Exploring Community-Based Suicide Prevention in the Context of Rural Australia: A Qualitative Study

The paper addresses elevated suicide rates in rural Australia, where social and geographic isolation, socioeconomic disadvantage, environmental disasters, limited access to and utilisation of mental health services, stigma, and stoic ideals heighten risk. Suicide risk increases with remoteness; rural men are up to twice as likely to die by suicide as urban men. Community-based approaches are positioned as critical to reach at-risk groups who may not have diagnosed mental illness or engage with formal services. Existing national efforts (e.g., National Suicide Prevention Trial) and toolkits underscore the need for local responsiveness, yet a lack of shared operational definition of “community-based” has hampered implementation. The research question is: In the context of rural areas, what are the key considerations when implementing community-based suicide prevention to meet community needs?

Prior work recognises community-based programs as cost-effective and foundational for local ownership and sustainability. Toolkits and frameworks (e.g., Suicide Prevention Australia’s Communities Matter toolkit; the US National Action Alliance’s guidance) advocate integrated strategies aligned with local context, culture, and readiness, though they often do not explicitly define “community-based”. Evaluations from Australia’s National Suicide Prevention Trial highlight barriers due to variable interpretations of “community-based”, the importance of the implementing agent’s role, community engagement levels, and resource availability. Research also emphasises addressing social determinants, stigma, isolation, and leveraging social capital, with culturally responsive approaches (e.g., Aboriginal and Torres Strait Islander communities) and participatory/co-design methods recommended. Evidence suggests community gatekeeper training, coordinated community responses, and universal, resilience-building initiatives can enhance protective factors and reduce suicidality.

Design: Qualitative study (first phase of a larger project developing Best Practice Guidelines for Youth Suicide Prevention in Rural Australian Communities) using semi-structured interviews and focus groups with experts in community-based suicide prevention. A positivist qualitative approach was adopted to examine perceptions across roles and generate generalisations guided by the data. Ethics: Approved by Human Research Ethics Committee (Project ID 23582); COREQ 32-item checklist followed. Participants: Purposive and snowball sampling of adults (≥18 years), English-speaking, self-identified experts with paid roles in rural community-based suicide prevention (community service providers, program providers, researchers, and policy developers) across Australia. Total n = 37; interviews = 32; focus groups = 2 (n = 2 and n = 3). Demographics: age 29–72 (Mean = 46, SD = 9.6); 62.2% female; 48.6% with lived experience. Roles: community-level service provider 48.6%; program provider 18.9%; policy/research 32.5%. Procedures: Recruitment via direct emails to known contacts/authors, web searches; snowballing to broaden reach. Informed consent obtained. A topic guide developed using a five-phase process included the question “How do you define community-based suicide prevention?” Sessions conducted Jan–Sep 2021 via Zoom (n = 32) or face-to-face (n = 1). Transcripts not routinely returned unless requested. Data analysis: Data collection continued until saturation. Audio-recorded, transcribed verbatim. Thematic analysis per Braun and Clarke: systematic reading, inductive coding by one researcher, verification by a second, and team consensus. Basic themes identified and confirmed; no new themes emerged with additional data.

Three overarching themes described community-based suicide prevention in rural Australia: 1) Community-led initiatives: - Grassroots, non-clinical efforts led by communities, with strong involvement of non-professional members and people with lived experience across design and delivery. - Partnerships and working groups unite community members, services, and professionals (including “natural supports”), enabling coordinated action and rapid postvention responses. - Natural leaders/champions and gatekeepers are pivotal to “get stuff done”—identifying risk, having safe conversations, linking to supports before crisis, and raising awareness (gatekeeper training seen as frontline defense). 2) Meeting community needs: - “Community” is context-specific—can be geographic regions or social groups united by shared interests, norms, or culture. Communities should define themselves. - Co-creation and co-design with communities to identify local issues and solutions fosters success, ownership, and sustainability; continuous community conversations needed to keep efforts aligned with current needs. - Culturally responsive approaches are essential; Indigenous communities benefit when interventions are run by the community, amplifying protective effects and supporting healing and restoration. 3) Programs to improve health and suicidality: - Primarily non-clinical, community-level programs address drivers and conditions contributing to suicidality (e.g., stigma, living circumstances), and social determinants of health. - Universal prevention and resilience-building across the life-course can enhance awareness and protective factors intergenerationally. - Varied, flexible modalities (free/subsidised/at-cost; face-to-face/telehealth/text/phone) mobilise available local resources and social capital. - Activities include awareness-raising, skills training for safe conversations, and coordinated postvention support for the bereaved. Overall, effective implementation relies on authentic community engagement, inclusive partnerships (including lived experience), local leadership, and tailoring to community-defined needs, culture, and readiness.

Findings clarify “community-based” as rooted in community leadership, co-design, and collaboration across formal and informal networks, rather than solely clinical service delivery. Community members—particularly natural leaders and gatekeepers—are central touchpoints who can identify distress, mitigate stigma, and facilitate early linkage to support in rural contexts where formal services may be less accessible. Framing suicide as a social phenomenon positions community-based programs as social innovations capable of driving change by addressing social determinants, enhancing protective factors, building social capital, and fostering whole-of-community healing. Partnerships that include people with lived experience at all stages help ensure relevance, reach, and equity. The transition from national to regional/local approaches requires guidance that supports flexible, culturally attuned adaptation to local definitions of community, needs, and resources, thereby improving sustainability and effectiveness in rural areas.

Transitioning suicide prevention from national to regional focus necessitates empowering rural communities to leverage local resources and social capital. Consensus among experts and existing guidelines indicates rural community organisations and members, including those with lived experience, should lead, co-design, and implement programs attuned to community-defined needs, cultures, and norms. Community-based approaches provide avenues to reach those not engaging with formal services, tackle social drivers (isolation, stigma), and mobilise action through partnerships and gatekeeper capacity. Clear guidance is needed for both community-level agents and policy actors on assessing community needs, engaging diverse stakeholders, reaching those most at risk, and adapting interventions across settings. Future work should evaluate the effectiveness of specific community-based components, refine operational definitions, and develop implementation frameworks that support local tailoring and sustainability.

Participant numbers varied across states and demographic groups. Differences in roles (service/program providers vs. research/policy) and associated power relations/experiences may have influenced responses; some researchers/policy participants reflected on prior service roles. Confidentiality limited the detail that could be provided alongside quotes. The views represent this purposive sample and may not be generalisable to all practitioners, communities, or rural areas.