Co-design and lived experience: Developing a suicide prevention strategy

Note: The following case study contains references to suicide and suicidality, which some individuals may find distressing.

The Suicide Prevention and Response Office (SPARO) was established in the Victorian Department of Health in July 2022 following a recommendation from the Royal Commission into Victoria’s Mental Health System (RCVMHS). The RCVMHS also recommended that SPARO develop Victoria’s new Suicide Prevention and Response Strategy, which should be co-designed with people with lived and living experience of suicide.

Following a public engagement process, the department engaged us to consult with people with lived and living experience as well as with sector and community representatives to co-design key elements of the future strategy, and to develop an accountability framework and provide evaluation advice.

We knew that effective co-design of the strategy would involve engaging people in settings where they felt most comfortable, with virtual engagement allowing us to reach out to stakeholders across the state. (This was especially important due to the disproportionate impact of suicide in regional and rural areas.) Over eight weeks, we facilitated 14 virtual sector and community roundtables, which were attended by more than 130 participants.

This number included representatives from health and mental health services, as well as from groups that experience higher rates of suicide, including Aboriginal and Torres Strait Islander peoples, members of multicultural and multifaith communities, LGBTIQA+ people, veterans, young people, people working in high-risk industries, residents of rural and regional areas, and others.

We then facilitated a virtual co-design process with three groups of people with lived and living experience of suicide: people with experience of suicidal thoughts and behaviours and suicide attempt survivors; family members, carers and supporters of people with experience of suicidal thoughts and behaviours; and people who have been bereaved by suicide. There was a diversity of genders, ages, locations, sexual orientations, and cultural backgrounds across these groups. Their perspectives would go on to inform the strategy’s vision, principles, priority areas, and priority actions and initiatives.

“This project was the most challenging and rewarding of my career,” says project manager Sarah Bell. ”A significant challenge was ensuring we had a broad representation of voices across the sector, community, and among people with lived and living experience. Another was distilling those perspectives into common and specific themes, so that the strategy spoke to everyone and reflected what had been shared with us.“

We took a trauma-informed approach to our consultations, which involved a number of elements:

• embedding a Lived and Living Experience Adviser within the team who could also provide peer support to participants;
• engaging an independent counselling service to be available to support participants during and immediately following sessions;
• establishing a distress protocol to be activated if a participant became distressed;
• using the same facilitators consistently across our co-design sessions in order to build trust and comfort;
• continually seeking and renewing participants’ consent, allowing them to choose which activities and conversations they took part in;
• providing regular reminders about the support services available to participants should they have required them in or out of session; and
• ensuring our own team’s wellbeing by establishing a rhythm of regular team debriefs.

“A trauma-informed approach means making all efforts to do no further harm to the people we’re engaging with,” says Bell. “This was fundamental for everything we did, from our planning to our conduct to our outputs.”

“We acknowledge that we can’t change what has happened, but we can carefully draw upon people’s experiences to influence improved help-seeker outcomes.”

Once our engagements were concluded, we worked closely with the SPARO team to deliver an accountability framework and evaluation advice that met day-to-day operating requirements and ensured knowledge transfer from the design process to the team that would ultimately implement it. We worked on-site with the SPARO team for eight weeks as it developed the final strategy.

Our co-design process ultimately equipped SPARO with a best-practice strategy guided by sector and community perspectives and informed by the decisions and views of people with lived and living experience of suicide. We left SPARO with a broadly-supported accountability framework and a clear roadmap for developing an evaluation plan that matched resourcing and strategic considerations. The Victorian Suicide Prevention and Response Strategy 2024-34 was released in September 2024 and is committed to “addressing and reducing the factors that contribute to suicide while boosting protective factors that can save lives.” It notes that all Victorians have a role to play in this effort.

“I’m encouraged by SPARO’s commitment to carrying lived experience voices through into the final product,” says Bell. “Suicide and suicidality don’t discriminate. They can touch any one of us. To me, this strategy is a terrific example of the shift we are seeing, with governments and organisations valuing and involving lived expertise to shape a better future for everyone.”

For crisis support, call Lifeline on 13 11 14 or visit the Lifeline website.

For mental health support, call Beyond Blue on 1300 224 636 or visit the Beyond Blue website.