Suicide Prevention Information for Asian communities Ivan Yeo Mental Health Promoter

“Suicide and suicidal behaviours are a major health and social issue in New Zealand. Each year approximately 500 people take their own lives. This figure represents a tragic loss of potential and a tremendous impact on those families, friends, workplaces and communities that are affected by the loss of someone through suicide”. Ministry of Health (2012)

Suicide in NZ: 2009 A total of 506 people died by suicide This equates to 11.2 deaths per 100,000 population (age-standardised). The 2009 suicide rate was 25.5% below the peak rate in 1998.

Sex There is a distinct gender difference in suicide rates. 77% of suicide deaths in 2009 were males. 391 male deaths (17.8 deaths per 100,000 male population, age-standardised). 115 female deaths (5.0 deaths per 100,000 female population, age-standardised). The 2009 male suicide rate was 25.4% below the peak rate in The female suicide rate has remained steady over time. Ministry of Health (2012)

Asian suicide deaths in NZ: : 25 (16 male, 9 female) 2008: 17 (9 male, 8 female) 2007: 14 (8 male, 6 female) 2006: 14 (5 male, 9 female) 2005: 13 (6 male, 7 female) 2004: 10 (6 male, 4 female) Difficult to identify trends: NZ’s Asian population has changed significantly over this time. Age-standardised rates are not calculated: because the numbers of deaths are small, “rates tend to be highly variable and may be misleading”

There are at least 2500 admissions to hospital for serious intentional self- harm injuries every year. For data comparability purposes, this figure excludes patients who were discharged from an emergency department with a length of stay of less than two days. Ministry of Health. (2012).

Intentional Self-Harm Hospitalisation (Asian Population) 2009: 87 (3.4 % of total). Females accounted for 58.6 % of all Asian intentional self-harm hospitalisations. 2008: 83 (3.4 % of total), 60.2 % female. 2007: 109 (4.1 % of total), 69.7% female. 2006: 85 (3 % of total), 71% female.

Why Do People Take Their Own Life? There are no simple or definitive explanations as to why people die by suicide The reasons that people choose to take their own life are very complex, and often the reasons are not clear to others. Commonwealth of Australia (2005) Why Do People Take Their Own Life?

Associate Minister of Health (2006)

Chinese often regard mental health problems, including depression and suicidal behaviours, to be caused by social factors, such as a failure to fulfil family and societal expectations. In Chinese culture, there is a strong stigma attached to suicide, which is often seen as shameful to both the individual and the collective esteem of the family. Completing suicide is not really seen as an individual act, but greatly impacts on families and significant others. Suicide Prevention Information New Zealand (2010)

Anecdotal evidence has suggested that the prevalence of self-harm and suicide attempts are increasing. Research in these areas has not yet been focused solely about Asians in New Zealand.

Health and Wellbeing of Asian Students: Youth’07 survey 15% Asian secondary school students reported having suicidal thoughts in the past year, and 8% had made a plan to attempt suicide 4% had made a suicide attempt in the past year. Overall, 20% of Asian male students and 31% of Asian female students had ‘poor’ mental and emotional health (WHO-5 Wellbeing Index) Parackal et al (2011)

For Chinese, Indian and other Asian students, depressive symptoms and suicidal thoughts & behaviours were more prevalent for females.

For Chinese students, the proportion who had thoughts of suicide decreased from 23% in 2001 to 15% in 2007, and the proportion who attempted suicide decreased from 10% in 2001 to 4% in For Indian students, there were no significant changes from 2001 to 2007 in suicide-related behaviours. Among Chinese and Indian students, 18% of females and 7-8% of males showed significant depressive symptoms. (no change )

Chinese, Indian and other Asian students are more likely than NZ European students to report obstacles to accessing healthcare. In 2007, 14% of Chinese students, 17% of Indian students and 16% of Asian students had been unable to access healthcare when they needed it. Major obstacles included - lack of knowledge about the healthcare system; - cost and transport; - concerns about confidentiality; and - “not wanting to make a fuss”.

Recognise the diversity and specific needs of the many Asian communities in Aotearoa New Zealand. Develop culturally appropriate programmes to de- stigmatise mental health issues. Provide resources, programmes and strategies that enable the healthy development of Asian young people. Youth’07 recommended:

International and New Zealand literature suggest that resiliency and protective factors can be more effective and insightful than solely focusing on risk and vulnerability. Ihimaera, L., & MacDonald, P. (2009) pg32

Defining Risk & Protective Factors Risk factors: increase the likelihood of suicidal behaviour or make a person more vulnerable; and Protective factors: reduce the likelihood of suicidal behaviour and work to improve a person’s ability to cope with difficult circumstances. Commonwealth of Australia. (2005)

Risk and proactive factors can occur at: individual or personal level (mental and physical health, self-esteem, and ability to deal with difficult circumstances, manage emotions, or cope with stress); social level (relationships and involvement with others such as family, friends, workmates, the wider community and the persons sense of belonging); and contextual level or the broader life environment (social, political, environmental, cultural and economic factors that contribute to available options and quality of life) Commonwealth of Australia. (2005)

Protective factors may include: connectedness to family personal resilience, coping and problem-solving skills responsibility for children family communication patterns presence of a significant other good physical and mental health positive beliefs and values community and social integration economic security in older age. Commonwealth of Australia. (2005)

For Asian communities family cultures community connection access to services and resources destigmatising mental illness

Current gaps research to understand suicidality and protective factors in New Zealand’s Asian communities. culturally competent and accessible services. accessible resources for a range of Asian groups.

Mental Health Foundation focuses on creating a society where all people can flourish and experience positive mental wellbeing. suicide prevention is a core focus of our work, which includes working with communities and professionals to support safe and effective suicide prevention activities, reduce stigma and develop positive mental health and wellbeing.

Suicide Prevention Information New Zealand a national information service provided by the Mental Health Foundation of New Zealand. provides high quality information to promote safe and effective suicide prevention activities. contracted by the Ministry of Health to support the New Zealand Suicide Prevention Strategy

Goals of NZSPS 1.Promote mental health and well-being, and prevent mental health problems 2.Improve the care of people who are experiencing mental disorders associated with suicidal behaviours 3.Improve the care of people who make non- fatal suicide attempts 4.Reduce access to the means of suicide Associate Minister of Health. (2006).

Goals of NZSPS 5.Promote the safe reporting and portrayal of suicidal behaviour by the media 6.Support families/ whānau, friends and others affected by a suicide or suicide attempt 7.Expand the evidence about rates, causes and effective interventions. Associate Minister of Health. (2006).

“Asian groups are culturally diverse and have varying degrees of acculturation to New Zealand society… Consequently, suicide prevention policies, programmes and services need to account for this diversity” Associate Minister of Health. (2006).

References Associate Minister of Health. (2006). The New Zealand Suicide Prevention Strategy 2006 – Wellington: Ministry of Health. Commonwealth of Australia. (2005). A Framework for Effective Community-Based Suicide Prevention (Draft for Consultation). Australian Government’s Community Life Project: Adelaide. Ihimaera, L., & MacDonald, P. (2009). Te Whakauruora. Restoration of Health: Maori Suicide Prevention Resource. Wellington: Ministry of Health Ministry of Health (2012) Suicide Facts 2009: Deaths and intentional self-harm hospitalisations. Wellington: Ministry of Health Parackal, S., Ameratunga, S., Tin Tin, S., Wong, S., & Denny, S. (2011). Youth’07: The health and wellbeing of secondary school students in New Zealand: Results for Chinese, Indian and other Asian students. Auckland: The University of Auckland. Suicide Prevention Information New Zealand (2010) adaptation of Department of Communities, The State of Queensland (2010) Responding to people at risk of suicide: How can you and your organisation help? Auckland: Mental Health Foundation of New Zealand.