10.2 What needs to happen

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10.2.1 Issues

Suicide affects people of all ages and from all walks of life, but populations such as young people, males and Māori experience disproportionately high numbers. We also heard of the deep concern from Rainbow communities about suicide within their communities. Our suicide rate for young people is among the worst in the OECD.²⁰⁹ New Zealand data show that considerably more than half of youth suicides involve alcohol or illicit drug exposure.²¹⁰

In terms of absolute numbers, our greatest loss of life through suicide occurs among people older than 24 (404 lives lost), particularly males aged 25–44 (136 lives lost).²¹¹ These statistics alone emphasise the magnitude of the problem. But we also heard many stories about how the lives of those affected by the suicide of a friend or loved one are forever changed – thousands of New Zealanders are touched by suicide in some way every year.

New Zealand has various suicide prevention initiatives in place. We heard many times that preventing suicide should be everyone’s business, and we agree with that sentiment. Literacy around this sensitive topic is low in New Zealand. In recent years there has been much more openness and public discussion about suicide. However, it is essential that there is safe messaging around these discussions and that they are culturally sound. Appropriate support and resources must be readily available immediately following public engagement with families and whānau and communities.²¹²

Nearly half of New Zealanders who die by suicide had recent contact with mental health services,²¹³ and the Chief Coroner told us that many more are likely to have had contact with a general practitioner over the previous year.²¹⁴ This suggests we are missing opportunities for preventative action and early intervention. In addition, mechanisms exist for reviewing how a suicide could have been prevented, such as district health board (DHB) sentinel event panels, the Suicide Mortality Review Committee and coronial inquiries.

Unfortunately, we heard that the coronial process is often extremely drawn out, especially for cases of suspected suicide, taking up to four years to complete. Some submitters described delays in the coronial process as adversarial and re-traumatising and said that communication and information sharing were inadequate. We understand that the coronial service has limited capacity, which contributes to lengthy delays.

It is unsatisfactory that grieving families are subject to extensive delays and that it is unclear whether coronial and Health and Disability Commissioner review processes should be put on hold pending the outcome of another statutory process or the findings of a DHB review. We also note the concerns of families who feel compelled to hire their own lawyer, if they can afford to, whereas clinicians and DHBs are generally represented by publicly funded legal counsel.

We think it is time for the Ministries of Justice and Health, with advice from the Health Quality and Safety Commission and in consultation with families and whānau, to review the processes for investigation of deaths by suicide, including the interface of the coronial process with DHB and Health and Disability Commissioner reviews. The aim should be to develop less adversarial processes that are undertaken within acceptable timeframes, ensure families and whānau are not disadvantaged by lack of access to publicly funded legal counsel, ensure clear pathways and better integration of reviews, provide greater support for bereaved families and whānau, and identify opportunities to improve services and prevent suicide.

We are aware of services that engage in routine quality improvement processes, including DHBs that have adopted a Zero Suicide in Services approach. These types of processes can be extremely beneficial, providing opportunities to learn from suicides and implement best practice. Such initiatives should be implemented more broadly across services.

The suicide of someone close – a parent, sibling, friend, or family or whānau member – is highly associated with increased suicide risk, although evidence is limited about the effectiveness of interventions to support people who have lost someone to suicide. Support for people who are bereaved by suicide is extremely important. Access to support and services that are timely, culturally appropriate and respectful can accelerate healing processes, while services that are not, can impede recovery. Support by others with experience of being bereaved by suicide has also been described as helpful by some submitters. We are aware that support for those bereaved by suicide is available, but is not consistent across the country. Concerns were also raised about whether the current workforce has appropriate skills and training and about a lack of culturally sensitive approaches to support people after someone has died by suicide.

10.2.2 What needs to happen

Develop a comprehensive, long-term, cross-sectoral national suicide prevention strategy and implementation plan

A draft national suicide prevention strategy was consulted on in 2017. Its progress was suspended pending the outcomes of this Inquiry. We believe a new suicide prevention strategy should be developed rapidly on the understanding that suicide prevention is a cross-party and cross-sectoral national priority and that implementation must be well resourced. A national suicide prevention target could be a component of the strategy. An implementation plan outlining required resources, assumptions, short- and long-term outcomes, and roles and responsibilities should accompany the new prevention strategy.

In addition to a strong long-term commitment to suicide prevention, including a bold national suicide prevention target, the suicide prevention strategy should:

• provide a clear vision and direction that recognise the complexity associated with suicide
• include processes for supporting people who have been bereaved by suicide that are timely, culturally appropriate and inclusive
• be responsive to Māori and Pacific world views
• be responsive to the needs of at-risk communities and population groups
• contain a coherent suite of complementary initiatives that put people at the centre, target priority population groups, and are evidence-informed and designed to allow for rigorous monitoring and evaluation
• include a strategic research agenda to systematically build our knowledge of the factors that contribute to suicide for different populations, strategies that are effective in reducing suicidal behaviours, including through appropriate reporting about suicide in the media, and the most effective ways to support people bereaved by suicide.

Set a medium-term national suicide reduction target

Views are mixed about establishing a suicide reduction target. On the one hand, suicide is complex and many factors contributing to it cannot be controlled for, making it challenging to achieve a target. On the other hand, setting a target sends a clear signal that suicide prevention is a priority and can galvanise energy around suicide prevention. Evidence from Scotland suggests a suicide target was important for decreasing rates of suicide in that country.

Advice received during consultation on the national suicide prevention strategy recommended that a target of 20% reduction in suicide rates over 10 years be adopted. We believe 20% reduction by 2030 is achievable if we intensify and sustain our suicide prevention efforts. This target must apply to all population groups – not only to the total population. We also need to be clear in setting a medium-term suicide reduction target that no suicide rate is acceptable – we should be aspiring to zero suicide.

We cannot expect to see an immediate decrease in suicide rates at a national level. While some strategies are available for delivering relatively rapid decreases, other opportunities for reducing suicide rates, such as addressing poverty and family violence, supporting and strengthening parenting, and nurturing resilience during the early years of life, may not show up in reduced suicide rates for a generation. This highlights that suicide reduction requires sustained and intensive effort over a long period, with strong cross-party and cross-sectoral commitment.

Access to the range of services and models identified earlier (Table 3 in section 4.4.1) will also be important. People who attempt suicide or express suicide ideation need to be able to access a wide range of therapies and interventions. Whether they present via their general practitioner, police, an emergency department or mental health services, clear avenues should be available for them to receive immediate access to appropriate, wrap-around support, including counselling and talk therapies and peer and whānau support, as well as access to alcohol and drug interventions.

Reducing suicide rates will also require a whole-of-government approach to supporting wellbeing and addressing multiple social determinants, as recommended in chapter 7.

Resource implementation well

Previous strategies have suffered from insufficient resourcing and a lack of attention to effective implementation. In addition to focusing on what needs to be achieved, a national cross-sectoral suicide prevention strategy must be accompanied by a concrete implementation plan that specifies the actions to be undertaken and the associated resources required to support effective implementation.

Suicide prevention receives relatively little funding and dedicated resources and expertise are lacking in central government. This lack of investment and focus does not support suicide prevention. We believe that a significantly increased strategic investment in suicide prevention is warranted.

Strengthen leadership

Better, stronger, sustained leadership is required to reduce our rates of suicide. One avenue for achieving this would be the establishment of a suicide prevention office. Such an office could serve as a repository of suicide information, support local implementation of programmes and coordinate cross-agency activities. It could be located in the Ministry of Health, in the new Mental Health and Wellbeing Commission (chapter 12) or elsewhere in government, for example as part of the proposed social wellbeing agency (chapter 7). We note some precedents overseas for having a named Cabinet Minister responsible for suicide prevention or forming a cross-sectoral steering and implementation group.

The new Mental Health and Wellbeing Commission would be well placed to undertake critical functions associated with the prevention of suicide, including leading development and reviews of national suicide strategies and championing their implementation, ensuring robust evaluations of strategy implementation and reporting on progress.

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