Alcohol links with crime and suicide

“You drink too much and bad things will happen”.

Drinking rates amongst young is declining, but is still high in older age groups.

Half of suicides and half of crime is linked to alcohol.

JLR, the media and a difficult mental health question

There have been a number of puzzling aspects about how the health of Jami-Lee Ross has played out in public. One obvious one is that it has played out in public as it has – Ross has come newsworthiness as an MP, but people with mental health problems tend to deal with them as privately as possible. Ross is not the first MP to have mental health problems they have had to deal with, it is a very stressful environment to work in.

The media have reported on this as they should, and I’m aware of the trickiness of reporting on someone’s mental health, especially when attempted suicide is mentioned. But I am surprised how they have done it unquestioningly. They seem to have taken Ross’ word for how things happened and how it affected him.

And I was surprised to see media (2) jump in with coverage of a Ross tweet on Saturday where Ross replied to a tweet from Bridges, saying “Are you sure you’re the right person to be criticising others on the topic of mental health??”

Stuff: Jami-Lee Ross takes Simon Bridges to task over mental health tweet

Newshub: Jami-Lee Ross rips into Simon Bridges in mental health tweet

One could easily assume that this is exactly the sort of publicity that Ross was aiming for – helping him attack his former parliamentary colleague and leader, despite Ross claiming some time ago that he bore no grudges.

Stuff went to Ross for further comment:

Ross told Stuff on Saturday afternoon he would be using his platform as an independent MP to “raise issues which are important”.

“Mental health services in New Zealand urgently need more funding,” he said.

“The government Simon and I were part of let the sector down and let the system reach crisis point.

“We now owe it to patients and mental health practitioners to work with the government constructively.”

I think this raises an important issue – how much should the media assist Ross with publicity?

And a more important one – should they do this without scrutinising Ross and his mental health claims. Ross chose to go public on mental health, and he continues to use mental health as a way of criticising his former leader and party.

While the media seems to have avoided questioning Ross’s mental health claims, some questions have been raised at Kiwiblog before now, and again yesterday.

I’m happy to take the downticks but I call “bullshit” on jlr’s “mental illness”.

I am not “mental health expert” but have had a couple of mates over the years suffer from a mental issue and a couple of my eldest’s school friend as well. Some involving committal and if that tosser claims he was “committed” then released after 24 hours then he’s full of shit. Plus, it was over a weekend so there would have been less “professionals” on duty to assess, commit and release.

I wondered at the time about how quickly Ross was released from care after he was committed after claiming to have attempted suicide. It had seemed like a very rapid recovery. And it was followed by a sustained attack on Bridges, Paula Bennett and National – that seemed an unusual thing to happen when someone was suffering from a severe mental health problem.

And:

My mental health meltdown happened in early November 2017, and I have only returned to work on a part-time basis since December 2018. Unsurprisingly, I am sceptical about how quickly Ross has supposedly recovered.

I can understand that media would be cautious about what they report on with Ross for fear of precipitating mental health problems, especially with talk of suicide in the mix.

I find it more difficult to understand some media giving Ross publicity in his ongoing attacks, without looking further into what Ross has claimed.

For example, is Ross the right person to be criticising others on the topic of mental health? And is it fair for him to use his mental health issues as a weapon against others? Bridges has vowed not to respond to Ross’ ongoing taunts, which is wise, as he would be at risk of Ross using that against him as he has done with other things.

Cameron Slater was going hard out on Whale Oil presumably on behalf of Ross attacking Bridges and Bennett and National until Slater had his own serious health problem.

While Slater is no longer posting at Whale Oil it was perhaps of interest to see Juana Atkins post yesterday, ironically What a tangled web we weave, applauding the media attention given to Ross.

If Simon Bridges thinks that the Jami-Lee Ross and Sarah Dowie story is going to go away he is wrong. The media are not going to let it go away.

He told the caucus on Thursday that what Jami-Lee Ross said about his staff member being put up to talking to the media by Deputy leader Paula Bennett was all BS. He clearly hasn’t considered the possibility that Jami-Lee Ross may have taken very, very detailed notes. If he keeps repeating that assertion, he may live to regret it.

This is similar to claims and threats that Slater had been making. Slater has a history of making claims and insinuations of having damning evidence, but failing to front up with any evidence.  A trick he shared with Winston Peters was attacking people and making insinuations, and trying too get the media to find the evidence they claimed to have.

A smart journalist would hound Paula Bennett until she says again that she had no involvement in setting up the Newsroom hit job on Jami-Lee Ross. Her continued lying is going to get her and Bridges into an awful bind that will likely cost them their jobs when the truth finally comes out.

Smart journalists should be very sceptical about encouragement to take particular lines of inquiry in this.

Smart journalists should have been asking why Slater and Whale Oil and Atkins have been either working with or using Ross so much in their joint attacks on National.

And I think it would be fair for smart journalists to be asking about the actual mental health situation with Ross.  So far Ross has been able to dish out free shots with the willing help of some media.

Ross has chosen to continue to go public using mental health as a political weapon. This deserves further scrutiny.

Something else that deserves further scrutiny (from Kiwiblog comments):

peterwn:

Interesting, Jami effectively has a ‘hot line’ to the media via his Twitter account since various journos ‘follow’ him. What do you have to do to get a similar ‘hot line’ to the media

Keeping Stock:

I suspect the “hotline” is not so much from Ross as from one of the people who is “advising” him.

And speaking of Ross; is there any truth in the allegation he had an extra-marital relationship with a journalist, and if so, isn’t it as much in the public interest for the journalist to be named as it was to name Sarah Dowie?

This is pertinent given that journalists have aided Ross with his attacks and claims from the start of this with the reporting of the leaking of Bridges’ expenses.

Journalists are still helping Ross with his attacks.

It’s not just Ross’ mental health that they are not questioning. It is also the complicity in Ross’ affairs of at least one person in their own ranks that they are sweeping under the carpet.

Sad and shocking surge in suicide rate

There was a lot of angst expressed this week when the news of journalist and TV presenter Greg Boyed’s death became known.

It was obvious from reports that he had struggled with depression that he had ended his own life (sadly while on holiday overseas with his wife and young child).

As sad as this high profile death was, it was just a minor blip in our shocking and escalating suicide statistics.

Provisional annual suicide figures were released yesterday : 668 people died by suicide in the 2017/2018 year.

That’s nearly 13 people on average per week who take their own lives in New Zealand. and the trend is bad.

  • 2007/2008 – 540 deaths, 12.20 per 100,000
  • 2008/2009 – 531 deaths, 12.04 per 100,000
  • 2009/2010 – 541 deaths, 12.26 per 100,000
  • 2010/2011 – 558 deaths, 12.65 per 100,000
  • 2011/2012 – 547 deaths, 12.34 per 100,000
  • 2012/2013 – 541 deaths, 12.10 per 100,000
  • 2013/2014 – 529 deaths, 11.73 per 100,000
  • 2014/2015 – 564 deaths, 12.27 per 100,000
  • 2015/2016 – 579 deaths, 12.33 per 100,000
  • 2016/2017 – 606 deaths, 12.64 per 100,000
  • 2017/2018 – 668 deaths, 13.67 per 100,000

So that is an alarming rise over the last two years.


Chief Coroner releases provisional annual suicide figures

Chief Coroner Judge Deborah Marshall today released the annual provisional suicide statistics, which show 668 people died by suicide in the 2017/18 year.

New Zealand’s suicide rate – the number of suicides per 100,000 population- is at the highest level since the provisional statistics were first recorded for the 2007/08 year and has increased for the fourth year in a row.

Judge Marshall says suicide continues to be a significant health and social problem in New Zealand.

“It’s a tragedy to see the number of self-inflicted deaths increase again. We need to keep talking about how to recognise the signs that someone may want to take their own life. If someone expresses thoughts and feelings about suicide, take them seriously.”

The 2017/18 annual provisional suicide statistics show:

  • Female suicides have increased by 44 compared to last year, while male suicides increased
    by 18. The ratio of female to male suicides is 1 : 2.46.
  • The age cohort with the highest number of suicides was the 20-24-year-old group, with 76
    deaths, followed by the 45-49-year-old group with 67 deaths.
  • The Maori suicide total (142 deaths) and rate (23.72 per 100,000) are the highest since the
    provisional statistics were first recorded for the 2007/08 year. Male Maori continue to be
    disproportionally represented in the provisional suicide statistics with 97 deaths last year.

“…the same comment is often repeated by Coroners. If you think someone is at risk, support
them to reach the appropriate services as soon as possible.”


Suicide Prevention

Most people who attempt suicide don’t want to die – they just want their pain to end or can’t see another way out of their situation. Support from people who care about them, and connection with their own sense of culture, identity and purpose, can help them to find a way through.

Information service

Through the Mental Health Foundation’s information service, we can link you to information about suicide prevention support available. Otherwise, if someone has attempted suicide, or you’re worried about their immediate safety, you can do the following:

  • Call your local mental health crisis assessment team or go with them to the emergency department (ED) at your nearest hospital.
  • If they are an immediate physical danger to themselves or others, call 111.
  • Stay with them until support arrives.
  • Remove any obvious means of suicide they might use, eg, guns, medication, car keys, knives, rope.
  • Try to stay calm and let them know you care.
  • Keep them talking: listen and ask questions without judging.
  • Make sure you are safe.

Factsheets

For more information about supporting yourself or someone else who is suicidal, we have developed a series of online factsheets:


Helplines


I have also been given this information:

Intellicare:

IntelliCare a suite of mobile apps that work together to target common causes of burnout, depression and anxiety like sleep problems, social isolation, lack of activity, and obsessive thinking.

These free apps are part of a nationwide research study funded by the National Institutes of Health in the USA.

People may download individual apps or the whole IntelliCare suite by clicking on the Intellicare logo.

https://intellicare.cbits.northwestern.edu/#apps

Beating the Blues:

Beating the Blues has 8 free (to people in NZ) sessions which each last about 50 minutes. Beating the Blues is based on Cognitive Behavioral Therapy (CBT).

http://www.beatingtheblues.co.nz/about-beating-the-blues.html


The amount of negativity and acrimony online could also be a problem. Try to be more positive, more constructive, and nicer.

Men, suicide and silence

The death rate from suicide is significantly higher than for road accidents, with over 600 people per year ending their own lives in the latest statistics.

Chief Coroner releases provisional annual suicide figures

  • 606 people died by suicide in 2016/17, up from 579 the previous year and 564 the year before
  • 20-24 years old – 79
  • 25-29 years old – 64
  • 40-44 years old – 64
  • 12.64 suicide rate per 100,000 suicide – higher than last year (12.33), similar to 2010/11 (12.65)
  • 21.73 suicide rate – Māori
  • 19.36 suicide rate – men
  • 6.12 suicide rate – women

Until recently it was a silent problem – talking openly about it was taboo.

Newsroom/Victoria University: Men, suicide, and four types of silence

New research from Victoria University of Wellington reveals that a key aspect of young men’s experiences of suicide bereavement is ubiquitous silence.

In the first study of its kind, Dr Chris Bowden, who is a lecturer in Victoria’s School of Education and recently graduated with a PhD in health, found that young men aged between 17 and 25 who lost a close male friend to suicide, suffered, grieved and eventually recovered in silence.

Bowden conducted in-depth “lived experience” interviews with the young men over a period of a year. These took place as “go-alongs” or “ride-alongs” while the men were working on cars, at barbeques, during events like burnouts, and while playing PlayStation or Xbox.

His research found the men experienced four types of silence following the suicide of a close friend: personal, private, public and analytic silence.

“Early on, the men were unable to describe what they were experiencing to others. They also chose to keep quiet, be stoical, suppress and control their emotions and keep their grief private. In public and social situations, the words and actions of others and their fear of being judged as weak and vulnerable often silenced them”.

Bowden says they chose to break their silence only with those they trusted, who understood what they were going through and who “were there for them”.

“The men also sought quiet places to reflect on, analyse and make sense of their experience and how it had transformed them”.

“In order to understand their experience as it was lived by them it was important to build trust and rapport, and to understand who they were and the friends they had lost”.

“A lack of research examining young men’s experiences of suicide bereavement means that their grief may go unnoticed, be minimised, or even misunderstood”.

Bowden recommends that health professionals, families/whānau and friends learn to see, listen to and interpret the silence of men in order to better understand their experience and need for care and support.

Where to get help:

– Lifeline: 0800 543 354 (24/7), Youthline: 0800 376 633 (24/7), text free to 234 (8am-midnight) or live chat (7pm-11pm)

– Kidsline: 0800 54 37 54 (24/7; Kidsline Buddies available 4pm-9pm)- Suicide Crisis Helpline: 0508 TAUTOKO / 0508 828 865 (24/7)

– What’s Up: 0800 WHATSUP / 0800 942 8787 (1pm-10pm weekdays, 3pm-10pm weekends) or live chat (5pm-10pm)- Healthline: 0800 611 116 (24/7)

– Samaritans: 0800 726 666 (24/7)- Depression Helpline: 0800 111 757 or text free to 4202 (24/7)- If you feel you or someone you know is at immediate risk, call 111.

Mike King predicts a rise in suicide rate

Mike King, who is closely involved in addressing the high rate of suicide in New Zealand, predicts the numbers will go up.

NZH: Mental health advocate Mike King is predicting a rise in our suicide rate

“We have to understand there are so many suicides that aren’t recorded.

“Coroners have to be 100 percent sure. So if there’s alcohol in the system, there are drugs in the system, if there’s any doubt at all that it may not have been [suicide], they are not recorded,” Mr King said on RadioLIVE on Saturday.

“The reason that those statistics are going to climb over the next few years is because as people have an understanding that this is a real thing, the threshold comes down.

“So please New Zealand, don’t be surprised when these numbers come up.”

That may be a warning based on what King sees happening (and not happening), it may be a shock tactic to make more happen in suicide prevention, or it may be a bit of both.

New mental health figures reveal 11.8 percent of 15- 24-year-olds are affected by psychological stress, defined in the Ministry of Health survey as having “high or very high probability of anxiety or depressive disorder”.

It’s an increase on last year’s 8.8 percent figure in the same age bracket, moving from 58,000 to 79,000 people.

That’s a lot of young people at risk.

Around one in ten young New Zealanders seeking mental health is having to wait more than two months to see a specialist.

New Zealand also has the highest suicide rate in the OECD for 15- to 19-year-olds.

Whatever it is we have a major problem with suicide in New Zealand.

Mr King says experts who blame poverty, housing and colonisation for the suicide rate are sending a dangerous – and incorrect – message.

This may in part be aimed at new Minister of Health David Clark who this week referred to poverty and colonisation – New Health Minister David Clark on youth suicide: We have a problem and we need to talk about it:

Labour campaigned on mental health and pledged the return of the mental health commissioner and an inquiry into mental health.

Terms of reference and other details around the inquiry were yet to be settled, Clark said, but forecast it as wide ranging, considering issues of colonisation and poverty.

He spoke of “hardship, or the after-effects of colonisation, or trauma in their own lives or personal histories”.

King’s view:

“Of the thousands of kids that I’ve spoken to that have been suicidal not one of them has come up to me and said, ‘Mike I want to kill myself because of housing’. Not one of them has said ‘I want to do it because of poverty’.

“What we are being told are the reasons and what I am hearing on a daily basis are completely different.”

“For most young people, their suicidal behaviour is driven by a little thing that everyone owns called the inner critic. That little voice constantly undermines their logical thinking.

“Self-esteem comes from having your thoughts and opinions validated by the significant adults in your life.”

Mr King says the solution will be found with communities supporting one another and not with the Government.

That’s a biggie – in our modern satellite society community interactions and support have shrunk. ‘Community’ is more often than not electronic based, especially for young people.

Rural suicides are a problem – modern farmers often work alone, rural communities are much smaller with a much smaller rural workforce, and despite their faults rural pubs are disappearing – perhaps in part the reduced road toll has become an increased suicide toll.

Clark:

“I think we need a public conversation about this. We can’t avoid it as a country. We have a problem and we need to talk about it.”

Perhaps a good place for him to start is with a private conversation with Mike King.

Unseemly stoush over youth suicide

Of all things youth suicide is one of the worst issues to become a victim of unseemly political niggling, but that is what has happened between the new Minister of Health David Clark and the previous Minister, Jonathan Coleman.

Coleman had problems with diplomacy and public relations, but Clark seems to have not graduated fully from being in opposition yet.

NZH:  New Health Minister David Clark on youth suicide: We have a problem and we need to talk about it

Labour campaigned on mental health and pledged the return of the mental health commissioner and an inquiry into mental health.

Terms of reference and other details around the inquiry were yet to be settled, Clark said, but forecast it as wide ranging, considering issues of colonisation and poverty.

He spoke of “hardship, or the after-effects of colonisation, or trauma in their own lives or personal histories”.

Past practices of shutting down debate on suicide did not deal with an issue that was persistent, Clark said.

“I think we need a public conversation about this. We can’t avoid it as a country. We have a problem and we need to talk about it.”

But he also challenged media to tell stories of survival and recovery, and not to dwell only of those who had taken their lives.

Not talking about it has failed so talking about it makes sense – as long as it is sensible talk. However continuing a political slanging match is not a good place to start.

New Health Minister Dr David Clark has leveled a stinging accusation at the previous government and his predecessor Dr Jonathan Coleman, saying funding and priority shortfalls led to more victims of suicide. Clark made the comments during an interview with the Herald as part of its Break The Silence campaign on youth suicide.

The interview charted the new Government’s hopes for greater suicide preventions and a pledge that more would be done to save the lives of those contemplating taking their own.

Our teen suicide statistics are the worst in the developed world and we have the second greatest number of self-inflicted deaths among those aged 25 and under.

The latest suicide statistics had the highest number of suicides ever – 606 people took their lives. And the figures were little better measured against an increasing population showing little movement in the last decade.

It is a problem that has proven difficult to deal with.

Clark was critical of Coleman and the previous government during the interview, saying officials were “frustrated” over the failure to develop a new Suicide Prevention Strategy after the previous one expired a year ago.

He also criticised Coleman for failing to match an increase in people seeking mental health support with funding.

Political bickering is not a good start to trying better ways of dealing with it.

Asked if that cost lives, Clark initially said it was “very hard on an individual level to say that somebody died because of a lack of funding”.

He then said: “The proposition you’ve put is one that seems reasonable to me, that if you don’t support people, more people are going to take their own lives. I don’t think we can deny that.”

Asked how he felt about there being no current suicide prevention policy, Clark said: “I have expressed publicly frustration with the previous minister. I don’t think there’s much point dwelling on that now. I feel the burden of office that I have picked up. I want to make sure we are in a position as government to find solutions.”

A response: Jonathan Coleman says he’ll hold new health minister to account over suicide target

National’s former health minister Dr Jonathan Coleman says he will be holding the new health minister to account if New Zealand’s suicide rate does not drop.

Coleman declined to be interviewed by the Herald for the story but spoke to Newstalk ZB’s Larry Williams this afternoon.

He told Williams he was surprised Clark was personalising the issue.

“Dr Clark is now signalling he is going to take personal responsibility for the suicide rate from this point on with a zero suicide target … I think he’s making a real rod for his own back,” he said.

“Of course we want to get the suicide rate down … it’s an extremely tragic and difficult area and I’m just very surprised that he’s prepared to talk like this – he’s not doing himself any favours.”

Coleman defended his record on mental health, saying the National government had put an extra $300 million of funding for mental health in the 2017 budget, with $100 million going into spending on portfolios like social welfare, housing and education that impact on mental health.

It’s too soon to know if that extra funding will make any significant difference, and it can easily be argued that it is too little, too late (that can always be argued in politics).

Asked by Williams if any government was accountable for New Zealand’s suicide rate, Coleman said it was “foolish” for the new health minister to say so.

“I genuinely wish Dr Clark well in improving that suicide rate because he’s now set the target, he’s said he will taking personal responsibility and I will be holding him to account over that,” he said.

“I hope he does succeed because this is people’s lives – but clearly if he doesn’t he will be failing to deliver on one of biggest things he campaigned on.”

It’s disappointing to see both Clark and Coleman making this issue political and personal. It is far too serious and important to be overshadowed by bickering.

Health is a very difficult portfolio to manage, because there will always be deaths, and there will always be demands and pressures on funding.

Youth suicide – and don’t forget middle aged suicide which is as big a problem – deserves better from both the Minister and the ex Minister.

Another National embarrassment

When things swing against political parties it can be hard to turn it around – especially when they keeping doing or saying silly things.

Steven Joyce dragged National down last week when they were already flagging behind Labour in the polls.

Today 38th ranked MP Simon O’Connor has National in the negative news column after a Facebook comment on Sunday night:

image-dynimg-full-q75

With opponents and journalists looking for something to kick of the week with this got a good airing.

Newshub:  No apology from National MP Simon O’Connor over suicide comments

Hundreds gathered outside Parliament on Sunday to urge the Government to do more on mental health. New Zealand has one of the highest suicide rates in the world, with more than 600 victims in the past year.

O’Connor’s tweet was in response to Jacinda Ardern’s involvment in that.

“It’s strange that Jacinda is so concerned about youth suicide but is happy to encourage the suicide of the elderly, disabled, and sick. Perhaps she just values one group more than the others? Just saying.”

Not surprisingly:

Hundreds expressed outrage on social media, including a number of MPs.

Ardern responded:

Ms Ardern told Newstalk ZB on Monday morning euthanasia and suicide were “completely different issues”.

“The 600 people in New Zealand who have taken their own lives will shock and appal all New Zealanders. The fact our mental health services aren’t doing enough for those people, that’s something we should be talking about this election.

“To draw then a comparison to the issue of the people having the ability to make choices about their own end of life if they’re facing terminal illness, is absolutely a completely different issue again.

“I’ve said openly that I believe people should be able to make their own choices in those circumstances. Mr O’Connor disagrees, he chaired a select committee on this issue and disagreed there too. That’s a conscience vote for us all.”

O’Connor said that no apology was necessary.

But rather than withdraw the comments Mr O’Connor is doubling-down, telling Newshub on Monday he had nothing to apologise for.

Mr O’Connor said he didn’t doubt Ms Ardern’s sincerity, but said she should “also be sad about those who are old or depressed or disabled who are also looking to suicide”, and called her views “inconsistent”.

“The intention of taking one’s life is called suicide. There are some who say that there are legitimate opportunities where it should be allowed, and we call that euthanasia or physician-assisted dying. So no, it’s just an inconsistent approach.”

“At one level saying youth suicide is bad, but saying other forms of suicide are acceptable, that’s an inconsistency. That’s always been the approach I’ve had,” he said.

“You cannot allow suicide for some and prevent it for others”.

Predictably Bill English was asked about it and all he could do was lamely slap O’Connor’s hand:

NZH: Bill English tells Simon O’Connor he’s wrong over euthanasia comments

National leader Bill English says he has texted his colleague Simon O’Connor to tell him it was wrong to link suicide and euthanasia.

Speaking at a press conference this afternoon, English said he didn’t agree with O’Connor.

“We don’t link euthanasia and suicide,” he said.

“In both cases, what’s important here is compassion for people who are vulnerable.

“For suicide, we’re trying to find better and wider solutions as a practical expression of that support for people who are at risk.”

But the damage had been done. This makes National look out of control and out of touch.

O’Connor completed training as a Catholic priest but didn’t seek ordination. He has previously expressed strong views against euthanasia.

But he isn’t totally devout in catholic practices.

Stuff in February last year: National MP Simon O’Connor to marry Minister Simon Bridges’ sister

National MP Simon O’Connor kicked off the new year proposing to Transport Minister Simon Bridges’ sister.

O’Connor’s fiance, Rachel Trimble, who still uses her ex-husband’s name, says politics really runs in the family and she’s joked to O’Connor that he should take her maiden name for fun.

“It’s quite confusing, I’ve had people think that I’m dating Simon Bridges, and I have to explain that he’s my brother,” Trimble said.

“I’m quite surprised he even likes me, considering I have five children…he’s a really kind and caring guy,” she said.

The kids are “great” and “fundamentally they still have a Dad, and it’s not me,” O’Connor said.

O’Connor admits when he was studying to be a priest in the seminary a decade ago he didn’t expect he’d end up marrying an older woman with five children.

Between 1995 and the end of 2004 O’Connor was studying for the priesthood with the Society of Mary.

He completed his studies but when it came to being ordained he decided it wasn’t for him.

“I’m still a man who has beliefs but it’s not a big part of who I am.”

“I don’t regret a day of being in the seminary but you can’t be a politico and a cleric.”

Trimble and O’Connor married in December last year. Unless rules have changed they would not have been able to get married in a Catholic Church.

This latest controversy is a relatively minor embarrassment for National but it could be another nail in their campaign coffin.

Modern living impacts on mental health and suicide

Peter Gluckman, from the Office of the Prime Minister’s Chief Science Advisor, has released a discussion document on youth suicide.

It says that complex issues are involved but the pressures of modern living are a major stress factor.

An edited version of the report:


Youth Suicide in New Zealand: a Discussion Paper

Not all suicide is the same and youth suicide often has different drivers to suicide at later ages. Further while much is spoken and argued about its prevention, it remains a complex and contentious area with much advocacy for unproven interventions.

In particular this paper makes the point that youth suicide is more than simply a mental health issue and that, with what we know at present, the focus must also include an emphasis on primary prevention starting from very early in life. This means promoting resilience to the inevitable exposure to emotional stresses and building self-control skills in early childhood and primary school years, by using approaches that we already know about.

It means promoting mental health awareness and ensuring that there are competent and adequate adult and peer support systems in secondary schools. This must be backed up by a capacity to find and rapidly support those children and young adults who are in mental distress and ensuring that the needed interventions and therapy are early and effective.

The changing context of a young person

The way that young people live their lives has changed greatly over recent decades and this has created a range of poorly understood but probably critical pressures that affect their psyche and behaviour.

Family structure has changed; childrearing practices have changed; for many, the level of parental engagement has changed. Technology has changed the nature of their social networks and communication; media, celebrities and other social factors can create unrealistic expectations and pressures on young people.

Compared to previous generations, youth face many more choices at an earlier age, but at the same time may have less clarity as to their path ahead. The role of traditional community supports such as sports, church and other youth groups has declined. Youth now have more access to credit cards and money that gives them greater freedoms.

The pace of these sociological and technological changes is unprecedented and it is not surprising that for many young people, particularly those with less psychological resilience, it can leave them with a growing sense of dislocation.

The many factors that impinge on the risk of youth suicide

Youth suicide cannot be considered as just a mental disorder. A number of factors interplay. Studies in the US5 and elsewhere4,6 show that the likelihood of a suicide attempt is associated with a number of factors including:

  • socio-demographic factors and restricted educational achievement;
  • family discord and poor family relationships;
  • the tendency to being impulsive;
  • what is termed externalising behaviour (anti-social behaviours, and alcohol
    problems);
  • what is termed internalising behaviour (e.g., depression);
  • low self-esteem, hopelessness, loneliness;
  • drug and alcohol misuse;
  • a history of suicidal behaviour among family and friends; and
  • partner- or family-violence exposure in adolescence.

Impulsive-aggressive behaviours are commonly associated with suicide in young
people and decline as a factor with age. Youth who demonstrate antisocial or
delinquent behaviours are 10 times more likely to have attempted suicide.

The key conclusion from these studies is that youth suicide needs to be regarded as much more complex than simply outward evidence of mental disorder. Rather, it needs to be seen as the result of a state of stressed, impaired or underdeveloped self-control in which mental health, emotional and brain development, alcohol, sociological, economic, and other factors interact to put some young people at greater risk.

Adolescence as a vulnerable period – brain, biology, and behaviour

There is now compelling evidence that children who enter puberty at a younger age
are at far greater risk of behavioural, psychological, and emotional disorder. There
are probably multiple reasons for this but most relate to:

  • a longer period before those counterbalancing inhibitory brain pathways
    fully mature;
  • greater sociological and sexual pressures related to the mismatch between
    the earlier onset of physical signs of maturity and psychosexual ideation and
    chronological age: and
  • socialising with older peers who may be engaged in or express anti-social
    behaviours.

There is unequivocal evidence that children who enter puberty relatively early:

  • are more likely to indulge in alcohol and drug abuse;
  • often demonstrate more impulsive behaviours; and
  • boys show greater impairment in the quality of their relationships.

Variation in suicide rates across population groups

Many factors appear to contribute to explaining the different prevalence of youth
suicide across different population groups. They include:

  • living in environments where low self-esteem within the peer group is
    common;
  • poverty, inequality, and social fragmentation;
  • having a high rate of engagement with the justice sector and a greater
    presence of gangs;
  • higher use of drugs and alcohol2; and
  • suicidal behaviour becoming a means of demonstrating worth to the peer
    group

Deficits in self-control

Adolescence is a period of relatively poorly developed self-control and heightened impulsive behaviour. This is why some stressors that do not lead to troubled emotional responses in more mature individuals can do so in some in this age group.

So, rather than resilience, which might be expected – and needed – we see severe and harmful (including self-harm) responses. These stressors can include aspects of engagement with peers (e.g., bullying, including cyber-bullying) and emotional situations (e.g., break up of relationships).

A further possible factor is a substantial change in the way we raise children: they now tend to be under tight control in the pre-pubertal period but less control postpuberty (as reflected in: school subject choice; parental controls on time, place and behaviour; access to credit cards; access to internet, etc.).

In contrast, 50 years ago, western child rearing practice followed a loose–tight pattern in which pre-pubertal children had more freedoms, especially to undertake risky play, but adolescence was much more constrained. This reversal may have resulted in a reduction in the capacity to self-assess risk in adolescence.

Alcohol and drugs

Alcohol intoxication or a history of alcohol abuse are often associated with youth suicide30. Alcohol misuse is often associated with triggering events (conflicts in peer and intimate relationships) and, in relation to suicidal behaviours, is probably underestimated and under-reported. Furthermore, alcohol reduces self-control, can increase despair and depression and, among those with mental disorders, exacerbates symptoms.

New Zealand data show that considerably more than half of youth suicides involve alcohol or illicit drug exposure.

Peer influences, bullying and cyber-bullying

Adolescence is a stage of life when there is a “trading of dependency on parents for dependency on peers”: it is therefore not surprising that peer relationships affect mood and behaviour, including possible suicidal behaviour.

Peer influences may be particularly evident in the growing evidence for online bullying leading to self-harm. Bullying in schools occurs in many countries to varying degrees but the reported rates are high in New Zealand.

Implications for reducing the incidence of youth suicide

Suicide prevention is complicated because we do not understand the causes well enough at the individual level. Completed suicide is a rare event so it is difficult to study in the way we can study influenza or diabetes. It is really hard to predict at an individual level, with perhaps the best indicator being a previous suicide attempt/self-harm even though most who commit self-harm (which may or may not be an attempted suicide) do not go on to commit suicide.

Nevertheless, the 8–9% of all youth who are suicide attempters – with their high subsequent life-course costs (as they often have long-term psychological morbidity) to themselves, family, whānau, and society – are an important risk-group to target.

There is no definitive solution but there is a growing consensus on the following.

Primary prevention: This must start in the pre-pubertal period and is aimed at  developing resilience to the inevitable stressors of growing up, and promoting development of impulse control. The broader benefits of this approach49 include major spillover benefits to educational achievement and, later, in employment, family stability, and quality-of-life measures.

Such approaches must start early in life – and early childhood is an important opportunity for enhancing these skills and should be an evaluable focus of all early childhood education. There needs to be intense engagement with the most vulnerable families in the first years of their children’s life.

There is clear and strong evidence that a primary prevention strategy using welldefined
and structured activities (e.g., Good Behaviour Game) focused on behaviour in primary school children as young as 6 and 7 contributes to reducing later adolescent suicidality as well as other unwanted behaviours, and we would strongly suggest the introduction of this into all primary schools.

Secondary prevention: This refers to programmes that focus on the adolescent period and seek to identify those at risk and make referrals when necessary. Such programmes include activities that seek to increase understandings and change attitudes about youth suicide and to enhance the capacity to intervene and prevent.

The role of teachers, trained counselors and peer leaders is seen as key. There is some evidence to support the importance of adults actively engaging with distressed students, but outside those situations where close counseling relationships have been developed, these programmes tend to be distressingly ineffective. Better results are claimed when secondary prevention is combined with primary prevention and engaging peer leaders (that is well-trained youth leaders).

Tertiary prevention: This focuses on those who are identified as being at particular risk, for example having attempted suicide. It generally involves CBT or medication or both; as noted above, the effect on suicidality, as opposed to other aspects of mental health, is relatively small. Although investing in youth mental health is a critical priority for the reduction of adolescent and adult mental health disorders, it cannot be the only strategy for reducing youth suicide.

Summary and conclusions

Youth suicide remains a complex, multifaceted challenge. A focus on adolescent mental health, although important, is not sufficient. Rather, we conclude that the high-priority need is to introduce and reinforce programmes focused on primary prevention starting early in life and developing secondary prevention strategiesinvolving well-trained and engaged mentors including peer mentors. Understanding and co-design with our communities and particularly with Māori perspectives will be crucial at each stage as we develop, test and take to scale approaches shown to make a difference.

The primary prevention approach involves strategies to improve impulse control and executive function from early childhood and this has broad spillover benefits. It involves combining these critical interventions in early childhood and primary education with secondary prevention approaches in adolescents and it requires a social investment approach particularly focusing on those communities with low resilience and self-esteem.

http://www.pmcsa.org.nz/wp-content/uploads/17-07-26-Youth-suicide-in-New-Zealand-a-Discussion-Paper.pdf

Former coroner calls to Break The Silence on suicide

The next article in a series at NZ Herald on suicide:  Let’s Talk: Former chief coroner Neil MacLean joins call to Break The Silence on suicide

Warning: This article is about youth suicide and may be distressing for some readers.

Former chief coroner Neil MacLean says breaking the silence on suicide could curb the “horrifying” number of young New Zealanders killing themselves.

“This is a drum I’ve been beating for a long time. We cannot ignore the sheer numbers and rate – it’s bigger than the road toll,” said MacLean, who retired from the post in 2015.

New Zealand has the worst teen suicide rate (officially those aged 15-19) in the world and the second worst youth suicide rate (25 and under). Our annual number of deaths has shown no signs of abating in the past 20 years.

In a special series called Break the Silence, the New Zealand Herald is aiming to bring youth suicide out of the shadows. MacLean has been one of the country’s biggest crusaders in this area and said suicide was one of the most difficult issues he faced during his almost 40 years as a coroner.

“Any unexpected death is going to produce a different type of grief, but with a suicide, particularly as it gets younger, there’s a new intensity of grief,” he said. The youngest suicide MacLean was aware of in New Zealand was that of an 8-year-old boy.

“There’s a feeling of waste, blame and anger. Everybody struggles to understand why it is when, generally the will to live is so strong, that a significant proportion of people get to the end where there is no option.”

Misunderstanding breeds fear. “It’s almost as if there’s a fear suicide is something you can catch, almost like an infection, and that if you stomp it out or ignore it, it will go away.

Some think it’s best to bury our head in the sand. Not me,” MacLean told the Herald.

During his time as chief coroner, MacLean controversially kickstarted the release of New Zealand’s annual provisional suicide statistics, allowing the public to see the number of suspected suicides for the first time.

Silence on suicide has been orthodox in New Zealand since the mid-1990s, largely because of a school of thought that talking about the issue could lead to suicidal ideation, copycat deaths or suicide contagion.

MacLean received swift criticism for releasing the statistics at the time, but stands by his decision.

“If people know what’s going on there is a better chance to do something about it. Like start talking about what we can do to help these kids.”

“The reality is, that although there are various theories of sociologists, psychologists and other disciplines, we are no closer to understanding why it is when the substantial majority of the population, including youth, do not commit suicide, and life is seen as precious, a small minority do not see life as precious.

“Despite my long experience in this area, neither do I. However, one thing I am very clear on through contact with thousands of New Zealanders, whether at inquests, lectures, talks, seminars or the like, is that our understanding in this area is still plagued with misinformation, and reluctance in some circles to open up the discussion and to face the reality of this puzzling phenomenon.

“I know from personal experience, most people want more information, particularly when someone they know is involved. What are the signs to look out for and how can they help?

“There are some encouraging signs of a willingness to open up the whole area of self-harming and self-inflicted death in New Zealand. I believe that done properly, such discussion can be beneficial and that to dismiss such discussion as dangerous and unwise is not helpful.”

Full article:

Previous articles:

WHERE TO GET HELP:

If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.

OR IF YOU NEED TO TALK TO SOMEONE ELSE:

• LIFELINE: 0800 543 354 (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757

Opening up on suicide

New Zealand has an appalling suicide rate, especially young people and especially young Maori people.

Every67hours

Our youth suicide rate (25 and under) is the second worst in the developed world.
The teen rate (15-19) is the worst, so high it raises the global average.

People and publications are becoming increasingly willing to talk openly about suicide.

Earlier this year from Jessica McAllen and MANA: THE LAST GOOD-BYE

Māori youth suicide rates are among the highest in the world. Mana talks to those fighting to turn the tide by helping rangatahi find a place to stand.

It is a detailed and sad article.

Today on Morning Report:  Suicide rates for the general population have reduced in a decade; not so for Maori

In the latest instalment of RNZ’s election year series ‘Is this the Brighter Future?’ our Maori issues correspondent Mihingarangi Forbes explores the state of Maori mental health.

And also today NZ Herald have started a series:

2012 was a particularly bad year.
144 youths took their own lives.

An unprecedented 19 were from Northland,
with one as young as 10.

Alarming and very sad.

WHAT BECOMES OF THE

BROKEN-HEARTED

I won’t try to précis the article here. See:

THE UNTOLD STORY OF TEEN SUICIDE IN THE NORTH


Also:

Break The Silence: Education Minister Nikki Kaye says time is right for national conversation about youth suicide

New Education Minister Nikki Kaye says the time is right for a national conversation about youth suicide after successive governments have failed to significantly reduce the number of young people killing themselves.

Only eight weeks into the job, New Zealand’s youngest female Education Minister is tackling the issue with ferocity and urgency.

It’s good to see Kaye driving this very difficult topic which until recently was taboo to talk about.

“Over successive governments youth suicide has been a longstanding issue, but that doesn’t mean we don’t need to take responsibility for that and continue to do more.

“This is about accepting that successive governments haven’t managed to design things in a way that’s made a significant difference, so we’ve just got to keep changing things up.”

“You know I’ve only been the Education Minister for eight weeks, but I do feel a sense of urgency about continuing to make change [in this area],” Kaye said.

She has already met the Government’s chief science advisor and education science adviser to ask “what we could potentially do differently as a country to make sure we are doing everything possible to reduce the number of young people taking their life”.

Suicide needs to be talked about more, especially by anyone contemplating ending their life.

Where to get help:

If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.

Or if you need to talk to someone else:

  • LIFELINE: 0800 543 354 (available 24/7)
  • SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
  • YOUTHLINE: 0800 376 633
  • KIDSLINE: 0800 543 754 (available 24/7)
  • WHATSUP: 0800 942 8787 (1pm to 11pm)
  • DEPRESSION HELPLINE: 0800 111 757 (available 24/7)
  • SAMARITANS: 0800 726 666
  • NEED TO TALK? Free call or text 1737 (available 24/7)