
Towards Zero Suicides
NSW Ministry of Health
The Challenge

Following the 2018 release of the NSW Mental Health Commission’s Strategic Framework for Suicide Prevention in NSW 2018-2023, the NSW Government allocated $87M of new funding over three years from 2019-20 to 2021-22, for a range of initiatives to reduce deaths by suicide and the harm associated with deaths and attempts. The suite of initiatives, known as Towards Zero Suicides (TZS):
- Affirmed suicide as a preventable cause of death.
- Recognised the vital role those with lived experience can play in improving suicide supports and reducing the incidence of this preventable cause of death.
- Drew from the NSW Mental Health Commission’s suicide prevention framework.
- Also drew from other evidence, such as the learnings of the Lifespan suicide prevention approach developed by the Centre of Research Excellence in Suicide Prevention (CRESP) and the Black Dog Institute.
The TZS approach was also consistent with the Premier’s Priority target, which at the time was to reduce the rate of suicide deaths in NSW by 20% by 2023. TZS also affirmed the role of evaluation in continuing to build the evidence for what works and inform future funding decisions.
TZS includes a suite of 15 program initiatives to strengthen both the health system’s response and community resilience. The 2022-23 NSW Government allocated a further $143.4 million over four years to the TZS initiatives as part of a $2.9 billion investment in mental health services.
Delivering six new initiatives (as part of a broader package of 15) was a major undertaking in itself, let alone during the COVID-19 pandemic, as well as multiple natural disasters and mental health workforce shortages. As a result, many of the initiatives were progressively rolled out across different sites/districts.
The Objective

A consortium led by Taylor Fry and ARTD Consultants was engaged by NSW Health to evaluate 6 of the 15 Towards Zero Suicides (TZS) initiatives between 2020 and 2023. The purpose of the evaluation was to report on both individual and overall program design, reach and delivery and the costs of delivering the services. This included for:
- Safe Havens –a non-clinical, peer led, in person service for people experiencing suicidal distress
- Suicide Prevention Outreach Teams (SPOT) – are staffed by mental health clinicians and peer workers who provide outreach support to people experiencing suicidal distress in the community.
- Zero Suicides in Care (ZSiC) – aims to enhance suicide prevention in NSW mental health services through improved staff training, cultural change, patient-centred care, and organisational leadership focused on safety.
- Community Gatekeeper Training – training provided to community members to increase the confidence and capability in identifying people at risk of suicide and having safe and supportive conversations, including referring people to appropriate supports.
- Post Suicide Support – a service providing supports for people bereaved and/or impacted by suicide.
- am/ Youth Aftercare – an aftercare service for children and young people at risk of suicide, piloted across four sites.
These initiatives represented the larger and new areas of spend, and included innovative elements such co-design processes and peer workers.
Our Approach

The evaluation focussed on process, outcomes, and economic components at a collective and individual program level. We provided a series of reports over the life of the evaluation to answer the key evaluation questions for each of the initiatives. These included: implementation review reports, progress and findings reports, interim evaluation reports, and a final evaluation report for each initiative. An overarching evaluation report sought to draw on the findings across these reports and to understand, collectively across the six initiatives:
- The quality of the design and implementation processes
- The outcomes the initiatives have achieved
- The impact the interventions had
- The costs and benefits of the interventions.
Key features of the evaluation were:
- Input from a world-class collaborative research group, combining lived experience of suicide with clinical and academic expertise in suicide prevention, evaluation theory, and a strong understanding of government systems and practice
- Co-design of the evaluations, as well as the engagement of peer researchers and Aboriginal Advisory Group to ensure the voice of those with lived experience of suicide was incorporated into the entire process of the evaluations, from design through to reporting
- Deliverables that can now be translated into practice and inform senior decision-making; and
- Rigorous measurement and detailed statistical analysis of outcomes.
The Impact

We were able to deliver insights and recommendations that have supported continuous quality improvement and informed decisions about the future of suicide prevention initiatives in NSW. We also examined service use outcomes for three TZS initiatives using large linked administrative datasets from both the Australian Government and NSW Health systems. We used a quasi-experimental design and hypothetical modelling to compare TZS client outcomes with other health consumers with similar characteristics but accessing other existing supports. These outcomes included subsequent self-harm/suicidal ideation presentations to emergency departments and patterns in community mental health service use.