John Henden: Boldness needed to tackle suicide rates

News from Chief Coroner Deborah Marshall that a record 606 people took their own lives in 2016/17, up from 579 the previous year and 564 the year before that, shows that how this country is tackling suicide is not working.

This month Health Minister Jonathan Coleman announced a $100 million allocation to fund 17 initiatives to bolster mental health services and try to stem New Zealand’s appalling record on youth suicide, which is the highest in the developed world.

Here to conduct workshops for the Samaritans, Life Matters and Hawkes Bay communities on suicide prevention, my message to Dr Coleman is that bold, new approaches are needed.

It is great that Dr Coleman has stated youth suicide is his top priority. Also on the right track is the discussion paper published last month by the government Chief Scientific Advisor, Sir Peter Gluckman, that called for more primary intervention starting early in life.

However, primary intervention can only do so much. It is front line services which deal with people contemplating ending their life, where most of the focus should be. Non-statutory organisations exist essentially because most official services don’t work. Beefing up crisis help-lines like Youthline and Samaritans is a first step to prevent suicides.

What Dr Coleman should do is channel away from institutions like psychiatric hospitals and units, switching funding to charitable and not-for-profit organisations working on the front line. It is a fact that these organisations save more lives than formal services.

Having worked in suicide prevention for 35 years - 15 of those within the psychiatric system and 20 outside -- I seriously caution Dr Coleman and district health boards against spending more money on hospital beds. 

This is my third visit in six years to conduct suicide prevention workshops for various groups; and, anecdotally, it looks like New Zealand, currently, is following the institutional approach that I was bought up by in the 1970s. This approach is based on medicating, containing and controlling patients but fails to really engage with them as people. From what I have been told, currently, the system is short on talking treatments.

By putting someone in a psychiatric hospital increases significantly, the likelihood of suicide both as an inpatient and following discharge.

Most psychiatric hospitals use the conventional bio-medical approach, whereby patients are admitted, assessed, diagnosed (usually with ‘depression’), prescribed medication, observed and reviewed. But nobody really talks to them in a therapeutic way.

It is now widely accepted that medication is symptom-alleviation, not treatment. And, it fails to prevent suicides. Moreover, many antidepressants increase suicide risk. New Zealand’s youth suicide record speaks for itself.

During my 15 years in the institutional system in the UK working on suicide prevention as a mental health nurse and later, in management, we experienced around 20 suicides among the teams I worked with.

In the last 23 years since adopting the solution-focused approach to suicide prevention, I have not had one death among 70 suicidal clients and nor (as far as I know) has any of the 3,500-4,000 therapists, worldwide, I have trained.

We are achieving zero suicide.

The solution-focused approach, begun in the 1980s in Milwaukee by Insoo Kim Berg and Steve de Shazer, is a collaborative approach between helper and helpee. In contrast to most therapies, where an expert hands down a solution, or problem-solves, the solution focused approach relies much on the client to construct their own solutions.

Crucially, suicide is left on the table as an option, but we ask, “what else could you do to get through this terrible crisis you find yourself in, that involves surviving”.

We say, “if you want to take the suicide option, I can’t stop you, but we can consider other options”, asking the person which might be best to try first. Paradoxically, because the suicide option is left on the table, the person is less likely to take it. With the traditional medical approach, the suicide option is taken away, often with dire consequences, ultimately.

I note there is much debate in New Zealand because the expert Suicide Prevention Advisory Group, watered down an original target of reducing suicide by 20 percent over 10 years, to the nebulous goal of “reducing suicide”. Actually, both these targets are extraordinary in their lack of ambition. The target should be for zero suicides within health and social care. It is being achieved elsewhere.

Around the world, 13 countries have signed up to Zero Suicide: International Declaration for Better Healthcare. Their motto is: ‘no one should die alone and in despair in our care’.  New Zealand is one of those signatories. This movement states that all suicides within healthcare are preventable.

The goal of reducing suicide by 20 percent simply is not good enough, because it suggests to staff that it is okay to let some people die.

It must be zero because there should be a commitment. Zero suicide is a no-blame approach. If there is a suicide, hospital staff ask: “what can we learn from this case and thus improve our service for the future?”

Zero suicide started in the Detroit Depression Service, in the US. They found that by having honest, open conversations and close monitoring of service users, they had no deaths over a three-year period, despite the economic hard times the city suffers.

The problem of New Zealand’s high youth suicide rate is not a short-term phenomenon. Current solutions are clearly not working; and, as Albert Einstein famously said, “insanity is doing the same thing over and over and expecting a different result.” If New Zealand is truly serious about tackling this devastating issue, it is time to set an aspirational target of zero suicide and take practical steps towards that goal by radically changing treatment approaches from ones that don’t work to ones that do.

UK-based John Henden, author of Preventing Suicide: The Solution Focused Approach, was brought to New Zealand to conduct workshops for the Samaritans, Life Matters and Napier Events.