Feeling humiliated or entrapped can trigger suicide ideation, in a "highly relevant" risk to Australia's defence and veterans' affairs systems, a royal commission has been told.
Governments and agencies need to ensure their actions do not exacerbate a person's "mounting distress levels", National Mental Health Commissioner Alan Woodward told the Royal Commission into Defence and Veteran Suicide on Monday.
"If you are designing administrative systems or policy decisions that affect the lives of people, don't create systems that might elevate their distress ... don't box people into a corner with no way out," he told the inquiry hearing, sitting in Hobart.
"Alongside defeat and humiliation ... feelings of entrapment are the fuel upon which suicidal ideation thrives."
The Department of Veterans' Affairs system which manages claims from injured, discharged or retired defence members has been a critical focus of the inquiry.
A failure to provide adequate support has been directly linked to high rates of suicide among veterans transitioning back into civilian life.
Mr Woodward said the defence culture was a "powerful force" which still appeared to reinforce the "myth" it was weak or unmanly for people to ask for help when they were in distress.
He said this was especially challenging for men in the services as it reinforced "this very narrow idea of what it is to be a male".
"That becomes very stressful and difficult for the people who say, 'I'm a male but I don't seem to fit'."
Mr Woodward said a profound shift in the current "formulaic" approach to suicide prevention was needed in Australia, expanding services to involve a range of governments and agencies and provide more "compassionate" care.
Multiple factors could trigger suicidal ideation, from childhood sexual abuse to a "toxic" domestic relationship, debt, or social isolation, he noted.
Relegating the problem to the health sector had only added barriers for people who often felt shame and fear about disclosing their suicidal thoughts, Mr Woodward said.
A recent study of patients in UK hospitals found that most people who had been admitted for suspected suicidal intent, and had been assessed as a low to moderate risk, later died of suicide.
Mr Woodward said while families and friends had a critical role in supporting a person with suicidal thoughts, care services also needed to be more aware that family relationships could also be a major factor in a person's distress.
He said this was one of the weakness of a "tick-a-box" approach to managing a suicide attempt where families were generally the first to be notified.
"My experience in looking at crisis lines ... is that the most frequently nominated issue that people phone those lines on is family and personal relationships," Mr Woodward said.
"If those relationships are poor, dysfunctional or toxic, they can be hugely destructive and distressing."
The inquiry continues, with evidence due later on Monday from Madonna Paul, whose husband took his own life after a decade serving in the air force.
The commission's interim report, due on Thursday, will include urgent recommendations, ahead of a final report due by June 2024.
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Australian Associated Press
