Warning: This article discusses suicide.
A group of MPs from across the political spectrum have released a plan to achieve the long-term aspiration of zero suicide in New Zealand.
Released on World Suicide Prevention Day, the Zero Suicide Aotearoa Report was commissioned by the Mental Health and Addiction Wellbeing Group, a cross-party committee launched last year to address New Zealand's unacceptably high suicide rate.
According to the report, each year an estimated 150,000 Kiwis think about taking their own life; approximately 50,000 make a suicide plan; 20,000 attempt to die by suicide; and more than 500 will do so.
In the year ending June 30, 2019, more people died by suspected suicide (685) than they did on New Zealand's roads (353).
Compiled by Labour MP Louisa Wall, National MP Matt Doocey, ACT Party leader David Seymour, New Zealand First MP Jenny Marcroft and Green Party MP and mental health spokesperson Chlöe Swarbrick, the Zero Suicide Aotearoa report will provide MPs with information, evidence and knowledge to support long-term thinking around mental health and addiction - as well as providing a framework for discussion and debate among politicians.
The report, which combines evidence and examples from around the world, has called for suicide prevention to become an integral part of the country's post-COVID recovery. It suggested a strong public health response should be supported in the coming year to help mitigate the psychosocial risk factors associated with the pandemic.
"The country should consider positioning the issue of mental health, wellbeing and suicide prevention as an integral part of the economic and social recovery of Aotearoa," it says.
"With the unknown impacts of COVID-19 in mind, it is important that the country takes immediate steps to further strengthen and prioritise its suicide prevention activities to help mitigate the possible increase in mental distress in the days, months and years that lie ahead."
The pandemic has offered a unique opportunity to press pause and consider how things may be done differently in the future, the report notes, as New Zealand works to rebuild socially and economically.
New Zealand's at-risk populations
Moving forward, the report recommends focusing on one or more of New Zealand's most at-risk groups in the coming year. High-priority populations that experience disproportionately higher numbers of suicide include:
- Māori - the suicide rate for Māori rose from 23.72 per 100,000 in 2017/2018 to the provisional rate of 28.23 per 100,000 in 2018/2019
- Pasifika - attempted suicide rates were three times higher for Pacific youth in comparison to non-Pacific and non-Māori youth in New Zealand
- Asian - the rate of suicide among people of Asian heritage fluctuates, but has been slowly rising from 5.93 per 100,000 in 2007/2008 to a high of 8.69 in 2017/2018
- Young people aged 15 to 19 - provisional youth suicide rates are at near-record levels in 2019/2020, especially among young Māori
- People bereaved by suicide - people who are bereaved by suicide are at an elevated risk of suffering from depression, anxiety, post-traumatic stress disorder and suicidal behaviour
- Men - men of working age (20 to 65) account for more than half of all suicides. It was the second leading cause of premature death for Māori males and the fourth leading cause of premature death for non-Māori males
- People experiencing extreme mental distress or addiction problems - the majority of those who die by suicide do not have a diagnosed mental health problem, but there is an increased risk of suicide by those experiencing mental illness or abusing substances
- Farmers - elevated rates of suicide amongst farmers are consistently reported in a number of countries, including New Zealand
- LGBTI+/rainbow community - people who identify as lesbian, gay, bisexual, transgender or intersex have higher rates of suicide and suicide attempts.
How can suicide be prevented - a summary
A multi-sectorial, holistic, public health approach to suicide prevention is far more effective than a one-size-fits-all strategy, the report found. A multi-dimensional model involving central government agencies, local communities and family and whanau will target multiple areas of the system simultaneously.
As of 2017, New Zealand is one of just 40 countries known to have developed a national suicide prevention strategy - Every Life Matters - that has been adopted by Government. The framework outlines a number of actions to reduce the number of suicides in New Zealand, with the ultimate aim being zero suicide. According to a recent study, countries with a national strategy in place had a "statistically significant decline" in suicide rates for men.
"A national strategy is important as it indicates a government's clear commitment to prioritising suicide prevention activities and providing leadership and guidance on the key evidence-based suicide prevention interventions," says the report.
Based on the World Health Organization's (WHO) analysis of international evidence, the "gold standard" for suicide prevention includes a range of interventions targeting at-risk individuals on societal, communal and individual levels.
For example, structural, societal or macro-level factors that may make an individual more at-risk of suicide include stigmas, inappropriate media reporting and barriers to accessing healthcare. Universal interventions to target these factors may include improved access to healthcare, responsible media reporting, improved mental health, social welfare and employment policies and raised awareness in the general population.
Key risk factors in the community or at a meso-level, such as discrimination and conflict, may be addressed with selective interventions, based around suicide prevention programmes at a local level. These programmes can provide targeted support in the workplace, prisons, rural localities and schools and universities.
Individual or micro-level risk factors may include chronic pain, mental health issues, or abusing alcohol. Indicated interventions include suicide prevention services such as crisis helplines and internet-based programmes, support for carers of high-risk individuals and increased training for health and social service providers.
The report also found that insight from people who have a lived experience of suicide is critical to the success of suicide prevention strategies. Approaches should be informed by evidence, including the knowledge of others with a first-hand understanding of suicide and its impacts.
The report concludes that Te Tiriti o Waitangi - the Treaty of Waitangi - should underpin all systems, structures, operating models and resourcing approaches for Māori.
Moving forward, the report has recommended for evidence-informed strategies to be identified for New Zealand's high-priority groups.
'No single answer' - expert opinions
Mental Health Foundation chief executive Shaun Robinson says the report is "sensible and well-informed".
"I think the report is very, very good," he said. "They recognise the complexity of suicide, which is a really good thing."
However, he hopes New Zealand's suicide prevention strategy, Every Life Matters - the strategy describing the Government's aims for suicide prevention over the next 10 years - will be given a more direct outline.
"What we hope to see in terms of the Every Life Matters strategy is we need to bring that down to an action plan, where people can see what is going to happen, when it's going to happen and their role in that. I think COVID-19 has slowed those sort of processes down, but that's where we need to get to."
AUT's Dianne Lummus, a programme leader for Master of Psychotherapy, Child and Adolescent, also praised the report's recognition that suicide interventions need to be multi-dimensional and broad-based.
As an at-risk group, it's imperative that interventions targeted towards youth focus on reducing anxiety, building secure attachments with parents and wider whanau and increasing emotional resilience, she said.
Victoria University clinical psychologist Dr Dougal Sutherland noted that the findings and recommendations outlined in the report make it clear "there is no single answer to the question" of how to reduce New Zealand's suicide rates.
"What is clear is that significant funding across multiple sectors of our society is needed if we are to achieve the goals set out by Zero Suicide Aotearoa," he said.
"This report is a sign that society is beginning to recognise the importance of attending to mental wellbeing as a priority."
