Supporting Families in Mental Illness NZ Friday 31 October Wellington

Statistics Role of the Coroner Overview of suicides in NZ Historical perspective Making a finding of suicide o Evidence o Intent Mental health Suicide prevention and postvention Reporting on suicide Amendments to Coroners Act 2006

Year (June-July)Number * * Lowest number by 2 since year

Specialist Judge Legal responsibility to investigate certain deaths Receives reports of sudden, unexplained deaths and deaths in special circumstances Makes findings as to cause and circumstances of death Makes recommendations to prevent deaths in similar circumstances

All suicides must be reported to the Coroner Coroner must open an inquiry into self-inflicted deaths Majority of suicide findings now made ‘on the papers’ Suicide is the largest class of death by external causes seen by Coroners (roughly 540 deaths annually)

Historical role of determining if a death is a suicide Finding of suicide had significant social and property ramifications Historically function of Coroner was on protecting the pecuniary interests of the Crown Social stigma attached to suicide (continues to some extent today) ‘The Death of Socrates’

Coroner must be satisfied that death was self-inflicted with intention of taking one’s own life Ordinarily a ‘balance of probabilities standard’ however to make a finding of suicide need greater cogency of evidence Suicide must never be presumed

Police act as Coroner’s agents at scene Witness statements o Behaviour and state of mind of deceased Detailed scene examination Cell-phone and computer records Coronial Services Unit seeks further info DHBs contacted to see if any contacted with MH services Reports from GPs and other health professionals Other inquiries may also be made

Drawing reasonable inferences from established facts Notes or messages left behind Scene examinations Contextual background (eg. emotional upheavals or stress) Clinical/psychological history An open finding may be made where suicidal intention can not be established

Research suggests mental disorders a factor in up to 70% of suicides and suicide attempts Risk of ‘medicalising’ suicide? Suicide multi-factorial and social factors relevant Not uncommon for MH services to become focus of a Coroner’s inquiry Mandatory inquests must be held if the person was a ‘patient’ as defined in Mental Health Act Mental health professionals often requested to provide information and give evidence at inquest

Extent to which Mental Health Act was invoked Should/could suicidal behaviour have been predicted? Sharing of information with family and whanau regarding the deceased’s risk of suicide Continuity of care issues (particularly inter- relationship between crisis and community teams)

Coroners look at individual cases Not well equipped to identify and comment on patterns and trends associated with suicide as a whole Recommendations will be based on particular circumstances of a case: o Fencing a known suicide spot o Specific policies of a certain MH service o Restricting access to suicide methods o Encourage people to seek assistance if someone expresses suicidal thoughts or threats to them

Immediate information-sharing about suicides between Coronial Services and DHBs through CASA. Aim is to stop the spread of suicide “contagion”. Allows DHB Traumatic Incident teams to be present when schools open the next morning (though postvention not solely focused on youth suicide). Recently formalised through MoU – secure process to share the highly sensitive information.

Effective and prompt postvention can be effective prevention Circle of persons touched by suicide particularly youth or school As this develops – ability to get quicker and more accurate background to connections with other suicides Provides better understanding of causative factors in the lead up to suicide Sometimes this info no easily discovered by Police

Proponents of media restrictions Point to international evidence that supports concern that media portrayal of suicide may precipitate suicidal behaviour No evidence that media publicity as form of education does any good Opponents of media restrictions Concerned with restrictions on freedom of expression Advocate public interest in knowing extent of problem in NZ

Reporting restrictions in Coroners Act – particulars of suicides cannot be reported without a coroner’s authority Coroner can only give authority if making particulars public is “unlikely to be detrimental to public safety” ‘Making public’ defined in Act Concern of ‘copy cat’ suicides, a contagion effect, or normalising suicide

Reporting restrictions apply only to individual cases Guidelines of suicide and media reporting Restrictions apply both prior to a finding of suicide, and after a finding is made Once finding is made only details that can be published are: o Name o Address o Occupation o Fact that Coroner found death to be self-infli cted

Law does not cover reporting of suicides occurring outside NZ (eg. high profile celebs) NZ has some of most restrictive provisions re. publication of suicide, yet one of highest youth suicide rates in OECD Difficulties enforcing breaches of the law, even where law deliberately flouted Social media an unstoppable force and is largely untouchable by these laws

To an extent s 71 acts as a deterrent to mainstream media Risk that restrictions may be muting appropriate discussion as well Encouraging appropriate discussion could potentially model the way young people deal with subject on social media A possible way forward – encouraging development of robust media guidelines to encourage and educate responsible reporting?

Coroners must determine whether allowing publication is ‘unlikely to be detrimental to public safety’ o No legislative or internal guidance o Expert advice sometimes sought o Countervailing public interests also to be taken into account (ie. public interest in deaths occurring in institutional setting) o Also strong privacy interests at stake View of Chief Coroner: if Coroner is satisfied that public good may come from permitting publication, that may outweigh any detriment to public safety

Restriction on reporting method (and place if suggestive of method). Chief Coroner to have ability to grant exemption if satisfied risk of copycat behaviour is small and outweighed by the public interest. Media may use the term “suspected suicide” before a coroner makes a finding if the facts support that term.

Law Commission – Suicide Reporting Govt has announced they have agreed to all the recommendations made by the Commission Media will be able to report a suicide or a suspected suicide has occurred – but won’t be able to name method or infer method Coroners could allow these details to be reported on case by case basis Changes will be included in Coroners Amendment forthcoming this year…