The 13th Australasian Injury Prevention Network Conference
Date: Monday, 13th November 2017
Good morning everyone.
Thank you Rebecca for the introduction. It’s a pleasure to be invited to present at this year’s Australasian Injury Prevention Network Conference.
I wish to start by acknowledging the traditional custodians of the land we are gathering on here in beautiful Ballarat. I acknowledge and respect their continuing culture and the contribution they make to the life of this city and this region, and pay my respect to elders, past, present and future.
Thank you to the conference organisers for this opportunity and to Professor Ivers in particular to talk about my work in the area of family violence and how it intersects with self-harm and suicide among children, and how this in turn relates to work in the area of injury prevention. I also acknowledge the other speakers in this session, the honourable Catherine King, Bruce Bolam, Professor Lee Sullivan, and Johnathan Passmore for such an excellent overview of where our regional priorities should be, and I also acknowledge all of you, the other fabulous conference participants.
‘Children have a universal right to live free from all forms of violence’, and a right to be safe, to survive and to thrive. This are some of the pledges we have made as a nation to children by signing up to the Convention on the Rights of the Child.
Yet family and domestic violence continues to loom large in the lives of Australian children. According to the ABS ‘at least two out of five assaults recorded during 2016 were FDV-related [family and domestic violence’. We also know that ‘[f]emales were significantly more likely than males to be victims of FDV-related Assault’, many of whom were mothers.
According to the Domestic Violence Resource Centre Victoria, ‘children are present in one out of every three family violence cases reported to police’.
Children’s involvement in domestic violence is not ‘peripheral’. Children exposed to family and domestic violence are at an increased risk of experiencing emotional, physical and sexual abuse, and we now know that they are at higher risks of suicide and intentional self-harm.
As with much information related to child wellbeing, National and disaggregated data about children affected by family and domestic violence is not readily available.
However, the latest AIHW Child Protection Report released in March this year contains some administrative data that highlights some of the violence that children experience within family context. During 2015–16 there were:
60,989 substantiated reports of abuse against 45,714 (children).
Of these substantiations the primary type of abuse were :
emotional abuse — 45%, widely understood to be code for exposure to FV
neglect — 25%
physical abuse — 18%
- Sexual abuse — 12%
Despite this knowledge, when talking about family and domestic violence, the experiences and needs of children affected tend to get lost or overlooked. So, it is encouraging that we are starting to have a national conversation that is starting to centre on children’s distinct experiences in this space, albeit on the back of a number of tragic cases that have made their way into our collective consciousness, like the tragic murder of 11 year-old Luke Batty by his father.
3. About the National Children’s Commissioner and the CRC
As the National Children’s Commissioner. I have a responsibility to monitor and promote the rights of all children in Australia. I report annually to the Federal Parliament about matters relating to the enjoyment and exercise of human rights by children in Australian. To date, I have produced four annual reports, and I am currently working on my fifth. Each report has contained the findings of a major investigation.
A child rights lens is not only relevant to children’s exposure to family and domestic violence but also to suicide and intentional self-harm.
Under the Convention on the Rights:
Article 6 guarantees children the right to life, survival and development;
Article 19 guarantees children the right to protection from all forms of violence; and
Article 24 provides for children’s right to the highest attainable standard of health.
- Article 12 enshrines children's right to be heard and is arguably the gateway to realising all other rights.
The UN Committee on the Rights of the Child, the body responsible for monitoring the implementation of the Convention, has interpreted article 19 to include freedom from self-inflicted violence. The Committee has also made specific reference to suicide and self-harm as health consequences of exposure to violence and maltreatment. The Committee has asked countries to not only report on child deaths due to intentional self-harm, but also provide information on prevention measures.
4. The scale of the issue
The latest ABS data released in October this year show that in 2016 intentional self-harm still continued to be the leading cause of death among Australian children and young people aged 5–17 years, with on average one child every week taking their own lives.
The Second Australian Child and Adolescent survey of Mental Health and Well-Being completed in 2015 reported that ‘around 7.5% of young people aged 12–17 years had seriously considered attempting suicide in the previous 12 months’.’ The same report also found that ‘around one in ten adolescents reported having ever self-harmed ... [that] is equivalent to 186,000 young people aged 12–17 years who had deliberately injured themselves’.
Similarly, the latest data from the Kids Helpline Insights Report 2016 indicates that 34% of all duty of care interventions initiated by Kids Helpline (KHL) counsellors in 2016 involved suicide concerns. This means in 2016,
about 168 counselling contacts each week related to suicide;
572 contacts involved immediate intentions of suicide, and
- 193 were from children attempting suicide at the time of the call
The scale of the issue is even more amplified for Aboriginal and Torres Strait Islander children. According to the ABS, when all child suicide deaths are combined for years 2012 to 2016, the Northern Territory — which has the highest proportion of Aboriginal children per capita — reported 13.9 deaths per 100,000 persons. This was - the highest of all jurisdictions by 10 times the minimum. Victoria reported rates of 1.7 deaths per 100,000.
My own investigations have shown that over a ten year period to 2012, over 28% of suicides of children under 18 related to Aboriginal and Torres Strait Islander children, despite making up only six per cent of the youth population. In addition, Aboriginal and Torres Strait Islander children made up around 80% of the younger suicide deaths — ie 4 to 11, and over 43% of the 12–13 year-old deaths.
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, over a three year period, 69–75% of referrals for ‘self-harm behaviour or intent’ were from Aboriginal children or young people. 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 pain or gain attention of those around’ them.
Family conflict and domestic violence is consistently raised as a precipitating factor for self-harm and suicide among children. My own 2014 examination of self-harm among children in Australia found that over 17% of contacts to the Kids Helpline in 2012/13 in relation to self-harm or suicide involved a co-concern of family conflict.
5. The intersection
Adverse family experiences, including domestic violence is now seen as one of the key distal risk factors that may predispose a child or young person to suicidal behaviours.
In making the link between domestic and family violence and self-injury and suicide in children, we are not only talking about children's physical safety but also the psychological and emotional safety of children exposed to violence.
The quote on the slide, from an anonymous submission to the Victorian Royal Commission into Family Violence, shows how this can play out for a young person:
I was incredibly suicidal from a very young age—it’s very painful to think about. I remember being what could only have been about 6 years old and just crying and crying and being so afraid, wondering how I could live if I ran away from home—I was also incredibly afraid of and obsessed by death. I was already starving and hurting myself when I was around 11.
6. Review of previous investigations by NCC
I would like to provide a little further detail of some of my work to date relevant to the topic of suicide and intentional self-harm by Australian children and young people.
In 2014, I examined intentional self-harm and suicidal behaviour in Australian children and young people aged 0–17 years, to shine a light on what we know about this issue, and to identify areas for action. Some of the key findings of my examination revealed that there are still significant gaps in our understanding of how and why children and young people engage in this behaviour, or of the factors likely to heighten or reduce risk.
In my report I recommended that a national research agenda for children be established to help reduce intentional self-harm among children. This should involve the direct participation of children, and focus on, in particular:
- the multiple risk factors and different protective factors central to targeting and supporting children and young people; and
- ways to encourage children to access appropriate help and support.
I highlighted the need for research into sibling violence, and intimate teen partner violence where available assault stats indicate a significant spike.
The recommendations are anchored in a national public health model to deliver a full suite of interventions, from broad based resilience building and the promotion of help seeking, through to targeted secondary interventions to at risk children, and clinical treatment where needed.
I also recommended routine nationally consistent data collection about child deaths due to suicide and in relation to self-harm. For example, data specially sourced for the project revealed that there were between 50–60 hospitalisations every week due to self-harming behaviour, mostly girls and mostly through self-poisoning.
Restricting access to the means used for intentional self-poisoning is known to be an effective suicide prevention strategy. While the maximum paracetamol pack size sold by Australian retailers and other than pharmacies changed from 25–20 (500 mg tablets/capsules/caplets) in September 2013, it may be that further restrictive measures are required.
Treatment for paracetamol overdose usually occurs when 10g (20 tablets) or more have been consumed.
In 1998, the UK government introduced legislation that reduced the maximum pack size of tablets and capsules that contain aspirin or paracetamol that can be sold or supplied from outlets other than registered pharmacies from 25–16 tablets. Further restriction could be considered in Australia. Age identification requirements may also assist in restricting access to means.
Clearly, children who end up in hospital due to self-harming is only the tip of the iceberg, and without regular data being made available — which remains the case today — we cannot grasp the size or nature of this problem.
During my investigation, specific concerns about the relationship between domestic and family violence and suicidal behaviour were brought to my attention. For example; the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council told me that data collected over the previous 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’. Similarly, the National Children’s and Youth Law Centre identified domestic violence in all reported suicide attempts to its service in the previous 18 months.
And one police officer from one state who had reviewed all child suicide death cases in the previous year, told me, ‘every child who had suicided in the last twelve months came from a domestic violence family’.
Because domestic and family violence was raised as a risk factor requiring further research, in 2015 I looked further at this issue. This was considered in the context of a broader project on the impact of family and domestic violence on children more generally. Again, the findings exposed this intersection.
For example, the submission from yourtown highlighted the co-existence of family and domestic violence and self-injury and suicide in Australian children. According to their data, of all contacts to their Kids Helpline (between January 2012 and December 2014), where family and domestic violence was raised as a concern (n=999):
- 72 (7.2%) also involved current thoughts of suicide
- 119 (11.9%) also involved self-injury
- 166 (16.6%) were by a child assessed as having a mental health disorder by the counsellor.
In my 2015 report I noted that children’s experiences of family and domestic violence are typically described as ‘witnessing violence’, ‘being exposed to violence’, and ‘being directly abused in the context of family and domestic violence’. Their experiences can be many and varied.
However, many experts have argued that as some children are naturally more resilient than others, what is most helpful is to focus on the effects of domestic violence on individual children, including how it makes children feel.
In the 2015 investigation, the Kids Helpline provided me with the thoughts and feelings of children through an examination of its case notes.
The feelings that children presented are important to unpack because they represent potential barriers to help seeking and disclosure.
Children are also not just bystanders and witnesses to family and domestic violence, they are also injured or murdered in this context. Research shows for instance that children comprised the second most frequent group of homicide victims of family and domestic violence (21%) after intimate partner homicides (56%), and that shockingly this equates to one child every two weeks on average being killed at the hands of their parents.
7. Prevention: the role of child-safe organisations
Let me now focus a little on the preventative end. I would like to talk about how the concept of “child safety” can contribute to children’s resilience, help seeking and prevention of injury, including self-injury in children. As noted in the Public Health Association of Australia’s submission for my 2015 investigation, ‘[t]he ideal is primary prevention, which aims to bring about a cultural shift toward...changing cultural norms to non-acceptance of violence ...’
As can be seen by the data presented here today, while some children seek help in relation to self-harming and suicidal ideation, relatively few seek help directly for domestic violence related issues, despite what we know about their exposure to it.
In my 2014 work I highlighted some of the barriers to seeking help experienced by children and the importance of understanding and addressing this.
As 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 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.
At the heart of “child safety” is the prevention of harm and the promotion of wellbeing. As community members and as people working in and leading organisations, we all have an opportunity to build places and spaces that are safe for children, where they can speak up, where they are valued and listened to, and where trusted adults will take constructive, helpful action. And in the sensitive areas of mental health and exposure to domestic violence, it is people like health professionals, teachers, coaches, youth workers and the like who may be the first to know or pick up on what might be happening for a child. In these contexts we may not be able to directly step in to address what is happening, but we can be responsive, alert to those who may be at risk, and able to have respectful conversations with children. We can also make sure the environments within which this can happen are safe for children and that we are well connected to local child friendly family support, domestic violence and mental health services who can help.
In my 2014 report I identified a range of protective factors for children associated with reducing non-suicidal self-harm and suicidal behaviour.
Similarly, in its submission, headspace also highlighted some factors that children and young people have said that help them to get help, such as:
awareness of mental health issues and 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.
This is where the development of “child safe organisations” (CSOs) — informed by a child rights approach — comes in; a project I am currently leading at a national level.
Organisations that are child safe not only recognise, respect and protect the rights of children they also acknowledge that children and young people gain great benefits from environments that give them a sense of inclusion, security and belonging.
A “child safe organisation” is one that creates a culture, adopts strategies and takes action to promote child wellbeing and protection from harm. A child safe organisation consciously and systematically:
creates an environment where children’s safety and well-being is the centre of thought, values and actions;
places emphasis on genuine engagement with and valuing of children;
creates conditions that reduce the likelihood of harm to children;
creates conditions that increase the likelihood of identifying any harm; and
- responds to any concerns, disclosures, allegations or suspicions of harm, inside or outside the organisation.
Organisations that put children rights at the centre, help us to fulfil our obligations under article 19 of the Convention to protect children from all forms of violence, article 6 to ensure children’s survival and development, and article 24 to protect children’s right to health.
In addition, theyy guarantee that children also feel that their identity — including their language and culture — is valued.
A child safe organisation therefore creates an environment that is respectful, inclusive and welcoming of the child, taking into account the particular needs of children from diverse backgrounds. This is consistent with our obligations under article 2 to ensure rights to each child without discrimination of any kind, as well as under article 8 to respect the right of the child to preserve their identity.
This is particularly relevant in the context of self-injury because we are aware that certain groups of children who are subject to discrimination, disadvantage and exclusion are more vulnerable to suicide and self-injury, and are less likely to seek help. These include:
Aboriginal and Torres Strait Islander children;
lesbian, gay, bisexual, transgender and intersex (LGBTI) children;
culturally and linguistically diverse (CALD) children;
children in rural and remote locations;
children with disabilities; and
- children in out-of-home care.
Many of the elements of a child’s identity and background overlap and intersect, and it is important that this is recognised and taken into account when creating a safe, respectful and inclusive environment.
Finally, and perhaps most importantly, placing an emphasis on genuine engagement with children relates to our obligation under article 12 to ensure that children have the opportunity to participate in decisions that affect them. The right to be heard — which includes hearing directly from children, engaging with them and taking their views seriously — is a core principle of the Convention, and respect for this right is central to respecting the other rights children have.
Ultimately, an organisation cannot build a genuinely protective and supportive environment for children unless they value them as holders of human rights.
As part of this commitment to the development of child safe organisations, I have worked closely with Community Services Ministers under the National Framework for protecting Australia's children to develop a National Principles for Child Safe Organisations.
The Principles are being developed through a cross-sector consultation and engagement process, involving everyone from sports and recreation to health services, from very small clubs to highly structured businesses. The timing has been designed to take into account the recommendations of the Royal Commission into Institutional Responses to Child Sexual Abuse, which has showed us categorically that children need to be both seen and heard — and ever present dangers of neglecting children rights and silencing their voices.
The Principles are underpinned by a child rights approach to building capacity to deliver child safety and wellbeing in organisations, families and communities. They consist of 10 principles largely based on those developed by the Royal Commission.
Once finalised, along with relevant tools and resources, it is hoped that the National Principles will drive implementation of a child safe culture across all sectors providing services to children across Australia. It is intended that the Principles will apply to all organisations dealing with children, regardless of their location or sector or size.
Building respect, resilience and relationships depends on organisations, and the people within those organisations, embedding children’s rights, child safety and child wellbeing in their organisational cultures.
A key aspect of this is encouraging and facilitating the meaningful participation of children and young people in the decisions and processes that affect them. In turn, equipping children and young people with the knowledge of their rights, providing safe spaces for their voices to be heard and empowering them to exercise their rights, promotes resilience and help-seeking behaviour. I hope that you will take up the challenge within your own work environments to champion a child rights approach to child safety and injury prevention. Thank you.
 Monica Campo, Children's exposure to domestic and family violence: Key issues and Responses, CFCA (Child Family Community Australia) Paper No. 36 (2015), 3
 Australian Bureau of Statistics (ABS), Recorded Crime - Victims, Australia Catalogue no. 4510.0 (2016), http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4510.0~2016~Main%20Features~Victims%20of%20Family%20and%20Domestic%20Violence%20Related%20Offences~6
 Australian Bureau of Statistics (ABS), Recorded Crime - Victims, Australia Catalogue no. 4510.0 (2016), http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4510.0~2016~Main%20Features~Victims%20of%20Family%20and%20Domestic%20Violence%20Related%20Offences~6
Domestic Violence Resource Centre Victoria, Facts on family violence 2017 (2017), citing Crime Statistics Agency, Family incidents, year ending 31 March 2016 (2016). State Government of Victoria.
Australian Human Rights Commission, Children’s Rights Report 2015, 14 October 2015, 164
 David Lawrence, Sarah Johnson, Jennifer Hafekost, Katrina Boterhoven de Haan, Michael Sawyer, John Ainley, and Stephen R. Zubrick, The mental health of children and adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing (2015), 106
 David Lawrence, Sarah Johnson, Jennifer Hafekost, Katrina Boterhoven de Haan, Michael Sawyer, John Ainley, and Stephen R. Zubrick, The mental health of children and adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing (2015), 103
 Yourtown, Kids Helpline Insights 2016: Insights into young people in Australia (2017), 7
 Central Australian Mental Health Service, Department of Health, Northern Territory, Submission 99, to Australian Human Rights Commission, National Children’s Commissioner’s Examination into Intentional Self-harm, With or Without Suicidal Intent, in Children and Young People, May 2014, 6.
 Ibid 2.
 Ibid 3.
 Fleming, Theresa M., Sally N. Merry, Elizabeth M. Robinson, Simon J. Denny, and Peter D. Watson. Self-reported suicide attempts and associated risk and protective factors among secondary school students in New Zealand. Australian & New Zealand Journal of Psychiatry 41, 3 (2007), 217.
 State of Victoria, Royal Commission into Family Violence: Summary and recommendations, Parl Paper No 132 (2014–16).
 Ngaanyatjarra Pitjantjatjatjara Yankunytjatjara Women’s Council (Aboriginal Corporation), Submission 128, p 12. At www.humanrights.gov.au/publications/childrens-rights-report-2014
 National Children’s and Youth Law Centre, Submission 138, p 3. At www.humanrights.gov.au/publications/childrens-rightsreport-2014
 Discussion, Roundtable, National Children’s Commissioner’s examination of intentional self-harm in children, (2014).
 BoysTown (Kids Helpline), Submission No 14 to Australian Human Rights Commission, National Children’s Commissioner’s examination into children affected by family and domestic violence, 2 June 2015, 8.
 S Jeffries, R Field and C E W Bond, ‘Protecting Australia’s Children: A Cross-Jurisdictional Review of Domestic Violence
Protection Order Legislation’ (2015) Psychiatry, Psychology and Law, 2 http://dx.doi.org.ezproxy.lib.uts.edu.au/10.1080/13218719.2015.1015204
 Tracy Cussen and Willow Bryant, ‘Domestic/family homicide in Australia’ (Research Paper No 38, Research in Practice Report, Australian Institute of Criminology, 2015) 2 <http://www.aic.gov.au/publications/current%20series/rip/21-40/rip38.html> cited in Australian Human Rights Commission, Children’s Rights Report 2015, 14 October 2015, 104
 Australian Human Rights Commission, Children’s Rights Report 2015, 14 October 2015, 139
 Australian Human Rights Commission, Children’s Rights Report 2014, 20 October 2014, 89
 headspace, Submission 89, p 8. At www.humanrights.gov.au/publications/childrens-rights-report-2014.
 headspace, Submission 89, p 7. At www.humanrights.gov.au/publications/childrens-rights-report-2014