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It is not known if there are discernible patterns in method lethality over successive episodes of self-harm and, if so, how these may be differentially associated with risks of self-harm repetition and suicide. Latent trajectory modelling estimated variation in patterns of suicide attempt lethality in 1,719 individuals attended by ambulance services on at least three occasions between 2012 and 2016. Cox regression modelling investigated hazards of suicide attempt repetition, all-cause, and suicide mortality as a function of these patterns. Two distinct trajectories provided optimal fit (BIC: -39,464.92). The first (Low/Moderate to Low/Moderate Lethality group; 92.5%) consisted of those consistently using methods associated with low to moderate potential lethality throughout the observation period. The second (High to Low/Moderate Lethality group; 7.5%) consisted of those who initially used methods with higher potential lethality but who switched to methods characterised by lower lethality. There were no significant differences between groups in the hazards of reattempting suicide (Hazard Ratio [HR] = 1.41, 95% CI 0.76 to 2.59) or all-cause mortality (HR = 1.21, 95% CI 0.63 to 2.32). However, those assigned to the High to Low/Moderate Lethality trajectory group may be at greater risk of suicide (Sub-Hazard Ratio [SHR] = 2.82, 95% CI 1.16 to 6.86). There may be discernible sub-groups of patients with important differences in clinical treatment needs and suicide risk profiles. These differences should be considered when undertaking psychosocial risk/needs assessments with those presenting to clinical services following self-harm.

Introduction For individuals presenting to the emergency department (ED) for a suicide attempt, the period after discharge from hospital is marked by heightened vulnerability for further suicide attempts. Effective care following a suicidal crisis has the potential to significantly decrease this risk. The current study aims to examine the impact of the LifeSpan multilevel suicide prevention model on experiences of care following a suicidal crisis. Perspectives from healthcare consumers (individuals who have presented to the ED following a suicidal crisis), carers, and health professionals will be explored. The LifeSpan model is currently being evaluated as a high-fidelity trial in four geographically defined regions in New South Wales, Australia. Methods and analysis This study will use a mixed methods prospective cohort design. Quantitative data collection includes a structured survey, administered to healthcare consumers from LifeSpan sites and control sites. Two cohorts of healthcare consumers will be recruited 12 months apart with baseline assessment occurring within 18 months of the ED presentation, and follow-up 12 months after the initial assessment. Survey participants will be recruited online and through participating EDs, mental health organisations and aftercare services. Qualitative interview data from healthcare consumers, carers who have accompanied a loved one to the ED following a suicidal crisis and health professionals who provide care to people at risk of suicide will be collected concurrently with the recruitment of the first cohort of survey participants. Purposive and convenience sampling techniques will be used for recruitment of interview participants. The primary outcome for this study will be healthcare consumers' experiences of service provided at the ED. Analysis will be undertaken of the change over time within LifeSpan sites, as well as between LifeSpan sites and control sites, using mixed effects repeated measures models as principal m

Outdoor exercise equipment has become popular as important environmental infrastructure to provide opportunities for physical activity and social connectedness in public settings. With higher sedentary behaviour and physical inactivity reported among older people, infrastructure changes and safe environments that promote older peoples' health and mobility are required. Due to ageing-related functional decline and health conditions associated with ageing, older adults may have special physical needs that require careful consideration when choosing outdoor equipment. However, limited information is available regarding the suitability of the types of exercise equipment for older people. This commentary provides further information on the type of equipment available, its functionality and suitability for older age populations and key considerations for the decision-maker involved in selecting, installing and supporting community use of outdoor exercise equipment. Recommendations on what is required to maximise usability from a system or organisational-based approach using research evidence is also discussed. Older people are more susceptible to the negative influences of their local environment and outdoor neighbourhood conditions. Consequently, the age-friendliness and suitability of the outdoor exercise equipment characteristics, location and settings may facilitate older adults' engagement in physical and social activities.

This chapter applies a spatial approach to discussion regarding policy relationships between different government agencies with different priorities. Government policy is traditionally dealt with in the abstract form of ideas, graphics and text in formal boardroom settings. Discussing abstract policy in a formal setting limits the capacity for creativity and adaptation of ideas and may also foster defensive behaviour by its proponents. An abstract and defensive debate can stymie progress toward a mutual understanding that is exacerbated when policies cross agency jurisdictions. To overcome the abstract nature of government policy debate and the limitations of formal settings, a spatial workshop exercise was developed to test the effectiveness of a spatial approach to understanding policy relationships between different agencies. A range of senior government agents participated, each with responsibility for land use but with different, overlapping priorities. The researchers found that using a physical spatial representation of policy generated a sense of fun while also encouraging positive discussion and understanding. Participants commented positively on the spatial approach that enabled new and clear understandings of policy. This study demonstrates that a spatial approach to policy discussion facilitated positive and productive interactions between government agencies.

This article explores historical, contemporary and emerging sites of contestation within sports, with a particular focus on women’s Australian Rules football in Australia. Sport played out on the field, in the media, popular culture, governance and legal arenas are positioned in this article as contested public spaces. The increasing presence of women in these spaces is seen as a shift towards a more socially just sporting space. With an emphasis on the contemporary sporting landscape and the historical commencement of the national women’s Australian Football League Women (AFLW) competition in February 2017, the evolution of this sport as a contested space can be understood as it relates to narratives of hope and opportunity for women. With overwhelming public feeling that the first AFLW season was a success, it is time to pause and consider what this development means for elite women’s sport, and women in contemporary Australian society more broadly.

© 2017 Informa UK Limited, trading as Taylor & Francis Group This article explores historical, contemporary and emerging sites of contestation within sports, with a particular focus on women’s Australian Rules football in Australia. Sport played out on the field, in the media, popular culture, governance and legal arenas are positioned in this article as contested public spaces. The increasing presence of women in these spaces is seen as a shift towards a more socially just sporting space. With an emphasis on the contemporary sporting landscape and the historical commencement of the national women’s Australian Football League Women (AFLW) competition in February 2017, the evolution of this sport as a contested space can be understood as it relates to narratives of hope and opportunity for women. With overwhelming public feeling that the first AFLW season was a success, it is time to pause and consider what this development means for elite women’s sport, and women in contemporary Australian society more broadly.

© 2017 Editorial Board, Urban Policy and ResearchEmerging shortages of community sporting facilities in Australian cities have led to calls for increased provision of playing fields through public park and open space planning processes. Drawing on a broad literature review and a specific case study of metropolitan Perth, this paper evaluates the value of organised sport as a function of contemporary public parks before proposing policy and practice to ensure that such an increase complements broader urban planning agendas. An analysis of the evolution of public park planning shows that, while the provision of organised sport was the primary function of public parks in the middle of the twentieth century, contemporary park planning is characterised by the embrace of broader ecological planning concepts such as green infrastructure and ecosystem services. These broader concepts are then applied to understand the value of organised sport held within public parks, including its unique benefits and notable limitations when considered alongside other forms of outdoor recreation. With these limitations in mind, this paper concludes by identifying existing and future policy and practice that can help to ensure that demand for community sporting facilities in new residential areas can be met in a manner that complements this ecological role for local parks.

© 2017 John Wiley & Sons Ltd.This paper explores the engagement in physical activity as a potential coping strategy for asylum seekers living in the Australian community without the right to work and with prolonged uncertainty, and benefits or barriers to undertaking such activity. Semi-structured in-depth interviews were held with 29 asylum seekers who had arrived to Australia by boat and were living in the community in the cities of Perth, Sydney or Melbourne in July-October 2013 after their release from immigration detention. The ratio of the numbers of men and women interviewed (23 men and 6 women) was comparable to the ratio of men and women who came by boat to Australia seeking asylum in 2012-2013. Nine participants reported that they participated in physical activity as a coping strategy. Seven other participants were so worried about their future and their families that they did not have the mental or physical energy to engage in physical activity. A further six wanted to participate in physical activity but faced a number of barriers to doing so. The seven remaining participants were either not asked about their physical activity engagement because they focused their discussion on other challenges or did not elaborate on why they were not engaging in physical activity. The findings suggest that physical activity, coupled with other coping strategies, are important for some asylum seekers in trying to manage the distress of being denied the right to work and living with prolonged uncertainty. In addition, these findings highlight the critical barrier that government policy plays in disabling engagement in physical activity, which further compounds social exclusion. This includes the lack of welfare support provided, which hinders people's financial ability to access activities and support in the community.

Objectives: There is accumulating evidence about effectiveness of a number of suicide prevention interventions, and a multilevel systems approach seems promising in reducing suicide risk. This approach requires that components ranging from individual-level to public health interventions are implemented simultaneously in a localised region. This paper presents estimated reductive effects on suicide attempts and deaths that might be expected in Australia if active components of the systems approach were to be implemented. Method: The study estimated population preventable fractions which indicate the extent to which suicide attempts and deaths might be decreased if the each of the proposed interventions was fully implemented. The population preventable fractions were based on the best available evidence available in the literature for the risk ratio for each intervention. Prevalence estimates were assessed for each component of the proposed systems approach: reducing access to suicide means, media guidelines, public health campaigns, gatekeeper programmes, school programmes, general practitioner training, psychotherapy and co-ordinated/assertive aftercare. Results: There was insufficient evidence available for the impact of a number of strategies, including frontline staff gatekeeper training, on either suicide attempts or deaths. Taking prevalence of exposure to the intervention into consideration, the strategies likely to bring about the strongest reduction in suicide attempts were psychosocial treatments and co-ordinated/assertive aftercare. The greatest impact on reductions in suicide deaths was found for psychosocial treatment, general practitioner training, gatekeeper training and reducing access to means of suicide. Conclusion: The evidence regarding the overall efficacy of the systems approach is important in identifying what strategies should be prioritised to achieve the biggest impact. The findings of the population preventable fraction calculations indicat

Urban fringe areas are vital resources for urbanized populations, but are under pressure to meet demand for a variety of land uses, including recreation. Bushwalking is a form of nature-based recreation experience founded on antiauthoritarianism, egalitarianism, and immersion in the Australian bush. An online and telephone survey gathered perceptions of bushwalking club members regarding their experiences on the urban fringe in Western Australia. Results reveal perceptions that the bushwalking experience is being eroded due to confinement into “tame” settings. Respondents perceived themselves as custodians of nature subject to inconsistent, unfair management treatment, fueling an existing bushwalker suspicion of authority. The article poses a challenge for urban fringe natural resource managers to harness the potential of bushwalking club members by overcoming negative perceptions and sharing common goals. The implication is that certain types of recreation could represent a natural resource management asset, rather than a threat to be managed.

The early childhood education and care reforms in Australia have been heralded as a cause for celebration, greatly anticipated by a sector that has lamented its invisibility. Drawing on qualitative data from a study of three towns in the south-west of Western Australia, this article aims to provoke reflection on where we stand with the celebrated aim of putting young children at the centre of the vision for Australia. The South-West Early Childhood Project investigated how childhood is constructed and how communities welcome families and young children. The study identified several themes: narratives of invisibility/ visibility; narratives of sitting still/being active; and narratives of conformity/diversity. The article foregrounds the acclaimed experience of the city of Reggio Emilia (Italy) and extends an invitation to communities in Australia to position themselves on a trajectory of hope by harnessing collective wisdom in support of landmark early childhood reforms.

Urban fringe natural areas on public land are important resources for tourism and recreation use. However these contested areas are also in demand for a range of other land uses. How the land is managed can strongly influence opportunities for nature based tourism and recreation, and the benefits that these bring to participants and host communities. This paper examines the case of tourism and recreation access to the forested urban fringe of Perth, Western Australia (WA) using a typology of land occupancy and management priorities originally devised for private land use. A review of legislation and policy relating to tourism and recreation access to land in WA was conducted. Tourism and recreation groups and land managers associated with access to the Perth urban fringe natural areas were interviewed regarding their perceptions of land access management. Most land in the WA study area is publically owned and is therefore technically accessible to the public. In regions dominated by multiple private land owners such as Europe and the UK, varying approaches to land use management may be classified according to a predictable land occupancy typology that tends to be consistently applied. By contrast, the single public land holder in this area of WA, the State Government, lacks consistency in its approach to recreational and tourist access to land. This creates both public and governmental uncertainty and confusion regarding where and how land may be accessed on the Perth urban fringe.

This paper presents an international review of policy and management regarding public recreational access to land of varying tenure and how it relates to Western Australia. This is an increasingly important issue in Australia with a growing population and associated pressure on natural resources to provide a range of services and needs. Government has identified a need to clearly define ‘access’ and better understand the complex legislative and non-legislative determinants governing access to land in Australia. The project defined responsible outdoor recreation access as individual or group walking based activities centred on responsible interaction within natural environments. Policy, legislation and management of recreational walking access to land, referred to as the right to roam, in the UK and New Zealand were reviewed. A comparative review of policy, legislation and management of land in WA was then conducted with regard to how this influences public access to land for walking based recreation. A significant portion of land in the UK and NZ is privately owned freehold that functioned to restrict public access to natural areas for recreation. It was found that establishment of a right to roam in the UK and NZ was based on several key elements: a clear justification for the right to roam, strong and broad community support, protection of landholder’s rights, and a consistent approach to implementation and management of the right to roam.In contrast, land in WA is primarily publically owned (93%). Public recreational access is determined more by the sometimes multiple management overlays that exist in any given area. As a consequence, the status of land accessibility in WA can be fluid and complex owing to the multiple management regimes and policies that can apply to any given area and adjustments in policy and management that can occur over time. This creates uncertainty with regard to rights of recreational access in WA. Understanding policy and management in

This report presents an international review of policy and management regarding public recreational access to land of varying tenure. This is an increasingly important issue in Australia with a growing population and the associated pressure on natural resources to provide a range of services and needs. Reviewing policy and management in regions where recreation access rights have been established across tenures will inform a strategic research direction for managing public recreational access to land in WA. The report is based on a desktop exercise and collaboration with WA Government representatives to source information relating to recreational access to land legislation in the UK, New Zealand and Western Australia. Information was sourced from published material, official websites and personal communications. The objectives were to: review the various elements that form the current legislative context for recreational access in UK and New Zealand; identify the various elements that form the current context in WA for outdoor recreational access; and develop a summary of implications resulting from comparisons of the WA, UK and NZ contexts.