AUT University Presentation Effective Suicide Prevention and Intervention

Outline 1.About SPINZ 2.Latest suicide statistics 3.What are the risk factors for suicide 4.What are the warning signs for suicide? 5.What are the protective factors against suicide? 6.What is being done for suicide prevention?

Outline 7.What is effective in preventing suicide? 8.What is not effective in preventing suicide? 9.Prevention models and interventions 10.Future considerations

The importance of self-care Suicide can be an emotional topic We are all likely affected in some way Important to notice what’s going on for us, and seek support if we need to

1. About SPINZ

What we do Part of the Provides a Resource and Information Service Produces resources and pamphlets Provides information for specific audiences via its website Gives presentations/workshops Runs events Works closely with media

Our website

Information for

2. Latest suicide statistics

Overview 483 people died by suicide in NZ in 2007 This equates to 11.0 deaths per 100,000 population 370 were male, 113 were female This equates to a ratio of 3.6:1

Overview Groups with the highest rates of suicide: males younger male adults (20-39 years) Māori people living in the most deprived areas But, the rate of attempted suicide is twice as high for women than for men

Age distribution

Youth suicide Of the 483 deaths, 94 were in the age group 71 were male, a rate of 22.9 per 100,000 population 23 were female, a rate of 7.6 per 100,000 The male rate was around three times the female rate

Youth suicide over time

3. What are the risk factors for suicide?

Risk factors The biggest risk factor is experiencing depression or another mental health disorder A history of self-harm or previous attempts Having been affected by a suicide death Exposure to trauma, such as violence, abuse or bullying Family factors, such as neglect, parental conflict, parental substance abuse, family violence

Risk factors Social isolation and lack of support Socioeconomic disadvantage Cultural breakdown, and loss of cultural identity, land, and language Stressful or negative life events, such as major losses, disappointments or humiliations – these are often the ‘trigger’ event

Risk factors The more risk factors a person has, the greater their risk of attempting suicide These risk factors may contribute to suicidal behaviours directly, or indirectly by influencing individual susceptibility to mental disorders

4. What are the warning signs for suicide?

Warning signs webcast

Warning Signs Threatening to hurt or kill themselves Talking or writing about death, dying or suicide Expressing feelings of hopelessness Looking for ways to kill themselves e.g. looking for pills, weapons or other means

Warning Signs Being unusually ‘down’, ‘low’, ‘angry’ or ‘depressed’ Acting recklessly Withdrawing from family and friends Increased alcohol or drug use Giving away possessions

5. What are the protective factors against suicide?

Protective factors Strong identity Connectedness Resilience – agency, relatedness, reflectiveness, communication Wellbeing, flourishing Not obvious suicide prevention activities but these do contribute to suicide prevention

Wellbeing and flourishing

6. What is being done for suicide prevention?

The NZ Suicide Prevention Strategy This strategy replaced the New Zealand Youth Suicide Prevention Strategy, which was published in 1998

Goals of The New Zealand Suicide Prevention Strategy 1.Promote mental health and wellbeing, and prevent mental health problems 2.Improve the care of people experiencing mental disorders 3.Improve the care of people who make suicide attempts 4.Reduce access to the means of suicide 5.Promote the safe reporting of suicidal behaviour by the media 6.Support families/whanau, friends and others affected by a suicide or suicide attempt 7.Expand the evidence about rates, causes and effective interventions

The New Zealand Suicide Prevention Action Plan, Included the Evidence for Action and the Summary for Action, published 2008 A one-year report on Action Plan has been done, published September 2009

7. What is effective in preventing suicide?

The evidence-base The evidence-base is used to inform the NZSPS and Action Plan Important that all suicide prevention policy and practice is based on good evidence Want to make sure interventions and prevention activities are going to be effective, and don’t cause harm, or are ineffective, thus a waste of resource

Activities with strong evidence of efficacy Education of GPs and other health professionals Restriction of suicide methods Gatekeeper education

Activities with promising evidence of efficacy Public awareness of depression Hotlines, internet-based tools and texting Support for those bereaved by suicide Psychological therapies Pharmacological interventions Responsible and informed media coverage

Barriers to effective suicide prevention (Beautrais, 2009) Power of advocacy and lobbying Power of rhetoric and emotion Power of anecdotal evidence Working solely from instinct, good intentions, or personal experience is not sufficient – suicide prevention activities must be based on evidence of effectiveness and safety.

8. What is not effective in preventing suicide?

Activities with evidence of harm School-based suicide awareness programmes Generic public health messages raising awareness of suicide No-harm and no-suicide contracts Recovered or repressed memory therapies

Raising awareness of suicide Works really well for other social issues: family violence, drink driving, alcohol abuse, depression But, when it comes to raising awareness of suicide, there is insufficient evidence to support its safety - it could have unintended consequences that increase the risk of suicide among those who are already vulnerable

Raising awareness of suicide Can happen by inadvertently normalising suicide, or by creating a solution modelling effect Instead, a safer way to address suicide is focusing on raising awareness of depression, and promoting help-seeking Not all suicide prevention activities need to be marketed as such to make a difference, an example being the National Depression Initiative

Talking more about suicide The best way to address the topic is often by focusing on talking more about suicide prevention, not suicide This avoids previously mentioned issues of awareness-raising and normalisation of suicide Also an opportunity to talk more about risk and protective factors, warning signs, and the importance of help-seeking

Talking more about suicide after a suicide death This issue often comes up around addressing the school after the death of a student Talking to a large group of young people about the suicide of a classmate can increase the risk of those already vulnerable Asking someone one-to-one if they’re thinking about suicide does not increase the risk of them dying by suicide

9. Prevention models and interventions

Prevention models There are several prevention models in health: The Primary, Secondary, Tertiary (PST) prevention model The Universal, Selective, Indicated (USI) prevention model The ecological model (micro, meso, macro)/social ecological model Traditionally suicide prevention has focused on the PST model

Prevention models No specific model is explicitly named in the NZSPS or Action Plan Instead, it includes some health care oriented strategies (broadly, individual/tertiary/micro interventions), as targeted initiatives for people who are most at risk of suicide… And some public health oriented strategies (broadly, universal/primary/macro interventions), to create a society that promotes mental health and wellbeing

Health care oriented strategies Covered by Goal 2, 3, 6 of the NZSPS: 2.Improve the care of people experiencing mental disorders NDI – Depression Helpline, The Journal programme, Depression and Lowdown websites and text and support

Health care oriented strategies for youth

Health care oriented strategies Covered by Goal 2, 3, 6 of the NZSPS: 3.Improve the care of people who make suicide attempts Whakawhanaungatanga: The Self Harm and Suicide Prevention Collaborative

Health care oriented strategies Covered by Goal 2, 3, 6 of the NZSPS: 6.Support families/whanau, friends and others affected by a suicide or suicide attempt Postvention Support Service (Initial Response Service, Community Postvention Response Service) and Traumatic Incident support in schools

Public health oriented strategies Covered by Goal 1, 4, 5, (7) of the NZSPS: 1.Promote mental health and wellbeing, and prevent mental health problems Development of programmes across Govt agencies: Campaign for Action on Family Violence, ALAC Culture Change Campaign, LMLM Campaigns

Public health oriented strategies Covered by Goal 1, 4, 5, (7) of the NZSPS : 4.Reduce access to the means of suicide Interventions around hanging, carbon monoxide poisoning, firearms, self- poisoning, jumping

Public health oriented strategies Covered by Goal 1, 4, 5, (7) of the NZSPS : 5.Promote the safe reporting of suicidal behaviour by the media Promoting collaboration between media and suicide prevention professionals and researchers, monitoring the internet

contact Ph SPINZ (Suicide Prevention Information New Zealand) a part of the Mental Health Foundation of New Zealand Working to reduce suicide by providing high quality information 2010