Torres and Cape Hospital and Health Service (TCHHS) initiated a quality improvement project in April 2023, focusing on Zero Suicide in Healthcare, Universal Aftercare, and Postvention Frameworks. Covering 35 communities across an 800km expanse of land and sea, TCHHS serves a population where approximately 70% are Aboriginal and Torres Strait Islander peoples. TCHHS therefore prioritized robust community and interagency consultation to adapt these frameworks to best suit local needs service wide. The approach followed the principle of “nothing for us without us,” informed by contemporary implementation science.

The Senior Project Officer (SPO) facilitated 150+ points of engagement over 12 months, specifically addressing Suicide Prevention in Healthcare. These engagements involved community leaders (such as Aboriginal Elders), community members (including lived experience representatives), and organizational teams (including clinicians and senior managers). The SPO transcribed conversation notes digitally for reflexive thematic analysis, a suitable method considering the lack of capacity for formal thematic analyses and the need to recognize implicit bias in the interviewer’s context (caucasian, male, not a local) Aboriginal &/or Torres Strait Islander Health Worker staff were engaged to accompany consultations where possible.

Preliminary data analysis identified: mistrust of public and private health systems, fractured interagency communication, privacy and data sovereignty concerns, and inaction post-historical consultation efforts. Project limitations included relying on a single person (the SPO) for both engagement and qualitative data analysis. Additionally, cross-cultural engagement opportunities, as per best-practice, was not always possible. Historical over-consultation around suicide without follow-up actions also hindered progress.

Despite these challenges, TCHHS received commendations for extending beyond typical consultation scope. The preliminary thematic data analyses informed project co-design and highlighted opportunities for further quality improvement, especially for cultural safety. As TCHHS builds on these “foundations of trust,” learnings from this process will shape more trauma-informed, person-centered consultation protocols for the future.

Three Key Learnings:

1. Consumer Engagement is not a tick and flick exercise: Consultation should centre on lived experience and First Nations perspectives and ensure that participants are informed about the subsequent outcomes of these conversations.
2. Enhance Interagency Communication: Consistent communication between agencies can go a long way in strengthening referral pathways and mitigating service duplication.
3. Address Crisis Support: More investment is needed for health promotion that reaches far and wide and aims to improve health literacy and help-seeking behaviour.