RIPPLE EFFECTS

Suicide prevention has become more urgent than ever in a time of fear, uncertainty and isolation. Experts are weighing in on the best ways for people and communities to reach out.

Provide support to those most at risk in a time of fear, uncertainty and isolation.

The newspaper headlines have painted a bleak picture about the impact of COVID-19 on the health and wellbeing of individuals in our community. The New Zealand and Australian Governments have identified suicide-prevention strategies in response to the COVID-19 pandemic, and for the foreseeable future, but how can individuals and communities help each other?

For many of us, our daily routine starts with some forms of media – reading the news online or in the newspaper, turning on the television for an update or scrolling through social media. Many of our personal responses to COVID-19 have been shaped by the messages we consume. At the peak of the crisis there were daily briefings from New Zealand Prime Minister Jacinda Ardern and her Australian counterpart Scott Morrison about how to reduce our risk of virus transmission, how to work and socialise, and how to identify our health needs. However, the unfortunate by-product of these messages was the potential to create fear and anxiety in the viewer. Many of us found our thoughts turned to the invisible effects of the pandemic and how switching off our old life might impact our emotional wellbeing as we move on with life post-pandemic. So is this going to have long-term ramifications for our mental health?

In March 2020, The University of Sydney’s Brain and Mind Centre released information about risk of suicide deaths due to COVID-19. Its modelling (usually described as the way academics use assumptions based on best-available information to calculate different scenarios through simulation) reported a possible 25 per cent surge in suicide deaths, and even more for young people – a possible 30 per cent increase. Emotional distress caused by social factors was also emphasised: insecure housing, job loss, long-term unemployment, social disconnection, women and children at increased risk of domestic violence and anxiety about the state of the world were all possibilities for many.

In New Zealand, the idea of identifying data about these risks was a little more ambiguous. The Ministry of Health stated there was no current evidence to support a spike in suicide deaths, however, as with Australia, increasing the spotlight on the flow-on effects of lockdown and a ‘new normal’ after COVID-19 highlighted that the effects of the pandemic will be long term. How this plays out as we emerge from our homes is yet to be seen.

The lived experience of suicide has always been a complex publichealth issue that impacts thousands of individuals each year. The World Health Organization suggests there may be up to 30 suicide attempts for each suicide death that is reported. New Zealand, in 2018/19, recorded its highest-ever suicide rate, with the impact of these largely preventable deaths extending across families and communities.

Research from Professor Julie Cerel and her team at the University of Kentucky suggests that for each person who dies, as many as 135 will be impacted: partners, children, neighbours, work colleagues – the list goes on. Prevention support and postvention support (for those people affected by a suicide) are imperative as we move ahead to reduce distress.

Funding announcements as a response to COVID-19 have been made to boost mental-health services. These have primarily focused on accessibility to services, mainly with the introduction or extension of telehealth as a way to connect people with their health providers. Beyond this individual contact with a health

professional, what else might be useful to address distress within groups and communities that can complement the work being done by health professionals?

Is it just about more support for people who have a pre-existing mental-health condition?

Matt Haig’s internationally successful 2014 memoir Reasons to Stay Alive placed the conversation of life after attempting suicide to the fore, detailing his life with depression and his gradual emergence from darkness to being able to manage, then thrive later in life. Importantly, he also tells of this not being a simple, linear process. Rather, there are peaks and troughs along life’s journey. His normalisation of the ways in which people live in the shadow of suicidal thoughts provided a platform for others to share their experiences.

We know that mental illness can be a risk factor for suicide attempts in terms of what it means to live with a condition and the way it shapes a person’s life, yet mental illness isn’t always the precursor to a suicide attempt. It is far more layered and complex.

“ONE OF THE POSITIVE THINGS WE’VE SEEN IS A GREATER FOCUS ON COMMUNITY RATHER THAN INDIVIDUALISM.” GEORGIE HARMAN

In March, when the New Zealand and Australian Governments chose to close their national borders and enforce lockdowns within communities to limit the spread of the virus, conversations regarding the effects of social isolation on the emotional health of the community surfaced. However, months on from that decision, some of the people in our community who live with mental illness have found that their risk hasn’t necessarily increased. Ingrid Ozols is a mental-health livedexperience speaker and CEO of Mental Health at Work (mh@work)

who regularly speaks about the importance of hearing from many voices about what it means to live a meaningful life while managing your mental health. She has found that the slowing down of life during lockdown has had unexpected gains for some people.

Working from home diminished the stress of peak-hour travel, allowed for more time to sleep in, to exercise and to work in a way that matched their needs in terms of hours. Being at home more often and being close to family positively benefited them.

Often, reduced demands allowed a simpler focus – i.e. allowing time for such things as baking, walking and meditating may be the panacea they have been searching for.

But, for others, the pandemic has been the opposite, adding to existing tensions or resulting in new strains and burdens not previously encountered. For those people, COVID-19 added another layer of complexity, as even their most supportive family and friends were understandably preoccupied with their own worries during that time.

What is the connection between emotional distress and increased risk of thoughts of suicide?

Like physical illness, mental illnesses are categorised in terms of particular criteria with causes ranging from genetic predisposition to chemical imbalances and trauma events. They are treated with psychotherapy and medications and are understood as medical conditions.

Yet, mental ill-health, and distress more generally, can be experienced when under pressure from a variety of sources. Such strains can be the outcome of relationship breakdowns, financial stress or the death of a loved one. With funding for suicide prevention research increasing over the past decade, there is an increased understanding of the ways in which, for some, life’s pressures can become too much and become a risk for suicide. Such a movement also provides fertile ground for a broader community discussion.

A 2020 study in the British Medical Journal, by Cambridge researchers, emphasised that the focus should shift from high-risk groups – those who are identified as having severe signs of a mental illness – to swift responses even if a person doesn’t seem unwell ‘enough’

One in six NZ adults has been diagnosed with a mental disorder in their lives.

to warrant it. Glancing at socialmedia posts across Twitter and Facebook during the initial stages of the pandemic, and as lockdown began to lessen, the perception of not necessarily all being in this together became apparent. Celebrities posting the challenges of lockdown in palatial properties triggered outrage from others about the inequalities we face and how they have been amplified by isolation.

As social-distancing measures lessen, does that mean that anxiety and distress will also lessen?

Not necessarily. Ingrid Ozols believes we don’t yet know enough about the ripple effect of COVID-19 on suicide risk. There are no accurate data yet to tell us what the risk of suicide is in response to COVID-19. But we need to think beyond mental illness and respond to distress in those around us in our local communities and among those we care about.

What has been clear from health-service information over the past few months is that we have all heeded the public-health messaging during COVID-19 about seeking medical help for anything other than the virus. Add to that the community being anxious about seeking medical help in a place where other people may be contagious.

Although very important to reduce the transmission of COVID-19, this has the flow-on effect of closing off opportunities to reach out for help when we aren’t feeling okay.

In lieu of accessing health care, support services such as Lifeline have extended their hours to make that simple step of connection via text or voice call more accessible.

Dr Anna Brooks, National Research Manager from Lifeline Australia, explains that March and April 2020 were record months for Lifeline. “We received almost 90,000 calls in each month,” she says. “We are currently receiving a call every 30 seconds. About 50 per cent of our callers have discussed COVID-19; there is certainly a heightened anxiety at this time. People are calling us because they are struggling with their mental health and they are experiencing loneliness.”

So what can we do?

‘R U OK? Day’ and its initiative to generate meaningful conversations about how people are coping, have

received some criticism over the past few years about needing to move beyond ‘How are you?’ and truly listen to what is being said. Often people are not sure what to say, or how to act, when they are worried about someone, or when a person shares their distress.

Ozols’ suggestion is simple yet effective in these strange times – take time and commit to picking up the phone, regularly. Although talking may seem like an innocuous activity, it provides a chance for people to share how they are feeling in real time. “All you need do then is listen to what they have to say,” she explains. “Just validate that these are unusual times and that what the other person is feeling is real.”

So what is the flow-on effect for family and friends who see this distress play out in front of them? It can be hard to watch when a person is distressed and needing help to manage their emotional reactions to this very extraordinary experience we are all living through. Care and compassion are needed at both stages of offering help – when the person is at risk, and if the person goes on to attempt suicide.

What can the broader community do to help?

Across New Zealand and Australia, opportunities for community connectivity have emerged as a way for people to look out for each other. “One of the positive things we’ve seen in the past couple of months is a greater focus on community rather than individualism,” says Georgie Harman, CEO of Beyond Blue, a mental-health wellbeing service in Australia. “People have got to know their neighbours. We’re more appreciative of essential workforces – health workers, teachers, supermarket staff, rubbish collectors. More of us are thinking more about our mental health and wellbeing, as well as our physical health.”

The purpose of reframing what that connection might look like, while keeping social-distancing requirements, requires creativity. Understanding the risk to a person’s wellbeing is not as simple as knowing if they have a mental-health diagnosis. Realising the ways their distress might be elevated and their connection with others inhibited might be the protective factor people need.

Wendy Liu is a social worker who specialises in grief and trauma. She often reflects on the ways in which we can look out for exceptions such as “stories of strangers being extraordinarily kind and friends and family finding creative ways to connect with one another”.

“I’m really hoping it brings the important things into focus such as connection, living with purpose and appreciation and looking out for others,” she says.

COVID-19 may also afford us the chance to have a collective conversation about loss and grief – of both death and non-death-related loss. As a society we are so focused on achievements and successes that talking about or being in the presence of loss is not so much in our language. Maybe COVID-19 will make us a bit more fluent, so it becomes something less isolating, less hidden, more ‘normal’.

Suicide risk and prevention are tricky topics to openly discuss. What we know from research is that often people who share their thoughts are met, understandably, with panic and concern. However strategies to enhance wellbeing across New Zealand and Australia can reduce suicide risk rather than just target those who we seen as severely depressed or anxious.

Not all risk looks the same – taking the time to check in with those in our homes, in our street and in our workplaces is crucial so that we can work alongside clinicians and politicians as we begin to understand the longer-term impacts of COVID-19 on our economy, employment, education and sense of purpose.

“JUST VALIDATE THAT THESE ARE UNUSUAL TIMES AND THAT WHAT THE OTHER PERSON IS FEELING IS REAL.”

INGRID OZOLS