What is behind New Zealandís high suicide rate?

Blaming mental illness for suicide may be missing a life-saving point in suicide prevention

Content warning: contains discussion of suicide

 

Our country has one of the highest suicide rates in the Western world, and the highest youth (15-24 years old) suicide rate in the OECD. The latest suicide statistics, released by the Chief Coroner in late August, showed that the number of New Zealanders taking their own lives has increased in the last three years, with the year 2016-2017 having the highest numbers ever recorded.

Why, in a country that is consistently ranked as the world’s best place to live, are so many New Zealanders turning to suicide as a way out?

Last month 606 shoes made their way to parliament, each pair representing someone lost to suicide. The project was supported by YesWeCare.nz and the Public Service Association. In response National MP Michael Woodhouse said that, “one suicide is too many – this is a whole of society problem”.

Labour Party Leader Jacinda Ardern said, “every single suicide is simply unacceptable,” and proposed a review into the reasons for this rise in suicide statistics, which she says likely include growing inequality, overstretched health services, increased societal pressures, and population growth.

People aged 18-24 are considered an at-risk group for suicide. At the University of Otago suicide prevention is provided by the Student Health centre. The centre provides mental health support and counselling appointments for students. They have recently managed to increase the number of mental health clinicians and the number of same-day assessment appointments they can offer to students. This year the centre has also adopted a proactive approach by highlighting a student led, non-medical approach, with the Silverline Festival as its flagship. Silverline aimed to challenge how we all engage with mental health and wellbeing - to encourage not just students but also the wider Dunedin community to be more aware and look out for their colleagues and friends.

“Suicide is an awful beast,” says University of Otago student Jean Balchin. Balchin spoke during the Silverline Festival, sharing her story of losing her brother to suicide. Balchin discussed how suicide is considered a “huge shameful secret,” and myths around suicide, like the belief that talking about suicide plants the idea of suicide, are actively harmful. The secrecy around suicide means that people are not equipped to engage with the issue, and are often afraid to even hear the word. But suicide is not a topic we can sweep under the carpet. Talking about suicide with appropriate and relevant information allows people to share their thoughts in a safe environment and for others to listen and help effectively.

Woodhouse claims that “improvements have been made” to the mental health sector, but that there is a need to continue to increase and improve performance with regard to suicide prevention. Funding for mental health and addiction services has increased from $1.1 billion in 2008/09 to $1.4 billion in 2015/16. National plans to invest an additional $100 million into a social investment fund for mental health, which includes 17 new initiatives “designed to improve access to effective and responsive mental health services”.

The Labour party has committed to funding health services, including a new policy for mental health support in every public secondary school. Since the Christchurch earthquake, Canterbury has the highest suicide rate in New Zealand. Labour plans to provide primary and intermediate schools in the Canterbury and Kaikoura regions with 80 fulltime jobs in mental health, with the aim of assisting with earthquake-related issues. Labour’s general health policy aims to reduce barriers for those accessing health care by decreasing the cost of visits to the GP and giving additional funding to GP training places.

Professor Said Shahtahmasebi, a researcher in the field of suicide who believes in a holistic approach to suicide prevention, questions Labour’s approach. Shahtahmasebi asks, “how can implementing more medicalisation of suicide, which has been the primary practice for decades and has only proved to be ineffective, prevent suicide? Even if we install psychiatric units at every corner and in every classroom, it will not prevent suicide.”

Earlier this year, mental health advocate and comedian Mike King announced his high-profile resignation from the suicide prevention panel, where King felt “like a lone voice in a room full of people who wanted to do the right thing but weren’t”. 

King labelled the government’s approach to suicide prevention as “deeply flawed”. He said that the major problem with their approach is that it is “clinically and academically driven with the most important component taken out of the equation: the communities”.

“It’s all academic bullshit,” says King. Literature about suicide in New Zealand gives the impression that suicide prevention strategies are only being aimed at Māori, who are overrepresented in statistics. However, suicide does not discriminate - it affects everyone. According to King, by focusing on one section of the community the government and suicide prevention programmes have only succeeded in “isolating the majority of the community”. He argues that a collective approach would be far more effective.

“Suicide is a war … and we need to go to war as a nation to fight this blight on New Zealanders,” King says. “Until we make this a fight for all New Zealanders we aren’t going to get on top of the problem.”

Poor housing, poverty, racism, colonisation and an increasing gap between the rich and the poor have been listed as five reasons for our high rates of youth suicide. But in all King’s time as an anti-suicide campaigner, not once has anyone ever told him: “I want to kill myself because of housing or poverty”. He doesn’t believe that argument makes sense. The country with the lowest suicide rate is South Africa – a country with housing, poverty, colonisation and racial problems worse than ours.

King believes that young people are taking their lives because of the ever-increasing gap between the generations. Nowadays, young people feel constantly judged by the significant adults in their lives, feeling like no matter what they do it will never be enough. If the significant adult in a young person’s life is “yelling at them or putting them down for not passing a math test or for not making the bed, why on earth would they want to talk to that adult about their suicidal thoughts?” King argues that “my generation needs to be made aware of this fact, as they are constantly looking for someone else to blame for their issues”.

Eighty percent of all school aged children who experience recurring suicidal thoughts never ask for help because they are worried about what other people will think, say or do if they share that information. King says that we need to stop judging young people and instead bring them into the conversation.

“For the record,” says King, “this is not my opinion. This is what over 160,000 young people from Bluff up to Kaitaia have told me.”

The government’s approach to suicide has been exactly the same for decades, so, as King says, it’s not a surprise that suicide numbers have not improved. Shahtahmasebi agrees, saying that the government has just been giving us “more of the same,” and somehow expecting to see different results.

King compares being suicidal to being in a car crash; instead of help coming to the person in need - as it would in the car crash case - the person in crisis has to get themselves help. The person suffering has to “ring up some random dude who is normal … explain why you want to commit suicide, but maybe you don’t even understand why you want to,” or they have to get their “butt out of bed to go to hospital to show scars of previous attempts”. Shahtahmasebi argues that this is not prevention, instead a belated and sometimes unhelpful intervention.

Being suicidal can isolate you; so instead of putting the onus on people in crisis, we could put it on those who aren’t. King says that when he was suicidal the last thing he wanted was to call someone or talk to his doctor. “I wanted a friend to walk into my room and tell me they love me … that I mean something in their life.”

Many of us don’t know how to deal with, or even approach, someone we suspect is suicidal. Both King and Shahtahmasebi argue that the biggest mistake of all is grouping depression, anxiety, suicidal thoughts, and mental illness together. King believes that classifying low to moderate depression, anxiety and suicidal thinking as a mental illness means that there is no longer a need to understand it; all we have to do is fix it.

But what young people who are anxious, depressed or suicidal want more than anything is to feel heard, to get their point across and hopefully be understood. Instead all they feel is invalidated and shut out.

Shahtahmasebi also criticises the government’s practice of merely pumping money into mental health services, and their refusal to see any evidence proving that this method does not work. The medical model of suicide focuses on finding a mental illness in a suicidal person that may or may not exist. Shahtahmasebi cites that “one-third of all suicide cases, on average, come into contact with mental health services and yet still go on to take their lives”. The remaining two-thirds who committed suicide had no contact with mental health services. The medical theory drives the idea that only people with mental illnesses commit suicide. A recent World Health Organisation (WHO) report states that the claim that all suicide is caused by mental illness is a myth. As King declared, “being anxious, or depressed, or having suicidal thoughts - that does not make you mentally ill, it makes you HUMAN”.

Linking suicide with mental illness could, in part, explain why over two-thirds of people who take their lives do not come into contact with health services: for fear of being labelled mentally ill - words which still carry stigma in our society.

Shahtahmasebi suggests that we should come up with a suicide strategy based on what we do know about – human behaviour and interaction. By following such a model we would let members of our communities know that we love and care for them, making it possible to remove suicide as an option. People considering suicide would instead know that there are people around them that they can rely on and communicate with.

King suggests something akin to life coaches in all schools who could identify children and young people who are struggling earlier. This would also involve training in the schoolyard environment and encouraging kids to talk about small problems before they have the opportunity to become bigger.

Other known alternatives to the medical approach of suicide that actually work can be seen in the work of Professors Shahtahmasebi and Omar, of Kentucky University and chair of the Stop Youth Suicide campaign. They ran a series of workshops between 2010 and 2015 in order to mobilise communities at grassroots to decrease youth suicide rates in particular areas in New Zealand. Their work in communities that participated – some with startling numbers of youth suicide - saw massive reductions in the time that the campaign was running.

King argues that it doesn’t matter which political party gets into power, because they don’t control the suicide prevention programmes. These programmes are run and evaluated by clinicians and academics without any customer consultation – but “who can best evaluate a haircut, other than the customer?”

“We do need the academics and clinicians, we need to work with them, but they also need us, we are the ones receiving the treatments, don’t shut us out,” says King.

“It is time to stop pretending that we understand suicide, because we don’t, and instead focus on developing caring communities and removing suicide as a choice because it is not an option,” says Professor Shahtahmasebi.

It may not be the social and environmental factors, or mental illnesses that are responsible for rising suicide in New Zealand. To eradicate suicide we must depoliticise suicide and set to work building strong and caring communities. There needs to be a change, and we need to work on change together.

 

Editors’ note: This week the Director of Student Health, Dr. Kim Maiai, released a Proposal for Management of Change examining the mental health treatment and support available to students on the Dunedin campus of the University of Otago.

The proposal comes in response to the 2016 Mental Health Services review. For information on the proposal, please see Critic’s news story: Management of Change Proposal Could See Shakeup to Mental Health Treatment, Redundancies

This article first appeared in Issue 26, 2017.
Posted 12:02pm Sunday 8th October 2017 by Zahra Shahtahmasebi.