Youth suicide prevention starts with building resilience young - PM's chief science adviser
Resilience programmes should be introduced into primary schools for children as young as 6 and 7, as part of plans to reduce New Zealand's high youth suicide rates.
There was "clear evidence" that behaviour programmes focused on primary school children contributed to reducing "later adolescent suicidality as well as other unwanted behaviours", the prime minister's chief science adviser has told ministers.
In a discussion document released on Wednesday, Sir Peter Gluckman delved into the risks associated with growing up in the 21st century and points to the need to better develop the resilience of children "to the inevitable stressors of growing up".
With young people hitting puberty earlier right across the Western world, analysis showed "compelling evidence" that children who enter puberty at a younger age, were at "far greater risk of behavioural, psychological and emotional disorder".
There was "unequivocal evidence" that children who entered puberty early were "more likely to indulge in alcohol and drug abuse" and often demonstrated more impulsive behaviours. Boys, in particular, showed greater impairment in the quality of their relationships.
Adolescence was a period of "relatively poorly developed self-control and heightened impulsive behaviour", Gluckman said.
"So, rather than resilience, which might be expected – and needed – we see severe and harmful (including self-harm) responses."
In fact, the rates of hospital admissions for self-harm were 50 to100 times higher than those for suicide. Many more than that again had suicidal thoughts, although that was difficult to quantify in statistics.
But a further possible factor in increasing rates of youth suicide was a "substantial change in the way we raise our children", Gluckman said.
"They now tend to be under tight control in the pre-pubertal period but less control post-puberty (as reflected in school subject choice, parental controls on time, place and behaviour, access to credit cards and the internet etc).
"In contrast, 50 years ago Western child-rearing practice followed a loose-tight pattern in which pre-pubertal children had more freedoms – especially to undertake risky play – but adolescence was much more constrained.
"This reversal may have resulted in a reduction in the capacity to self-assess risk in adolescence."
As well as changes in family structure and parenting practices, children were also growing up with different levels of parental engagement, and technology had changed the nature of their social networks and communication.
Meanwhile, media, celebrities and other social factors were combining to create "unrealistic expectations and pressures on young people".
"Compared to previous generations, youth face many more choices at an earlier age, but at the same time may have less clarity as to their path ahead," Gluckman said.
New Zealand's youth suicide mortality rate in 2010 was 15.6 per 100,000 adolescents aged 15-19 – the highest among reported OECD rates.
But National rates should be treated with caution, Gluckman advised. "There were reasons why many countries may under-report," he said.
From July 1, 2014 to June 30, this year, there were 238 suicides among New Zealanders aged 12-24. Rates were significantly higher for Maori youth aged 15-24, and had not lowered. But the Maori youth population was smaller, meaning the total number of Maori youth suicides was low and it was hard to pinpoint a trend.
Suicide prevention was hard, because causes were not understood well enough at the individual level.
"Completed suicide is a rare event, so it is difficult to study in the way we can study influenza or diabetes."
But primary prevention, with the right programmes placed early on in schools was "strongly suggested". But some formal programmes that had been implemented were likely not helping.
"Indeed, some programmes may actually increase the risk of suicidality."
Reducing access to alcohol, further education to enhance the skills of young people growing up in a digital world and whole-school cultural changes in positive messaging and cultivating media literacy, self-control and social skills were among the most effective early prevention methods.
Programmes that focused on young teens and young adults in their adolescence had seen some successes. But some of those programmes were "distressingly ineffective".
But a focus solely on youth mental health, "although important, is not sufficient", Gluckman said.
"Rather, we conclude that the high-priority need is to introduce and reinforce programmes focused on primary prevention starting early in life and developing secondary prevention strategies involving well-trained and engaged mentors, including peer mentors."
Earlier on Wednesday, Health Minister Jonathan Coleman announced the Government would extend funding for the Suicide Mortality Review Committee to continue its work, beyond its trial period.
"Our suicide rate is too high, particularly the rates for youth and specifically Maori and Pacific young people," said Coleman.
"Although wider interventions and support have been made available, there is always more we can do."
The review committee was established under the New Zealand Suicide Prevention Action Plan 2013-16 and operated on a trial basis under the Health Quality & Safety Commission. It will now receive $750,000 annually, reprioritised from Ministry of Health baseline funding.
In line with international trends, there had been a significant increase in demand for mental health and addiction services in recent years.
"To help meet this increase, the Government's funding for mental health and addiction services has lifted by $300 million. In addition to this, Budget 2017 committed an extra $224m, including $124m for new approaches.
"Cabinet is in the process of considering new mental health initiatives, and the details of these are expected to be released in the next few weeks."