Proposed suicide prevention plan 'deeply flawed', warns mental health advocate
Proposals aimed at preventing suicide are deeply flawed, one of Taranaki's most experienced mental health advocates has warned.
The Ministry of Health's plan ignores at least 10 crucial problems, including those of rural men, women aged 16-24, and older people, Gordon Hudson, who recently retired after nearly two decades as a mental health worker based in New Plymouth, said.
The proposals also fail to take account of issues such as rural GP shortages, euthanasia and planned self-neglect, the crisis in mental health and addiction services, the over-reliance on police as first responders to suicide and self-harm emergencies, and the legalisation of marijuana for relief of chronic pain and anxiety.
Most of all, the plan is indifferent to the Ministry of Health's previous lack of commitment to suicide prevention, and disregards the need for resourcing, and measurable and achievable goals, Hudson said.
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The draft document, which is out for public consultation, had a "commendable" focus on Maori, Pacific Islanders and youth living in the main centres, said Hudson, but overlooked suicide in country areas.
"In many regions, rural males aged 25 to 64 are the most at risk," Hudson said in a submission to the Ministry.
Unlike in most other provinces, Taranaki's rural suicide statistics had in fact dropped significantly, he said, down to about two a year on average, as opposed to the previous annual rate of about 10.
But Hudson that had little to do with the Ministry of Health. A joint Ministry and Taranaki District Health Board report in 2008 had identified the problem, but failed to recommend remedies.
Instead it had been left to non-government organisations (NGOs) such as Like Minds Taranaki, which Hudson managed, Suicide Prevention Taranaki and others.
Through them, presentations on risk factors were made to every small rural community, all rural mail box holders got a publication called Feeling Down on the Farm, and the initiative was well-supported by the Taranaki Rural Support Trust.
The long-term result was 37 fewer rural suicides in the past five years compared to the previous five years.
"This had very little support from either the Ministry of Health or the Taranaki DHB, although the latter clearly was instrumental in helping treat and support people in acute distress."
Hudson said the Ministry's approach concentrated on suicide statistics in the larger cities. "There seems little understanding of the very different employment, economic, social and cultural aspects associated with the rural sector.
"I have recently been informed by a Taranaki MP that the Ministry of Health does not even have a 'rural desk' at head office. That is indeed a sad indictment."
The proposed prevention strategy emphasised the need to build stronger, more aware and resilient family/whanau and communities, which was a wise recommendation - so long as the Ministry and health boards took more interest in suicide prevention, especially in the country and among older people.
But Hudson said he was disappointed the strategy appeared to ignore people aged over 75. Many led isolated, lonely and more emotionally vulnerable lives.
In recent years, statistics showed those aged 85 and above were among the highest risk cohorts in New Zealand society, with a suicide rate of 31.4 per 100,000.
He said those who drafted the document presumably felt older people did not warrant their attention, or that they had somehow covered them.
"Sadly, we seem to accept that such a high rate of suicide, as well as self-inflicted self-neglect, are inevitable because they are expected to die anyway. This is unacceptable."
At a time when the nation was involved in a debate on euthanasia, and there was growing concern about significant rises in dementia numbers, he said it seemed odd that the Ministry of Health was showing complacency. Half of people with dementia suffered treatable depression.
With euthanasia being a major discussion point, it seemed any planned suicide prevention strategy should at least include that debate and proposed political action.
"The coming legislation on euthanasia will automatically raise public awareness of the issue of planned self-neglect by, for instance, refusing medication or refusing to eat. Some people starve themselves to death because they feel it's the only option left to end their life."
Hudson said the strategy neglected younger females, particularly Maori, who were becoming more violent, especially if in informal gangs, initiating physical and mental abuse and taking greater risks with alcohol and other drugs.
It was not a new problem, and was well-known to police and the justice system, as well as secondary schools and organisations attempting to counter it.
Greater involvement by police as first responders to mental health crisis calls was also a concern, he said. "The police are the first preferred choice for acute support, as there is confidence they will attend urgently and will liaise with the Taranaki District Health Board crisis team."
But while the DHB and police worked closely and well together, in many instances that approach was not ideal. Acute mental health emergencies were best dealt with by the crisis team first, "with the support of the police as required".
On the shortage of general practitioners, he said outside New Plymouth, Taranaki had the lowest ratio of GPs to population of anywhere in New Zealand. A great potential for suicide reduction was lost if GPs were not readily available as a first call for advice, treatment and support.
The Ministry of Health's acknowledgement of the chronic GP shortage was an admission it had not succeeded in training and retaining GPs and encouraging more to practise in rural communities.
The strategy document's value was also seriously undermined by not mentioning the general failure of the mental health system and the misuse of alcohol and drugs as major factors in self-harm and suicide.
Mental health and addiction services, government and NGO, had been under extreme pressure for many years, he said.
"Access to services is often anything but timely; being accepted into the tertiary mental health services sector is often too difficult; access to crisis services is inadequate and certainly not, in many cases, timely; and ongoing support in the community has been unable to meet the demand."
A government desire to prevent discussion about suicide had resulted in the issue being under-recognised, under-resourced and never adequately addressed by the Ministry of Health or its DHBs.
"The Ministry's resourcing for suicide prevention reflects its stance on suicide prevention – too few funds for too few initiatives. It's difficult to see this strategy will produce anything different from failed past government initiatives."
Far too many DHBs in New Zealand faced national exposure for their inability to provide timely professional care and support for mental health problems. "Quite frankly, the public has lost confidence in the Ministry of Health to address these issues.
"The Ministry has denied their existence for so long. Unless there is a professionally responsive mental health and addiction service in New Zealand, there is little hope for there ever being a significant drop in self-harm and suicide in New Zealand.
"This is a major challenge for the Ministry, and it being aware of and admitting to the fact that we do have a serious issue with our tertiary mental health services would be an excellent start.
"It would be a much more appropriate response than the present denial of the crisis, and belittling those people who at significant personal cost have courageously shared their experiences with the present system."
He said anyone seeking a contract with the Ministry would know how much detail it required in terms of achievable objectives with measurable outcomes. On that measure, this document would have no chance, and would not even get past the first stage of funding.
It was laudable in its aims to promote better awareness and resilience to individuals and their family/whanau as well as their wider communities, but practical measures were needed.
He was pleased to see the strategy recommended communities work together to establish age-friendly communities.
"A footnote describes age-friendly communities as communities that commit to physically accessible and inclusive social-living environments that promote healthy and active aging and a good quality of life, particularly for those in their later years."
The Ministry responds: We have "demonstrated commitment to support the health of rural New Zealanders"
It's important to have many voices contributing to this conversation and it's clear from your article that some time has been spent reviewing the draft suicide prevention strategy document, writes Dr John Crawshaw, director of mental health.
We encourage the author and those quoted to make a submission so that we can ensure we capture their feedback as part of the consultation process.
Suicide has a devastating ripple effect across communities, not just for those who die by suicide, but for their whânau, families, friends, colleagues, sports team mates, neighbours and the wider community. The impacts of suicide on all our lives are long-lasting and profound.
The Ministry of Health and the Ministry for Primary Industries have jointly funded rural mental health initiatives since 2015, and have a demonstrated commitment to support the health of rural New Zealanders.
In the health sector the Rural Health Alliance Aotearoa New Zealand (RHÂNZ) is contracted to deliver this work. RHÂNZ works closely with Rural Support Trusts across the country.
The 2015/16 joint funding was $575,000 and in 2016/17 it was $500,000.
This rural mental health initiative to date has included:
- Delivery of 42 suicide prevention workshops across rural New Zealand
- Development of a new workshop programme focused on assisting professionals to better manage suicidal patients in a rural setting
- A rural mental health and addiction framework - available on the RHÂNZ website: http://www.rhaanz.org.nz/rural-mental-health-initiatives/
There has been a two stage process to the development of the draft suicide prevention strategy.
To inform development of the draft suicide prevention strategy last year the Ministry of Health held 23 workshops around the country with families, providers, clinicians, academics, and other government agencies.
A draft strategy document has been developed and we are currently consulting on this. Now is the time for interested people and organisations to provide us with feedback on how we can work together to prevent suicide.
It is vital that everyone gets involved and works together so that we can make a real impact.
I encourage people to read the draft strategy and attend one of our public meetings to share their views or make a submission.
The draft strategy and more information about how to make a submission is available on our website:
The consultation period ends at 11pm, 12 June 2017.
WHERE TO GET HELP
Lifeline (open 24/7) - 0800 543 354
Depression Helpline (open 24/7) - 0800 111 757
Healthline (open 24/7) - 0800 611 116
Samaritans (open 24/7) - 0800 726 666
Suicide Crisis Helpline (open 24/7) - 0508 828 865 (0508 TAUTOKO). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.
0800 WHATSUP children's helpline - phone 0800 9428 787 between 1pm and 10pm on weekdays and from 3pm to 10pm on weekends. Online chat is available from 7pm to 10pm every day.
Kidsline (open 24/7) - 0800 543 754. This service is for children aged 5 to 18. Those who ring between 4pm and 9pm on weekdays will speak to a Kidsline buddy. These are specially trained teenage telephone counsellors.
Your local Rural Support Trust - 0800 787 254 (0800 RURAL HELP)
Alcohol Drug Helpline (open 24/7) - 0800 787 797. You can also text 8691 for free.
For further information, contact the Mental Health Foundation's free Resource and Information Service (09 623 4812).
- Taranaki Daily News