AUT University Presentation Effective Suicide Prevention and Intervention

AUT University Presentation

Effective Suicide Prevention

and Intervention

Outline

1. About SPINZ

2. Latest suicide statistics

3. What are the risk factors for suicide

4. What are the warning signs for suicide?

5. What are the protective factors against suicide?

6. What is being done for suicide prevention?

Outline

7. What is effective in preventing suicide?

8. What is not effective in preventing suicide?

9. Prevention models and interventions

10.Future considerations

The importance of self-care

• Suicide can be an emotional topic

• We are all likely affected in some way

• Important to notice what’s going on for us, and seek support if we need to

1. About SPINZ

What we do

• Part of the• Provides a Resource and Information Service• Produces resources and pamphlets• Provides information for specific audiences via its

website www.spinz.org.nz• Gives presentations/workshops• Runs events • Works closely with media

Our website

Information for

2. Latest suicide statistics

Overview

• 483 people died by suicide in NZ in 2007• This equates to 11.0 deaths per 100,000

population

• 370 were male, 113 were female• This equates to a ratio of 3.6:1

Overview

Groups with the highest rates of suicide:• males• younger male adults (20-39 years)• Māori• people living in the most deprived areas

• But, the rate of attempted suicide is twice as high for women than for men

Age distribution

Youth suicide

• Of the 483 deaths, 94 were in the 15-24 age group

• 71 were male, a rate of 22.9 per 100,000 population

• 23 were female, a rate of 7.6 per 100,000• The male rate was around three times the

female rate

Youth suicide over time

3. What are the risk factors for suicide?

Risk factors

• The biggest risk factor is experiencing depression or another mental health disorder

• A history of self-harm or previous attempts• Having been affected by a suicide death• Exposure to trauma, such as violence, abuse

or bullying• Family factors, such as neglect, parental

conflict, parental substance abuse, family violence

Risk factors

• Social isolation and lack of support• Socioeconomic disadvantage• Cultural breakdown, and loss of cultural

identity, land, and language• Stressful or negative life events, such as major

losses, disappointments or humiliations – these are often the ‘trigger’ event

Risk factors

• The more risk factors a person has, the greater their risk of attempting suicide

• These risk factors may contribute to suicidal behaviours directly, or indirectly by influencing individual susceptibility to mental disorders

4. What are the warning signs for suicide?

Warning signs webcast

Warning Signs

• Threatening to hurt or kill themselves• Talking or writing about death, dying or suicide• Expressing feelings of hopelessness• Looking for ways to kill themselves e.g. looking

for pills, weapons or other means

Warning Signs

• Being unusually ‘down’, ‘low’, ‘angry’ or ‘depressed’

• Acting recklessly• Withdrawing from family and friends• Increased alcohol or drug use• Giving away possessions

5. What are the protective factors against suicide?

Protective factors

• Strong identity• Connectedness• Resilience – agency, relatedness,

reflectiveness, communication• Wellbeing, flourishing

• Not obvious suicide prevention activities but these do contribute to suicide prevention

Wellbeing and flourishing

6. What is being done for suicide prevention?

The NZ Suicide Prevention Strategy 2006-2012

• This strategy replaced the New Zealand Youth Suicide Prevention Strategy, which was published in 1998

Goals of The New Zealand Suicide Prevention Strategy1. Promote mental health and wellbeing, and prevent

mental health problems2. Improve the care of people experiencing mental

disorders3. Improve the care of people who make suicide attempts4. Reduce access to the means of suicide5. Promote the safe reporting of suicidal behaviour by the

media6. Support families/whanau, friends and others affected by

a suicide or suicide attempt7. Expand the evidence about rates, causes and effective

interventions

The New Zealand Suicide Prevention Action Plan, 2008-2012

• Included the Evidence for Action and the Summary for Action, published 2008

• A one-year report on Action Plan has been done, published September 2009

7. What is effective in preventing suicide?

The evidence-base

• The evidence-base is used to inform the NZSPS and Action Plan

• Important that all suicide prevention policy and practice is based on good evidence

• Want to make sure interventions and prevention activities are going to be effective, and don’t cause harm, or are ineffective, thus a waste of resource

Activities with strong evidence of efficacy

• Education of GPs and other health professionals

• Restriction of suicide methods• Gatekeeper education

Activities with promising evidence of efficacy• Public awareness of depression• Hotlines, internet-based tools

and texting• Support for those bereaved by

suicide• Psychological therapies• Pharmacological interventions• Responsible and informed

media coverage

Barriers to effective suicide prevention (Beautrais, 2009)

• Power of advocacy and lobbying• Power of rhetoric and emotion• Power of anecdotal evidence

• Working solely from instinct, good intentions, or personal experience is not sufficient – suicide prevention activities must be based on evidence of effectiveness and safety.

8. What is not effective in preventing suicide?

Activities with evidence of harm

• School-based suicide awareness programmes

• Generic public health messages raising awareness of suicide

• No-harm and no-suicide contracts

• Recovered or repressed memory therapies

Raising awareness of suicide

• Works really well for other social issues: family violence, drink driving, alcohol abuse, depression

• But, when it comes to raising awareness of suicide, there is insufficient evidence to support its safety - it could have unintended consequences that increase the risk of suicide among those who are already vulnerable

Raising awareness of suicide

• Can happen by inadvertently normalising suicide, or by creating a solution modelling effect

• Instead, a safer way to address suicide is focusing on raising awareness of depression, and promoting help-seeking

• Not all suicide prevention activities need to be marketed as such to make a difference, an example being the National Depression Initiative

Talking more about suicide

• The best way to address the topic is often by focusing on talking more about suicide prevention, not suicide

• This avoids previously mentioned issues of awareness-raising and normalisation of suicide

• Also an opportunity to talk more about risk and protective factors, warning signs, and the importance of help-seeking

Talking more about suicide after a suicide death

• This issue often comes up around addressing the school after the death of a student

• Talking to a large group of young people about the suicide of a classmate can increase the risk of those already vulnerable

• Asking someone one-to-one if they’re thinking about suicide does not increase the risk of them dying by suicide

9. Prevention models and interventions

Prevention models

There are several prevention models in health:• The Primary, Secondary, Tertiary (PST)

prevention model• The Universal, Selective, Indicated (USI)

prevention model• The ecological model (micro, meso,

macro)/social ecological model• Traditionally suicide prevention has focused

on the PST model

Prevention models

• No specific model is explicitly named in the NZSPS or Action Plan

• Instead, it includes some health care oriented strategies (broadly, individual/tertiary/micro interventions), as targeted initiatives for people who are most at risk of suicide…

• And some public health oriented strategies (broadly, universal/primary/macro interventions), to create a society that promotes mental health and wellbeing

Health care oriented strategies

Covered by Goal 2, 3, 6of the NZSPS:

2. Improve the care of people experiencing mental disorders

• NDI – Depression Helpline, The Journal programme, Depression and Lowdown websites and text and email support

Health care oriented strategies for youth

Health care oriented strategies

Covered by Goal 2, 3, 6 of the NZSPS:

3. Improve the care of people who make suicide attempts

• Whakawhanaungatanga: The Self Harm and Suicide Prevention Collaborative

Health care oriented strategies

Covered by Goal 2, 3, 6 of the NZSPS:

6. Support families/whanau, friends and others affected by a suicide or suicide attempt

• Postvention Support Service (Initial Response Service, Community Postvention Response Service) and Traumatic Incident support in schools

Public health oriented strategies

Covered by Goal 1, 4, 5,

(7) of the NZSPS:

1. Promote mental health and wellbeing, and prevent mental health problems

• Development of programmes across Govt agencies: Campaign for Action on Family Violence, ALAC Culture Change Campaign, LMLM Campaigns

Public health oriented strategies

Covered by Goal 1, 4, 5, (7) of the NZSPS :

4. Reduce access to the means of suicide

• Interventions around hanging, carbon monoxide poisoning, firearms, self-poisoning, jumping

Public health oriented strategies

Covered by Goal 1, 4, 5, (7) of the NZSPS :

5. Promote the safe reporting of suicidal behaviour by the media

• Promoting collaboration between media and suicide prevention professionals and researchers, monitoring the internet

contact

Ph 09 300 7035info@spinz.org.nz

SPINZ (Suicide Prevention Information New Zealand)a part of the Mental Health Foundation of New Zealandwww.spinz.org.nz

Working to reduce suicide by providing high quality information

2010