Suggested Actions for
Suicide Prevention 2017

These suggested actions for suicide prevention are a summary of proposals received during the development of the draft Suicide Prevention Strategy, including from clinicians, academics and members of the public who attended engagement workshops.

  • Suggested actions have been categorised into three broad themes:
  • Building positive wellbeing throughout people’s lives
  • Recognising and appropriately supporting people in distress
  • Relieving the impact of suicidal behaviour on people’s lives
  • A theme that cross-cuts all the others is the need to use Māori and Pacific models of wellbeing to inform our work, particularly when working with whānau/families.

Building positive wellbeing throughout people’s lives

Support for parents, whānau and families

  • Parenting programmes
  • Better financial support for families – poverty (either unemployment or long, low-paid working hours) is affecting overall family/whānau health and mental health
  • Tikanga and whakapapa knowledge in whānau
  • Support/education for parents/whānau to have difficult conversations with children
  • Addressing family violence
  • Lack of coaching for parents of teenagers – there are a number of supports for parents during early childhood and primary school, this drops off as the children reach secondary school age. Suggestion of ‘Wise Tips’ type campaign; use of social media; peer mentoring for youth

Positive environments physical/emotional/cultural

  • Are You OK? campaign to raise awareness of needing to talk / Community members trained to recognise signs and support people to seek help
  • Acknowledge and use Māori pathways – clear culturally focussed pathway connected in a whole-of-system approach
  • Schools/communities equipped to teach resilience, coping mechanisms and life skills, ie, money management
  • Community initiatives/development to foster connectedness
  • Meaningful employment and increased minimum wage
  • Mentoring programmes / people have a ‘safe’ person to talk to
  • Drop-in centres/safe spaces for youth or anyone that needs it
  • Raise awareness of currently available supports / services / phone trees / whānau/family
  • Education about ‘healthy’ relationships for people to recognise abusive behaviours early
  • Reduce access to alcohol

Communities equipped and able to provide support

  • Provide training for communities wanting to do more to prevent suicide (ie, different solutions needed for each community)
  • Campaign to recognise signs and ask people if they are OK and then knowledge of where to go for further support
  • Use existing community leaders to promote wellness, people listen to those they respect
  • Make reducing suicides a national health target (including in district health boards, DHBs, and prisons)

Wellbeing is promoted

  • More focus on holistic wellbeing for children/youth, can use Whare Tapa Whā model
  • Teach resilience strategies
  • Change language from suicide prevention to life-enhancing strategies; this will enable wider uptake with less stigma
  • Programmes to enhance social connectedness
  • Positive role models, mentors, youth leadership for other youth seen as more accessible than adults and professional services

Addressing stigma

  • Media, for example,
  • Teaching parents of teenagers how to have safe conversations about risk and suicidal behaviour
  • Promoting support and resources (eg, Tihei Mauri Ora publication by Mental Health Foundation)
  • Normalising talking about and seeking help for stress/anxiousness/grief/ depression – Keeping it secret perpetuates the shame
  • Change the language, services labelled as ‘mental health’ puts people off seeking help
  • Further pubic campaigns, like John Kirwan, that show that depression/suicidal thoughts can hit anyone and that people need to talk and seek help

Suicide prevention awareness

  • Wide ranging and wide reaching adverting campaigns aimed at different groups
  • Talk about suicide more – need to talk about it to prevent and not be afraid it will lead people to take their own lives
  • Suicide prevention is not just a health issue, need a whole-of-government/society approach
  • Raise awareness of signs/symptoms of mental stress

Health/mental health literacy

  • Health literacy needs to be promoted widely, and this means different agencies and sectors working together
  • School-based programmes
  • Recognition that people aren’t happy all the time and providing tools to get through the bad times
  • Education programme based on tikanga framework
  • Multi-media awareness campaign
  • Focus on alcohol and other drugs (AOD) harm

Recognising and appropriately supporting people in distress

Services are accessible and responsive

  • Ensure people are helped at first contact point
  • Free services, GP costs are a barrier
  • Need wider access to help than via GP, ie, text and telephone counselling
  • Increase mental health workforce
  • Make services more visible to the community
  • Services open for longer hours than 8am to 5pm week days
  • Access shouldn’t be precipitated by crisis
  • Rural access is a major issue – trains or other forms of public transport for people in rural or distant communities
  • Increase funding for mental health services to widen access and reduce waiting
  • Increase in pre-crisis services, ie, more anger management, relationship counselling, confidential person for teenagers to contact

Services are appropriate and effective

  • Increase Māori and Pacific workforce
  • Provide services differently, ie, via marae-based hubs
  • Suicide prevention is not just a health issue; it’s multi-agency and across society so needs a whole-of-government and society approach
  • Join up with other sectors, ie, Education to have counsellors/psychologists at schools, make it more accessible for youth
  • Examine needs for patient confidentiality with needs of whānau/family to be involved in wellness
  • People attempting to access services are never turned away but helped to find the right services
  • Different services are need for youth, Māori, men, etc – one service may not be appropriate for all
  • Rural living means there’s often no choice in services

Services – gaps or lack of knowledge of their existence

  • Crisis Assessment and Treatment Team (CAT Team) needs to be scaled up and better funded, would save ambulance and Police time on call-outs, which are much better dealt with by trained mental health services. The CAT Team often has a very high threshold for attending and ambulance and Police pick up the rest – there needs to be a lower level service for non-suicidal people in mental distress. Need to talk to St John and Wellington Free Ambulance and get their views
  • Knowledge of what services are available, every door is the right door, follow-up is undertaken – increasing knowledge about what services are available from different agencies and how they can be accessed if needed – people need to be able to access any service and be seamlessly provided with what they need; it is important that follow-up is done in the right place and in a timely way
  • Common definitions – currently there are no common definitions for terms like risk, which means one agency/service may feel they need to respond, but another feels they don’t meet the criteria
  • Funding – an inter-agency protocol where funds can be allocated from more than one agency in order to purchase a service or piece of work that contributes to suicide prevention
  • Work with public figures who have a profile in the suicide prevention area – there is a disjoint between what government can do and popular figures who have an interest / work in the area, possibilities of partnerships to fill a gap of getting messages across via a publicly known figure
  • Mental health assessment unit attached to an emergency department (ED) – A lot of ED time is used on people who have self-harmed or attempted suicide, and there are often no avenues to use for discharge and referral. A mental health assessment unit attached to ED would have a triage function, more appropriate assessment and planned approach to management and treatment and could help to ensure that anybody presenting to ED for self-harm or a suicide attempt is linked to a social worker /and or their GP is informed. Could include piloting such an ED unit in one district health board (DHB); include evaluation and analysis before national implementation
  • A DHB performance indicator of maximum length of wait for follow-up (post-attempt) of seven days

Treatment of mental health conditions

  • Upscale depression.org, eg, by including a suicide prevention module within ‘The Journal’ as well as a suicide screening tool on the website front page
  • Target depression.org so that it is more appealing to working-age men, given they comprise the largest number of deaths by suicide
  • Find ways of bringing the content of depression.org to those who are not computer literate or who do not have internet access
  • Update, promote and improve mobile device compatibility for SPARX (
  • Post attempt, provide access to resilience building programmes that include whānau/family
  • Crisis resolution plans written as part of post-attempt follow-up
  • Strengthen non-governmental organisation (NGO) services where there is a lack of community support
  • Appropriate response and intervention after a risk assessment

Use of technology data and infrastructure

  • ‘Aunty Dee’ app
  • Telehealth for suicidality/suicidal behaviours
  • Electronic health records, need to share information better
  • One central contact number for mental health crises
  • Development of phone apps to help people navigate and contact services
  • Interagency discussion about information sharing to prevent suicide, need to tackle privacy versus safety

Workforce development

  • Use InterRAI assessment as a screening point for older people
  • GP use of PHQ-9 with older people
  • Ambulance officer training module for responding to suicide attempts
  • Dedicated suicide prevention training for health professionals at undergraduate level
  • Career pathway described for suicide prevention coordinator roles
  • Primary health care workforce skilled and confident with depression and suicide risk assessments/questioning with older people

Integration/inter-agency work

  • Connect Family Start with Well Child Tamariki Ora programme and Infant Mental Health
  • Wrap-around care approach in cases of child abuse
  • Communication, links and access between primary health care physicians and Work and Income New Zealand (WINZ)

Public health interventions

  • Teaching problem/stress solving skills at school level
  • Mental health first aid in workplaces

Awareness of, and access, to support

  • Everyone knows how and where to access support
  • Make suicide/mental health OK to talk about
  • Better promote available resources and services

Coverage of available support

  • A phone app to facilitate the kōrero through a suite of preventative measures. People understand how to use the app, and can use it to seek help with various services including GPs
  • Look at rural access issues
  • Ensure cultural competence about differing world views and better integrate mainstream services with marae-based services

Actions to reduce suicidal behaviour of youth

  • Schools accessing Child and Adolescent Mental Health Services (CAMHS) – inconsistent accessibility, varying thresholds and the importance of strong connection with guidance counsellors. Access issues are amplified for rural schools
  • Consider utilising the Youth One Stop Shop model – local people available to support young people
  • Mobilise a volunteer movement – university or polytechnic students, given appropriate training and supervision, supported to mentor students through secondary school. Consider credits/formal acknowledgement of their contribution through mentoring
  • Role of Victim Support in youth suicides – noting the rest of the family including children. NOTE: Ministry of Education has an informal notification process in Auckland whereby after a suspected suicide, their staff are notified and they then contact the schools of children in the deceased’s family that there has been a ‘death in the family’ so that schools are aware and can support the children affected
  • Consider whether the existing services meet the need of at-risk young people – review existing services; consider designing new services if they do not match the needs

Information sharing and privacy

  • Feedback between mental health services and Police after suicide attempts – communication between mental health services and Police after suicide attempts – create a mechanism for secondary mental health services and the Police to be able to contact each other (bidirectional) after Police attend a 1X call-out, where there are issues to address to improve practices in future call-outs. This mechanism would enable constructive feedback in both directions to improve the service to people at risk of suicide. This could be supported by a procedure for escalating issues that may need addressing at a level higher than local communities
  • Connect emergency department (ED) presentations to schools – when a young person presents at the ED, potential to notify school, in order for schools to support implementation of services
  • Integration within agencies as well as between agencies – some integration issues within agencies, such as a lack of information sharing (eg, between WINZ and Child, Youth and Family (now Oranga Tamariki) and between secondary mental health services and community mental health services). Important to have feedback loops for information within agencies as well as between agencies
  • Parental consent as a barrier to accessing services – requires investigation as to where the barriers are, whether these are real/legal barriers or misunderstandings of the Privacy Act 1993

Relieving the impact of suicidal behaviour on people’s lives

Effective support for communities and families – longer-term community support

  • Develop victim support groups
  • Have targeted postvention services for different groups
  • Develop a campaign about supporting those who experience loss due to suicide
  • Educate people such as funeral directors so they can provide appropriate services and support

Research

  • Use the Integrated Data Infrastructure (IDI) to enhance the understanding of the history behind an attempt or completed suicide
  • Convene an academic external review panel
  • More research/data collection and evidence base

Social determinants of suicide

  • Improve (agency and NGO) infrastructure and networks/connections to protect children
  • Utilise connection with health services at the ante-natal stage for building emotional awareness, protective factors, mental health literacy
  • Expand number of infant mental health teams
  • Investigate conditions of WINZ job-seeker benefit (with medical exemption) with regards to limitations on part-time work, noting that employment is a protective factor for suicide
  • Use the IDI data to investigate social determinants further

HP6586

April 2017

Suggested Actions for Suicide Prevention 20171