Dr Muriel Newman The tragedy of suicide

It is a dreadful reality that in New Zealand far more people die by suicide than in motor vehicle accidents. And there are thousands of attempted suicides that result in hospitalisation. It is thought that for every suicide death there are around 11 non-fatal attempts, although for teenagers it is said to be as high as 25.

Last month the Chief Coroner released the annual suicide estimates for the year to the end of June 2019, showing that New Zealand’s suicide rate is now at its highest level since provisional records were first released in 2007. Some 685 children, teenagers and adults took their own lives, an increase of 17 deaths since last year. Eleven of those who died were aged between 10 and 14 years. There were 73 teenagers, and 91 aged 20 to 24, an increase of 15. Forty-five per cent were employed, 27 per cent were unemployed, 10 per cent were students, and 10 per cent were pensioners.

Three-quarters had experienced depression, a third had problems with substance abuse or addiction, and one in five experienced anxiety. Other risk factors included job insecurity, long working hours, relationship difficulties and an inability to seek help. Other factors identified in coroners’ reports included engagement with the criminal justice system, illness or injury, grief, and housing issues.

While the statistics showed only one prisoner had committed suicide, British research published in The Lancet showed that the suicide risk for people recently released from prison was far higher than for the general population, especially during the first few weeks, similar to another high-risk group, recently discharged psychiatric patients. In 2003 The Lancet also shed light on child suicide through a Swedish study that found the risk of suicide was more than twice as high among children in

one-parent households compared with those living with both parents.

It remains unconscionable that New Zealand’s welfare system continues to incentivise single women to have and raise children on their own, without the support of the child’s father, even though the evidence is clear that singleparent beneficiary households are a risk factor for children. As former governorgeneral Sir Michael Hardie Boyes explained, “Fatherless families are more likely to give rise . . . to the risks of being abused, of being emotionally, even physically scarred, of dropping out of school, of becoming pregnant, of living on the streets, of being hooked on alcohol or drugs, of being caught up in gangs, in crime, of being unemployable, of having no ambition, no vision, no hope, at risk of handing down hopelessness to the next generation, at risk of suicide.”

Reforming welfare to support single parents through work-related benefits, as most other countries do, would undoubtedly reduce the suicide risk for children and young people.

When looking into the Government’s plan for combating suicide, the Ministry of Health’s website exposes the shocking reality that the current mental health strategy expired in 2016. With an outdated strategy guiding mental health services, it is little wonder that suicide is on the rise. What’s worse is that Prime Minister Jacinda Ardern is refusing to be held to account by setting suicide reduction targets, in spite of the Government’s $6 million mental health inquiry recommending last November that a target of a 20 per cent reduction by 2030 should be set.

The reason given by the Prime Minister for not introducing a suicide target was, “A target implies we have a tolerance for suicide, and we do not. The goal is for no one to be lost to suicide.” She would not, however, set a zero target, and be held accountable for its achievement. The reality is that she knows that under her Government, key social “wellbeing” indicators such as homelessness, state house waiting lists and child poverty have deteriorated. With the economy now slowing, and financial pressure on families mounting, there is a real risk that New Zealand’s suicide numbers will continue to rise.

But it doesn’t have to be like this. One country that has worked hard to reduce suicide through a comprehensive approach is Denmark. The strategy they adopted was multi-pronged. They reduced access to dangerous means of suicide, including restricting the availability of popular medications used for drug overdoses. They introduced catalytic converters into car exhaust systems to reduce toxic concentrations of carbon monoxide. They tightened firearm security, and psychiatric wards were redesigned to eliminate suicide opportunities. Free psychiatric care for all citizens was introduced, including separate psychiatric emergency rooms, early intervention services for young people with psychosis, and specialised treatment for anxiety and depression.

Suicide prevention clinics were set up to provide counselling, therapy and practical support to anyone with suicidal thoughts or behaviours. Psychiatric emergency outreach teams were established to support people in crisis by having a psychiatrist and an ambulance on call seven days a week. A Strengthening Outpatient Care After Discharge (SAFE) project was introduced to offer home visits and family support to patients discharged from psychiatric hospitals. The Danish Lifeline began operating a suicide hotline with anonymous counselling by trained volunteers.

Other areas identified for improvement involve targeted interventions for selected at-risk groups, including people experiencing social adversities, the homeless, children in foster care, people living in sheltered housing and nursing homes, prisoners, and those suffering from alcohol and drug addictions. The Danish example shows that with a proactive approach to suicide prevention, lives can be saved.

And as if the problem of suicide in New Zealand is not bad enough, the Government is now considering legalising cannabis, even though its use doubles the risk of psychosis and schizophrenia, significantly increasing the risk of suicide.

"When looking into the Government’s plan for combating suicide, the Ministry of Health’s website exposes the shocking reality that the current mental health strategy expired in 2016. "