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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.



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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

5–9 10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–49

50–54

55–59

60–64

65–69

70–74

75–79

0.05.0

10.015.020.025.030.035.040.045.0

AsianEuropean & OtherMāoriPacificAll ethnicities

Age group (years)

Rate

per

100

,000

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

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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.

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c Work and Income: unemployment is a risk factor for suicide. For example, about 30 percent of working age men who died by suicide between 2007 and 2011 were unemployed. This means that frontline staff are frequently exposed to clients who may be at risk of suicide. Although staff are not mental health professionals, they have received some mental health awareness training, and there is guidance on what to do if confronted by a client openly threatening suicide but this may not be widely understood. To build greater capability in this area, a comprehensive Suicide Awareness learning programme is in the early stages of deployment for 4,000 client facing staff. Work and Income work with Police whenever a client threatens self-harm.

d Ministry of Education: the Ministry of Education’s Traumatic Incident Service responded to 109 requests for suicide related support during 2015/2016. Features of this work are the ongoing wellbeing of those impacted by the event and the need to deal with the risk of contagion and impacts across several schools. The Service has developed a resource kit for schools on the topic of preventing and responding to suicide, and supports schools to develop and implement suicide prevention and response plans.

e CYF: there were 14 suicides by children and young people in the care of CYF between 2000/01 and 2016/17. Suicide also appears to be a significant issue among children and young people who have been the subject of notifications to CYF. For example, 79 of the 194 rangatahi Māori aged 15 to 24 years who died by suicide between 2007 and 2011 had been notified to CYF at some point.

28 The Ministry of Health has initiated an analysis of data within the Integrated Data Infrastructure (IDI) to understand patterns in the way that people who die by suicide or experience suicidal behaviour contact government, the impact of those contacts, and to identify the opportunities to prevent suicide and reduce the associated government costs. This work will be completed alongside the proposed consultation process. In the meantime, Appendix Three contains a table from the Suicide Mortality Review Feasibility Study 2014/15 which gives an indication of the sorts of findings that could arise from the IDI work.

A cross-society approach 29 There is a significantly stronger focus on a cross-society approach, which reflects a clear

theme that has emerged from community consultation to date. To make a substantial and sustained impact, everyone needs to be involved in suicide prevention: whānau, families, friends, colleagues, sports teammates, hapū, iwi, community groups, churches, organisations such as employers or NGOs, and other government services. The Government and the health sector cannot do it on their own.

30 This reflects the fact that there are many people who are affected by suicidal behaviour, or who are in a position to influence the risk of it occurring through improving wellbeing generally or reducing risk factors. Harnessing the efforts of everyone makes it more likely that the measures that are taken will respond in ways that work for a particular person or group who is at risk of suicide. These people will, however, require support and guidance on how to respond in appropriate ways, and how to effectively involve people with more specific skills in providing additional guidance and support to avoid the risk of them inadvertently increasing rather than reducing risks.



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RELATIONSHIP WITH OTHER WORK 37 The draft Strategy also complements and builds on a range of other cross-government

work that helps to build resilience and wellbeing generally, and reduces risk factors for suicide. These include:

a The emphasis through, for example, Better Public Services and Whānau Ora, on cross-government approaches to educational achievement, employment, good housing, violence prevention, and early intervention for those who are most at risk of harm.

b The Bullying Prevention Advisory Group, which involves 17 agencies (including government agencies) working together to reduce bullying in New Zealand schools. Through its focus on supporting schools to create safe, positive environments that reduce bullying and on improving student wellbeing and achievement, the group’s activities contribute to improving wellbeing and preventing suicidal behaviour.

c The Ministerial Group on Family Violence and Sexual Violence Work Programme, which is implementing a range of initiatives to stop violence from occurring, reduce the harm it causes, and break the cycle of re-victimisation and re-offending.

Reduced violence and offending will contribute to preventing suicidal behaviour, while preventing suicidal behaviour can involve initiatives that can contribute to reducing the likelihood of family violence and sexual violence.

d The release of the New Zealand Health Strategy in April 2016, with its vision of people living well, staying well and getting well. The Health Strategy’s themes of, for example, a people-powered system, supporting people closer to home; and the system functioning as one team rather than isolated silos, provided building blocks for the approach taken to the draft Strategy.

e The National Drug Policy 2015 to 2020, given the significance of alcohol and other drug misuse, and other addictions, as risk factors for suicide.

Comment 38 A final Suicide Prevention Strategy will guide actions by government agencies and the

wider community. These actions will likely have a more collective and sustainable impact on reducing suicide, and suicidal behaviour more generally, than under the previous Strategy. Those joint efforts need to involve coordinated and complementary actions by individuals, families and whānau, non-government organisations, government agencies and the wider community to reduce the risk of suicidal behaviour. There will also need to be more seamless and integrated follow-up and support for people in distress, as well as after suicidal behaviour has occurred.

39 The draft Strategy itself does not set out which specific actions will be implemented by government agencies and the wider community to make the substantial and sustained

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impact on suicide rates – and which will bring the strategy to life. The actions that are chosen to bring the strategy to life will be informed by the public consultation process.

40 The final actions chosen will also need to take into account the expected return on any required investment. Those returns could come from a combination of some or all of the following:

a Fewer people dying prematurely, and a reduction in the associated losses from people leaving the workforce.

b Reduced psychological distress, pain and suffering.

c Improved physical and mental health, and improved quality of life.

d A reduction in the demands placed on health services, and reduced pressure on Police, Corrections, Work and Income, Coroners and Victim Support.

e A reduced level of indirect costs because fewer people leave the workforce.

Next steps 41 It is proposed to release the draft Suicide Prevention Strategy for public consultation on

Wednesday 12 April, 2017. This will be followed by a full, eight week, consultation process, over and above the statutory holidays that occur during the eight weeks.

42 The consultation process will be completed on 12 June 2017. This is before the three month pre-election period commences on 23 June, during which there are limitations on the extent of public engagement by officials.

43 The consultation will focus on three broad areas:

a whether the proposed pathways for action are appropriate;

b whether the potential action areas are appropriate; and

c the relative priority of the action areas and the particular activities within those action areas.

44 Consultation on the draft Strategy will be complemented by completing the analysis of data within the Integrated Data Infrastructure, and the analysis of other data, such as that held by Police. A cross-government suicide prevention investment framework to guide implementation, and a robust evaluation and monitoring framework and system to track progress, will also be developed. This will allow better tracking of progress than was possible under the previous strategy.

45 A report back to Cabinet on the outcome of the public consultation process, along with a proposed final Suicide Prevention Strategy, and its place in the updated mental health and addiction strategy will be provided in late 2017.

Consultation46 There has been extensive consultation to date with stakeholders as part of the process of

preparing the draft Strategy. The views of family and whānau, advocacy agencies, service planners and funders, non-government providers, clinicians, academics, and government agencies were gathered through 23 national, regional and local workshops to inform development of the draft Strategy. These workshops were supplemented by responses to an open invitation for written feedback. Most of the workshops were held in partnership with local NGOs.

47 The draft Strategy was developed by the Ministries of Health (lead), Education, Justice and Social Development, the Department of Corrections, ACC, Te Puni Kōkiri, New

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Zealand Defence Force, New Zealand Police and the Ministry for Pacific Peoples. All these agencies support the draft Strategy and acknowledge the importance of suicide prevention in New Zealand. These agencies were consulted on the Cabinet paper and their views have been incorporated into it.

48 The Treasury, the Ministry for Primary Industries, the Ministry of Business Innovation and Employment, the Health Promotion Agency, the Health Quality and Safety Commission, the Department of Prime Minister and Cabinet, and the Ministry for Women, have been informed about the Cabinet paper and the draft Strategy.

Financial Implications49 Paragraph redacted - Withheld under S9(2)(f)(iv) Confidentiality of advice

tendered by Ministers and officials.50 Paragraph redacted - Withheld under S9(2)(f)(iv) Confidentiality of advice

tendered by Ministers and officials.Human Rights51 The proposals in this paper are consistent with the New Zealand Bill of Rights Act 1990

and the Human Rights Act 1993. The Suicide Prevention Strategy is a universal strategy but particular focus is paid to preventing suicide among groups that have higher than average suicide rates, including Māori, Pacific, young people, and people with mental illness (especially those admitted to hospital for intentional self-harm).

Legislative Implications52 This paper has no legislative implications.

Regulatory Impact Analysis53 A regulatory impact analysis is not required.

Gender Implications54 Over 70 percent of people who die by suicide are males, whereas almost 70 percent of

those hospitalised for intentional self-harm are female. There is also evidence of higher rates of suicidal behaviour amongst LGBTIQ communities; this evidence is difficult to confirm quantitatively as gender orientation is not consistently or comprehensively collected in many datasets.

Disability Perspective 55 The draft Strategy is consistent with the New Zealand Disability Strategy 2016 and

informed by the UN Convention on the Rights of Persons with Disabilities.

Publicity56 A press release will be issued to alert the general public to the draft Strategy and inviting

interested people to make a submission. This Cabinet paper will be released in the near future. The Ministry has developed a comprehensive communications plan, which includes engaging with key stakeholders throughout the consultation period.

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RecommendationsIt is recommended that Cabinet Social Policy Committee:

1 note that the previous Suicide Prevention Strategy 2006–2016 and the Suicide Prevention Action Plan 2013–2016 have now ended;

2 note that all actions in the New Zealand Suicide Prevention Action Plan 2013–2016 have now been implemented and that further progress reports on its implementation are not required;

3 note that preparations for a new suicide prevention strategy have been underway since 2015;

4 approve the release of the attached ‘A Strategy to Prevent Suicide in New Zealand: Draft for public consultation (the draft Strategy)’ for public consultation;

5 note that minor editorial amendments may be made to the draft Strategy prior to its release;

6 note that the Ministry of Health proposes to release the draft Strategy on 12 April 2017, with submissions closing on 12 June 2017;

7 note that this Cabinet paper will be released in the near future; and

8 invite the Minister of Health to report back to Cabinet Social Policy Committee in late 2017 on the outcome of the consultation and a proposed final Suicide Prevention Strategy.

Approved for Lodgement

Hon Dr Jonathan ColemanMinister of Health

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Appendix One: How Terms Relating to Suicide are used in the Cabinet Paper and Draft Strategy

This Cabinet paper and the draft Suicide Prevention Strategy use terms related to suicide that have different meanings to different people. The following definitions will be used in this draft Strategy for these terms:

a Suicide: a death where there is evidence that the person deliberately brought about their own death. In New Zealand a coronial ruling determines whether a death is classified as suicide.

b Attempted suicide: any action or actions where people try to intentionally kill themselves that are non-fatal and may or may not result in injury.

c Deliberate or intentional self-harm: behaviour or behaviours that result in injury that may or may not be serious but are not intended to be fatal.

d Suicidal ideation: thoughts of intentionally killing oneself.

e Suicidal behaviour: suicide, attempted suicide, deliberate or intentional self-harm and suicidal ideation.

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Appendix Two: Some background about suicide 1 Official figures on suicidal behaviour are released by the Ministry of Health. The latest

official data is for 2013. The Coroner prepares provisional and forecast figures. The overall figures show:

a The highest suicide rate was 15.1 deaths per 100,000 people in 1998 (577 deaths), but have declined since then, with a low of 10.9 per 100,000 people in 2011 (488 deaths).

b Suicide rates fluctuated between 10.9 and 12.3 per 100,000 between 2006 and 2013 (varying between 458 and 550 deaths).

c The Chief Coroner indicates that there may have been an increase in the number of suicides since 2013 to an estimated 580 to 620 in 2016/17, compared with 508 in 2013.

2 Suicide rates vary between age groups and by ethnicity. For example:

a Suicide rates for men are 2.5 times higher than those of woman, with men being almost three-quarters of those who die by suicide.

b Suicide rates for youth aged 15–24 years (18.0 per 100,000) are 60 percent higher than for people of all ages (11.0 per 100,000).

c Suicide rates for Māori (15.8 per 100,000) are 60 percent higher than non-Māori (9.7 per 100,000).

d Less than 40 percent of all people who die by suicide had used secondary mental health services in the preceding year.

e Deprivation is associated with increased rates of suicide, particularly for youth, Māori and Pacific (but not other groups).

3 Although international comparisons are difficult, New Zealand’s overall suicide rate appears to be in the middle of those for the OECD. For example, it is higher than the United Kingdom, Canada and Sweden, but lower than Australia and the United States – both countries where the rate has increased in recent years.

4 However, New Zealand’s rates are particularly high for Māori and youth. For example, in a 2013 OECD report:

a New Zealand’s youth suicide rate for females (11.7 per 100,000) was the highest female youth rate in the OECD.

b New Zealand’s youth suicide rate for males (24.1 per 100,000) was third highest in the OECD, just behind Finland (26.4 suicides per 100,000) and Ireland (24.2 per 100,000) – with Māori youth suicide rates being almost three times the overall New Zealand rate.

5 There are also high rates of suicidal behaviour: For example, in 2013:

a An estimated 150,000 people in New Zealand thought about taking their own life, around 50,000 made a plan to take their own life and around 20,000 attempted suicide.

b There were 7,267 hospitalisations for intentional self-harm recorded. This is 177 hospitalisations per 100,000 people.

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c The incidence of hospitalisation for intentional self-harm was twice as high for females (246.9 per 100,000 females) than for males (107.1 per 100,000 males).

IMPACTS OF SUICIDE 6 Suicidal behaviour has lasting harmful effects on individuals, families, whānau and

communities. In addition to a loss of life-years for those who die by suicide, the impacts include:

a psychological distress, impaired physical and mental health, pain and suffering, and loss of employment and quality of life, the costs of funerals and the impacts on families of dealing with death;

b impacts on government agencies such as ambulances, health services, Police callouts and investigations, the coronial process, Victim Support and Corrections’ management of risks and responses to suicide; and

c indirect costs associated with the loss of a person from the workforce.

7 The monetary impact of suicide has been quantified as approximately $2 billion per year in 2015 dollars, based on the number of suicides and the amount of suicidal behaviour that occurred in 2013.

CAUSES OF SUICIDAL BEHAVIOUR 8 Suicidal behaviours can affect anyone, regardless of their background and experience,

with there being no single cause. Rather, it is the outcome of interactions between the build-up of many different factors and experiences across a person’s life.

a Protective factors reduce the likelihood of suicide through strengthening a person’s wellbeing (for example, their resilience). They include: secure cultural identity and religious beliefs; family and community connectedness and support; an ability to deal with life’s difficulties (for example, problem solving skills); and a sense of hopefulness.

b Risk factors increase the likelihood of suicidal behaviour. They include experiencing stressful life events; trauma or abuse; mental health issues; alcohol and drug misuse; poor physical health, or a lack of social support; and a sense of hopelessness.

9 Protective and risk factors interact in ways that differ from person to person, across the different stages of people’s lives, and between groups of people. This means it is difficult to determine the particular cause of suicide or suicidal behaviour, even where there appears to be a clearly identifiable precipitating event.

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Appendix Three: Table from Suicide Mortality Review Feasibility Study 2014/15

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Appendix Four: Suicide Prevention Action Plan 2013–2016 initiativesObjective 1: Support families, whānau, hapū, iwi and communities to prevent suicideActions Area Actions Status Lead

1. Build the capacity of Māori whānau, hapū, iwi, Pasifika families and communities to prevent suicide

1.1 Supporting Māori whānau, hapū, iwi, Pasifika families and communities to develop solutions to prevent suicide; through community initiatives, training and education; leadership and building the evidence base

In place and ongoing. Health

1.2 Create opportunities for young people to be involved in community development projects – Youth in Emergency Services (YES)

In place and ongoing. MSD

1.3 Support small communities to build resilience to overcome the loss of a major employer or industry

Occurs as and when needed MSD

2. Ensure good quality information and resources on suicide prevention are available to families, whānau, hapū, iwi, communities and frontline workers

2.1 Reorient the existing suicide information service and provide good information to the media

24,268 people have accessed new suicide prevention information on the Mental Health Foundation’s website.

Health

2.2 Develop and disseminate a toolkit for DHBs to guide their work to prevent suicide and respond to suicide clusters or contagion

Completed – All DHBs now implementing suicide prevention and postvention plans.

Health

2.3 Disseminate the resource kit Preventing and Responding to Suicide; and foster sector use of the kit

All schools have a copy of the resource and an online version is available from the Ministry of Education

Education

3. Train community health and social support services staff, families, whānau, hapū, iwi and community members to identify and support individuals at risk of suicide

3.1 Train community health and social services staff, and community to identify, support and refer individuals at risk


3.2 Train frontline Police responding to people experiencing mental distress

In place and ongoing. NZ Police

3.3 Train Work and Income staff working with mentally distressed clients


3.4 Improve training for District Court security staff, victims’ advisors and Family Court Coordinators

Improved training is in place and continues to be delivered.

Justice

Objective 2: Support families, whānau, hapū, iwi and communities after a suicide

4. Ensure a range of accessible support services is available for families, whānau and others who are bereaved by suicide

4.1 Expand Victim Support’s Initial Response Service to be available nationwide

In place and Victim Support continues to provide an initial response service.

Health

4.2 Expand the availability of specialist-facilitated group support programmes for people bereaved by suicide

More facilitators continue to be trained.

Health

4.3 Provide support and guidance for people bereaved by suicide establishing peer support groups


5. Support communities to respond following suicides

5.1 Increase the capacity of the Community Postvention Response Service (CPRS)

In place – services now cover all of New Zealand

Health

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Objective 3: Improve services and support for people at high risk of suicide who are receiving government services

6. Improve services and support for people experiencing mental health problems and AOD problems

6.1 Provide training for primary health care practitioners on recognising and managing mental health issues

Training for Primary Care staff is regularly advertised through appropriate networks.

Health

6.2 Improve the care of people presenting to emergency departments for self-harm, and ensure appropriate follow-up after discharge

Completed and has been published on the Ministry of Health’s website.

Health

7. Improve services and support for children and young people in contact with Child, Youth and Family (CYF)

7.1 Provide specialist training for CYF caregivers


7.2 Deliver specialist training to all care and protection, and youth justice residential staff

Care and protection, and youth justice residential staff continue to undertake training such as QPR training, Responding to Suicide/Youth workshops, and local suicide screening training workshops

MSD

7.3 Strengthen suicide identification and assessment in social workers’ assessment framework


7.4 Design and implement enhanced training in suicide identification, assessment and management for social workers


8. Improve services and support for people in prison

8.1 Improve mental health and suicide screening tools used in prisons

The Mental Health Screening Tool has become business as usual across all sites.

Corrections

8.2 Improve information and training for Corrections staff on mental health, suicide awareness and prevention

Over 3400 staff members have been trained.

Corrections

8.3 Ensure prisoners at risk of suicide or with mental health issues can access support

In place and ongoing. Corrections

8.4 Provide information and support to prisoners, staff and prisoners’ support people after a suicide death or non-fatal attempt

These resources are available. Corrections

8.5 Reduce access to means of suicide in correctional facilities

Hanging points have been removed from over 200 cells.

Corrections

Objective 4: Use social media to prevent suicide

9. Identify and respond to suicide contagion through social media

9.1 Trial an initiative to monitor and respond to suicide contagion on social media sites during a suicide cluster

The trial was completed in 2013.Health

NZ Police

10. Reduce cyber-bullying

10.1 Make available information, tools and resources on good cyber citizenship and reducing cyber-bullying

Published early 2015: Digital Technology – Safe and Responsible Use in Schools.

Education

Objective 5: Strengthen the infrastructure for suicide prevention

11. Make better use of the data the government already collects on suicide deaths and self- harm incidents

11.1 Trial a suicide mortality review mechanism to improve knowledge and to better identify key intervention points for suicide prevention

The trial has been completed. Reports were released in May 2016. Decisions are yet to be made about the recommendation to continue the Suicide Mortality Review Committee on a long-term basis.

Health

11.2 Share provisional coronial data with DHBs to help local responses

All DHBs are using the data sharing system.

Health

11.3 Develop a Suicide Prevention Outcomes Framework

A framework has been developed and is informing the development of the next suicide prevention strategy. It will be made publicly available alongside the next strategy.

Health

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