1. RLD SUICIDE PREVENTION DAYSTRENGTHENING PROTECTIVE FACTORSINSTILLING HOPEGregory Luke Larkin MD MS MSPH FACEPLion Foundation Chair of Emergency Medicine Annette Beautrais PhD Senior Research FellowThe University of Auckland, South Auckland Clinical School l.larkin@auckland.ac.nz,a.beautrais@auckland.ac.nz

2. AGENDA Magnitude of the Problem The Problem of Suicide in New Zealand Risk and Protective Factors Microlevel (Individual) Meso-level(Community, Organisation) Macro-level (State, National) Your questions 3. MAGNITUDE OF THE PROBLEM 4. WORLD SUICIDE RATES 5. MAGNITUDE OF THE PROBLEM >1 million deaths worldwide EVERY year - an under-estimate 51% of all violent deaths More deaths than all wars & homicides combined In any one year - 4% have thoughts of suicide, 1% plan(WMHS) Overall rate of suicide has NOT declined in the past decade; 6. SUICIDE Under-counted Under-recognised Under-funded (prevention) Under-addressed Poorly understood PREVENTABLE in many cases 7. A DIFFICULT PUBLIC HEALTH PROBLEM In top 10 causes of death worldwide In top 3 causes of death in 15-35 age group Annual global rate - 16 per 100,000 people (3-4X higher in men) Despite considerable research & new knowledge, relatively little progressin developing effective interventions By contrast, reductions in CVD, stroke, MVA, HIV/AIDS, homicide, cancers Suicide is a more difficult, complex problem than these issues. 8. PREDICTIONSBy 2020 depression will be the 2nd major cause of YPLLs & DALYs(after CVD) Suicides - estimated 1.5 million p.a. worldwide 9. SUICIDE IN NEW ZEALAND 10. NZ suicide deaths and rates 2004 2005 2006 2007 2008 2009 2010NumbersTotal 486 511524483497506522Male 379380386370366391380Female 109131138113131115142RatesTotal11.7 12.2 12.2 11.0 11.2 11.2 11.5Male 18.6 18.6 18.5 17.4 16.9 17.8 16.0Female 5.26.06.34.95.85.06.4 11. 0510 1520 2530 1948 Rate 1950 1952 1954 1956 1958 1960 1962 1964 1966 1968 1970 1972 1974 1976 1978Year 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006Males 2008FemalesSuicide age-standardised rates, by sex, 1948-2010 2010 12. Suicide as a percentage of all deaths in that age group 2010 Percent45 Males Females40353025201510 5 0 59 1014 1519 2024 2529 3034 3539 4044 4549 5054 5559 6064 6569 7074 7579 8084 85+ Five-year age group 13. Suicide age-specific death rates, by 5-year age group, 2010Rate 60MalesFemales 50 40 30 20 1001519 2024 2529 3034 3539 4044 4549 5054 5559 6064 6569 7074 7579 8084 85+Five-year age group 14. Mori and non-Mori suicide rates, by sex 1996-2010 Rate35Mori malesMori females30Non-Mori malesNon-Mori females25201510 5 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 20082009 2010Year 15. Methods of NZ suicide deaths 2010 Submersion (drowning)1.5%Firearms and explosives8.0% Cutting and piercinginstrument 1.7%Hanging, strangulation Jumping from high place and suffocation 1.7% 60.5%Other and unspecified means3.3% Poisoning liquids and solids 11.9%Poisoning gases and vapours11.3% 16. New Zealand Suicide Prevention Strategyhttp://www.moh.govt.nz/moh.nsf/indexmh/suicideprevention-strategyandplan#strategy 17. NZ - SUICIDE PREVENTION STRATEGYNZSPS 7 goals promote mental health & wellbeing improve care of people with mental disorders associated with suicidalbehaviours improve care of attempters reduce access to means of suicide promote safe reporting & portrayal of suicidal behaviour by themedia provide postvention support expand evidence about rates, causes & effective interventions. 18. RISK & PROTECTIVE FACTORS19 19. MICRO-LEVEL RISK FACTORS Genetic vulnerabilities Psychiatric illness Impulsivity Aggression Hopelessness Previous suicide attempts Poor coping skills Physical illness/injury, TBI, PTSD Sexual orientation 20. MICRO-LEVEL PREVENTION STRATEGIESIndividual interventions Psychotherapy, medication, psychosocial supportDiet, exercise Building coping skills, resiliency (e.g. anger/conflictmanagement), optimism, wellness Impulsivity/anger management Cyber, phone, txt msg interventions Medication, appointment reminders Tailored safety planning 21. PROTECTIVE FACTORS HEALTHMicro-level (Individual) activities Acute distress or crisis Engage with health services Keep appointments Take medications and follow treatments as prescribed Have a safety plan, & follow it when you encounter difficulties Ensure you are safe If things dont get better, ask for help Ask for help and support from family, friends, health services Go to the ED or local Psych Emergency Services Call helplines - Free 0800 543 354; If immediate danger - call 111 22. PROTECTIVE FACTORS - PSYCHOLOGICALMost people exposed to difficult life experiences do not die bysuicide. Likely explained by differences in protective factors: Resilience - ability to cope with, and adjust to adversity A sense of self-worth and self-efficacy Effective coping and problem-solving skills Outward focus (serving others) Adaptive help-seeking behaviour Life satisfaction A positive therapeutic relationship 23. PROTECTIVE FACTORS HEALTHMicro-level (Individual) activities Specific daily wellbeing practices Diet Keep a gratitude journal Keep a hope box Make plans, set challenges for yourself Volunteer activities help others Pets - responsibility/exercise Ensure social contact Take up hobbies, exercise, interests 24. PROTECTIVE FACTORS HEALTHMost people who die by suicide are depressed but not takingeffective antidepressants Many not diagnosed Of those diagnosed, many are untreated or under-treated Many more do not take their meds as prescribed.YET There are effective medications and therapies Educate primary care (GPs) to assess, treat and manage depressed & suicidal patients Encourage help-seeking, adherence with treatments & meds 25. PROTECTIVE FACTORS - INDIVIDUAL & SOCIAL Social connectedness, good relationships with friends, colleagues and neighbours Social support from other people Marriage - men; children for women (but cannot prescribe!) Religious/spiritual beliefs 26. MESO-LEVEL RISK FACTORS Relationship, legal, financial, disciplinary problems Physical and emotional abuse, neglect, bullying Family violence Parental psychopathology Unemployment Social isolation Academic pressures Institutional settings (prisons, services, schools) Clusters and contagion Healthcare settings (inpatient units) 27. MESO-LEVEL STRATEGIES Institutional strategies Education, screening, skills building, gatekeeper support Psychosocial interventions Anti-bullying, IPV screening, parenting/family support, crisis lines,social support Primary care screening, assessment, education Healthcare settings (EDs, inpatient units) Community settings Cluster management, postvention/bereavement support,workplace support 28. MACRO-LEVEL RISK FACTORS Public laws/policies (e.g. drug & alcohol access) Season/weather Disasters (long term) Media over-reporting Cyber-exposure; cyber bullying; Social disintegration, individualism, materialism Globalisation, macro-economic restructuring Cultural differences/isolation 29. MACRO-LEVEL STRATEGIES Community, state, national policy interventions Meansrestrictions Drugs/alcohol policies Media guidelinesHealth & wellness promotionSocial policies & employmentHealth literacy, destigmatisationPublic service messagesMedia and cyber-based programmes 30. PROTECTIVE FACTORS MEANS RESTRICTION Suicidal behaviour is often ambivalent & impulsive, and/or contemplated when someone is intoxicated May not be pursued if access to a favoured method or a particular site of suicide is thwarted. Therefore restricting access to means of suicide is a very effective protection against suicide Shown for domestic gas, VEG, metro railway systems, guns, bridges, jumping sites, medications - prescribed & OTC 31. RE-INSTALLING BARRIERS33 Grafton Bridge, Auckland, New Zealand Removal of safety barriers in place 60 yrs led to a 5.6-fold increase in Ss from the bridge 3 Ss in the 4 years prior to removal, 19 Ss in 5 yrs after removal. Reinstatement of barriers eliminated Ss from the bridge and appears to have decreased Ss by jumping the city. No increase in Ss by jumping from other sites.Beautrais et al, 2010 32. SUICIDES AT GRAFTON BRIDGE34 193 0 1992-1995 1997-2001 2002-Present 33. STRENGTHENING PROTECTIVE FACTORS & INSTILLING HOPEWINNING WAYS TO WELLBEING 34. ADVANCING SUICIDE PREVENTIONINSTILLING HOPE We now have a sufficient body of evidence and data aboutrisk & protective factors for suicide. The time to convert that evidence into effective programmesis NOW. Requires sustained investment in funding, training &development of a suicide research & prevention workforce,and in IT, regulatory & funding infrastructures which supportsuicide prevention The present absence of strong evidence for effectiveprogrammes is a call for action 35. KEYNOTE SPEAKERSCONFERENCE SPEAKERS Professor Sir Peter GluckmanProfessor Jane Pirkis Prime Ministers Science Adviser, New Zealand University of Melbourne, Australia Professor Eric CaineProfessor David Fergusson University of Rochester School of MedicineUniversity of Otago, Christchurch New Zealand Rochester, NY, USA Professor G Luke Larkin Paul KellyThe University of Auckland, New Zealand CEO, Console Ireland Assoc. Professor Sally Merry Dr John CrawshawThe University of Auckland, New Zealand Director of Mental Health, Ministry of Health, New Zealand Dr Shyamala Nada-Raja University of Otago, Dunedin, New Zealand Di Grennell Te Puni Kokiri, New Zealand Dr Jemaima Tiatia Centre for Pacific Studies The University of Auckland, Professor Helen Christensen New Zealand Executive Director, Black Dog Institute, Sydney, & Professor of Mental Health, University of New South Sandra Palmer & Eliza Snelgar, Wales, AustraliaCommunity Postvention Response Service (CPRS), CASA, New Zealand Professor Simon HatcherUniversity of Ottawa, Canada Dr Nik Coupe 36. CONFERENCE TOPICS TOPICS The science of suicide New Zealand suicide prevention prevention policy Suicide clusters Pacific suicide prevention e-health and suicide The Emergency Department prevention as a site for suicideprevention Suicide as a public health problem Pathways to suicide Postvention Public/private partnershipsin suicide prevention Mori and suicide prevention 37. SUICIDE PREVENTION 2012: IDEAS, INNOVATION, IMPLEMENTATIONFRIDAY SEPTEMBER 28TH, 20128.30am to 5pmELLERSLIE EVENT CENTRE www.suicideprevention2012.weebly.com