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent

Psychology 255, p 256. 97 Ombudsman Western Australia, Investigation into ways that State government departments and authorities can prevent or reduce suicide by young people (2014). At http://www.ombudsman.wa.gov.au/Improving_Admin/AI_Reports.htm (viewed 1 October 2014). 98 R Robertson, P Rush, L Wall and D Higgins, Rarely an isolated incident: Acknowledging the interrelatedness of child maltreatment,

victimisation and trauma, Australian Institute of Family Studies (2013). 99 R Miller, Cumulative harm: a conceptual overview, Victorian Government Department of Human Services (2007). 100 Wasserman, Z Rihmer, D Rujescu, M Sarchiapone, M Sokolowski, D Titelman, G Zalsman, Z Zemishlany and V Carli,

‘The European Psychatrict Association guidance on suicide treatment and prevention (2012) European Psychiatry, p 133. 101 Ngaanyatjarra Pitjantjatjatjara Yankunytjatjara Women’s Council (Aboriginal Corporation), Submission 128, p 12. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 102 National Children’s and Youth Law Centre, Submission 138, p 3. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 103 NSW Government, Submission 134, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 104 Orygen Youth Health Research Centre, Submission 82, p 5. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 105 Young and Well Cooperative Research Centre, Submission 121, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 106 R O’Connor, S Platt, J Gordon, International Handbook of Suicide Prevention (2011), p 293. 107 A Freuchen, E Kjelsberg, A Lundervold and B Groholt, ‘Differences between children and adolescents who commit suicide and

their peers: A psychological autopsy of suicide victims compared to accident victims and a community sample’ (2012) 6(1) Child and Adolescent Psychiatry and Mental Health, p 2. 108 K Bentley, M Nock and D Barlow, ‘The Four-Function Model of Nonsuicidal Self-injury: Key Directions for Future Research’ (2014) Clinical Psychological Science. 109 Young and Well Cooperative Research Centre, Submission 121, p 2. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 110 Orygen Youth Health Research Centre, Submission 82, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 111 Rosemount Good Shepherd Youth and Family Services, Submission 45, p 4. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 112 beyondblue, Submission 78, Attachment A, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 113 NSW Government, Submission 134, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 114 BoysTown (Kids Helpline), Submission 116, p 30. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 115 BoysTown (Kids Helpline), Submission 116, p 30. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 116 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent

Psychology 255, p 257. 117 Jesuit Social Services, Submission 83, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

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118 K Bentley, M Nock and D Barlow, ‘The Four-Function Model of Nonsuicidal Self-injury: Key Directions for Future Research’ (2014) Clinical Psychological Science, p 7. 119 R O’Connor, S Platt, J Gordon, International Handbook of Suicide Prevention (2011), p 293. 120 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent

Psychology 255, p 257. 121 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255, p 257. 122 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent

Psychology 255, p 257. 123 V Tuisku, O Kiviruusu, M Pelkonen, L Karlsson, T Strandholm and M Marttunen, ‘Depressed adolescents as young adults - Predictors of suicide attempt and non-suicidal self-injury during an 8-year follow-up’ (2014) Journal of Affective Disorders, p 314. 124 V Tuisku, O Kiviruusu, M Pelkonen, L Karlsson, T Strandholm and M Marttunen, ‘Depressed adolescents as young adults -

Predictors of suicide attempt and non-suicidal self-injury during an 8-year follow-up’ (2014) Journal of Affective Disorders, p 314. 125 L Taliaferro, J Muehlenkamp, ‘Risk and Protective Factors that Distinguish Adolescents Who Attempt Suicide From Those Who Only Consider Suicide in the Past Year’ (2014) 44(1) Suicide and Life-Threatening Behaviour, The American Association of

Suicidology, p 19. 126 BoysTown (Kids Helpline), Submission 116, p 41. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 127 BoysTown (Kids Helpline), Submission 116, p 35. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 128 Child Death and Serious Injury Review Committee South Australia, Submission 50, p 7. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 129 headspace, Submission 89, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 130 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide

and Life-Threatening Behavior, p 99. 131 Black Dog Institute, Submission 88, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 132 headspace, Submission 89, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 133 Menzies School of Health Research, Submission 102, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 134 Child Death and Serious Injury Review Committee South Austraila, Submission 50, p 7. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 135 Queensland Commission for Children and Young People and Child Guardian, Submission 64, p 7. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. 136 Orygen Youth Health Research Centre, Submission 82, p 13. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 137 P Hazell, ‘Adolescent suicide clusters: evidence, mechanisms and prevention’ (1993) 27 Australian and New Zealand Journal of Psychiatry 653, p 654. 138 L Johansson, P Lindqvist and A Eriksson, ‘Teenage suicide cluster formation and contagion: implications for primary care’ (2006)

7(32) BMC Family Practice, p 3. 139 Living is for Everyone, Professor Jane Pirkis, Expert Insight 4, http://www.livingisforeveryone.com.au/Expert-insight-4.html (viewed 1 October 2014). 140 Menzies School of Health Research, Submission 102, p 14-15. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 141 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide and Life-Threatening Behavior, p 97. 142 Y Cheung, M Spittal, M Williamson, S Tung and J Pirkis, ‘Predictors of suicides occurring within suicide clusters in Australia,

2004-2008’ (2014) 118 Social Science & Medicine, p 135. 143 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide and Life-Threatening Behavior, p 97. 144 Y Cheung, M Spittal, M Williamson, S Tung and J Pirkis, ‘Predictors of suicides occurring within suicide clusters in Australia,

2004-2008’ (2014) 118 Social Science & Medicine, p 135. 145 L Johansson, P Lindqvist and A Eriksson, ‘Teenage suicide cluster formation and contagion: implications for primary care’ (2006) 7(32) BMC Family Practice, p 3. 146 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide

and Life-Threatening Behavior, p 97. 147 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide and Life-Threatening Behavior, p 97. 148 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide

and Life-Threatening Behavior, p 105. 149 Y Cheung, M Spittal, M Williamson, S Tung and J Pirkis, ‘Predictors of suicides occurring within suicide clusters in Australia, 2004-2008’ (2014) 118 Social Science & Medicine, p 135. 150 Australian Institute of Suicide Research and Prevention, Submission 95, p 3. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 151 Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 2. At www.humanrights.gov.au/publications/ childrens-rights-report-2014.

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152 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide and Life-Threatening Behavior, p 97. 153 Coronial Council of Victoria, Submission 130, p 27. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 154 Coronial Council of Victoria, Submission 130, p 27, para 11.8. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 155 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide and Life-Threatening Behavior, p 97. 156 Hunter Institute of Mental Health, Submission 93, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 157 Living is for Everyone, Professor Jane Pirkis, Expert Insight 4, http://www.livingisforeveryone.com.au/Expert-insight-4.html

(viewed 1 October 2014). 158 Child Death and Serious Injury Review Committee South Australia, Submission 50, p 10-11. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. 159 Young and Well Cooperative Research Centre, Submission 121, p 3. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 160 Black Dog Institute, Submission 88, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 161 Name withheld, Submission 57, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 162 Jesuit Social Services, Submission 83, p 16. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 163 headspace, Submission 89, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 164 P Hazell, ‘Adolescent suicide clusters: evidence, mechanisms and prevention’ (1993) 27 Australian and New Zealand Journal of

Psychiatry 653, p 654. 165 G Cox, J Robinson, M Williamson, A Lockley, Y Cheung and J Pirkis, ‘Suicide clusters in young people: Evidence for the effectiveness of postvention strategies’ (2012) 33(4) Crisis: The Journal of Crisis Intervention and Suicide Prevention, p 208. 166 Australian Healthcare Associates, Evaluation of Suicide Prevention Activities, Final Report (2014), p 10. At http://www.health.gov.

au/internet/main/publishing.nsf/Content/mental-pubs-e-evalsuic (viewed 1 October 2014). 167 headspace, Submission 89, p 12. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 168 Northern Territory Council of Social Service, Submission 77, p 9. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 169 Central Australian Mental Health Service, Department of Health, Northern Territory, Submission 99, p 4. At www.humanrights.gov. au/publications/childrens-rights-report-2014. 170 Commonwealth of Australia, Developing a community plan for preventing and responding to suicide clusters (2012).

At http://www.livingisforeveryone.com.au/Library-item.html?id=1448 (viewed 1 October 2014). 171 A Clifford, C Dora and K Tsey, ‘A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand’ (2013) 13(463) BMC Public Health, p 11. 172 J Whitlock, ‘Self-Injurious Behavior in Adolescents’ (2010) 7(5) PLoS Med. 173 Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 2. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 174 S Jarvi, B Jackson, L Swenson and H Crawford, ‘The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature’ (2013) 17(1) Archives of Suicide Research, p 1-19. 175 Rosemount Good Shepherd Youth and Family Services, Submission 45, p 5. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 176 J Whitlock, ‘Self-Injurious Behavior in Adolescents’ (2010) 7(5) PLoS Med. 177 Name withheld, Submission 25, p 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 178 S Jarvi, B Jackson, L Swenson and H Crawford, ‘The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the

Literature’ (2013) 17(1) Archives of Suicide Research, p 12. 179 Nam withheld, Submission 25, pages 1-2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 180 Professor Graham Martin, Submission 40, p 18. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 181 Dr Mareka Frost, Submission 72. At www.humanrights.gov.au/publications/childrens-rights-report-2014; St Johns Ambulance

Australia, Submission 92, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014; Young and Well Cooperative Research Centre, Submission 121. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 182 ACT Health and Education and Training Directorate, Submission 133, p 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 183 Jesuit Social Services, Submission 83, p 11. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 184 Northern Territory Council of Social Service, Submission 77, p 10. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 185 Phoenix Centre, Submission 115. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 186 BoysTown (Kids Helpline), Submission 116. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 187 Youth Affairs Council of Western Australia, Submission 118. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 188 Phoenix Centre, Submission 115. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 189 ACT Community Services Directorate, Submission 105, p 4. At www.humanrights.gov.au/publications/childrens-rights-

report-2014.

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190 ACT Community Services Directorate, Submission 105, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 191 C Wilson and F Deane, ‘Brief report: Need for autonomy and other perceived barriers relating’ (2012) 35 Journal of Adolescence 233. 192 C Wilson and F Deane, ‘Brief report: Need for autonomy and other perceived barriers relating’ (2012) 35 Journal of Adolescence

233.

193 J Wilson and F Deane, Help-negation, Encyclopaedia of Adolescence (2012), pages 1281-1288. 194 Dr Mareka Frost, Submission 72, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 195 C Wilson, D Rickwood, J Bushnell, P Caputi and S Thomas, ‘The effects of need for autonomy and preference for seeking help from informal sources on emerging adults’ intentions to access mental health services for common mental disorders and suicidal

thoughts’ (2011) 10(1) Advances in Mental Health 29. 196 Dr Mareka Frost, Submission 72, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 197 headspace, Submission 89, p 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 198 Menzies School of Health Research, Submission 102, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 199 G Martin, ‘Editorial on help-seeking’ (2012) 11(1) Advances in Mental Health, p 5. 200 Black Dog Institute, Submission 88, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 201 Australasian College for Emergency Medicine and The Royal Australian and New Zealand College of Psychiatrists, Guidelines for

the Management of Deliberate Self Harm in Young People (2000). 202 Menzies School of Health Research, Submission 102, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 203 Name withheld, Submission 44, p 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 204 Menzies School of Health Research, Submission 102, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 205 Menzies School of Health Research, Submission 102, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 206 I White, A Dawson, N Buckley, G Carter and C Levey, ‘A model for the management of self-poisioning’ (1997) 167(3) The Medical

Journal of Australia. 207 House of Representatives Standing Committee on Health and Ageing, Before it’s too late: Report on early intervention programs aimed at preventing youth suicide (2011), p 50, para 4.51. At http://www.aph.gov.au/parliamentary_business/committees/house_

of_representatives_committees?url=haa/./youthsuicide/report.htm# (viewed 1 October 2014). 208 Rosemount Good Shepherd Youth and Family Services, Submission 45, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 209 Toni Falk, Submission 26, p 30. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 210 Rosemount Good Shepherd Youth and Family Services, Submission 45, pages 14-15. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 211 Menzies School of Health Research, Submission 102, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 212 Menzies School of Health Research, Submission 102, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 213 Menzies School of Health Research, Submission 102, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 214 C Wilson, J Bushnell and P Caputi, ‘Early access and help seeking: practice implications and new initiatives’ (2011) 5 Early

Intervention in Psychiatry 34, p 38. 215 headspace, Submission 89, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 216 C Wilson, J Bushnell and P Caputi, ‘Early access and help seeking: practice implications and new initiatives’ (2011) 5 Early

Intervention in Psychiatry 34, p 38. 217 World Health Organisation, Preventing suicide: A global imperative (2014), pages 28-44. At http://www.who.int/mental_health/ suicide-prevention/world_report_2014/en/ (viewed 1 October 2014). 218 World Health Organisation, Preventing suicide: A global imperative (2014), p 7. At http://www.who.int/mental_health/suicide-

prevention/world_report_2014/en/ (viewed 1 October 2014). 219 World Health Organisation, Preventing suicide: A global imperative (2014), pages 46-51. At http://www.who.int/mental_health/ suicide-prevention/world_report_2014/en/ (viewed 1 October 2014). 220 World Health Organisation, Preventing suicide: A global imperative (2014), p 8. At http://www.who.int/mental_health/suicide-

prevention/world_report_2014/en/ (viewed 1 October 2014). 221 World Health Organisation, Preventing suicide: A global imperative (2014), p 8. At http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ (viewed 1 October 2014). 222 World Health Organisation, Preventing suicide: A global imperative (2014), p 8. At http://www.who.int/mental_health/suicide-

prevention/world_report_2014/en/ (viewed 1 October 2014). 223 World Health Organisation, Preventing suicide: A global imperative (2014), p 58. At http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ (viewed 1 October 2014). 224 Australian Government Department of Health, Living is for Everyone: A framework for prevention of suicide in Australia

(2007), p 21. At http://www.livingisforeveryone.com.au/uploads/docs/LIFE_framework-web.pdf (viewed 1 October 2014); Australian Government Department of Health, National Aboriginal and Torres Strait Islander Suicide Prevention Strategy (2013), p 20. At http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pub-atsi-suicide-prevention-strategy (viewed 1 October 2014).

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225 National Coalition for Suicide Prevention, Response to the World Health Organisation World Suicide Report, One World Connected: An Assessment of Australia’s Progress in Suicide Prevention, Discussion Paper (2014), p 11. At http://suicidepreventionaust.org/wp-content/uploads/2014/09/NCSP_Australian-Response-to-WHO-World-Suicide-Report_ singlepage.pdf

226 Black Dog Institute, Submission 88, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 227 Queensland Mental Health Commission, Submission 126, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 228 Queensland Mental Health Commission, Submission 126, p 3. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 229 Child Death Review Team, Ombudsman of New South Wales, Submission 63, p 3. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 230 Queensland Commission for Children and Young People and Child Guardian, Submission 64, p 16-17. At www.humanrights.gov.

au/publications/childrens-rights-report-2014. 231 Menzies School of Health Research, Submission 102, p 4; Royal Australasian College of Physicians, Submission 109, p 5; Phoenix Centre, Submission 115, p 3; Rosemount Good Shepherd Youth and Family Services, Submission 45, p 11; Queensland

Commission for Children and Young People and Child Guardian, Submission 64, pages 4-5; Northern Territory Council of Social Service, Submission 77, p 10; Black Dog Institute, Submission 88, p 11; headspace, Submission 89, p 12; Australian Institute for Suicide Research and Prevention, Submission 95, p 15. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 232 Menzies School of Health Research, Submission 102, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 233 Royal Australasian College of Physicians, Submission 109, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 234 Rosemount Good Shepherd Youth and Family Services, Submission 45, p 15. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 235 Orygen Youth Health Research Centre, Submission 82, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 236 J Robinson, S Hetrick, C Martin, ‘Preventing suicide in young people’ (2010) Australian and New Zealand Journal of Psychiatry 45, pages 3-26. 237 Child and Youth Mental Health Service, Children’s Health Queensland, Submission 131, p 10-11. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. (viewed 1 October 2014). 238 J Washburn, S Richardt, D Styer, M Gebhardt, K Juzwin, A Yourek and D Aldridge, ‘Psychotherapeutic approaches to non-suicidal self-injury in adolescents’ (2012) 6(14) Child and Adolescent Psychiatry and Mental Health, pages 1-2. 239 Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 5. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 240 Jesuit Social Services, Submission 83, p 10; Black Dog Institute, Submission 88, p 10; Orygen Youth Health Research Centre, Submission 82, p 14; Rosemount Good Shepherd Youth and Family Services, Submission 45, p 12; Phoenix Centre, Submission 115, p 5; Menzies School of Health Research, Submission 102, p 39; Australian Institute for Suicide Research and Prevention, Submission 95, p 16. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 241 R Breslin, O Lucas, L Sabir and L Wharton, ‘Is gatekeeper training an effective suicide prevention strategy?’ (2012) Cambridge Medicine Journal. At http://www.cambridgemedicine.org/article/doi/10.7244/cmj-1355155789 (viewed 1 October 2014). 242 Orygen Youth Health Research Centre, Submission 82, p 11. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 243 Orygen Youth Health Research Centre, Submission 82, p 11. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 244 Menzies School of Health Research, Submission 102, p 39. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 245 Menzies School of Health Research, Submissions 102, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 246 United Synergies and the National Standby Suicide Bereavement Response Service, Submission 122, p 18. At www.humanrights. gov.au/publications/childrens-rights-report-2014. 247 Early Childhood Australia, Submission 124, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 248 Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 6. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 249 Mental health First Aid Australia, Submission 54, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 250 Australian Healthcare Associates, Evaluation of Suicide Prevention Activities, Final Report (2014), p 166. At http://www.health.gov. au/internet/main/publishing.nsf/Content/mental-pubs-e-evalsuic (viewed 1 October 2014). 251 Australian Healthcare Associates, Evaluation of Suicide Prevention Activities, Final Report (2014), p 165. At http://www.health.gov. au/internet/main/publishing.nsf/Content/mental-pubs-e-evalsuic (viewed 1 October 2014). 252 beyondblue, beyondblue to lead redevelopment of Mind Matters, http://www.beyondblue.org.au/about-us/news/ news/2013/07/26/-i-beyondblue-i-to-lead-redevelopment-of-mind-matters (viewed 1 October 2014). 253 Australian Healthcare Associates, Evaluation of Suicide Prevention Activities, Final Report (2014), p 166. At http://www.health.gov. au/internet/main/publishing.nsf/Content/mental-pubs-e-evalsuic (viewed 1 October 2014).

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Chapter 3: Endnotes

254 P Slee, M Lawson, A Russell, H Williams, K Dix, L Owens, G Skrzypiec, B Spears, KidsMatter Evaluation Final Report, Centre for Analysis of Educational Futures, Flinders University of South Australia (2009), p viii. At http://www.kidsmatter.edu.au/sites/default/ files/public/kidsmatter-full-report-web.pdf (viewed 1 October 2014.

255 P Slee, M Lawson, A Russell, H Williams, K Dix, L Owens, G Skrzypiec, B Spears, KidsMatter Evaluation Final Report, Centre for Analysis of Educational Futures, Flinders University of South Australia (2009), p viii. At http://www.kidsmatter.edu.au/sites/default/ files/public/kidsmatter-full-report-web.pdf (viewed 1 October 2014.

256 P Slee, M Lawson, A Russell, H Williams, K Dix, L Owens, G Skrzypiec, B Spears, KidsMatter Evaluation Final Report, Centre for Analysis of Educational Futures, Flinders University of South Australia (2009), p 93. At http://www.kidsmatter.edu.au/sites/default/ files/public/kidsmatter-full-report-web.pdf (viewed 1 October 2014).

257 P Slee, M Lawson, A Russell, H Williams, K Dix, L Owens, G Skrzypiec, B Spears, KidsMatter Evaluation Final Report, Centre for Analysis of Educational Futures, Flinders University of South Australia (2009), p 93. At http://www.kidsmatter.edu.au/sites/default/ files/public/kidsmatter-full-report-web.pdf (viewed 1 October 2014.

258 P Slee, M Lawson, A Russell, H Williams, K Dix, L Owens, G Skrzypiec, B Spears, KidsMatter Evaluation Final Report, Centre for Analysis of Educational Futures, Flinders University of South Australia (2009), p 93. At http://www.kidsmatter.edu.au/sites/default/ files/public/kidsmatter-full-report-web.pdf (viewed 1 October 2014.

259 P Slee, R Harvey, K Dix, G Skrzypiec, H Williams, M Lawson and S Krieg MidsMatter Early Childhood Evaluation Report, Research Centre for Student Wellbeing and Prevention of Violence, Flinders University, Adelaide (2012), p 93. At https://www.kidsmatter. edu.au/sites/default/files/public/KMEC%20Evaluation%20Report%20Executive%2 0Summary.pdf (viewed 1 October 2014).

260 Early Childhood Australia, Submission 124, p 17. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 261 beyondblue, Submission 78, pages 5-6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 262 Victorian Government Department of Education and Early Childhood Development, Building Respectful Relationships: Stepping out against gender-based violence (2014). At https://fuse.education.vic.gov.au/content/29a93fbb-0553-4f9c-a382-c30f29afb120/

BRR%20full%20document%20110614.pdf (viewed 1 October 2014). 263 National Association for Prevention of Child Abuse and Neglect, Love Bites, http://napcan.org.au/our-programs/love-bites/ (viewed 1 October 2014). 264 KoolKIDS, Empowering children to live well with themselves and others, http://www.kool-kids.com.au/ (viewed 1 October 2014). 265 headspace, Submission 89, p 12. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 266 Rosemount Good Shepherd Youth and Family Services, Submission 45, p 5. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 267 Name withheld, Submission 65, p 23. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 268 Central Australian Mental Health Service, Department of Health, Northern Territory, Submission 99, p 6. At www.humanrights.gov.

au/publications/childrens-rights-report-2014. 269 headspace, Submission 89, p 14-15. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 270 headspace, Submission 89, p 14-15. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 271 headspace, Submission 89, p 14-15. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 272 Young and Well Cooperative Research Centre, Submission 121, p 7. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 273 Dr Mareka Frost, Submission 72, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 274 Dr Mareka Frost, Submission 72, p 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 275 K Robinson, P Bansel, N Denson, G Ovenden and C Davies, Growing Up Queer: Issues facing young Australians who are gender

variant and sexuality diverse, Young and Well Cooperative Research Centre (2014), p 47. At http://www.youngandwellcrc.org.au/ knowledge-hub/publications/growing-queer/ (viewed 1 October 2014). 276 K Robinson, P Bansel, N Denson, G Ovenden and C Davies, Growing Up Queer: Issues facing young Australians who are gender variant and sexuality diverse, Young and Well Cooperative Research Centre (2014), p 31. At http://www.youngandwellcrc.org.au/

knowledge-hub/publications/growing-queer/ (viewed 1 October 2014). 277 K Robinson, P Bansel, N Denson, G Ovenden and C Davies, Growing Up Queer: Issues facing young Australians who are gender variant and sexuality diverse, Young and Well Cooperative Research Centre (2014), p x. At http://www.youngandwellcrc.org.au/

knowledge-hub/publications/growing-queer/ (viewed 1 October 2014). 278 D De Leo, J Sveticic and A Milner, ‘Suicide in Indigenous people in Queensland, Australia: Trends and methods, 1994-2007’ (2011) 45 Australian and New Zealand Journal of Psychiatry, 532, p 534. 279 Australian Institute for Suicide Research and Prevention, Submission 95, p 4. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 280 People Culture Environment, The Elders’ Report into Preventing Indigenous Self-harm and Youth Suicide (2014), p 4. At http://www.bepartofthehealing.org/ (viewed 1 October 2014). 281 People Culture Environment, The Elders’ Report into Preventing Indigenous Self-harm and Youth Suicide (2014), p 5.

At http://www.bepartofthehealing.org/ (viewed 1 October 2014). 282 Ngaanyatjarra Pitjantjatjatjara Yankunytjatjara Women’s Council (Aboriginal Corporation), Submission 128, p 15. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 283 Northern Territory Council of Social Service, Submission 77, p 5. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 284 G Robinson, S Silburn, B Leckning, Suicide of Children and Youth in the NT, 2006-2010: Public Release Report for the Child Deaths Review and Prevention

Children’s Rights Report 2014 • 171

Committee, Menzies Centre for Child Development and Education (2012), p 41. 285 Menzies School of Health Research, Submission 102, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 286 G Robinson, S Silburn, B Leckning, Suicide of Children and Youth in the NT, 2006-2010: Public Release Report for the Child Deaths Review and Prevention Committee, Menzies Centre for Child Development and Education (2012), p 41.

287 Central Australian Mental Health Service, Department of Health, Northern Territory, Submission 2, p 6. At www.humanrights.gov. au/publications/childrens-rights-report-2014. 288 Central Australian Mental Health Service, Department of Health, Northern Territory, Submission 99, p 2. At www.humanrights.gov. au/publications/childrens-rights-report-2014. 289 Central Australian Mental Health Service, Department of Health, Northern Territory, Submission 99, p 2. At www.humanrights.gov.

au/publications/childrens-rights-report-2014. 290 Central Australian Mental Health Service, Department of Health, Northern Territory, Submission 99, p 3. At www.humanrights.gov. au/publications/childrens-rights-report-2014. 291 Kimberley Aboriginal Law and Cultural Centre, Submission 31, p 2. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 292 Australian Institute of Health and Welfare, Submission 114, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 293 Australian Institute of Health and Welfare, Submission 114, p 2. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 294 Kimberley Aboriginal Law and Cultural Centre, Submission 31, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 295 People Culture Environment, The Elders’ Report into Preventing Indigenous Self-harm and Youth Suicide (2014), p 16.

At http://www.bepartofthehealing.org/ (viewed 1 October 2014). 296 People Culture Environment, The Elders’ Report into Preventing Indigenous Self-harm and Youth Suicide (2014), p 15. At http://www.bepartofthehealing.org/ (viewed 1 October 2014). 297 People Culture Environment, The Elders’ Report into Preventing Indigenous Self-harm and Youth Suicide (2014), p 10.

At http://www.bepartofthehealing.org/ (viewed 1 October 2014). 298 People Culture Environment, The Elders’ Report into Preventing Indigenous Self-harm and Youth Suicide (2014), p 4. At http://www.bepartofthehealing.org/ (viewed 1 October 2014). 299 Victorian Commission for Children and Young People, Submission 129, p 13. At www.humanrights.gov.au/publications/childrens-

rights-report-2014; Victorian Department of Health, Victorian Aboriginal Suicide Prevention and Response Action Plan 2010-2015 (2010). 300 Victorian Commission for Children and Young People, Submission 129, p 13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 301 Kimberley Aboriginal Law and Cultural Centre, Submission 31, p 5. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 302 People Culture Environment, The Elders’ Report into Preventing Indigenous Self-harm and Youth Suicide (2014), p 9. At http://www.bepartofthehealing.org/ (viewed 1 October 2014). 303 Kimberley Aboriginal Law and Cultural Centre, Submission 31, pages 8-9. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 304 D Palmer, Yiriman is like a school for our young people: the Yiriman Project. Three-year evaluation 2010-2012 Report Two: 2011, Kimberley Aboriginal Law and Culture Centre, Fitzroy Crossing (2012), p 124. 305 D Palmer, Yiriman is like a school for our young people: the Yiriman Project. Three-year evaluation 2010-2012 Report Two: 2011,

Kimberley Aboriginal Law and Culture Centre, Fitzroy Crossing (2012), p 5. 306 Kimberley Aboriginal Law and Cultural Centre, Submission 31, p 9. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 307 Kimberley Aboriginal Law and Cultural Centre, Submission 31, p 3. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 308 D Palmer, Yiriman is like a school for our young people: the Yiriman Project. Three-year evaluation 2010-2012 Report Two: 2011, Kimberley Aboriginal Law and Culture Centre, Fitzroy Crossing (2012), p 78. 309 Lowitja Institute, Submission 85, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 310 Lowitja Institute, Submission 85, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 311 Australian Institute for Suicide Research and Prevention, Submission 95, pages 3-4. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 312 Young and Well Cooperative Research Centre, Submission 121, p 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 313 Northern Territory Council of Social Service, Submission 77, p 9; Jesuit Social Services, Submission 83, p 11; Black Dog Institute,

Submission 88, p 9. At  www.humanrights.gov.au/publications/childrens-rights-report-2014. 314 Jesuit Social Services, Submission 83, p 14. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 315 Northern Territory Council of Social Service, Submission 77, p 14. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 316 Dr Sarah Lutkin, Submission 113, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 317 Dr Sarah Lutkin, Submission 113, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

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Chapter 3: Endnotes

318 Youth Affairs Council of Western Australia, Submission 118, p 19. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 319 Menzies School of Health Research, Submission 102, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 320 Menzies School of Health Research, Submission 102, p 32. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 321 Twenty10 incorporating GLCS NSW & the University of Western Sydney, Submission 97, p 9. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. 322 Twenty10 incorporating GLCS NSW & the University of Western Sydney, Submission 97, p 9. At www.humanrights.gov.au/

publications/childrens-rights-report-2014. 323 Organisation Intersex International Australia, Submission 137, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 324 Organisation Intersex International Australia, Submission 137. At  www.humanrights.gov.au/publications/childrens-rights-

report-2014. 325 Twenty10 incorporating GLCS NSW & the University of Western Sydney, Submission 97, p 13. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. 326 National LGBTI Health Alliance, Submission 100, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 327 Twenty10 incorporating GLCS NSW & the University of Western Sydney, Submission 97, p 10. At www.humanrights.gov.au/

publications/childrens-rights-report-2014. 328 National LGBTI Health Alliance, Submission 100, p 2; Twenty10 incorporating GLCS NSW & the University of Western Sydney, Submission 97, p 16; New South Wales Gay and Lesbian Rights Lobby (GLRL), Submission 100. At www.humanrights.gov.au/

publications/childrens-rights-report-2014. 329 L Hillier, T Jones, M Monagle, N Overton, L Gahan, J Blackman and A Mitchell, Writing Themselves in 3: The Third national study on the sexual health and wellbeing of same sex attracted and gender questioning young people LaTrobe University (2010). 330 K Robinson, P Bansel, N Denson, G Ovenden and C Davies, Growing Up Queer: Issues facing young Australians who are gender

variant and sexuality diverse, Young and Well Cooperative Research Centre (2014). 331 Suicide Prevention Australia, Position statement: suicide and self-harm among gay, lesbian, bisexual and transgender communities (2009). At http://suicidepreventionaust.org/statement/suicide-and-self-harm-among-gay-lesbian-bisexual-and-

transgender-communities/ (viewed 1 October 2014). 332 Suicide Prevention Australia, Position statement: suicide and self-harm among gay, lesbian, bisexual and transgender communities (2009). At http://suicidepreventionaust.org/statement/suicide-and-self-harm-among-gay-lesbian-bisexual-and-

transgender-communities/ (viewed 1 October 2014). 333 The Centre for Multicultural Youth, Mind Matters: The mental health and well-being of young people from diverse cultural backgrounds (2014). At http://cmy.net.au/publications/mind-matters (viewed 1 October 2014); Dr Erminia Colucci, Submission

104. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 334 Phoenix Centre, Submission 115. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 335 The Centre for Multicultural Youth, ‘Mind Matters: The mental health and well-being of young people from diverse cultural backgrounds’ (2014), p 8. 336 BoysTown (Kids Helpline), Submission 116, p 27, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 337 The Phoenix Centre, Submission 115, pages 6-7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 338 Convention on the Rights of Persons with Disabilities, 2007, art 1. 339 Australian Institute of Health and Welfare, Australia’s Welfare 2013, Australian Welfare Series No 11 (2013), p 176. 340 Australian Institute of Health and Welfare, Australia’s Welfare 2013, Australian Welfare Series No 11 (2013), p 176. 341 ACT Community Services Directorate, Submission 105, p 2. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 342 Royal Australasian College of Physicians, Submission 109, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 343 Australian Psychological Society, Submission 91, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 344 D Greydanus, D Patel and H Pratt, ‘Suicide Risk in Adolescents with Chronic Illness: Implications for Primary Care and Speciality

Pediatric Practice: A Review’ (2010) 52(12) Developmental Medicine and Child Neurology 1083, p 1086; A Barnes, M Eisenberg and M Resnick, ‘Suicide and self‐injury among children and youth with chronic health conditions’ (2010) 125 Pediatrics 889, p 889. 345 Royal Australian and New Zealand College of Psychiatrists, Addressing the Needs of Siblings of Children with a Disability or Chronic Illness, Position Statement 69 (2011), p 1. At https://www.ranzcp.org/Files/Resources/College_Statements/Position_ Statements/ps69-pdf.aspx. 346 Siblings Australia, Submission 24, p 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 347 Siblings Australia, Submission 24, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 348 B Edwards, D Higgins, M Gray, N Zmijewski, M Kingston, The Nature and Impact of Caring for Family Members With a Disability in Australia, Australian Institute of Family Studies Research Report No 16 (2008). 349 Royal Australasian College of Physicians, Submission 109, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 350 Young and Well Cooperative Research Centre, Submission 121, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

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351 ACT Community Services Directorate, Submission 105, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 352 Young and Well Cooperative Research Centre, Submission 121, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 353 Young and Well Cooperative Research Centre, Submission 121, p 5. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 354 Young and Well Cooperative Research Centre, Submission 121, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 355 The Phoenix Centre, Submission 115; Royal Australian and New Zealand College of Psychiatrists, Submission 41; Early

Childhood Australia, Submission 124; Youth Affairs Council of Western Australia, Submission 118; Northern Territory Council of Social Service, Submission 77. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 356 Phoenix Centre, Submission 115, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 357 N Procter, ‘Refugee and Asylum Seeker Self Harm with Implications for Transition to Employment Participation - A Review’ (2011) 16(3) Suicidologi 30; D Silove, ‘No refuge from terror: the impact of detention on trauma affected refugees seeking asylum to Australia’ (2007) 44 Transcult Psychiatry 359. 358 Human Rights and Equal Opportunity Commission , A last resort? National Inquiry into Children in Immigration Detention (2004). At www.humanrights.gov.au/last-resort-report-national-inquiry-children-immigration-detention-2004 (viewed 1 October 2014 2014). 359 Human Rights and Equal Opportunity Commission , A last resort? National Inquiry into Children in Immigration Detention (2004). At www.humanrights.gov.au/last-resort-report-national-inquiry-children-immigration-detention-2004 (viewed 1 October 2014 2014). 360 Australian Human Rights Commission, National Inquiry into Children in Immigration Detention 2014, https://www.humanrights. gov.au/our-work/asylum-seekers-and-refugees/national-inquiry-children-immigration-detention-2014 (viewed 1 October 2014). 361 Australian Human Rights Commission, National Inquiry into Children in Immigration Detention 2014, https://www.humanrights. gov.au/our-work/asylum-seekers-and-refugees/national-inquiry-children-immigration-detention-2014 (viewed 1 October 2014). 362 Children’s Hospital at Westmead Refugee Clinic, Submission 1 to National Inquiry into Children in Immigration Detention 2014; Royal Australian and New Zealand College of Psychiatrists, Submission 48 to National Inquiry into Children in Immigration Detention 2014. At https://www.humanrights.gov.au/our-work/asylum-seekers-and-refugees/national-inquiry-children-immigration-detention-2014-0. 363 Orygen Youth Health Research Centre, Submission 82, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 364 Orygen Youth Health Research Centre, Submission 82, p 13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 365 Menzies School of Health Research, Submission 102, p 35. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 366 Early Childhood Australia, Submission 124, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 367 Orygen Youth Health Research Centre, Submission 82, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 368 J Cashmore and M Paxman, Longitudinal Study of Wards Leaving Care: Four to Five Years On, Social Policy Research Centre, University of New South Wales Australia (2007), p 89. At http://www.community.nsw.gov.au/docswr/_assets/main/documents/ research_wards_leavingcare2.pdf (viewed 1 October 2014). 369 Menzies School of Health Research, Submission 102, p 35. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 370 Menzies School of Health Research, Submission 102, p 45. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 371 ACT Community Services Directorate, Submission 105, p 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 372 Orygen Youth Health Research Centre, Submission 82, p 13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 373 Orygen Youth Health Research Centre, Submission 82, p 13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 374 Orygen Youth Health Research Centre, Submission 82, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 375 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Introduction. At http://www.abs.gov.au/ausstats/ abs@.nsf/Lookup/3303.0main+features100002012 (viewed 1 October 2014). 376 National Coronial Information System, Data collection, Classification structures used , http://www.ncis.org.au/data-collection-2/ classification-structures-used/ (viewed 1 October 2014). 377 Manager, National Coronial Information System, Email to Australian Human Rights Commission, 30 September 2014. 378 Manager, National Coronial Information System, Email to Australian Human Rights Commission, 25 September 2014. 379 National Coronial Information System, Data quality, Data limitations, http://www.ncis.org.au/data-quality/data-limitations/ (viewed 1 October 2014). 380 Australian Bureau of Statistics, Submission 110, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

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381 Australian Bureau of Statistics, Submission 110, p 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 382 Orygen Youth Health Research Centre, Submission 82, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 383 Youth Affairs Council of Western Australia, Submission 118, p 14. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 384 National Aboriginal and Torres Strait Islander Leadership in Mental Health, Submission 123, p 13. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. 385 Coronial Council of Victoria, Submission 130, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 386 Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 5. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 387 Australian Bureau of Statistics, 3303.0 - Causes of Death, Australia, 2012 (2014), Explanatory Note 31. At http://www.abs.gov.au/ AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12012?OpenDocument (viewed 1 October 2014). 388 National Coronial Information System, Data quality, Data limitations, http://www.ncis.org.au/data-quality/data-limitations/

(viewed 1 October 2014). 389 Coronial Council of Victoria, Submission 130, p 10, para 2.13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 390 Queensland Commission for Children and Young People and Child Guardian, Submission 64, p 11. At www.humanrights.gov.au/

publications/childrens-rights-report-2014. 391 Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 4. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 392 Menzies School of Health Research, Submission 102, p 14. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 393 Coronial Council of Victoria, Submission 130, p 1. www.humanrights.gov.au/publications/childrens-rights-report-2014. 394 Coronial Council of Victoria, Submission 130, p 22. www.humanrights.gov.au/publications/childrens-rights-report-2014. 395 Manager, National Coronial Information System, Email to Australian Human Rights Commission, 6 October 2014. 396 Menzies School of Health Research, Submission 102, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 397 ACT Children and Young People Death Review Committee, Submission 48, p 2. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 398 Australian Bureau of Statistics, Information paper: Cause of death certification (2008), p 2. At http://www.ausstats.abs.gov.au/ ausstats/subscriber.nsf/0/475BC02643DB45EDCA25750B000E38A4/$File/1205055001_2008.pdf (viewed 1 October 2014). 399 Women’s Health Victoria, Submission 74, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 400 Public Health Association of Australia, Submission 119, p 13; Northern Territory Council of Social Service, Submission 77, p 13.

At www.humanrights.gov.au/publications/childrens-rights-report-2014. 401 Northern Territory Council of Social Service, Submission 77, p 14. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 402 Organisation Intersex International Australia, Submission 137; Twenty10 incorporating GLCS NSW & the University of Western

Sydney, Submission 97; National LGBTI Health Alliance, Submission 100. At  www.humanrights.gov.au/publications/childrens-rights-report-2014. 403 Transgender Victoria, Submission 84. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 404 Twenty10 incorporating GLCS NSW & the University of Western Sydney, Submission 97, p 13; Organisation Intersex International Australia, Submission 137, p 31; National LGBTI Health Alliance, Submission 100, p 2. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 405 A Tovell, K McKenna, C Bradley and S Pointer, Hospital separations due to injury and poisoning, Australia 2009-10 (2012). At http://www.aihw.gov.au/publication-detail/?id=60129542183 (viewed 1 October 2014). 406 Western Australian Council of Social Service, Submission 52, p 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 407 Australian Institute of Health and Welfare, Indigenous child safety (2014), p 7, box 3.1. At http://www.aihw.gov.au/publication-detail/?id=60129547839 (viewed 1 October 2014). 408 Rosemount Good Shepherd Youth and Family Services, Submission 45, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 409 beyondblue, Submission 78, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 410 Black Dog Institute, Submission 88, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 411 Australian Psychological Society, Submission 91, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 412 Menzies School of Health Research, Submission 102, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 413 Youth Affairs Council of Western Australia, Submission 118, p 16. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 414 Public Health Association Australia, Submission 119, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 415 Young and Well Cooperative Research Centre, Submission 121, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 416 United Synergies and the National Standby Suicide Bereavement Response Service, Submission 122, p 16. At www.humanrights. gov.au/publications/childrens-rights-report-2014.

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417 The Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 4. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 418 Child and Youth Mental Health Service, Children’s Health Queensland, Submission 131, p 10. At www.humanrights.gov.au/ publications/childrens-rights-report-2014. 419 NSW Government, Submission 134, p 10. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 420 Australian Institute of Health and Welfare, Submission 114, p 1. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 421 National Children’s and Youth Law Centre, Submission 138, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 422 Victorian Commission for Children and Young People, Submission 129, p 12. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 423 Australian Bureau of Statistics, Submission 110, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 424 Australian Bureau of Statistics, Submission 110, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 425 Australian Institute of Health and Welfare, Submission 114, p 2. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 426 Australian Psychological Society, Submission 91, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 427 Victorian Commission for Children and Young People, Submission 129, p 10. At www.humanrights.gov.au/publications/childrens-

rights-report-2014. 428 Australian Institute for Suicide Research and Prevention, Submission 95, p 14. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 429 Twenty10 incorporating GLCS NSW & the University of Western Sydney, Submission 97, p 7. At www.humanrights.gov.au/

publications/childrens-rights-report-2014. 430 National Coalition for Suicide Prevention, Response to the World Health Organisation World Suicide Report, One World Connected: An Assessment of Australia’s Progress in Suicide Prevention, Discussion Paper (2014), p 12.

At http://suicidepreventionaust.org/wp-content/uploads/2014/09/NCSP_Australian-Response-to-WHO-World-Suicide-Report_ singlepage_.pdf (viewed 1 October 2014). 431 Australian and New Zealand Child Death Review and Prevention Group, Letter to the National Children’s Commissioner, 3 December 2013. 432 Australian and New Zealand Child Death Review and Prevention Group, Letter to the National Children’s Commissioner,

3 December 2013. 433 Australian and New Zealand Child Death Review and Prevention Group, Letter to the National Children’s Commissioner, 3 December 2013. 434 Menzies School of Health Research, Submission 102, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 435 It is important to acknowledge at the beginning of this section that not all percentages add up to 100%. This is due to rounding

off.

436 Consumer Safety Institute Amsterdam and AIHW National Injury Surveillance Unit, International Classification of External Injuries (ICEC), Version 1.2 (2004), p 119. At http://www.rivm.nl/who-fic/ICECIeng.htm (viewed 1 October 2014). 437 Australian Bureau of Statistics, Customised report (2014), Table 3(f): Data are based on five jurisdictions for which the quality of Indigenous identification in mortality data is considered acceptable (NSW, Qld, SA, WA and NT only). See Explanatory Notes 68-

76 for further information on interpreting data relating to Indigenous persons. 438 Australian Bureau of Statistics, Technical Paper on Socio-Economic Indexes for Areas (SEIFA) (2011), p 7. At http://www.ausstats. abs.gov.au/ausstats/subscriber.nsf/0/22CEDA8038AF7A0DCA257B3B00116E34/$File/2033.0.55.001%20seifa%202011%20

technical%20paper.pdf (viewed 1 October 2014). 439 BoysTown (Kids Helpline), Submission 116, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 440 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 441 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 442 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 443 BoysTown (Kids Helpline), Submission 116, p 4, para 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 444 BoysTown (Kids Helpline), Submission 116, p 4, para 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 445 BoysTown (Kids Helpline), Submission 116, p 5, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 446 BoysTown (Kids Helpline), Submission 116, p 31, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 447 BoysTown (Kids Helpline), Submission 116, p 31, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 448 BoysTown (Kids Helpline), Submission 116, p 32, Table 14. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 449 BoysTown (Kids Helpline), Submission 116, p 5, Table 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 450 BoysTown (Kids Helpline), Submission 116, p 8, Figure 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 451 BoysTown (Kids Helpline), Submission 116, p 5, Table 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 452 BoysTown (Kids Helpline), Submission 116, p 8, Figure 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 453 BoysTown (Kids Helpline), Submission 116, p 8, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 454 BoysTown (Kids Helpline), Submission 116, p 5, para 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 455 BoysTown (Kids Helpline), Submission 116, p 5, Table 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 456 BoysTown (Kids Helpline), Submission 116, p 8, Figure 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 457 BoysTown (Kids Helpline), Submission 116, p 5, para 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

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458 BoysTown (Kids Helpline), Submission 116, p 5, Table 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 459 BoysTown (Kids Helpline), Submission 116, p 8, Figure 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 460 BoysTown (Kids Helpline), Submission 116, p 8, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 461 BoysTown (Kids Helpline), Submission 116, p 5, para 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 462 BoysTown (Kids Helpline), Submission 116, p 5, Table 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 463 BoysTown (Kids Helpline), Submission 116, p 8, Figure 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 464 BoysTown (Kids Helpline), Submission 116, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 465 BoysTown (Kids Helpline), Submission 116, p 7, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 466 BoysTown (Kids Helpline), Submission 116, p 7, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 467 BoysTown (Kids Helpline), Submission 116, p 7, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 468 BoysTown (Kids Helpline), Submission 116, p 7, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 469 BoysTown (Kids Helpline), Submission 116, p 7, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 470 BoysTown (Kids Helpline), Submission 116, p 7, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 471 BoysTown (Kids Helpline), Submission 116, p 7, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 472 BoysTown (Kids Helpline), Submission 116, p 7, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 473 BoysTown (Kids Helpline), Submission 116, p 7, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 474 BoysTown (Kids Helpline), Submission 116, p 7, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 475 BoysTown (Kids Helpline), Submission 116, p 7, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 476 BoysTown (Kids Helpline), Submission 116, p 12, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 477 BoysTown (Kids Helpline), Submission 116, p 12, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 478 BoysTown (Kids Helpline), Submission 116, p 12, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 479 BoysTown (Kids Helpline), Submission 116, p 12, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 480 BoysTown (Kids Helpline), Submission 116, p 13, Figure 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 481 BoysTown (Kids Helpline), Submission 116, p 14, Figure 9. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 482 BoysTown (Kids Helpline), Submission 116, p 13, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 483 BoysTown (Kids Helpline), Submission 116, p 14, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 484 BoysTown (Kids Helpline), Submission 116, p 12, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 485 BoysTown (Kids Helpline), Submission 116, p 12, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 486 BoysTown (Kids Helpline), Submission 116, p 13, Figure 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 487 BoysTown (Kids Helpline), Submission 116, p 14, Figure 9. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 488 BoysTown (Kids Helpline), Submission 116, p 13, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 489 BoysTown (Kids Helpline), Submission 116, p 14, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 490 BoysTown (Kids Helpline), Submission 116, p 12, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 491 BoysTown (Kids Helpline), Submission 116, p 12, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 492 BoysTown (Kids Helpline), Submission 116, p 13, Figure 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 493 BoysTown (Kids Helpline), Submission 116, p 14, Figure 9. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 494 BoysTown (Kids Helpline), Submission 116, p 12, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 495 BoysTown (Kids Helpline), Submission 116, p 19, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 496 BoysTown (Kids Helpline), Submission 116, p 19, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 497 BoysTown (Kids Helpline), Submission 116, p 19, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 498 BoysTown (Kids Helpline), Submission 116, p 19, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 499 BoysTown (Kids Helpline), Submission 116, p 19, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 500 BoysTown (Kids Helpline), Submission 116, p 20, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 501 BoysTown (Kids Helpline), Submission 116, p 20, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 502 BoysTown (Kids Helpline), Submission 116, p 20, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 503 BoysTown (Kids Helpline), Submission 116, p 20, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 504 BoysTown (Kids Helpline), Submission 116, p 20, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 505 BoysTown (Kids Helpline), Submission 116, p 20, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 506 BoysTown (Kids Helpline), Submission 116, p 20, Table 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 507 BoysTown (Kids Helpline), Submission 116, p 20, Table 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 508 BoysTown (Kids Helpline), Submission 116, p 20, Table 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 509 BoysTown (Kids Helpline), Submission 116, p 20, Table 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 510 BoysTown (Kids Helpline), Submission 116, p 23, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 511 BoysTown (Kids Helpline), Submission 116, p 23, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 512 BoysTown (Kids Helpline), Submission 116, p 23, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 513 BoysTown (Kids Helpline), Submission 116, p 23, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 514 BoysTown (Kids Helpline), Submission 116, p 23, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 515 BoysTown (Kids Helpline), Submission 116, p 24, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 516 BoysTown (Kids Helpline), Submission 116, p 24, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 517 BoysTown (Kids Helpline), Submission 116, p 24, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 518 BoysTown (Kids Helpline), Submission 116, p 24, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 519 BoysTown (Kids Helpline), Submission 116, p 24, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014.

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520 BoysTown (Kids Helpline), Submission 116, p 25, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 521 BoysTown (Kids Helpline), Submission 116, p 25, Table 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 522 BoysTown (Kids Helpline), Submission 116, p 25, Table 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 523 BoysTown (Kids Helpline), Submission 116, p 25, Table 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 524 BoysTown (Kids Helpline), Submission 116, p 25, Table 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 525 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 526 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 527 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 528 BoysTown (Kids Helpline), Submission 116, p 5, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 529 BoysTown (Kids Helpline), Submission 116, p 5, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 530 BoysTown (Kids Helpline), Submission 116, p 5, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 531 BoysTown (Kids Helpline), Submission 116, p 29, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 532 BoysTown (Kids Helpline), Submission 116, p 29, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 533 BoysTown (Kids Helpline), Submission 116, p 30, Table 11. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 534 BoysTown (Kids Helpline), Submission 116, p 6, Table 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 535 BoysTown (Kids Helpline), Submission 116, p 10, Figure 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 536 BoysTown (Kids Helpline), Submission 116, p 18, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 537 BoysTown (Kids Helpline), Submission 116, p 6, Table 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 538 BoysTown (Kids Helpline), Submission 116, p 10, Figure 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 539 BoysTown (Kids Helpline), Submission 116, p 6, Table 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 540 BoysTown (Kids Helpline), Submission 116, p 10, Figure 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 541 BoysTown (Kids Helpline), Submission 116, p 17, para 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 542 BoysTown (Kids Helpline), Submission 116, p 6, Table 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 543 BoysTown (Kids Helpline), Submission 116, p 10, Figure 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 544 BoysTown (Kids Helpline), Submission 116, p 6, Table 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 545 BoysTown (Kids Helpline), Submission 116, p 10, Figure 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 546 BoysTown (Kids Helpline), Submission 116, p 6, Table 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 547 BoysTown (Kids Helpline), Submission 116, p 10, Figure 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 548 BoysTown (Kids Helpline), Submission 116, p 6, Table 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 549 BoysTown (Kids Helpline), Submission 116, p 9, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 550 BoysTown (Kids Helpline), Submission 116, p 9, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 551 BoysTown (Kids Helpline), Submission 116, p 9, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 552 BoysTown (Kids Helpline), Submission 116, p 9, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 553 BoysTown (Kids Helpline), Submission 116, p 9, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 554 BoysTown (Kids Helpline), Submission 116, p 9, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 555 BoysTown (Kids Helpline), Submission 116, p 9, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 556 BoysTown (Kids Helpline), Submission 116, p 9, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 557 BoysTown (Kids Helpline), Submission 116, p 9, para 3. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 558 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 559 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 560 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 561 BoysTown (Kids Helpline), Submission 116, p 15, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 562 BoysTown (Kids Helpline), Submission 116, p 16, Figure 12. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 563 BoysTown (Kids Helpline), Submission 116, p 17, Figure 13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 564 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 565 BoysTown (Kids Helpline), Submission 116, p 16, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 566 BoysTown (Kids Helpline), Submission 116, p 17, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 567 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 568 BoysTown (Kids Helpline), Submission 116, p 15, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 569 BoysTown (Kids Helpline), Submission 116, p 16, Figure 12. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 570 BoysTown (Kids Helpline), Submission 116, p 17, Figure 13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 571 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 572 BoysTown (Kids Helpline), Submission 116, p 16, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 573 BoysTown (Kids Helpline), Submission 116, p 17, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 574 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 575 BoysTown (Kids Helpline), Submission 116, p 15, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 576 BoysTown (Kids Helpline), Submission 116, p 16, Figure 12. At www.humanrights.gov.au/publications/childrens-rights-

report-2014.

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Chapter 3: Endnotes

577 BoysTown (Kids Helpline), Submission 116, p 17, Figure 13. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 578 BoysTown (Kids Helpline), Submission 116, p 14, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 579 BoysTown (Kids Helpline), Submission 116, p 21, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 580 BoysTown (Kids Helpline), Submission 116, p 21, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 581 BoysTown (Kids Helpline), Submission 116, p 21, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 582 BoysTown (Kids Helpline), Submission 116, p 21, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 583 BoysTown (Kids Helpline), Submission 116, p 21, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 584 BoysTown (Kids Helpline), Submission 116, p 22, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 585 BoysTown (Kids Helpline), Submission 116, p 22, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 586 BoysTown (Kids Helpline), Submission 116, p 22, para 1. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 587 BoysTown (Kids Helpline), Submission 116, p 22, Table 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 588 BoysTown (Kids Helpline), Submission 116, p 22, Table 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 589 BoysTown (Kids Helpline), Submission 116, p 22, Table 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 590 BoysTown (Kids Helpline), Submission 116, p 25, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 591 BoysTown (Kids Helpline), Submission 116, p 25, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 592 BoysTown (Kids Helpline), Submission 116, p 25, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 593 BoysTown (Kids Helpline), Submission 116, p 25, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 594 BoysTown (Kids Helpline), Submission 116, p 25, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 595 BoysTown (Kids Helpline), Submission 116, p 26, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 596 BoysTown (Kids Helpline), Submission 116, p 26, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 597 BoysTown (Kids Helpline), Submission 116, p 26, para 2. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 598 BoysTown (Kids Helpline), Submission 116, p 26, Table 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 599 BoysTown (Kids Helpline), Submission 116, p 26, Table 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 600 BoysTown (Kids Helpline), Submission 116, p 26, Table 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 601 BoysTown (Kids Helpline), Submission 116, p 26, Table 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 602 BoysTown (Kids Helpline), Submission 116, p 26, Table 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 603 BoysTown (Kids Helpline), Submission 116, p 26, Table 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 604 Child Death and Serious Injury Review Committee South Australia, Submission 50, p 1. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 605 Menzies School of Health Research, Submission 102, p 17. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 606 The Royal Australian and New Zealand College of Psychiatrists, Submission 41, p 2. At www.humanrights.gov.au/publications/

childrens-rights-report-2014. 607 L Biddle, J Donovan, A Owen-Smith, J Potokar, D Longson, K Hawton, N Kapur and D Gunnell, ‘Factors influencing the decision to use hanging as a method of suicide: qualitative study’ (2010) 197 The British Journal of Psychiatry 320, p 320. 608 Black Dog Institute, Submission 88, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 609 Black Dog Institute, Submission 88, p 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 610 R Soole, K Kolves and D De Leo, ‘Factors Related to Childhood Suicides: Analysis of the Queensland Child Death Register’

(2014) Crisis: The Journal of Crisis Intervention and Suicide Prevention, p 8. At http://dx.doi.org/10.1027/0227-5910/a000267 (viewed 1 October 2014). 611 R Lenroot and J Giedd, ‘Brain development in children and adolescents: Insights from anatomical magnetic resonance imaging’ (2006) 30(6) Neuroscience & Biobehavioural Reviews 718. 612 S Spano, ‘Adolescent Brain Development’ (2003) 22(1) Youth Studies Australia 36. 613 R Soole, K Kolves and D De Leo, ‘Factors Related to Childhood Suicides: Analysis of the Queensland Child Death Register’

(2014) Crisis: The Journal of Crisis Intervention and Suicide Prevention. At http://dx.doi.org/10.1027/0227-5910/a000267 (viewed 1 October 2014). 614 R Soole, K Kolves and D De Leo, ‘Factors Related to Childhood Suicides: Analysis of the Queensland Child Death Register’ (2014) Crisis: The Journal of Crisis Intervention and Suicide Prevention, p 1. At http://dx.doi.org/10.1027/0227-5910/a000267

(viewed 1 October 2014). 615 Australian Bureau of Statistics, 3238.0 - Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026 (2014), Summary of findings, Australia. At  http://www.abs.gov.au/ausstats/abs@.nsf/Products/C19A0C6E4794A3FACA257CC900

143A3D?opendocument (viewed 1 October 2014). 616 Australian Government Department of Health, National Aboriginal and Torres Strait Islander Suicide Prevention Strategy (2013), p 39. http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pub-atsi-suicide-prevention-strategy

(viewed 1 October 2014). 617 Australian Government National Health and Medical Research Council, Suicide Prevention in Aboriginal and Torres Strait Islander Youth - Targeted Call for Research outcomes, https://www.nhmrc.gov.au/grants/apply-funding/targeted-and-urgent-calls-

research/mental-health-targeted-call-research/suicide (viewed 1 October 2014). 618 Australian Bureau of Statistics, Submission 110, p 4. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 619 Nan Hu, Rebecca Glauert and Jianghong Li, Submission 101, p 1. At www.humanrights.gov.au/publications/childrens-rights-

report-2014.

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620 A Tovell, K McKenna, C Bradley and S Pointer, Hospital separations due to injury and poisoning, Australia 2009-10, Injury research and statistic series No 69 (2012), p 1, para 2. At http://www.aihw.gov.au/publication-detail/?id=60129542183 (viewed 1 October 2014).

621 Australian Government Department of Health, Therapeutic Goods Administration, Paracetamol: changes to pack size, http://www.tga.gov.au/newsroom/media-2013-paracetamol-130826.htm#.VB7SNksUVlI (viewed 1 October 2014). 622 L Hawkins, J Edwards and P Dargan, ‘Impact of restricting paracetamol pack sizes on paracetamol poisoning in the United Kingdom: a review of the literature (2007) 30(6) Drug Safety: An International Journal of Medical Toxicology and Drug Experience

465. At http://www.ncbi.nlm.nih.gov/pubmed/17536874 (viewed 1 October 2014). 623 Y Lin, TH Liu, TA Liu, Y Chang, C Chou and H Wu, ‘Pharmaceutical poisoning exposure and outcome analysis in children admitted to the Pediatric Emergency Department’ (2011) 52 Pediatrics and Neonatology 11, p 17; S Zakharov, T Navratil and

D Pelclova, ‘Suicide attempts by deliberate self-poisoning in children and adolescents’ (2013) 210 Psychiatry Research 302, p 304; E Johnstone, D Owens and S Lawrie, Companion to Psychiatric Studies (8th ed, 2010), p 701. 624 S Zakharov, T Navratil and D Pelclova, ‘Suicide attempts by deliberate self-poisoning in children and adolescents’ (2013) 210 Psychiatry Research 302, p 304. 625 BoysTown (Kids Helpline), Submission 116, p 42. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 626 D Rickwood, C Wilson and F Deane, ‘Supporting young people to seek professional support for mental health problems’ (2006)

InPsych: The Bulletin of the Australian Psychological Society Ltd. At http://www.psychology.org.au/publications/inpsych/ highlights2006/#s3 (viewed 1 October 2014). 627 ACT Children and Young People Death Review Committee, Submission 48, p 1. At www.humanrights.gov.au/publications/ childrens-rights-report-2014. 628 National Coalition for Suicide Prevention, Response to the World Health Organisation World Suicide Report, One World

Connected: An Assessment of Australia’s Progress in Suicide Prevention, Discussion Paper (2014), p 12. At http:// suicidepreventionaust.org/wp-content/uploads/2014/09/NCSP_Australian-Response-to-WHO-World-Suicide-Report_ singlepage_.pdf (viewed 1 October 2014). 629 Northern Territory Council of Social Service, Submission 77, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 630 Black Dog Institute, Submission 88, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 631 Orygen Youth Health Research Centre, Submission 82, p 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 632 Orygen Youth Health Research Centre, Submission 82, p 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 633 The Liberal Party and The Nationals, The Coalition’s Policy for Efficient Mental Health Research and Services (2013). At http://www.liberal.org.au/our-policies (viewed 1 October 2014). 634 Minister for Health and Minister for Sport, ‘Delivering on our commitments to invest in youth mental health’, (Media Release, 13 May 2014). At http://www.health.gov.au/internet/budget/publishing.nsf/content/budget2014-hmedia10.htm (viewed 1 October 2014). 635 Director of Strategy, Development and Policy, Orygen Youth Health Research Centre, Email to Australian Human Rights Commission, 9 September 2014. 636 The Liberal Party and The Nationals, The Coalition’s Policy for Efficient Mental Health Research and Services (2013), p 4. At http://www.liberal.org.au/our-policies (viewed 1 October 2014). 637 The Senate Community Affairs References Committee, The Hidden Toll: Suicide in Australia (2010). At http://www.aph.gov. au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2008-10/suicide/report/index (viewed 1 October 2014). 638 House of Representatives Standing Committee on Health and Ageing, Before it’s too late: Report on early intervention programs aimed at preventing youth suicide (2011). At http://www.aph.gov.au/parliamentary_business/committees/house_of_ representatives_committees?url=haa/./youthsuicide/report.htm# (viewed 1 October 2014). 639 R O’Connor, S Platt and J Gordon, International Handbook of Suicide Prevention: Research, Policy and Practice (2011), p 10. 640 J Muehlenlamp, L Claes, L Havertape and P Plener, ‘International prevalence of adolescent non-suicidal self-injury and deliberate self-harm’ (2012) 6(10) Child and Adolescent Psychiatry and Mental Health, p 6. 641 R O’Connor, S Platt, J Gordon, International Handbook of Suicide Prevention (2011), p 293. 642 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255, p 257. 643 K Bentley, M Nock and D Barlow, ‘The Four-Function Model of Nonsuicidal Self-injury: Key Directions for Future Research’ (2014) Clinical Psychological Science, p 7. 644 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255, p 257. 645 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255, p 257. 646 M Nock, ‘Future directions for the study of suicide and self-injury’ (2012) 41(2) Journal of Clinical Child and Adolescent Psychology 255, p 257. 647 Australian Government National Health and Medical Research Council, National Statement on Ethical Conduct in Human Research (2014). At https://www.nhmrc.gov.au/guidelines/publications/e72 (viewed 1 October 2014).

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648 Orygen Youth Health Research Centre, Submission 82, pages 77-80. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 649 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide and Life-Threatening Behavior, p 97. 650 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide

and Life-Threatening Behavior, p 97. 651 C Haw, K Hawton, C Niedzwiedz, and S Platt, ‘Suicide Clusters: A Review of Risk Factors and Mechanisms’ (2013) 43(1) Suicide and Life-Threatening Behavior, p 105. 652 G Cox, J Robinson, M Williamson, A Lockley, Y Cheung and J Pirkis, ‘Suicide clusters in young people: Evidence for the

effectiveness of postvention strategies’ (2012) 33(4) Crisis: The Journal of Crisis Intervention and Suicide Prevention, p 208. 653 Australian Healthcare Associates, Evaluation of Suicide Prevention Activities, Final Report (2014), p 10. At http://www.health.gov. au/internet/main/publishing.nsf/Content/mental-pubs-e-evalsuic (viewed 1 October 2014). 654 Orygen Youth Health Research Centre, Submission 82, p 11. At www.humanrights.gov.au/publications/childrens-rights-

report-2014. 655 Menzies School of Health Research, Submission 102, p 39. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 656 S Jarvi, B Jackson, L Swenson and H Crawford, ‘The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the

Literature’ (2013) 17(1) Archives of Suicide Research, p 12. 657 L Biddle, J Donovan, A Owen-Smith, J Potokar, D Longson, K Hawton, N Kapur and D Gunnell, ‘Factors influencing the decision to use hanging as a method of suicide: qualitative study’ (2010) 197 The British Journal of Psychiatry 320, p 320. 658 Black Dog Institute, Submission 88, p 5. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 659 Black Dog Institute, Submission 88, p 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 660 C Wilson, J Bushnell and P Caputi, ‘Early access and help seeking: practice implications and new initiatives’ (2011) 5

Early Intervention in Psychiatry 34, p 38. 661 headspace, Submission 89, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 662 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 663 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 664 BoysTown (Kids Helpline), Submission 116, p 4, para 6. At www.humanrights.gov.au/publications/childrens-rights-report-2014. 665 National Coalition for Suicide Prevention, Response to the World Health Organisation World Suicide Report, One World

Connected: An Assessment of Australia’s Progress in Suicide Prevention, Discussion Paper (2014), p 12. At http://suicidepreventionaust.org/wp-content/uploads/2014/09/NCSP_Australian-Response-to-WHO-World-Suicide-Report_ singlepage_.pdf (viewed 1 October 2014). 666 World Health Organisation, Preventing suicide: A global imperative (2014), p 12. At http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ (viewed 1 October 2014). 667 M Nock, The Oxford Handbook of Suicide and Self-Injury (2014), p 502.

Chapter 3: Endnotes

182

Appendices

Appendices

182

Children’s Rights Report 2014 • 183

A selection of photos from roundtables throughout Australia about intentional self-harm, with or without suicidal intent

184

Date Engagement Location

4.10.13 Shine for Kids: Annual Charity Golf Day Sydney, NSW

9.10.13 Sydney Children’s Hospital Network Sydney, NSW

10.10.13 Resilient Kids, Resilient Communities Conference Melbourne, VIC

11.10.13 PLAN International Australia: Crucial Voices Symposium - Innovative Approaches to Promoting Girls’ Participation in Political Spaces

Melbourne, VIC

18.10.13 CCSA: Continuing the Conversation - Are All the Voices Being Heard Conference Hunter Valley, NSW

21.10.13 Anglicare Victoria: Totally Kids Conference Melbourne, VIC

21.10.13 Berry Street Annual Celebration Melbourne, VIC

23.10.13 Amata Health Advisory Council Meeting Amata, SA

23.10.13 Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council Annual General Meeting Amata, SA

25.10.13 Goodstart Early Learning and Care Reference Group Meeting Sydney, NSW

2.11.13 Australian Research Alliance for Children and Youth: Infant and Early Childhood Social and Emotional Wellbeing Conference Canberra, ACT

4.12.13 Australian Red Cross National Practitioner’s Forum: Improving Services for Unaccompanied Minors and Young People Seeking Asylum

Melbourne, VIC

26.2.14 Australian Human Rights Commission Rights Talk Event: International Women’s Day AHRC, NSW

7.3.14 National Children’s Week Council Annual Meeting Sydney, NSW

13.3.14 Australian National University Symposium: Children and Communities in Australia Canberra, ACT

Appendix 1: Speaking engagements

Children’s Rights Report 2014 • 185

Date Engagement Location

17.3.14 Murdoch Children’s Research Institute: Community Child Health Early Years Seminar Melbourne, VIC

18.3.14 Meeting of the Community Reference Group (Advisory group to the Royal Children’s Hospital Mental Health) Melbourne, VIC

19.3.14 Royal Children’s Hospital Grand Rounds Melbourne, VIC

25.3.14 5th Annual National Juvenile Justice Summit Melbourne, VIC

28.3.14 Australian and New Zealand Child Death Review and Prevention Group Annual Meeting Melbourne, VIC

1.4.14 Families Australia: 2014 Child Aware Approaches Conference Melbourne, VIC

7.4.14 Australian and New Zealand Mental Health Association: No 2 Bullying Conference Gold Coast, QLD

9.4.14 Centre for Children and Young People, Southern Cross University: Involving Children and Young People in Improving Policy, Programs and Services Symposium

Lismore, NSW

16.4.14 University of South Australia Panel Discussion: Diversity and Employment - Going Beyond Gender Adelaide, SA

6.5.14 Network of Community Activities: 40th Anniversary Annual General Meeting Sydney, NSW

9.5.14 Australian Child Rights Taskforce: National Videoconference Sydney, NSW

14.5.14 Law Institute of Victoria Young Lawyers’ Section: Hot Topics Event Melbourne, VIC

16.5.14 Queensland Catholic Education Commission: Student Protection In-Service Day for Catholic School Authorities Brisbane, QLD

19.6.14 Association of Children’s Welfare Agencies Board Meeting Sydney, NSW

30.6.14 Marist Youth Care Dinner Sydney, NSW

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Appendix 2: Face-to-face meetings and teleconferences about issues affecting children and young people

Date Meeting Location

3.10.13 The Australian Foster & Kinship Carer Partnership: provides a national focus on issues and events that affect foster and kinship carers Australia wide

AHRC, NSW

3.10.13 Good Beginnings Australia: provides free early childhood and practical parenting programs for children and families across Australia

AHRC, NSW

4.10.13 Craig Kelly MP, Federal Member for Hughes Sydney, NSW

8.10.13 Preventing Anxiety and Victimisation through education (PAVe) Project Advisory Committee: formed to provide advice, input and assistance to the Project

Sydney, NSW

9.10.13 Australian Literacy & Numeracy Foundation: dedicated to raising national language, literacy and numeracy standards, especially in remote and marginalised communities

AHRC, NSW

11.10.13 YMCA Australia: works to empower and support young people to reach their potential and develop resilience Melbourne, VIC

14.10.13 The Association of Women Educators: committed to gender equity and the full participation of women and girls in education AHRC, NSW

14.10.13 Australian Research Alliance for Children & Youth: works to progress and promote evidence-based programs and strategies to improve the wellbeing of children and youth

AHRC, NSW

15.10.13 Pam Hemphill: Principal of Child Dispute Services, Family Court of Australia AHRC, NSW

16.10.13 Council of Australian Student Exchange Organisations: acts to promote the importance and educational value of student exchange programs and seeks improvements in the policy and regulatory framework

AHRC, NSW

28.10.13 Lin Hatfield Dodds, National Director, UnitingCare Australia, and Claerwen Little, Chief Executive Officer, Children, Young People & Families

AHRC, NSW

29.10.13 Australian Research Alliance for Children & Youth: The Nest Aboriginal and Torres Strait Islander Workshop AHRC, NSW

Children’s Rights Report 2014 • 187

Date Meeting Location

31.10.13 Play by the Rules Management Committee: organisation that works to build the capacity and preparedness, and positively influence the behaviours, of sport and recreation providers to better deal with the issues that impact on safe, fair and inclusive sport and recreation

AHRC, NSW

31.10.13 Australian Curriculum, Assessment and Reporting Authority: independent authority that works to improve the educational outcomes of all young Australians

Sydney, NSW

1.11.13 Foundation to Prevent Violence Against Women and their Children: national organisation designed to drive cultural and attitudinal change to prevent violence against women and their children

AHRC, NSW

4.11.13 Benevolent Society: not-for-profit organisation to empower and educate for societal change AHRC, NSW

12.11.13 Maggie Atkinson: Children’s Commissioner for England London, UK

13.11.13 Keith Towler: Children’s Commissioner for Wales Wales, UK

10.12.13 Australian Young, Pregnant and Parenting Network: formed to support pregnant and parenting young people to create the best possible start for themselves and their children

AHRC, NSW

10.12.13 Australian Institute of Health & Welfare: national agency set up to provide reliable, regular and relevant information and statistics on Australia’s health and welfare

AHRC, NSW

11.12.13 Professor Barbara McDonald: Commissioner, Australian Law Reform Commission AHRC, NSW

11.12.13 Productivity Commission: Australian Government independent research and advisory body covering a range of economic, social and environment issues affecting the welfare of Australians

AHRC, NSW

12.12.13 Life Without Barriers: provides care and support services across Australia in urban, rural and remote locations AHRC, NSW

15.12.13 Bourke Public School Bourke, NSW

15.12.13 Bourke High School Bourke, NSW

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Date Meeting Location

18.12.13 Goodstart Early Learning: 13,000 Goodstart staff support over 61,000 families and the 73,000 children that attend their 641 centres nationwide

AHRC, NSW

18.12.13 Online Safety Consultative Working Group: created to assist with the implementation of the Australian Government’s commitment to online safety, by providing advice to Government on online safety issues such as cyberbullying, privacy breaches, and exposure to illegal online content

Sydney, NSW

19.12.13 Goodstart Early Learning: 13,000 Goodstart staff support over 61,000 families and the 73,000 children that attend their 641 centres nationwide

AHRC, NSW

20.12.13 Australian Securities & Investments Commission: provides materials on financial literacy for young people aged 16-25 years AHRC, NSW

24.12.13 Dr Maria Herczog: Member, United Nations Committee on the Rights of the Child AHRC, NSW

9.1.14 Dr Anne Crowley: Postdoctoral Fellow in Social Work, University of Newcastle AHRC, NSW

17.1.14 Professor Mary Crock: Professor of Public Law, University of Sydney Sydney, NSW

22.1.14 Professor Anne Graham: Director, Centre for Children and Young People, Southern Cross University AHRC, NSW

23.1.14 Footys4All: not-for-profit organisation supplying new sporting balls to disadvantaged, underprivileged and socially displaced children

AHRC, NSW

30.1.14 Alannah & Madeline Foundation: national charity protecting children from violence AHRC, NSW

31.1.14 Alasdair Roy: ACT Children and Young People Commissioner Sydney, NSW

31.1.14 Abul Rizvi: Deputy Secretary, Department of Communications AHRC, NSW

4.2.14 Life Without Barriers: provides care and support services across Australia in urban, rural and remote locations AHRC, NSW

Appendix 2: Face-to-face meetings and teleconferences about issues affecting children and young people

Children’s Rights Report 2014 • 189

Date Meeting Location

5.2.14 National roundtable consultations for the National Plan to Reduce Violence against Women and their Children 2010-2022 Adelaide, SA

7.2.14 Professor Beverley Raphael and Amanda Harris: Australian National University AHRC, NSW

12.2.14 Australian Law Reform Commission: conducted a recent Inquiry into Serious Invasions of Privacy in the Digital Era Sydney, NSW

14.2.14 Australian Council of Human Rights Agencies: comprising state and territory statutory authorities with responsibility for discrimination, equal opportunity and human rights laws and the Australian Human Rights Commission

AHRC, NSW

17.2.14 National Mental Health Commission: provides independent reports and advice to the community and government on what’s working and what’s not

AHRC, NSW

25.2.14 Australian Crime Commission Canberra, ACT

25.2.14 Department of Education: Martin Hehir, Deputy Secretary, Schools and Youth; Louise Hanlon, Group Manager, Schools Reform Taskforce; Jacqui Wilson, Deputy Secretary, Early Childhood Education and Care

Canberra, ACT

27.2.14 Professor Heather Carmichael-Olsen: Clinical Professor, Psychiatry and Behavioural Sciences Research, University of Washington

AHRC, NSW

27.2.14 Association of Women Educators: committed to gender equity and the full participation of women and girls in education AHRC, NSW

28.2.14 Senator the Hon George Brandis QC, Attorney-General AHRC, NSW

28.2.14 Abul Rizvi: Deputy Secretary, Department of Communications AHRC, NSW

3.3.14 Finn Pratt: Secretary, Department of Social Services Canberra, ACT

3.3.14 Katy Gallagher, ACT Chief Minister Canberra, ACT

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Date Meeting Location

3.3.14 Australian Institute of Health and Welfare: national agency set up to provide reliable, regular and relevant information and statistics on Australia’s health and welfare

Canberra, ACT

4.3.14 Senator Sarah Hanson-Young, Australian Greens Senator for South Australia Canberra, ACT

4.3.14 The Hon Peter Dutton MP, Minister for Health and Minister for Sport Canberra, ACT

4.3.14 Office of the Prime Minister: Andrew Hirst, Deputy Chief of Staff, and Leonie McGregor, Senior Adviser, Social Policy Canberra, ACT

5.3.14 Community Affairs References Committee: Senator Rachel Siewert, Chair, and Senator Boyce, Deputy Chair Canberra, ACT

5.3.14 Professor Deborah Mitchell: Australian Demographic & Social Research Institute, Australian National University Canberra, ACT

11.3.14 Australian Government Department of Social Services AHRC, NSW

18.3.14 Australian Research Alliance for Children & Youth: The Nest Aboriginal and Torres Strait Islander Follow-Up Workshop Melbourne, VIC

21.3.14 UNICEF Australia: works in over 190 countries to promote and protect the rights of children Sydney, NSW

24.3.14 The Hon Sussan Ley, Assistant Minister for Education Canberra, ACT

4.4.14 Child Rights Taskforce: co-convened by UNICEF Australia and the National Children’s and Youth Law Centre AHRC, NSW

16.4.14

17.4.14

Australian Council of Human Rights Agencies: comprising state and territory statutory authorities with responsibility for discrimination, equal opportunity and human rights laws and the Australian Human Rights Commission

Adelaide, SA

28.4.14 Save the Children Australia: works to protect children from harm and help them access quality education and health services AHRC, NSW

29.4.14 Shine for Kids: charity supporting children with a parent in the criminal justice system Sydney, NSW

Appendix 2: Face-to-face meetings and teleconferences about issues affecting children and young people

Children’s Rights Report 2014 • 191

Date Meeting Location

29.4.14 Australian Institute of Family Studies: Australian Government key research body in the area of family wellbeing AHRC, NSW

1.5.14 Facebook: engages with the Australian Human Rights Commission in relation to human rights complaints and online safety issues and initiatives

AHRC, NSW

5.5.14 Early Childhood Australia: National Advisory Group meeting for the development of a Statement of Intent on Supporting Children’s Rights in Early Childhood Education and Care

Canberra, ACT

9.5.14 Royal Commission into Institutional Responses to Child Sexual Abuse: investigating how institutions such as schools, churches, sports clubs and government organisations have responded to allegations and instances of child sexual abuse

Sydney, NSW

9.5.14 Child Rights Taskforce: co-convened by UNICEF Australia and the National Children’s and Youth Law Centre Sydney, NSW

15.5.14 Australian Children’s Commissioners and Guardians: comprising all Australian state and territory Children’s Commissioners and Guardians, and the National Children’s Commissioner, this group aims to promote children’s rights and participation and ensure the best interests of children are considered in public policy and program development across Australia

Melbourne, VIC

23.6.14 Early Childhood Australia: National Advisory Group meeting for the development of a Statement of Intent on Supporting Children’s Rights in Early Childhood Education and Care

Canberra, ACT

23.6.14 Australian Government Department of Social Services Canberra, ACT

24.6.14 Bravehearts: aims to empower, educate and protect by providing healing and support, engendering child sexual assault prevention and protection strategies, advocating for understanding and promoting increased education and research

AHRC, NSW

26.6.14 Australian Literacy & Numeracy Foundation: dedicated to raising national language, literacy and numeracy standards, especially in remote and marginalised communities

AHRC, NSW

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Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Draft Supporting young children’s rights Statement of intent (2015-2018)

Purpose

Supporting young children’s rights: Statement of intent (2015-2018) provides high-level principles and areas for future collective work, advocacy and action by Early Childhood Australia (ECA), its members and the National Children’s Commissioner in relation to the rights of young children.1

Supporting young children’s rights: Statement of intent (2015-2018) supports ECA to be a clear and credible advocate in campaigning for the rights and wellbeing of young children.2 ECA and the National Children’s Commissioner have worked collaboratively to identify key areas for action in Australia.

Overview

Australia ratified the United Nations Conventions on the Rights of the Child in 1990 (the ‘Convention’ or ‘UNCRC’). This Convention is an international human rights treaty which formally and explicitly outlines the rights of children in international law including basic human rights such as the right to be free from abuse, neglect and exploitation, the right to an education and healthcare and the right to be free from discrimination based on race, gender or religion. The Convention emphasises respect for the inherent human dignity of all children, the importance of recognising diversity,3 and the principle of non-discrimination. Whilst the Convention is not incorporated as a whole into Australian national and state laws, its principles inform and guide components of various legislation, policy, service provision and practice.

Of particular note to the development of this document, the national legislative framework for early childhood service delivery, the Education and Care Services National Law (2010) explicitly supports the incorporation of the Convention into legislation in Australia. Similarly the Early Years Learning Framework (2009) explicitly incorporates the Convention into the national guide for curriculum decision making in early education and care. These documents highlight the central role of young children’s rights in the provision of quality teaching and learning and mainstream service delivery.

Early childhood educators guided by the EYLF will reinforce in their daily practice the principles laid out in the United Nations Convention on the Rights of the Child. The Convention states that all children have the right to an education that lays a foundation for the rest of their lives, maximises their ability, and respects their family, cultural and other identities and languages. The Convention also recognises children’s right to play and be active participants in all matters affecting their lives.

The Early Years Learning Framework, 2009, p 5

1 Including children from birth to primary school age. 2 Early Childhood Australia Strategic Plan 2014-2017. 3 Including learning styles, abilities, disabilities, gender, family circumstances and geographic location.

Children’s Rights Report 2014 • 193

The articles within the UNCRC are embedded within the objectives and guiding principles of the Education and Care Services National Law (2010) and Regulations (2011). The objectives and guiding principles of the Education and Care Services National Law (2010) provide the purpose of the Act. Of note is the following relevant key guiding principles (Section 3):

• That the rights and best interests of the child are paramount; • That children are successful, competent and capable learners; • That the principles of equity, inclusion4 and diversity underlie this Law; • That Australia’s Aboriginal and Torres Strait Islander cultures are valued; • That the role of parents and families is respected and supported; • That best practice is expected in the provision of education and care services.

Why do we need a joint Statement of intent?

As a national legislative framework and policy document the Education and Care National Law (2010) and the Early Years Learning Framework (2009) explicitly incorporate the UNCRC and highlight the central role of children’s rights in the provision of quality teaching, learning and mainstream service delivery.

Areas for action

Australia’s first National Children’s Commissioner, Ms Megan Mitchell, tabled her inaugural report—the Children’s Rights Report 2013—to Parliament in November 2013. This report examined the implementation of the UNCRC in Australia. In this report the National Children’s Commissioner identified five emerging themes to progress the better protection of children’s rights in Australia. The above key documents and these five themes have informed the focus of Early Childhood Australia’s Supporting young children’s rights: Statement of intent (2015-2018).

The five key themes include:

• the right to be heard • freedom from violence, abuse and neglect • the opportunity to thrive • engaged civics and citizenship • action and accountability.

Key documents

Our position statement is based on an analysis and review of the following key Australian child rights documents:

• Education and Care Services National Law (2010) and the Education and Care Services National Regulations (2011) • United Nations Convention on the Rights of the Child (United Nations, 1989) • Children’s Rights Report (Australian Human Rights Commission, 2013) • UN Committee on the Rights of the Child: Concluding Observations, Australia

(UN Committee on the Rights of the Child, 2012) • Listen to Children Report (Child Rights Taskforce Report, 2011) • National Framework for Protecting Australia’s Children 2009-2020 (Council of

Australian Governments, 2009)

4 Inclusion: involves taking into account all children’s social, cultural and linguistic diversity (including learning styles, abilities, disabilities, gender, family circumstances and geographic location) in curriculum decision-making processes. The intent is to ensure that all children’s experiences are recognised and valued. The intent is also to ensure that all children have equitable access to resources and participation, and opportunities to demonstrate their learning and to value difference (Early Years Learning Framework, 2009).

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• Investing in the Early Years—A National Early Childhood Development Strategy 2009-2020 (Council of Australian Governments, 2009) • ECA Code of Ethics (Early Childhood Australia, 2006) • ECA Reconciliation Action Plan (Early Childhood Australia, 2012) • A Guide to General Comment 7: Implementing Child Rights in Early Childhood (United Nations

Committee on the Rights of the Child, United Nations Children’s Fund and the Bernard van Leer Foundation, 2006)

1. The right to be heard: Promoting children’s voice and participation in decision-making processes, and enabling greater opportunities to hear from children about their concerns

I would feel better if in life we kids had more of a say as we do have a voice and we would like to be heard and this is perfect for me as I am being heard. I would feel much better if everyone in life was equal.

Child from Victoria

4 year old girl from Queensland

The key priority areas for action identified by ECA and the National Children’s Commissioner specific to young children for 2015-2018 include:

Action 1.1: building early childhood professionals’ capacity, skills and knowledge to work, think and behave in a way that supports the implementation of children’s rights, including the right to express their views, in everyday practice.

Action 1.2: support professionals working with young children to recognise that all children, including very young children, have the right to be heard and to participate in decision-making processes.

Action 1.3: support professionals working with young children to understand that they have the responsibility to listen to children, consider their opinions and act in the best interests of children.

Action 1.4: to promote young children’s voices and participation requires professionals to be able to identify and use appropriate resources and tools to ethically support children’s participation and decision-making.

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Children’s Rights Report 2014 • 195

The right to be heard

What this means for a child What this means for a professional working with young children

What this means for ECA and the National Children’s Commissioner

I will:

• be recognised as a successful, competent and capable learner

• be encouraged to express my views and opinions and know that these views and opinions will be listened to and valued

• have a say about decisions affecting me • be supported to access the information I need to

be safely connected to and contribute to my world and the decisions affecting me • know that my family is recognised and respected as having the key responsibility for my upbringing • have privacy.

I will:

• recognise children’s agency and their individual and evolving capacity to participate in day-to-day considerations relating to their lives

• build my capacity, skills and knowledge of children’s rights to enable me to implement these in my day-to-day practice

• facilitate learning environments that foster opportunities for all children to express themselves

• listen to and value children’s views and opinions and show that their views have been acted on

• advocate for children’s views and opinions to be heard and valued within the early learning environment, the family and the community.

ECA and the National Children’s Commissioner commit to:

• identify and promote the use of appropriate resources and tools to promote children’s voices and to support children’s participation in decision making

• ethically contribute young children’s voices to the public debate on issues of relevance to young children.

Relevant UNCRC Articles and Acts • UNCRC Article 12—Right to respect for the views of the child • UNCRC Article 13—Right to freedom of expression • UNCRC Article 5, 18—Right to family • Education and Care Services National Law (2011) Section 3—children are successful, competent

and capable learners • Education and Care Services National Regulations (2011) Section 155—educators must provide education and care services to children in a way that: » encourages children to express themselves and their opinions; and

» allows children to undertake experiences that develop self-reliance and self-esteem; and » maintains at all times the dignity and rights of each child; and » gives each child positive guidance and encouragement toward acceptable behaviour; and » has regard to the family and cultural values, age, and physical and intellectual development

and abilities of each child being educated and cared for by the service. • The Early Years Learning Framework (2009)—learning outcomes: » Children have a strong sense of identity » Children are connected with and contribute to their world

» Children have a strong sense of wellbeing » Children are confident and involved learners » [particularly] Children are effective communicators

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2. Freedom from violence, abuse and neglect: Delivering safe environments and respect for the dignity of the child

I think that everyone should be safe.

10 year old child from South Australia

5 year old boy from New South Wales

The key priority areas for action identified by ECA and the National Children’s Commissioner specific to young children for 2015-2018 include:

Action 2.1: supporting children’s services to consider and build their organisational capacity to become child safe and child friendly organisations.

Action 2.2: advocating that children’ services settings be free from harm.

Action 2.3: promoting a better understanding of child protection issues, including the identification and support of vulnerable children, children at risk and the implementation of appropriate supports, services and responses.

Action 2.4: Improving interdisciplinary responses across education, health and social services to support vulnerable children and children at risk of violence, abuse and neglect.

Action 2.5: Support professionals working with young children to build strong partnerships with families to provide a safe environment for their children.

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Children’s Rights Report 2014 • 197

Freedom from violence, abuse and neglect

What this means for a child What this means for a professional working with young children

What this means for ECA and the National Children’s Commissioner

I will:

• be safe no matter where I am • be supported and protected by the people in my life from

violence, abuse and neglect • live and grow up safely • be cared for and have a

home • be listened to and concerns heard, respected and acted

upon.

I will:

• develop my understanding of risk and protective factors that contribute to children’s safety as well as relevant legislation and mechanisms for protecting children from violence, abuse and neglect

• listen to children and recognise and respond to signs of violence, abuse and neglect

• improve my understanding of each child’s family and support their connections with relevant local services that support safe environments for children

• facilitate learning environments that foster opportunities for all children to express themselves

• model respectful relationships.

ECA and the National Children’s Commissioner will:

• support organisations providing services for young children, to be child safe and child friendly

• promote appropriate strategies to support professionals to respond to risk, abuse and neglect

• advocate for the protection of all children from violence, abuse and neglect.

Relevant UNCRC Article and Education and Care Services Act • UNCRC Article 18, 33, 34, 37, 39—Right to protection • Education and Care Services National Law5 (2010) Section 166—an approved provider, a nominated supervisor, a staff member or volunteer must ensure that no child being educated and cared for by the

service is subjected to: » Any form of corporal punishment; or » Any discipline that is unreasonable in the circumstances. • Education and Care Services National Law Act (2010) Section 167—an approved provider and a

nominated supervisor of an education and care service must ensure that every reasonable precaution is taken to protect children being educated and cared for by the service from harm and from any hazard likely to cause harm. • Education and Care Services Regulations (2011) Section 84—educators must be aware of the existence, application and obligations under state based child protection laws.

» The Early Years Learning Framework (2009)—learning outcomes: » Children have a strong sense of identity » Children are connected with and contribute to their world » [particularly] Children have a strong sense of wellbeing

» Children are confident and involved learners » Children are effective communicators

5 Variations to the applied law include the Child Care Act 2001 (Tasmania) and the Education and Care Services National Law (Queensland) Act 2013 which does not specifically prohibit corporal punishment in schools or in Tasmanian childcare services (Australian Institute of Families Studies, 2014).

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3. The opportunity to thrive: Safeguarding the health and wellbeing of all children in Australia, including building an effective early intervention and prevention system; with a focus on the most vulnerable children—along the lines of proportionate universalism

Helping poor children have a good house and have food that is good to eat.

4 year old girl from Victoria

3 ½ year old girl from South Australia

The key priority areas for action identified by ECA and the National Children’s Commissioner specific to young children for 2014-2018 include:

Action 3.1: Promote and support cultural awareness training and the importance of connections with country with educators, children, families and community.

Action 3.2: Advocating a child’s right to access, participate and benefit from quality education as identified under the UNCRC. A

Action 3.3: Advocate for and support vulnerable children and children at risk to have priority of access to early childhood education and care services.

Action 3.4: Supporting families to connect to professional services to maximise children’s opportunities.

Action 3.5: Promote and advocate for children to have play based learning opportunities, leisure and rest.

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Children’s Rights Report 2014 • 199

The opportunity to thrive

What this means for a child What this means for a professional working with young children

What this means for ECA and the National Children’s Commissioner

I will:

• be recognised as a successful, competent and capable learner

• know that my family and my values, beliefs, culture, religion and values are recognised and respected

• be supported to know, enjoy, understand and express my culture, religion, language and beliefs

• support my engagement in lifelong learning • have access to education, play and cultural activities • be given the opportunity,

time and space to play and rest.

I will:

• know, learn and understand the history of Australia’s first people • learn more about my culture and the cultures of the

children and families within my community • commit to ongoing professional development on cultural

awareness and approved learning frameworks for educating children about culture and diversity • value quality resources that

inform my work with children and their families so that I am culturally sensitive and responsive • facilitate a learning environment

that will promote opportunities for children to thrive and excel • provide children with information relevant to their

day-to-day lives in consultation with families and based on the child’s evolving capacity and understanding • recognise children’s current

capacity and abilities and support children to learn • support, promote and advocate for the provision of play based

learning opportunities for children in early childhood education and care settings.

ECA and the National Children’s Commissioner commit to:

• engage with recognised national and international experts in the field of children’s rights so as to keep informed and up-to-date of changes relevant to the early childhood education and care sector

• inform organisations working with young children of relevant evidence based practice and research in relation to children’s rights.

ECA will:

• continue their commitment to the Reconciliation Action Plan and promoting reconciliation across the early childhood sector to close the gap in outcomes for Aboriginal and Torres Strait Islander children

• advocate for children to be given the opportunity, time and space to play and rest.

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Relevant UNCRC Article and Education and Care Services Act • UNCRC Article 4, 42—A right to education • UNCRC Article 17—A right to information • UNCRC Article 5, 18—Right to family • UNCRC Article 31—Right to play, rest and leisure • Education and Care Services Regulation (2011) Section 73, 74, 75 and 76—programming, assessment

and documentation be implemented and delivered by suitably qualified educators to contribute to the learning outcomes of each child attending an education and care service. • Education and Care Services Regulations (2011) Section 84—educators must be aware of the existence, application and obligations under state based child protection laws.

» The Early Years Learning Framework (2009)—learning outcomes: » Children have a strong sense of identity » Children are connected with and contribute to their world » Children have a strong sense of wellbeing

» [particularly] Children are confident and involved learners » Children are effective communicators

4. Engaged civics and citizenship: Through education and awareness of children and the community about their rights and responsibilities in practical and meaningful ways

Life would be better for children and young people in Australia if we were all treated with equality and†we were all treated fairly. Life would be better if everyone learned the meaning of freedom.

10 year old child from Victoria

4 year old girl from South Australia

The key priority areas for action identified by ECA and the National Children’s Commissioner that are specific to young children for 2015-2018 include:

Action 4.1: Supporting educators to provide rights education in early childhood education and day-to-day practice.

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Children’s Rights Report 2014 • 201

Action 4.2: Supporting professionals to provide children growing up in a digital world to engage in that world positively and to know about and develop basic skills in privacy preservation and internet safety.

Action 4.3: Supporting professionals working with young children to recognise children as active citizens who have a role in contributing to their broader community whilst respecting and acknowledging each child’s evolving capacity.

Action 4.4: Supporting professionals working with children to create environments that are free of bullying, both offline and on-line.

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Engaged civics and citizenship

What this means for a child What this means for a professional working with young children

What this means for ECA and the National Children’s Commissioner

I will:

• be informed about my rights and responsibilities as a citizen within my community

• be provided with information and support to engage in and exercise my civic rights and responsibilities

• be recognised as a participant in the digital world

• be supported to access the information I need to be safely connected and to contribute to my world

• be asked for my consent, and the consent of my family, when sharing my personal information, including my images

• have my privacy protected • know that my family is recognised and respected as having the key responsibility

for my upbringing.

I will:

• build my capacity, skills and knowledge of children’s rights to enable me to implement these in my day-to-day practice

• support children to know and understand their rights and responsibilities

• keep informed and maintain resources that will best support children’s learning on civic responsibly and children’s rights

• provide daily opportunities for children to exercise their rights and responsibilities in their early learning education and care environment, their family and their community

• provide support to children, and their families, to promote children’s privacy and personal safety particularly in relation to digital technology used in the early learning environment, services for young children and at home

• value and respect diversity • respect relationships.

ECA and the National Children’s Commissioner commit to:

• promote resources to support children’s rights education in early childhood and within the community

• promote and develop resources for educators, professionals working with young children, children and the community to promote children’s personal safety, particularly in relation to digital technology

• support and promote the ongoing development of national standards and ethics in relation to children’s rights.

Relevant UNCRC Article and Education and Care Services Act • UNCRC Article 4, 42—Right to know your rights • UNCRC Article 17—A right to information • UNCRC Article 5, 18—Right to family • UNCRC Article 18—A right to privacy • Education and Care Services Regulations (2011) Section 84—educators must be aware

of the existence, application and obligations under state based child protection laws • The Early Years Learning Framework (2009)—learning outcomes: » Children have a strong sense of identity » Children are connected with and contribute to their world

» Children have a strong sense of wellbeing » [particularly] Children are confident and involved learners » Children are effective communicators • National Quality Framework (2012) Standard 3.3.2—Children are supported to become environmentally responsible and show respect for the environment.

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Children’s Rights Report 2014 • 203

5. Action and accountability: Taking action to collect comprehensive national data about child wellbeing, progress a national vision for children, and develop mechanisms by which children’s interests are systematically considered in law policy and practice development and review

Life would be better for children if the government made sure every child had all the rights. I think every child should have food and water.

An Australian child

5 year old boy from Victoria

The key priority areas for action identified by ECA and the National Children’s Commissioner specific to young children for 2015-2018 include:

Action 5.1: Developing and supporting mechanisms to ethically contribute young children’s voices to national data sets, laws, policy and day-to-day practices with children.

Action 5.2: Taking action to support the progress of a national vision for young children in Australia.

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Action and accountability

What this means for a child What this means for a professional working with young children

What this means for ECA and the National Children’s Commissioner

I will:

• be informed about opportunities to contribute to decisions, debates and research activities

• be informed about how my contributions will impact on myself, my family and my community

• know that my contributions are valued • be encouraged to express my views and opinions and

these views and opinions will be listened to and valued • have a say about decisions affecting me • be supported to access

the information I need to be safely connected and to contribute to my world • be asked for my consent, and the consent of my family, when sharing my personal information, including my images • have privacy.

I will:

• build my knowledge on how to ethically engage with young children and share their contributions

• support children to have their views, experiences and achievements reflected in national data sets

• advocate for engaging children ethically in data collection processes with their ongoing informed consent

• take a critically reflective stance on my own professional practices with children and be amenable to feedback.

ECA and the National Children’s Commissioner commit to:

• promote and develop resources to support educators to ethically engage with young children

• ethically contribute young children’s voices to the public debate on issues of relevance to young children

• advocate for ethical national and state based data collection relating to children’s views, experiences and opinions.

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Children’s Rights Report 2014 • 205

Relevant UNCRC Article and Education and Care Services Act • UNCRC Article 12—Respect for the views of the child • UNCRC Article 13—Right to freedom of expression • UNCRC Article 5, 18—Right to family • UNCRC Article 4, 42—Right to know your rights • UNCRC Article 17—A right to information • UNCRC Article 18—A right to privacy • Education and Care Services National Law (2011) Section 3—children are successful, competent and

capable learners. • Education and Care Services National Regulations (2011) Section 155—educators must provide education and care services to children in a way that: » encourages children to express themselves and their opinions; and

» allows children to undertake experiences that develop self-reliance and self-esteem; and » maintains at all times the dignity and rights of each child; and » gives each child positive guidance and encouragement toward acceptable behaviour; and » has regard to the family and cultural values, age, and physical and intellectual development and

abilities of each child being educated and cared for by the service. • The Early Years Learning Framework (2009)—learning outcomes: » Children have a strong sense of identity » [particularly] Children are connected with and contribute to their world

» Children have a strong sense of wellbeing » Children are confident and involved learners » Children are effective communicators

206

Glossary

Educators:

The EYLF (2009) describes educators as ‘early childhood practitioners who work directly with children in early childhood settings’ (DEEWR, p. 45).

Convention:

A convention is an agreement between States (countries) covering particular matters, especially one less formal than a treaty.

Inclusion: The EYLF (209) identifies inclusion involves taking into account all children’s social, cultural and linguistic diversity (including learning styles, abilities, disabilities, gender, family circumstances and geographic location) in curriculum decision-making processes. The intent is to ensure that all children’s experiences are recognised and valued. The intent is also to ensure that all children have equitable access to resources and participation, and opportunities to demonstrate their learning and to value difference .

Family:

Within this document the term ‘family’ is all encompassing and recognises that children may have different people who are their main care providers and are recognised by the child as their family. This may include parents, carers, grandparents, extended family.

Participation:

Article 12 of the Convention on the Rights of the Child states that children have the right to participate in decision-making processes that may be relevant in their lives and to influence decisions taken in their regard— within the family, the school or the community. The principle affirms that children are full-fledged persons who have the right to express their views in all matters affecting them and requires that those views be heard and given due weight in accordance with the child’s age and maturity. It recognises the potential of children to enrich decision-making processes, to share perspectives and to participate as citizens and actors of change. The practical meaning of children’s right to participation must be considered in each and every matter concerning children.

Privacy:

In this document privacy is intended to include consideration of children’s records and children’s personal information (verbal and written), children’s identity, photos and images being protected and kept safe. Privacy also includes adult and children’s consent being sought for the sharing of information. The Privacy Act 1988 defines privacy as ‘ … information or an opinion, whether true or not, and whether recorded in a material form or not, about an identified individual, or an individual who is reasonably identifiable’. Common examples cited are an individual’s name, photo, commentary or opinion about a person.

Appendix 3: Draft Statement of Intent Supporting Young Children’s Rights

Children’s Rights Report 2014 • 207

References

• Australian Human Rights Commission. (2013). Children’s Rights Report—National Children’s Commissioner. Sydney: Australian Human Rights Commission.

• Child Rights Taskforce. (2011). Listen to Children—Child rights NGO Report Australia. Accessed July, 2014, from http://www.childrights.org.au/__data/assets/pdf_file/0014/14405/Listening-to-children-Report-2011-colour.pdf.

• Commonwealth of Australia. (1998). Privacy Act 1988.

• Council of Australian Governments. (2009). National Framework for Protecting Australia’s Children 2009 - 2020. Accessed July, 2014, from http://www.dss.gov.au/sites/default/files/documents/child_protection_ framework.pdf.

• Council of Australian Governments. (2009). Investing in the Early Years - A National Early Childhood Development Strategy 2009-2020. Accessed July, 2014, from https://www.coag.gov.au/sites/default/files/ national_ECD_strategy.pdf.

• Department of Education Employment and Workplace Relations (DEEWR). (2009a). Belonging, being and becoming: The early years learning framework for Australia. Barton, ACT: Commonwealth of Australia.

• Early Childhood Australia (ECA). (2006). ECA Code of Ethics. Deakin West: Early Childhood Australia.

• Early Childhood Australia (ECA). (2012). ECA Reconciliation Action Plan. Deakin West: Early Childhood Australia.

• Early Childhood Australia (ECA). (2014). Early Childhood Australia Strategic Plan 2014-2017. Deakin West: Early Childhood Australia.

• Education and Care Services National Law (2010) and the Education and Care Services National Regulation (2011).

• Holzer, P., & Lamont, A. (2014). Corporal punishment: Key issues. Australian Institute of Families Studies.

• United Nations Committee on the Rights of the Child, United Nations Children’s Fund and the Bernard van Leer Foundation. (2006). A Guide to General Comment 7: Implementing Child Rights in Early Childhood.

• United Nations. (1989). United Nations Convention on the Rights of the Child.

• United Nations Convention on the Rights of the Child. (2012). UN Committee on the Rights of the Child: Concluding Observations, Australia.

208

Appendix 4: Consultations with children and young people

Date Consultation Location

10.10.13 Resilient Kids, Resilient Communities Conference Melbourne, VIC

15.10.13 Marrickville West Primary School Sydney, NSW

30.10.13 The Infants’ Home, Ashfield Sydney, NSW

16.12.13 Tough Diddaz and Young Diggers Bourke, NSW

1.3.14 2.3.14

NSW Recognition Council 2014 Recognition Festival Jervis Bay, NSW

24.6.14 UNICEF Young Ambassadors Sydney, NSW

Children’s Rights Report 2014 • 209

Appendix 5: Submissions to my examination into intentional self-harm, with or without suicidal intent, in children and young people

140 written submissions were received in response to the National Children’s Commissioner’s examination into intentional self-harm, with or without suicidal intent, in children and young people.

Submissions were received from individuals, government, private and non-government organisations.

Some submissions are redacted to protect privacy and confidentiality.

Submission No Submitted by

1 Confidential

2 Name Withheld

3 Name Withheld

4 Name Withheld

5 Name Withheld

6 Name Withheld

7 Name Withheld

8 Name Withheld

9 Name Withheld

10 Name Withheld

11 Confidential

12 Name Withheld

13 Name Withheld

14 Name Withheld

15 Name Withheld

16 Confidential

17 Confidential

18 Name Withheld

19 Name Withheld

20 Name Withheld

21 Name Withheld

22 Name Withheld

23 Name Withheld

24 Siblings Australia

25 Name Withheld

26 Name Withheld

210

Submission No Submitted by

27 Name Withheld

28 Children and Young People’s Mental Health

29 Name Withheld

30 Name Withheld

31 Kimberley Aboriginal Law and Cultural Centre

32 Name Withheld

33 Name Withheld

34 Name Withheld

35 GI Think Tank

36 Dr Martin Harris

37 Dr Simon Crisp

38 Name Withheld

39 Name Withheld

40 Professor Graham Martin

41 The Royal Australian and New Zealand College of Psychiatrists

42 Commissioner for Children and Young People, Western Australia

43 Name Withheld

44 Name Withheld

45 Rosemount Good Shepherd Youth and Family Services

46 Hobsons City Council

47 Confidential

48 ACT Children and Young People Death Review Committee

49 Australian Institute of Family Studies

50 Child Death and Serious Injury Review Committee South Australia

51 CatholicCare

52 Western Australian Council of Social Service

53 Peer Support Australia

54 Mental Health First Aid Australia

55 Sabine Beecher

Appendix 5: Submissions to my examination into intentional self-harm, with or without suicidal intent, in children and young people

Children’s Rights Report 2014 • 211

Submission No Submitted by

56 Name Withheld

57 Name Withheld

58 Name Withheld

59 Name Withheld

60 C & R Cocciolone

61 Name Withheld

62 Parent and Teen Support

63 Child Death Review Team, Ombudsman New South Wales

64 Queensland Commission for Children and Young People and Child Guardian

65 Name Withheld

66 Dr Elizabeth Green

67 Confidential

68 Confidential

69 Name Withheld

70 Name Withheld

71 Palombi Biotech Medical Pharmaceutical

72 Dr Mareka Frost

73 Bernadette Zeeman

74 Women’s Health Victoria

75 Batyr

76 Youth Insearch Foundation

77 Northern Territory Council of Social Service

78 beyondblue

79 Confidential

80 Scouts Australia

81 International Eating Disorder Action

82 Orygen Youth Health Research Centre

83 Jesuit Social Services

84 Transgender Victoria

212

Submission No Submitted by

85 Lowitja Institute

86 Citizens Commission on Human Rights

87 North West Qld Mental Health Network

88 Black Dog Institute

89 headspace

90 Humanist Society of Victoria

91 Australian Psychological Society

92 St John Ambulance Australia

93 Hunter Institute for Mental Health

94 Professional Practice Committee, School Counsellors Forum, NSW Non-Government Schools

95 Australian Institute for Suicide Research and Prevention

96 Church of Scientology, Melbourne

97 Twenty10 incorporating GLCS NSW & the University of Western Sydney

98 Warren Bartik

99 Central Australian Mental Health Services, Department of Health, Northern Territory

100 National LGBTI Health Alliance

101 Nan Hu, Rebecca Glauert and Jianghong Li

102 Menzies School of Health Research

103 Mental Health Commission of New South Wales

104 Dr Erminia Colucci

105 ACT Community Services Directorate

106 Confidential

107 New South Wales Gay and Lesbian Rights Lobby

108 Name Withheld

109 The Royal Australasian College of Physicians

110 Australian Bureau of Statistics

111 Name Withheld

112 The Hon Michael Ferguson MP, Minister for Health, Tasmania

Appendix 5: Submissions to my examination into intentional self-harm, with or without suicidal intent, in children and young people

Children’s Rights Report 2014 • 213

Submission No Submitted by

113 Dr Sarah Lutkin

114 Australian Institute of Health and Welfare

115 Phoenix Centre

116 BoysTown (Kids Helpline)

117 Confidential

118 Youth Affairs Council of Western Australia

119 Public Health Association Australia

120 Name Withheld

121 Young and Well Cooperative Research Centre

122 United Synergies and the National Standby Suicide Bereavement Response Service

123 National Aboriginal and Torres Strait Islander Leadership in Mental Health

124 Early Childhood Australia

125 Rosemary Ac

126 Queensland Mental Health Commission

127 Karen Glauser-Edwards

128 Ngaanyatjarra Pitjantjatjatjara Yankunytjatjara Women’s Council

129 Victorian Commission for Children and Young People

130 Coronial Council of Victoria

131 Child and Youth Mental Health Service, Children’s Health Queensland

132 AIMIA Digital Policy Group

133 ACT Health

134 NSW Government

135 Name Withheld

136 Illawarra-Shoalhaven Medicare Local

137 Organisation Intersex International Australia

138 National Children’s and Youth Law Centre

139 National Children’s and Youth Law Centre

140 Confidential

214

National roundtables were held as part of the National Children’s Commissioner’s examination into intentional self-harm, with or without suicidal intent, in children and young people.

In order to stimulate discussion, up to two expert participants presented at each roundtable.

Date Roundtable Location

13.5.14 Attendees at the New South Wales roundtable included:

• Professor Philip Hazell, Director of Infant Child and Adolescent Mental Health Services Sydney and South Western Sydney Local Health Districts; Head of Discipline of Psychiatry, The University of Sydney Medical School (Presenter)

• Mr John Dalgleish, Manager of Strategy and Research, Kids Helpline (Presenter) • Superintendent Luke Freudenstein AMP, Redfern Local Area Commander, New South Wales Police • Professor Rebecca Ivers, Director of the Injury Division, The

George Institute for Global Health • The Honourable Magistrate Michael Barnes, NSW State Coroner • Dr Michael Dudley, Chair of the Suicide Prevention Australia

Board • Ms Kerri Lawrence, Manager of Strategy and Policy, Mental Health Commission of New South Wales • Mr Matthew Keeley, Director of the National Children’s and Youth

Law Centre • Ms Annette Michaux, Director of Social Policy and Strategy, Parenting Research Centre • Ms Kathryn McKenzie, Director of Systemic Reviews, NSW

Ombudsman • Clinical Professor David Bennett AO, Senior Clinical Adviser of Youth Health and Wellbeing, NSW Kids and Families • Dr Sally Gibson, Senior Manager of Youth Health and Wellbeing,

NSW Kids and Families • Dr Ros Montague, Acting Director of Mental Health, Children and Young People, NSW Ministry of Health • Mr Eamon Waterford, Director of Policy and Advocacy, Youth

Action NSW • Mr Brett Paradise, Executive Director, Twenty10 • Mr Gregor Macfie, Director of Policy and Research, Office of

Communities, Commission for Children and Young People • Mr Shane Cross, Clinical Services Manager, headspace Campbelltown

Sydney, NSW

Appendix 6: National roundtables

Children’s Rights Report 2014 • 215

Date Roundtable Location

20.6.14 Attendees at the Tasmanian roundtable included:

• Dr Martin Harris, Mental Health Academic, Centre for Rural Research, University of Tasmania (Presenter) • Ms Annie McLean, Senior Policy Consultant, Commissioner for Children Tasmania • Ms Jeanette Banks, Coordinator Promotions and Project,

Commissioner for Children Tasmania • Mr Michael Kelly, CEO, Relationships Australia Tasmania • Ms Paula Rooney, Suicide Prevention Project Officer, Phoenix

Centre • Mr Nick Goddard, Acting Director of Mental Health, Alcohol and Drug Directorate, Department of Health and Human Services • Dr Charlotte McKercher, Postdoctoral Research Fellow, Menzies

Research Institute Tasmania • Inspector Kim Stevens, Department of Police and Emergency Management • Mr Stuart Oldfield, Manager Youth Justice South, Children and

Youth Services • Coroner Olivia McTaggart, Magistrates Court of Tasmania • Victor Stojcevski, Senior Policy Adviser/Coronial Division

Coordinator, Magistrates Court of Tasmania • Dr Len Lambeth, Chief Psychiatrist of Tasmania • Dr Nicky Beamish, Community Psychiatrist

Hobart, Tasmania

25.6.14 Attendees at the roundtable focused on Aboriginal and Torres Strait Islander children and young people included:

• Mr Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner, Australian Human Rights Commission (Co-Chair)

• Associate Professor Melissa Haswell, School of Public Health and Community Medicine, The University of New South Wales (Presenter)

• Ms Vanessa Lee, Senior Lecturer, The University of Sydney; Vice-President of the Public Health Association Australia, Aboriginal and Torres Strait Islander Health (Presenter)

• Mr Andrew Jackomos PSM, Victorian Commissioner for Aboriginal Children and Young People • Mr Mike Smith, Co-Convenor of the Mental Health Special Interest Group, Public Health Association of Australia • Mr David Kirby, General Manager of Health Services, Mallee

District Aboriginal Services • Ms Lisa Hillan, Programs Director, Healing Foundation • Ms Samantha Wild, Aboriginal and Torres Strait Islander Project

Manager, headspace • Dr Robyn Shields, NSW Deputy Mental Health Commissioner

Sydney, NSW

216

Date Roundtable Location

25.6.14 Attendees at the research roundtable included:

• Conjoint Professor Gregory Carter, Centre for Translational Neuroscience and Mental Health, University of Newcastle (Presenter)

• Mr Conan Liu, Head of Maternal Health, Children and Families Unit, Australian Institute of Health and Welfare (Presenter) • Ms Jo Phillips, Principal Project Manager of Data Holdings and Services, Queensland Registry of Births, Deaths and Marriages • Mr James Eynstone-Hinkins, Director of Social and Demographic

Statistics, Australian Bureau of Statistics • Ms Sue Murray, CEO, Suicide Prevention Australia • Professor Alan Hayes, Director of the Australian Institute of

Family Studies • Professor Helen Christensen, Director, Black Dog Institute • Dr Fiona Shand, Research Fellow, Black Dog Institute • Ms Lyn Harrison, CEO, Rosemount Good Shepherd Youth and

Family Services

Sydney, NSW

27.6.14 Attendees at the Australian Capital Territory roundtable included:

• Dr Sue Packer AM, ACT Children and Young People Death Review Committee (Presenter) • Mr Alan Woodward, Executive Director, Lifeline Research Foundation (Presenter) • Professor Beverly Raphael, Director of Psychological Medicine,

Mental Health ACT

Canberra, ACT

30.6.14 Attendees at the Queensland roundtable included:

• Dr Kairi Kolves, Senior Research Fellow, Australian Institute for Suicide Research and Prevention, Griffith University (Presenter) • Professor Anna Stewart, Queensland Child Death Case Review Committee (Presenter) • Ms Jill Fisher, United Synergies and the National Standby Suicide

Bereavement Response Service • Professor Graham Martin, Centre for Psychiatry and Clinical Neuroscience Research (Suicide Prevention Studies), The

University of Queensland • Ms Casey Bloom, Queensland Commission for Children and Young People and Child Guardian • Magistrate Leanne O’Shea, Brisbane Children’s Court • Mr John Dalgleish, Manager of Strategy and Research, Kids

Helpline

Brisbane, QLD

Appendix 6: National roundtables

Children’s Rights Report 2014 • 217

Date Roundtable Location

30.6.14 (continued)

• Dr Lesley van Schoubroeck, Queensland Mental Health Commissioner • Ms Carmel Ybarlucea, Executive Director, Queensland Mental Health Commission • Dr Simone Caynes, Principal Policy Advisor, Queensland Mental

Health Commission • Senior Sergeant Michael Mitchell, Queensland Police Service • Ms Amelia Callaghan, State Manager for Queensland and the

Northern Territory, headspace • Deputy State Coroner John Lock, Queensland Courts • Ms Susan Beattie, Principal Researcher, Domestic Violence Unit,

Queensland Courts

Brisbane, QLD

3.7.14 Attendees at the Victorian roundtable included:

• Professor Patrick McGorry AO, Executive Director, Orygen Youth Health Research Centre (Presenter) • Professor Susan Sawyer, Director of the Centre for Adolescent Health, Royal Children’s Hospital Melbourne (Presenter) • Mr Bernie Geary OAM, Principal Commissioner, Victorian

Commission for Children and Young People • Ms Jo Robinson, Research Fellow, Orygen Youth Health Research Centre • Professor Jeremy Oats, Chair of the Victorian Consultative

Council on Obstetric and Paediatric Mortality and Morbidity • Ms Josie Taylor, Manager of Youth Support Programs, Barwon Youth • Dr Michelle Blanchard, Head of Projects and Partnerships, Young

and Well Cooperative Research Centre • Commander Sue Clark, Victorian Police • Ms Lyndal Bugeja, Manager, Coroners Prevention Unit, Coroners

Court of Victoria • Ms Susan Beaton, Suicide Prevention Specialist Consultant and Suicide Prevention Advisor, beyondblue • Dr Penny Mitchell, Centre for Youth Mental Health, The University

of Melbourne • Ms Christine Withers, Manager of Policy, Research and Communications, Victorian Commission for Children and Young

People • Dr Virginia Dods, Senior Policy Adviser, Victorian Commission for Children and Young People • Ms Toni Morton, Manager of Drugs, Policy and Strategy, Victorian

Department of Health

Melbourne, VIC

218

Date Roundtable Location

4.7.14 Attendees at the South Australian roundtable included:

• South Australian State Coroner Mark Johns, Coroner’s Court (Presenter) • Ms Pam Simmons, Guardian, Office of the Guardian for Children and Young People • Ms Helen Scales, Project Advisor, Wellbeing: Resilience and

Mental Health, South Australian Office for Children and Young People • Superintendent Barry Lewis, Portfolio Manager of Strategy, Policy and Programs Section, South Australia Police • Senior Sergeant Sharon Walker-Roberts, Coordinator Victim

Policy Unit, South Australia Police • Senior Sergeant Neil Hodgson, Youth Programs Unit State Coordinator, South Australia Police • Professor Jon Jureidini, Child Psychiatrist, University of Adelaide • Mr Tim Crowley, Mental Health Nurse Practitioner, Trauma and

Complex Care, Child and Adolescent Mental Health Services, Health SA • Ms Angela Davis, Child Death and Serious Injury Review Committee South Australia • Dr Paul Dignam, Psychiatrist, Child and Adolescent Mental Health

Services, Health SA • Professor James Harrison, Director of the Research Centre for Injury Studies, Flinders University • Ms Lynne James, Principal Project Officer, Suicide Prevention,

Health SA

Adelaide, SA

15.7.14 Attendees at the Royal Children’s Hospital Mental Health Community Reference Group roundtable included:

• Mr Harry Gelber OAM, Manager of Community Development, Royal Children’s Hospital Melbourne • Dr Richard Haslam, Director of Mental Health Program, Royal Children’s Hospital Melbourne • Ms Alison Smith, Operations Manager of Mental Health Program,

Royal Children’s Hospital Melbourne • Leanne Crothers, Orygen Youth Health Research Centre • Agnes Girdwood, Consumer Consultant • Johnny Kin, Centre for Multicultural Youth • Bethia Wilson, Independent Chairperson • Evelyn Man, Team Coordinator, Psychiatric Nurse • Charlie Reston, Area Manager, Child Protection, Department of

Human Services

Melbourne, VIC

Appendix 6: National roundtables

Children’s Rights Report 2014 • 219

Date Roundtable Location

15.7.14 (continued)

• Rosemary Lawton, Consumer Consultant • Cindy Smith, Dianella Community Health • Debbie Collings, Djerriwarrah Employment and Education Services

• Prakash Chidambram, Consultant Psychiatrist • Bradley Foot, Western Region Health Centre • Jennifer Smith, Anglicare Victoria • David Reid • Joanne Moore, Principal, Travancore School • John Hodgson, General Practitioner, Dianella Community Health

Service • Jo Winter, Royal Children’s Hospital Melbourne • Lisa Harrison, MacKillop Family Services • Moira Rayner, Koori Soail Emotional and Wellbeing Officer, Royal

Children’s Hospital Melbourne • Shona Ballinger, School Focus Youth Service • Cassandra Di Censo, IMYOS Clinician • Peter Gartside, Mental Health Manager, Macedon Ranger and

North Western Melbourne Medicare Local • Vivienne Waysman, Intake Manager, Royal Children’s Hospital Melbourne • Nyree Campbell, Merri Community Health Services • Carol Trusler, Department of Education, Employment and Training • Karen Marsh, Department of Education and Early Childhood

Development • Sandra Radovini • Marg Keatly, Department of Education, Employment and Training • Sean Ironside • Alga Andretta, ISIS Family Care • Bernadette Duffy, SFYS Melton/Brimbank • Swagata Bapat, Manager of Training and Communications,

Orygen Youth Health Research Centre

Melbourne, VIC

18.7.14 Attendees at the Perth roundtable included:

• Mr Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner, Australian Human Rights Commission (Co-Chair)

• Dr Rosanna Capolingua, Chair of the Child and Adolescent Health Service Western Australia (Presenter) • Ms Adele Cox, Member of the Ministerial Council for Suicide Prevention Western Australia

Perth, WA

220

Date Roundtable Location

18.7.14 (continued)

• Mr Deon Brink, Manager of Corporate Governance, St John’s Ambulance • Dr Sarah Johnson, Senior Research Officer, Telethon Kids Institute • Dr Simon Davies, Acting Manager of Specialist Services, Child

and Adolescent Mental Health Services Western Australia • Dr Barry Jones, Child Psychiatrist • Ms Jenni Perkins, Acting Western Australia Commissioner for

Children and Young People • Ms Leanne Pech, Senior Policy Officer, Western Australia Commission for Children and Young People • Ms Pui San Whittaker, Acting Manager, Suicide Prevention,

Western Australia Mental Health Commission • Ms Sue Robinson, Principal Analyst, Ombudsman Western Australia

Perth, WA

9.9.14 Attendees at the Northern Territory roundtable included:

• Mr Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner, Australian Human Rights Commission (Co-Chair)

• Associate Professor Gary Robinson, Centre for Child Development and Education, Menzies School of Health Research (Presenter)

• Ms Monique Gale, Suicide Prevention Coordinator, Northern Territory Government (Presenter) • Mr Howard Bath, Northern Territory Commissioner for Children and Young People • Professor Sven Silburn, Centre for Child Development and

Education, Menzies School of Health Research • Dr John McKenzie, Senior Research Officer, Menzies School of Health Research • Superintendent Kylie Proctor, Northern Territory Police, Fire and

Emergency Services • Ms Samantha Bowden, Northern Territory Council of Social Service • Ms Sally Weir, Operations Manager, headspace Darwin and

Wellbeing Services • Ms Leonie Warburton, Northern Territory Department of Health • Deputy Coroner Kathryn Ganley, Office of the Coroner Northern

Territory

Darwin, NT

Appendix 6: National roundtables

Children’s Rights Report 2014 • 221

Date Roundtable Location

11.9.14 Attendees at the Alice Springs roundtable included:

• Mr Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner, Australian Human Rights Commission (Co-Chair)

• Dr Don Zoellner, Research Associate, Charles Darwin University • Ms Christine Williamson, Manager of Youth Programs, NPY Women’s Council • Ms Nina Levin, Anglicare Northern Territory • Ms Annette Fuller, Program Manager Central Australia, World

Vision Australia • Mr Paul Tomaszewski, CEO, Mental Health Association of Central Australia • Mr William MacGregor, Bush Mob • Farley Fraser, Youth Services Coordinator, Central Australian

Aboriginal Congress • Ms Tania Warren, Senior Community Facilitator, CREATE Foundation • Dr Megan Chambers, Psychiatrist • Ms Alira Bayndrian, Manager of the Child and Youth Mental

Health Team, Central Australian Health Service

Alice Springs, NT

222

Appendix 7: Individual consultations with stakeholders relating to the examination on into intentional self-harm, with or without suicidal intent, in children and young people

Date Consultation Location

15.4.14 headspace: national mental health foundation for young people aged 12-25 years, with over 60 support centres around Australia AHRC, NSW

24.4.14 Black Dog Institute: organisation dedicated to improving the lives of people affected by mood disorders through research, expertise and national education programs

Sydney, NSW

30.5.14 Young and Well Cooperative Research Centre: unites young people with researchers, practitioners and policy makers across the non-profit, academic, government and corporate sectors

AHRC, NSW

18.6.14 Twenty10: not-for-profit organisation working with and supporting people of diverse genders, sexes and sexualities, their families and communities

Sydney, NSW

19.6.14 The Hon Jacquie Petrusma MP, Minister for Human Services, Minister for Women, Tasmania Hobart, TAS

28.7.14 Professor Jon Jureidini: Department of Psychological Medicine, University of Adelaide AHRC, NSW

28.7.14 beyondblue: works to reduce the impact of anxiety, depression and suicide in the community by raising awareness and understanding, empowering people to seek help, and supporting recovery, management and resilience

AHRC, NSW

4.8.14 Office for Children and Young People: provides universal and targeted services to improve the health, learning, safety and wellbeing of children and young people aged 0-18 and beyond, especially those challenged by the circumstances in which they live

AHRC, NSW

21.8.14 headspace: national mental health foundation for young people aged 12-25 years, with over 60 support centres around Australia AHRC, NSW

Children’s Rights Report 2014 • 223

Appendix 8: DLA Piper

DLA Piper and the following staff made a significant contribution in hosting a number of national roundtables and transcribing the discussions that took place.

DLA Piper staff

• Alexandra Beltran • Alyssa.Chin • Caitlan Cooper-Trent • Daniel Creasey • Daniel Li • Dinika Roopani • Dylan Burke • Elise Imbesi • Emma Parkinson • Emily Christie • Fleur Hawes • Gavan Mackenzie • Hannah Morris • Heidi Edwards • Jacob Smit • Jack Quirk

• James Kahika • Jessica Courtney • Jessica Taylor • Joanna Young • Julian Conti • Katarina Bilandzic • Kristie Swainston • Lauren Crossman • Lucille Dockery • Matthew Blunt • Michaelene McKinstry • Nicolas Patrick • Olivia Loxley • Sarah-Jane Dobson • Stacey Gannon • Tina Douglas

224

Appendix 9: Letter to the Minister for Health, and the Minister’s reply

Children’s Rights Report 2014 • 225

226

Appendix 9: Letter to the Minister for Health, and the Minister’s reply

Children’s Rights Report 2014 • 227

Appendix 9: Letter to the Minister for Health, and the Minister’s reply

228

Current child and youth focused activity addressing recommendations in The Hidden Toll and Before It’s Too Late reports

1. Mental health promotion and prevention targeting young people

MindMatters (redevelopment)

MindMatters is the national mental health initiative for Australian secondary schools. It was originally developed in the late 1990s in response to escalating rates of youth suicide.

The MindMatters initiative aims to increase a school's capacity to implement a ‘whole-school’ approach to mental health promotion, prevention and early intervention. This is achieved through providing teachers and other staff in secondary schools with professional development, resources and support to implement evidence-based strategies under the MindMatters 'whole-school' framework.

In 2013, beyondblue was funded for the redevelopment and ongoing delivery of MindMatters. The redevelopment will ensure that the programme is consistent with the current evidence base and meets the current needs of the school environment.

Kids Matter (expansion)

The KidsMatter suite of initiatives, which includes KidsMatter Primary (KMP) and KidsMatter Early Childhood (KMEC), aims to contribute to: improving the mental health and wellbeing of children; a reduction in mental health difficulties among children; and the provision of greater support for children experiencing mental health difficulties and their families.

beyondblue is funded to deliver the KidsMatter suite of initiatives. As Contract Manager, beyondblue implements KidsMatter and subcontracts the Australian Psychological Society, Early Childhood Australia and Principals Australia Institute to deliver the initiatives.

In response to the 2010 Senate Inquiry into Suicide in Australia, additional funding of $18.4m (GST exclusive) over four years was allocated to expand the KMP initiative under the Taking Action to Tackle Suicide (TATS) package. Through this expansion, the programme continues to exceed targets, with the 2013-14 target of 2,000 primary schools participating met in early 2014. The programme is on track to meet its next target of 2,600 primary schools by June 2015.

Response Ability Teacher Education

Response Ability Teacher Education aims to increase coverage of mental health and suicide prevention in pre-service education for teachers and early childhood staff.

2. Early Intervention

headspace — (centre expansion)

headspace provides a national coordinated focus on youth mental health and related drug and alcohol problems and aims to improve access for young people aged 12-25 years to appropriate services and ensure better coordination between services.

Children’s Rights Report 2014 • 229

The headspace model provides for holistic care in four key areas — mental health, related physical health, alcohol and other drug use, and social and vocational support. The model provides a service platform for, and entry point to, existing services by engaging a range of youth workers and mental health Professionals, as well as by referring young people to other appropriate services.

The headspace programme was established in 2006. The 2010-11 and 2011-12 Budgets expanded the programme progressively to a target of 90 sites across Australia. To date, 85 headspace locations have been announced (Rounds 1 to 6). Of these locations, 39 are located in rural and regional areas across Australia.

As confirmed through the 2014-15 Budget, an additional 10 sites will be funded to bring the expanded headspace network to 100 sites across Australia. Once all 100 sites are fully operational, they will assist up to 80,000 young Australians each year.

eheadspace

In addition to the roll-out of additional headspace sites, young people from all over Australia are able to access eheadspace.

eheadspace provides free, confidential and anonymous telephone and web-based support services to young people between the ages of 12 and 25 years with, or at risk of developing, a mild to moderate mental illness. eheadspace provides the core headspace model in an online environment.

Early Psychosis Youth Services (EPYS) — (establishing)

headspace is funded for the provision of Early Psychosis Youth Services (EPYS) through the headspace network of centres. These services are based on the Early Psychosis Prevention and Intervention Centre (EPPIC) model developed by Orygen Youth Health Research Centre.

Through this programme, nine headspace centres will be expanded to provide ‘headspace early psychosis services’, with at least one of these centres located in each State and Territory.

This initiative aims to provide a single point of entry for treatment, as well as ease of transition between levels of care for young people and their families, replacing often complex treatment and support pathways.

Project Synergy

The Australian Government’s election commitment was to provide the Young and Well Cooperative Research Centre with $5.2 million over three years (2013-14 to 2015-16) to establish a comprehensive’ new e-mental platform that will make it easier for young people to get the help they need and to manage their treatment.

The new online platform will act as a behind-the-scenes Information Technology solution to better integrate and link existing online mental health services and technologies to improve young Australians’ mental health care journey.

Telephone Counselling and Web Based Support Measure

The Government continues to fund a range of online and telephone services under the 2006 COAG Telephone Counselling and Web Based support Measure.

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Those with a child and/or youth focus are as follows:

• Inspire Foundation - ReachOut.com - Provides a ReachOut.com online information and support service for young people seeking help and information and, where appropriate, it refers and links users to the relevant online and offline clinical services and agencies; based on urgency and clinical need.

• Boystown - Kids Helpline provides a nationally available, real-time, web-chat, email counselling and information service for young people for a wide range of mental health issues.

• Canteen - Young People Living with Cancer E-Mental Health Service - is a service to young Australians aged 14 to 25 years seeking assistance for living with cancer (either as a patient or having a family member who is living with cancer).

• Curtin University of Technology - OCD? Not Me! Curtin On-Line OCD Treatment for Young People -- the university is developing a self-help obsessive compulsive disorder (OCD) online therapy service and is conducting pilot of the online service for a minimum of 150 young people with OCD.

3. Clinical supports

Individuals including children, with a clinically diagnosed mental illness can access selected mental health services, particularly psychological therapy and focussed psychological strategies through two key programmes.

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative

Under this initiative, Medicare rebates are available to patients for selected mental health services provided by GPs, psychiatrists, psychologists (clinical and registered), eligible social workers and occupational therapists.

Allied mental health services under this initiative include psychological therapy services provided by clinical psychologists, and focussed psychological strategies services provided by appropriately qualified GPs and eligible psychologists, social workers and occupational therapists.

Access to Allied Psychological Services (ATAPS) Programme

The Access to Allied Psychological Services (ATAPS) Programme is currently funded through Medicare Locals, is designed to complement the Medicare rebateable allied mental health services available under the Better Access initiative and is targeted to hard to reach groups, who may have difficulty in accessing Better Access services. These include people at risk of suicide or self harm.

Funding of $ 40.5 million over 5 years (from 2011-12) has been provided under the Taking Action to Tackle Suicide (TATS) package for the ATAPS Suicide Prevention Service initiative which provides psychological interventions to people at risk of suicide and self-harm for a period of up to two months.

In addition, under the Taking Action to Tackle Suicide (TATS) package, $34.1 million was provided over five years (from 2011-12) for additional ATAPS services for children with mental health or development issues. A further $69.9 million in ATAPS programme

• funding was allocated over five years (from 2011-12) to increase the service delivery to children under 12 years and their families.

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4. Suicide Prevention

Australian Government investment for suicide prevention activity is provided through the National Suicide Prevention Programme (NSPP) and the Taking Action to Tackle Suicide (TATS) package.

The NSPP supports broad population health approaches to suicide prevention (including postvention support) in addition to activities targeting high risk groups, including youth. Over the period 2011-12 to 2013-14, $10.2 million (GST Exclusive) has been allocated to suicide prevention activity targeting young people. Examples of supported projects include:

• The Peer Support Programme, delivered by the Peer Support Foundation. This is a national peer led program which fosters the mental, physical and social well-being of young people and their community by supporting positive cultural change within schools; and

• The Yiriman project, coordinated by the Kimberley Law and Aboriginal Cultural Centre in WA, which runs youth activities with support from senior cultural men and has established links with local agencies such as cultural activities and camps that build strong relationships, self-identity and confidence in young people.

All current NSPP-funded projects, including those mentioned above, will receive continued funding in 2014-15.

Under the TATS Community Prevention for High Risk Groups measure, funding is being provided for 6 projects that seek to prevent suicide in Aboriginal and Torres Strait Islander youth over the period 2012-13 to 2014-15. These projects include:

• Developing a life skills approach to building strengths and capacity for youth in remote Indigenous communities, delivered by Menzies School of Health Research. This project is working with Ngukurr, a community in South East Arnhem Land, to design and pilot a life skills development program for youth. The project will produce a framework and resources for adapting the program to other remote Indigenous communities; and

• Culture Rebound — Connected Yarrabah Youth, delivered by the Gurriny Yealamucka Health Services Aboriginal Corporation. The project is focusing on increasing community capacity in suicide prevention activities, ensuring that the youth of Yarrabah (12-25 years focus) develop a strong sense of personal identity and purpose through cultural empowerment.

In addition, the MindOUT! Mental Health and Suicide Prevention project receives funding under the Community Prevention for High Risk Groups measure of the TATS package.

Delivered by the National LGBTI Health Alliance, MindOUT! seeks to improve mental health and suicide prevention outcomes for LGBTI populations, including LGBTI youth. The MindOUT! Project is establishing networks and linkages between the LGBTI sector, mainstream mental health services and other significant suicide prevention and mental health projects, programmes and research. The objective of these activities is to improve understanding of the various issues faced by sub-groups of this population, to break down barriers to help seeking, and build the capacity of organisations to promote inclusive service provision to better support LGBTI people in need. This project will also receive continued funding in 2014-15.

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The Outreach Teams to Schools measure was introduced under the TATS package in response to the 2010 Senate Inquiry into Suicide in Australia. headspace National Youth Mental Health Foundation (headspace) is funded to provide postvention services to schools impacted by suicide. This service is known as headspace School Support.

headspace School Support is designed to respond to, and work with, schools in the event of a suicide in order to minimise the distress caused to staff and students, and to coordinate the appropriate services and resources required. headspace School Support is available to schools with secondary school enrolments on a voluntary, invitation basis.

5. Research

The following current activities address recommendations within the two Parliamentary Committee reports which call for support for research into youth suicide prevention and suicide prevention more broadly.

The National Centre for Excellence in Youth Mental Health (the centre) will be a nationally shared resource which aims to address issues such as workforce shortages through innovative workforce development packages. Funding will be provided to Orygen Youth Health Research Centre (Orygen), a leading research institute in the area of youth mental health to establish and operate the centre in collaboration with research partnership nodes in other States.

Once established, the National Centre for Excellence in Youth Mental Health will:

• Invest in new programmes of research on how enhanced mental health can lift national economic productivity and reduce deliberate self-harm and suicide; • Provide training, career support, and information resources to mental health clinicians and service planners; • Undertake clinical trials to find new and innovative treatments for mental illness

in young people; • Develop new forms of intervention that can be used to treat young people through headspace, the Early Psychosis Youth Centres, and e-mental health systems; and • Evaluate and refine the national system of youth mental health care.

As part of the National Health and Medical Research Council (NHMRC) Mental Health Special Initiative, funding was provided from 2012 to establish and operate a new Centre of Research Excellence in Suicide Prevention (CRESP). CRESP aims to generate new research to increase the knowledge base regarding effective prevention and treatment in suicide prevention. You may wish to contact the Centre via the details below to find out more about their research activities:

NHMRC Centre of Research Excellence in Suicide Prevention Black Dog Institute Hospital Road RANDWICK NSW 2031

www.cresp.edu.au

NSPP funding has been provided since 2008 to the Australian Institute of Suicide Research and Prevention to operate the National Centre of Excellence in Suicide Prevention (NCESP).

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The Centre continues to deliver advice on evidence-based best practices and evaluation in suicide prevention, to support Australian Commonwealth Departments, non-government agencies, academics and community groups in their respective initiatives in the field of suicide prevention. As part of their funded activities, the Centre also produces a bi-annual critical literature review regarding suicide and suicide prevention.

In April 2014, the Evaluation of suicide prevention activities was completed and published on the Department of Health website at www.health.gov.au/internet/ main/ publishing.nsf/Content/mental-pubs-e-evalsuic.

The evaluation assessed activities funded under the National Suicide Prevention Programme (NSPP) and selected elements of the Taking Action to Tackle Suicide (TATS) package over the seven-year period from 2006-07 to 2012-13.

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Further Information

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Australian Human Rights Commission www.humanrights.gov.au