Shannai Pearce knows what it feels like to think there is nothing left for you in life.
When she tried to kill herself at the age of 14, she felt totally alone. She was being abused, but social workers told her she was just "attention-seeking" when she asked for help.
"I was at breaking point, there was nobody to help me," she said.
You might think as tragic an event as a child's suicide attempt would trigger a vast network into action to make sure that child was protected, safe.
But this is not that story.
"They put me in a room in hospital with security on my door 24-7, and they gave me some sleeping tablets," she says. "I didn't see a psychiatrist – nobody. Then my case worker came to pick me up and take me to a youth refuge, where they said I would lose my accommodation if I self-harmed again.
"I never heard from the hospital after that. I just got a bill for the ambulance a couple of months later."
A report released on Thursday shows that many people who try to harm or kill themselves are being failed by a healthcare system experts say is full of cracks left by overstretched hospitals and a shortage of community care.
The new analysis from the Black Dog Institute and the NHMRC Centre for Research Excellence in Suicide Prevention, conducted over a six-year period, has investigated every time someone purposefully injured themselves so badly they were admitted to hospital in NSW.
It found that 37 per cent of the tens of thousands of people hospitalised for their injuries were never admitted for psychiatric care or given follow-up psychiatric treatment in the community.
Of those who were treated in the community, the majority received only one follow-up activity, which typically lasted for half an hour.
The research found many suicide survivors felt they were not taken seriously or treated with respect, said study author Fiona Shand.
"We heard reports of people who felt like they were being punished," she said. "Emergency departments are very busy places, staff get burnt out, and despite their best efforts sometimes people don't respond the way they should."
The study found more than 43,200 people had been hospitalised for self-harm, with a total of more than 67,000 admissions – meaning some were treated on multiple occasions.
It also included in-depth surveys with nearly 200 Australians who had attempted suicide or cared for someone who had. It found the average number of suicide attempts and hospital attendances was three. One quarter had tried to kill themselves five or more times.
Malcolm Hopwood, the president of the Australian and New Zealand College of Psychiatrists, said the split between services funded and provided by the commonwealth and those handled by the states meant people could slip through the cracks between hospital and the community.
"On occasion the follow-up really doesn't seem to occur, or it doesn't seem adequate for the level of risk," he said.
UNSW suicide risk expert and public hospital psychiatrist Matthew Large said often people self-harmed when they were intoxicated and were sometimes reluctant to have treatment when they sobered up.
But he believed many were not being offered the care they needed, because hurting yourself meant you were at an extremely high risk of future suicide.
"We are talking about people who often have unstable personalities and substance abuse issues, and the public sector doesn't cater very well for them, and the private sector doesn't either unless you have got money," he said. "They need to be actively followed up in the community … admission though is often not the answer as they often get worse in hospital, and hospital doesn't stop them from self-harming very much at all".
He said every person who self-harmed should be made comfortable, treated respectfully and talked to, but that this didn't always happen.
Minister for Mental Health Pru Goward said she was seriously concerned by the figures, and the government was developing a new suicide prevention framework.
"The period immediately after a person leaves a mental health inpatient unit is a particularly vulnerable time," she said.
But she said there had been some improvement in follow-up care for people with mental illness, from about 48 per cent in 2010/11 to 63 per cent in 2013/14.
Shannai Pearce has been able to get over her experiences as a teenager, finally getting help from GPs and close friends when she turned 20. While she says it "threw my life off-track for a while", the now 24-year old is studying to be a social worker, with the hope she will be able to help kids like her.
"It is really scary because I feel like I'm going to be entering a system I already knew needed fixing, and it had more money then than it does now," she said. "But I just want people to know – it's OK. You can get help, and you are going to be OK."
Self-harm in Australia
- Self-harm hospitalisations have increased by 50 per cent since the turn of the century.
- On average nearly 2500 Australians kill themselves every year, with about three times more men dying than women.
- Women are far more likely to self-harm than men, accounting for double the number of hospitalisations.
- Many people who engage in self-harm say they are attempting to replace emotional pain with physical pain.
Help is available via Lifeline: 13 11 14
The story Black Dog Institute suicide attempt study finds that patients get no follow-up first appeared on The Sydney Morning Herald.