Preventing suicide among gender and sexual minorities Gender and sexual minorities are known to be at high risk of suicide. Lesbian, gay, bisexual, transsexual, and intersex (LGBTI) people were recognised as being specific high-risk groups for suicide in a 2010 senate committee report. While every suicide may not be preventable, a focus on the particular associated predictive factors may help. Transgender individuals were singled out as being at particular risk in the report, and the committee recommended that these groups be recognised as being more vulnerable to suicidal behaviours and that a "targeted approach" to prevention and awareness be put in place. But what is the actual evidence for this elevated risk? And what, if anything, has been shown to be effective in terms of prevention? While there's been a lot of international research on suicidal behaviours among sexual minorities, particularly in the United States, there have only been a few studies carried out in Australia. Still, the international research does indeed point to a heightened level of vulnerability. The first population-based study on the relationship between sexuality and suicidality in young males, for instance, found that gay males were 13.9 times more likely than heterosexual males to have attempted suicide during their lifetime. Other international studies have found lesbian, gay, and bisexual individuals to be at a higher risk for suicidal ideation, suicide attempts, and suicide. Lesbian, gay and bisexual adolescents appear to be at particularly high risk. The limited research conducted in Australia also indicates a high level of risk among lesbians, gays, and bisexuals. Although no population-based studies have been carried out, research based on a sample of 4,824 people from the electoral roll in Canberra showed that gay men were at a higher risk for suicidality than heterosexual men, and bisexual men were at a higher risk than gay men. What's more, statistically significant differences in "feeling suicidal" between both gay and bisexual men and heterosexuals were found in men living in Melbourne. There have been no studies reporting the level of risk for minority gender individuals in Australia, but a US study found 32% of a group of 505 transsexual people surveyed had attempted suicide over their lifetime. Surprisingly, given all this evidence for heightened risk, very little has been done in terms of specifically tailoring mental health campaigns (let alone suicide prevention initiatives) to minority sexuality and gender groups. One intervention carried out in Utah in the 1970s, in which individuals in a gay community were trained as advocates and staffed a 24-hour crisis line, saw emergency room visits due to suicide attempt fall from an estimated six to ten per month to just three over a seven-month period. Given the particular risk for suicidal behaviours during the teenage years and the "coming out" process, schools have been the focus of different preventative activities. An evaluation of the implementation of the Massachusetts State Board of Education's recommendations to improve the school environment for lesbian, gay and bisexual students found those attending schools without "gay-sensitive instruction" were at greater risk of suicide. A supportive school environment clearly acts as a buffer to suicidal behaviours among lesbian, gay, bisexual, and transgender students. Indeed, a study of Austrian gay and bisexual individuals found that suicide attempts at school were associated with a lack of acceptance, and positive reactions to "coming out" offset this risk. Given the evidence for this heightened vulnerability, it's important for prevention campaigns to target lesbian, gay, bisexual, and transsexual, and intersex people by being culturally relevant, accessible, and focused on the specific factors that increase the risk for suicidality. This is particularly the case during adolescence when young people are especially vulnerable while coming to terms with their sexuality or gender-identification. Encouragingly, the Department of Health and Ageing recently launched a national suicide prevention project specifically targeting LGBTI individuals. The initiative provides a platform for learning from the experiences of other countries and puts into place strategies that have been shown to be effective. This includes safer and more tolerant schools and communities, well-designed advertising campaigns, and the provision of help services that are sensitive to the needs of lesbian, gay, bisexual, transsexual, and intersex adults and youths. Such campaigns will need to be evaluated to measure their effectiveness. Many suicides are preventable. When risk groups are identified, as is the case with LGBTI individuals, it is incumbent on us to use our knowledge about how to help people to the greatest possible extent. Delaney Skerrett receives funding from the Commonwealth Department of Health and Ageing and Queensland Health. He is a member of the MindOUT! LGBTI Mental Health Promotion Framework Task Group.