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A mother's anguish

Benice Richmond wonders what could have been done to save her daughter.

Benice Richmond still lies awake at night tormented by the death of her 17-year-old daughter at the end of last year. She wonders if there was something more she could have done to prevent Tamika from taking her own life.

Richmond partly blames herself for Tamika's death. It's a common experience of family members who are grieving and coming to terms with their loved ones' choice to end their own life.

But Richmond also blames the system. Getting help, she remembers, seemed impossible.

Tamika, who was thought to have a borderline personality disorder, first tried to kill herself at 12. She attempted suicide four times before professionals started to take notice, her mother says.

After being admitted to the ACT's Child and Adolescent Mental Health Services (CAMHS) at 14, Tamika was repeatedly moved from counsellor to psychologist until she died three years later.

''The help you get from CAMHS may be for a limited period … Every six months they would change her counsellor or her psychologist because that is how it is done in the system, you can't stay on the books for that long, they have to change and reassess,'' Richmond says. ''For people with mental health issues constant change is ridiculous.

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''People need to be able to access services and not have to wait years.

''The services have to really have a good hard look at themselves to see if they're really doing something to help because most of the time it is just a Band-Aid service. At the acute stage, it's far too late.''

Richmond says the biggest problem with suicide is the stigma associated with it. The shame and guilt that go hand in hand with suicide usually means people keep it hidden. But secrecy and the tragedy of suicide often weighs heavily on those closely linked to it.

It is why Richmond wants people to know about her ordeal - so that the stories of suicide can finally come out from behind closed doors.

''You're out there and you feel like you're the only one going through it [caring for someone who has attempted suicide],'' Richmond says.

''You go to some groups and you realise, wow, you're not alone in your thoughts, you're not going mad. Maybe you're not a bad person after all, because there are people out there like you and doing it just as tough as you, if not harder at times.''

Lifeline Canberra chief executive Mike Zissler says there are a significant number of deaths by suicide in Canberra - about 40 to 45 each year. But people only ever hear about half a dozen of them.

He says people don't talk about suicide. He also says it's very much misunderstood.

''Suicide is underreported in the ACT.

''The reality is the media feels constrained in reporting each and every suicide.

''But unlike the road toll, where we report the details of every single one, no one hears about suicides in the ACT. I think this is a problem. I think suicides should be publicly reported.''

Zissler's view on the need for more reporting on suicide is not without its complications.

The Australian Press Council guidelines on media coverage of suicide - with which The Canberra Times always seeks to comply - caution that an individual case should only be reported on if it meets at least one of the following criteria: it clearly is in the public interest; the express permission of family and friends of the deceased has been granted; and is not against the wishes of authorities such as police, schools or public health bodies.

The overriding concern is that reporting of specific suicide could induce other suicides, especially if there are unusual circumstances at play.

However, Zissler insists we don't know enough about suicides in Canberra and have no high-level review of suicide deaths here.

''Every time there's an accident it's reviewed, it's assessed, and if something can be done to fix the roads, fix the signage, to make the recommendations about changing vehicle types, speed limits - all those things are done.

''That level of detail around suicide doesn't exist … we don't really react to them. When people know about it, things get done.''

It's why he has been advocating for a suicide review committee in the capital - to see if there are known hot spots or patterns in suicides that can be avoided.

2010 Australian of the Year Professor Pat McGorry said there was secrecy attached to suicide and agreed it should be published like the road toll and made widely available as a key performance indicator.

''I personally feel, and I run a public mental health service, if we lose somebody there was always a way that we could have prevented it,'' he said.

ACT Health says suicide remains a significant issue and they are committed to its prevention.

While evidence suggests reporting on individual suicide encourages copycat behaviour, ACT Health supports public discussion about suicide prevention and strategies and services to assist vulnerable people and their families.

SupportLink chief executive Tony Campbell says his team is unanimous that every suicide comes with its own story. Finding absolute commonality in the pathways that people take before suicide is not possible, he says.

And while SupportLink applauds attempts to reduce suicide in the territory, Campbell says establishing targets would be futile and damaging.

''Public exposure to suicide rates and debates generated in the setting of 'targets', in our view, will facilitate additional suicides within the territory,'' Campbell says.

''Setting targets also releases a view that all suicides are preventable.

''This is a highly complex area, where government solutions should be carefully made against the backdrop of solid research and expert opinion and not by the emotiveness generated by our shared dislike of suicide.''

The director of the Australian National University's Centre for Mental Health Research, Kathy Griffiths, is part of an ACT suicide prevention working party and says the territory has been working hard to implement strategies to prevent people taking their own lives in the capital.

But she says suicide prevention issues are low-funded relative to other areas of mental health. The limited amount of money available to implement strategies is a problem, she says.

And while she says we don't know a lot about suicide intervention, which is a problem, she believes people tempted to blame health professionals should understand they are in a difficult position.

''It [suicide] is actually extremely difficult to predict,'' Griffiths says.

''What we need to be doing is preventing things … before it gets to a point where people are in that state where they're extremely depressed and under care.

We can do something right back when people are young, when people haven't even got any symptoms at all.

''Some of the work being done at the centre is to deliver online self-help in school classrooms to prevent mental health problems when the child or adolescent has no symptoms.''

About two-thirds of the population who have a mental disorder don't get professional help. In a 12-month period, 20 per cent of the population has a diagnosable mental disorder.

''There's a huge unmet need out there for formal help,'' Griffiths said.

''The other circumstance is where somebody has received professional help in the past but for whatever reason is not going back and getting help when their symptoms are getting worse.''

''Part of the education around the help-seeking process is to let people know the first contact may not be the best contact for them so not to give up.''

Director of Clinical Services and Chief Psychiatrist Peter Norrie says mental health care 20 to 30 years ago was a lot more rigid and the stigma associated with it was greater.

He says the community's attitude was to hide mental illness and lock people away.

''As we've moved into modern mental health care we've reduced the institutional care and increased people's human rights and the ability to work together and the suicide rate has gone down,'' Norrie says.

''Even though you could argue that there's more risk because the person has more freedom, in actual fact because the trust is there the rate has become lower over a 20 to 30-year period.

''It's about creating an environment in which people are comfortable.

''The good work we've done needs to continue and we need to continue to encourage people that it is OK to talk.''

Executive director of Mental Health, Justice Health and Alcohol and Drug Services Katrina Bracher admits our health-care sector is a complex industry. She says the relationship between the private sector and the public sector, the acute sector and the non-government sector, is hard to navigate. But she said ACT Health tried hard in a number of ways to support people to get to the right place.

''If somebody has a mental illness we do want them to contact us,'' Bracher said.

''If we're not the right place for the person to receive the most appropriate care at that point in time we facilitate them going - it might be back to the non-government sector, it might be back to their GP, it might be back to their private psychologist or psychiatrist or it might be in some cases into our inpatient care.''

When asked if people were ''falling through the cracks'' Norrie said, ''I fundamentally believe this is a responsive service. If something is not perfect everyone goes back and asks how we can do better. Nothing is 100 per cent, we'd all wish it was, but it's actually about the ability to learn.''

If this raises issues for you or your family and friends please contact Lifeline on 131 114 or the Crisis Assessment Treatment Team on 1800 629 354.