APPROVAL to Consult on a Draft Suicide Prevention Strategy

In confidence

Office of the Minister of Health

Cabinet Social Policy Committee

APPROVAL TO consult on A draft suicide PREVENTion strategy

Purpose

1  This paper seeks Cabinet agreement to the Ministry of Health releasing ‘A Strategy to Prevent Suicide in New Zealand: Draft for public consultation’ (the draft Strategy).

Executive summary

2  Suicidal behaviour affects a significant number of people every year, and has substantial impacts on the people themselves, their families and whānau, and the wider community. There are about 500 suicides each year and about 20,000 attempted suicides.

3  Preparations for a new suicide prevention strategy to follow and build on the New Zealand Suicide Prevention Strategy 2006–2016 (previous Strategy), have been underway since 2015. Several activities were evaluated and found to be effective and have likely contributed to the almost 10 percent reduction in suicide rates between 2006 and 2013.

4  Public and sector expectation is now high that there will be a new suicide prevention strategy to replace the previous Strategy. They need to be given confidence that a new suicide prevention strategy will be available soon to guide suicide prevention activities.

5  Key themes to emerge from preparatory work on how to prevent suicide include: the need for a broad cross-society and cross-government approach; building individual, family, whānau and community wellbeing; reducing the stigma around suicide and mental illness; providing better access to support, services, and professional help; providing parents and whānau with ongoing support; and publicly and safely talk about suicide.

6  Consistent with these themes, the attached draft Strategy builds on the previous Strategy in two main ways:

a  There is a significantly stronger focus on a cross-government approach. Working together means seamless and integrated responses, based on good information sharing, that have a collective and sustained impact on suicide rates – and reducing the substantial adverse impacts that suicidal behaviour also has on agencies.

b  There is a significantly stronger focus on a cross-society approach. To make a substantial and sustained impact, everyone needs to be involved. Health (particularly mental health) services, and the government generally, cannot do it alone.

7  Consultation on the draft Strategy is proposed to begin on 12 April 2017 and conclude on 12 June 2017. It will focus on: the proposed pathways for action; the proposed action areas; and the relative priority of possible actions within these areas.

8  Paragraph redacted - Withheld under S9(2)(f)(iv) Confidentiality of advice tendered by Ministers and officials.

9  Paragraph redacted - Withheld under S9(2)(f)(iv) Confidentiality of advice tendered by Ministers and officials.

10  Paragraph redacted - Withheld under S9(2)(f)(iv) Confidentiality of advice tendered by Ministers and officials.

Background

11  Suicidal behaviour (see Appendix One for a description of terms) affects a significant number of people every year, with suicide being the third leading cause of premature mortality. The figures show that overall suicide rates have decreased by almost 30 percent since they peaked at 15.1 deaths per 100,000 people (577 deaths) in 1998.

12  Since the previous Strategy was introduced in 2006, there has been an almost 10 percent reduction in suicide rates (a rate of 12.2 per 100,000 people in 2006 compared a rate of 11.0 per 100,000 people in 2013, the last year for which official statistics are available). It should be noted however, that suicide rates, as well as the number of suicide deaths fluctuate between years.

13  Suicide rates vary between different population groups (see Figure One; Appendix Two contains further information on varying rates). There is a markedly higher rate of suicidal behaviour among some groups. This includes people who are or have been in the care of CYF or Department of Corrections, or have had contact with the Police, as well as the following population groups:

a  youth – 22 percent of all suicides;

b  Māori – 20 percent of all suicides, half of whom were aged 15 to 24 years; and

c  men – 70 percent of all suicides.

Figure one: Suicide rates by ethnicity and five-year age group (from 5 years of age to 79 years of age), 2009–2013

14  It is estimated that a further 150,000 people in New Zealand think about taking their own life, around 50,000 make a plan to take their own life and around 20,000 attempt suicide every year. Further information is in Appendix Two.

15  Suicidal behaviour has lasting harmful impacts. Those impacts include:

a  the loss of years of life, psychological distress, impaired physical and mental health, pain and suffering, and loss of quality of life;

b  the demands placed on government agencies such as health services, Police, Coroners, and Department of Corrections, and non-governmental organisations; and

c  the indirect costs arising from the loss of people from the workforce and society.

16  An indication of the substantial scale of these costs comes from the estimated monetary impacts of suicidal behaviour. For suicide alone, these have been quantified by the Ministry of Health at approximately $2 billion per year (2015 $). This estimate is consistent with estimates published by the Auditor-General, and is based on the economic cost of a single suicide at $602,700 and the non-economic cost at $3.4 million (which reflect the values of statistical lives used by the Ministry of Transport). The extent of these costs also suggests that there is significant potential return on investments that are effective at reducing suicidal behaviour.

17  There is considerable political, media, and public concern about suicidal behaviour and its impact, with Cabinet also expressing concern (CAB Min (15) 13/1 refers). In recent years, the government’s response to these concerns has been reflected in the previous Strategy.

New Zealand Suicide Prevention Strategy 2006–2016 (the previous Strategy)

18  The previous Strategy:

a  aimed to reduce the rate of suicide and suicidal behaviour, reduce inequities in suicidal behaviour between groups, and reduce its harmful effects;

b  sought to achieve these goals through establishing a framework to organise and co-ordinate a range of prevention efforts that addressed causes of suicide (see Appendix Two); and

c  had two associated Action Plans that set out specific steps to be implemented.

19  In December 2015, Cabinet Social Policy Committee noted that 29 out of the 30 actions in the New Zealand Suicide Prevention Action Plan 2013–2016 (Action Plan) were in place or had been completed [SOC-15MIN-0059 refers]. All 30 actions are now in place or have been completed (see Appendix Four for a summary of the actions and their current status).

20  The only outstanding action at the last update was ‘Action 11.3 – Develop a Suicide Prevention Outcomes Framework’. This has been developed and has informed the development of the draft Strategy. As all the actions have now been completed, I will not be making further progress reports on this Action Plan.

21  Several activities (for example, Victim Support and the Community Postvention Response service) under the previous Strategy were evaluated and found to be effective and led to improvements in service delivery. Most activities also reflected international evidence on what is effective at reducing suicide. These activities contributed to the almost 10 percent reduction in suicide rates between 2006 and 2013, the most recent year that data is available for (from 12.2 per 100,000 to 11.0 per 100,000). The previous Strategy as a whole was not, however, formally evaluated. This makes it difficult to be certain about how much of the reduction in suicide rates the previous Strategy was responsible for.

Preparations for a new strategy

22  With the previous Strategy coming to an end in 2016, preparations for a new suicide prevention strategy began in 2015. Those preparations were guided by Cabinet noting that making a significant impact on preventing suicide required a multi-sectorial, multi-component approach (CAB Min (15) 13/1 refers). Preparatory work has included reviewing the literature, some initial statistical analysis, a review of international guidance, working with an external Advisory Group, as well as extensive workshops with interested parties. Cross-agency working and steering groups have driven the development of the draft Strategy.

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Table One: Summary of the Draft Suicide Prevention Strategy

Vision: “All people experience a life worth living and have pae ora (healthy futures).” This is captured in: ‘Ka kitea te pae tawhiti. Kia mau ki te ora.’ – ‘See the broad horizon, hold on to life’.
Purpose: Reduce the suicide rate for all people through reducing suicidal behaviour.
Pathways: Reduce suicidal behaviour by increasing protective factors and reducing risk factors through universal (for all), targeted (for higher risk groups) and indicated (for people at high risk) activities under one or more of the following three pathways.

Pathway one: Building positive wellbeing throughout people’s lives

·  Building people’s ability to withstand adversity and cope when they are faced with adversity.
·  Strengthening whānaungatanga and positive close relationships with others.
·  Making communities and environments more supportive and ensure they promote wellbeing.
Examples of activities this could include are:
·  individuals, whānau, families and friends encouraging each other to participate in programmes and activities that can help improve their wellbeing (eg, physical activity)
·  employers establishing workplace positive wellbeing programmes and strategies (eg, to prevent and deal with bullying in the workplace)
·  implementing and extending wellbeing in schools programmes (eg, extending some of the Positive Behaviour for Learning initiatives and improving policies for preventing bullying).

Pathway two: Recognising and appropriately supporting people in distress

·  Providing appropriate care and support to people in distress.
·  Strengthening the ability of whānau, families, friends and communities generally to recognise and support people in distress.
·  Building joined up systems to recognise and support people in distress.
Examples of activities this pathway could include are:
·  develop and increase access to e-therapies (eg, adapting and promoting existing e-therapy programmes for older adults and for working age males)
·  ensuring people can access services regardless of where they live.

Pathway three: Relieving the impact of suicidal behaviour on people’s lives

·  Supporting individuals after a suicide attempt or self-harm.
·  Support whānau, families, friends and communities after suicidal behaviour in their whānau, family, peer group or community.
·  Building systems to inform better prevention of suicidal behaviour (such as learning from past suicidal behaviour).
Examples of activities this pathway could include are:
·  providing specialist practical and emotional support to whānau, families and friends of those bereaved
·  producing a dashboard showing progress on preventing suicidal behaviour.
Focus: The initial focus of targeted activities will be on the following groups with markedly higher suicide rates.
·  Māori (particularly those aged 15–44 years and those aged 15–24 years living in areas of high deprivation).
·  Mental health service users and those admitted to hospital for intentional self-harm.
·  Pacific peoples (particularly Pacific peoples aged 15–44 years and Pacific peoples aged 15–24 living in areas of high deprivation).
·  Young people aged 15–24 years.

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23  Key themes to emerge from this work to date on how to best reduce suicide rates are to:

a  build individual, family and community wellbeing

b  reduce the stigma around mental health and break down the fear of seeking help

c  provide better access to support, services, and professional help

d  build cohesive families and provide parents and whānau with ongoing support

e  use Māori and Pacific models of wellbeing to inform our work, particularly when working with whānau/families

f  publicly and safely talk about suicide (for example, advertising on TV, billboards and social media).

24  Public and sector expectation is high that there will be a new suicide prevention strategy to replace the previous Strategy. This is reflected, for example, in suicide and suicide prevention being the focus of considerable correspondence and comment, a petition to Parliament, and media organisations continuing to give them a strong profile. The public and sector expectations are such that the only effective response to give them confidence that concrete progress is being made is to release the draft Strategy for consultation.

Approach to the draft Strategy

25  The attached draft Strategy is summarised in Table One on the previous page. Consistent with the feedback received during the consultation to date, the draft Strategy builds on the previous Strategy. One way it does this is through simplifying the purpose so that it can be more easily measured: the purpose is now reducing New Zealand’s suicide rate for all people through reducing suicidal behaviour. There are two other – and more significant – ways in which the draft Strategy builds on the previous Strategy that are described below.

A cross-government approach

26  There is a significantly stronger focus on a cross-government approach. Working together means seamless and integrated responses, based on good information sharing, that have a collective and sustained impact on suicide rates. Many agencies have a strong interest in working with the health sector to make a difference, including Police, Department of Corrections, Work and Income, the Ministry for Vulnerable Children, Oranga Tamariki.

27  That interest stems from the impact they can have on reducing suicide rates, and suicidal behaviour more generally through the wide range of complementary levers available to them. It also recognises the significant impact that suicidal behaviour has on many government agencies. Examples of the impact on other agencies include the following:

a  Police: Police are required to attend and investigate each of the approximately 500 suicides each year, as well as attending threatened or attempted suicides. In 2016, they attended almost 19,000 threatened or attempted suicides (nine percent more than in 2015). In addition, as Appendix Three shows, having a criminal offence record increases the risk of suicide.

b  Department of Corrections: there were 60 suspected suicides in prisons during the nine years ending July 2016 (a crude suicide rate of about 67 per 100,000 prisoners each year, which is substantially higher than national rates of between 10.9 and 12.9 per 100,000 people each year in recent years). Impacts for the Department of Corrections following a suspected prisoner suicide include: a clinical review of each suicide to identify any service; quality assurance or practice issues; staff attendance at Coronial Inquests; and providing support to health, custodial staff and family and whānau.