youth suicide and teen suicide

8/8/2019 Youth Suicide and Teen Suicide

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CANTERBURY SUI CIDE PROJECT

TEEN SUI CI DE and YOUTH SUICIDEThis paper summarises current information about youth suicide in New Zealand.The paper distinguishes between t e e n suicide and y o u t h suicide, provides currentstatistics about youth suicide in New Zealand, information about the risk factorsand causes of youth suicide, and appropriate points of intervention to reduce andprevent suicide.

It is important to distinguish between youth suicide and teen suicide.Yo u t h suicide includes suicides in the age range 15 to 24 years; Teen suicide is13-19 years. The data which are commonly presented for New Zealand youthsuicide rates are for 15-24 year olds. The risk of suicide increases with increasing

age from 13 to 19, then levels off. Suicide rates are higher amongst 20-24 yearolds than 15-19 year olds. The information below applies to y o u t h s u i c i d e , ag e s 1 5 - 2 4 and includes information about teen suicides (ages 15-18).

INTRODUCTION

Suicide is the second leading cause of death in young people in New Zealand(after motor vehicle crashes) and accounts for approximately 25% of all deaths of young people aged from 15 to 24 years. Youth suicides (15-24 years) account for20% of all suicides that occur in New Zealand every year.

Good New s about Youth Suicide in New Zealand

In New Zealand male youth suicide rates have recently declined substantially Rates have reduced by 50% in less than 10 years, from 43.9 per 100,000in 1995 to 21.9 per 100,000 in 2003.

We have increased knowledge about risk factors and causes of youth suicide.

A national youth suicide prevention strategy was developed in 1998 andprovided a framework for youth suicide prevention. This will be replaced onJune 29 2006 with a National Suicide Prevention Strategy for people of all ages, including youth.

There has been increased public, political and policy awareness of suicideissues in the last 10-15 years.

Contrary to some media claims, New Zealand does not have the highestmale youth suicide rate in the world. (e.g. The suicide rate for young malesin the Russian Federation is 3 times the suicide rate for New Zealand youngmales).

Canterbury Suicide Project


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Age and Y outh Suicide

Youth suicide includes all young people aged 15-24.

Suicide among children


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Yo uth Suicide and Ethnicity

Because of changes in the way in which ethnicity has been recorded for youthsuicide statistics, it is possible to present comparisons by ethnicity (M ori; non-M ori) only from 1996 onwards. Figure 2 shows annual rates per 100 000, of M ori and non-M ori youth suicide, over the period from 1996 to 2002. AlthoughM ori rates of suicide are higher than non-M ori rates the data for both groupsshow a similar trend for rates to decline.

Figure 2. Youth suicide rates by ethnicity and gender in New Zealand, 1996 to2002

0

5

10

15

20

25

30

35

1996 1997 1998 1999 2000 2001 2002

M ori Male

Non M ori Male

M ori Female

Non M

ori Female

Age-standardised rate (per 100,000)



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THE SPECTRUM OF SUICIDAL BEHAV IOUR

While public attention has tended to focus on completed suicide, there is evidenceof a range of suicidal behaviours which extend from thoughts and ideas aboutsuicide which are never acted upon, through suicide attempts of varying degreesof medical severity, to completed suicide.

Suicidal Ideatio n

A significant minority of young people may have suicidal thoughts and ideas,with the majority not acting upon these ideas.

Evidence suggests that in New Zealand, amongst young people aged 15-24years, up to one quarter of young people will experience suicidal thoughtsand ideas, however, the majority will not act on these thoughts.

Suicide Attempt

Suicide attempts may range from the minor to the medically severe.

Evidence suggests that up to one in ten young people will make a suicideattempt. Most of these attempts are of minor medical severity, do not requiremedical attention, and are not undertaken with serious intent to die.

Nevertheless, a small group of young people with persistent suicidal ideationand serious suicide attempt behaviour are at high risk for further suicideattempts and for suicide.

Suicide

Recent publicity about rates of youth suicide in New Zealand implies that rates arehigh and increasing This is NOT the case. In fact, suicide is rare, rates of maleyouth suicide are declining substantially and suicide is a far less frequentoccurrence than suicidal ideation and suicide attempt behaviour in young people.



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GENDER AND YOUTH SUICIDAL BEHA VIOUR

Figure 1 illustrates gender differences in youth suicide. The relationships betweengender and suicidal behaviours are complex.

Young females make more suicide attempts than young males but youngmales are more likely to die by suicide. This is sometimes referred to as the

gender paradox of suicidal behaviour.

Young female typically may be more likely to make more suicide attemptsbecause they are more likely to develop depressive and anxiety disorders(which place them at risk of suicide) than males.

Young males more often die by suicide, despite the fact that females makemore suicide attempts, because males tend to use more lethal methods(including carbon monoxide poisoning from vehicle exhaust gas, hanging andgunshot) of suicide attempt than females.

Young females typically choose drug overdose for suicide attempt, and thismethod, by contrast with the methods chosen by males, has a low risk of fatality.

Recent trends, from the mid-1990s onwards, suggest that the male:femaleyouth suicide ratio in New Zealand is decreasing substantially and rapidlybecause the male youth suicide rate is declining while the female rate isincreasing. This change would appear to largely reflect method choice, withyoung females now more likely to choose the more lethal methods of suicidewhich males have traditionally used.

Further information about gender differences in suicidal behaviour is availablein this paper:

Beautrais AL. Gender issues in youth suicidal behaviour. EmergencyMedicine, 2002, 14(1):35-42.Please contact us for a copy of this paper: [email protected]

mailto:[email protected]:[email protected]


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SUICI DE RISK FACTORS AN D CAU SES

Psychiatric Illness

Psychiatric illness is the strongest risk factor for suicidal behaviour. The clearmajority (approximately 90%) of young people who die by suicide or makeserious suicide attempts have at least one recognisable psychiatric disorder atthe time of their attempt.

The most common disorders are mood disorders (including depression andbipolar disorder), substance use disorders (including alcohol abuse anddependence, cannabis abuse and dependence, and other drug abuse anddependence) and antisocial behaviours (including conduct disorder andantisocial personality disorder). Of these disorders, mood disorders are thetype of disorder most commonly associated with suicidal behaviour.

Other mental disorders which are associated with increased risk of suicidalbehaviour are psychotic disorders (including schizophrenia) and eatingdisorders.

Panic disorder and social phobia may also be associated with a slightlyincreased risk of suicidal behaviour.

Frequently, young people with serious suicidal behaviour have co-morbid (orco-occurring) mental disorders. Most commonly, the disorders which co-occurare depression and substance use disorder. Those with more than onedisorder, compared with those with a single disorder, tend to have markedlyincreased risks of suicidal behaviour.

Young people with serious suicidal behaviour often have a history of previoussuicide attempts, and/or of inpatient or outpatient care for mental healthproblems.

Social and Demographic Risk Factors

Young people tend to be at increased risk of suicidal behaviour if they are from

socially disadvantaged backgrounds characterised by:

low socioeconomic status

limited educational achievement

low income

Family and Childhood Risk Factors

Young people with suicidal behaviour tend to come from family backgroundscharacterised by dysfunctional or difficult circumstances. These include:

poor relationships between parents;



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parental separation and divorce;

parental mental illness (including alcohol and other substance abuseproblems, mood disorders and antisocial behaviours);

a family history of suicidal behaviour;

parental and family violence;

physical, sexual or emotional abuse during childhood;

poor family relationships and communication styles.

Often, young people at risk of suicidal behaviour tend to come from multipleproblem family backgrounds in which several of these family risk factors arecommonly present for enduring periods of time.

Perso nality Disorders and Traits

Certain temperaments, personality traits, psychological vulnerabilities, cognitiveand coping styles may act as predisposing factors in suicidal behaviour. Thecommon thread in these psychological constructs linked with suicidal behaviour isthat they all predispose the individual to react in negative ways to perceivedstressful situations. For example, individuals scoring high on measures of impulsivity or aggression may be more prone to engage in self harm behaviourswhen exposed to adversity.

In young people a wide range of psychological factors have been associated withincreased risk of suicide and suicide attempt. These factors include low self-esteem, hopelessness, extraversion, neuroticism, locus of control, impulsivity, andimpulsive violence aggressivity, self-consciousness, social disengagement andcognitive rigidity.

Some studies suggest that personality disorders may be present in up to one thirdof those who die by suicide. The most common disorders are borderline, antisocialand avoidant personality disorders.

Three important psychological traits associated with suicidal behaviour arediscussed below:

Hopelessness Hopelessness is strongly associated with suicidal ideation, suicide attemptand suicide and has been reported to be more strongly associated withsuicide than depression.

Impulsive A ggression Individuals with aggressive and impulsive temperaments are at increased riskof suicide and suicide attempt. In these individuals suicidal behaviour mayoccur in the absence of a mood disorder and may be associated withantisocial behaviours and conduct disorder, alcohol and substance abuse,



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impulsive behaviour, high scores on measures of novelty-seeking, andhistories of childhood adversity.

NeuroticismThe neurotic (depressive, withdrawn) temperament is linked to increasedrisks of suicide and suicide attempt, in youth and in adults.

Stressful Life Events

Suicidal behaviour in young people is often precipitated by stressful events,particularly losses and conflicts (usually, relationship breakdowns) anddisciplinary or legal crises.

These probably act as precipitating factors for suicidal behaviour only whenthey occur in those individuals who are vulnerable to suicidal behaviourbecause they have some of the other risk factors listed above.

Stressful Life Circumstances

A range of stressful life circumstances have been linked with suicidal behaviour.These include:

Unemployment: There is some evidence linking population increases insuicide rates with rises in unemployment. However, rather thanunemployment leading to suicidal behaviour, it seems that suicidal behaviourand unemployment are outcomes which arise from common adverse social,family and personal factors.

Sexual orientation: Within the last decade, an increasing number of welldesigned research studies have suggested that there is an increased risk of suicide attempt behaviour amongst gay, lesbian and bisexual youth.

Alienated young people: Young people who are not strongly affiliated toschool, work or family have substantially increased risk of suicidal behaviour.Youth who could be described as drifting, unaffiliated, alienated, or

rootless are more likely to die by suicide than those who have social orfamily support. The risk of suicide is increased amongst those who drop outof school or who have a period of absence from school. Young people wholive away from their parents have an increased risk of suicide. These

alienated youth are likely to have other risks for suicidal behaviours whichhave been the reason for their becoming alienated from family, dropping outof school and not being in the workforce.

Physical illness and disability: Young people with poor physical health and/ordisability are at higher risk of suicidal behaviour than their healthy peers.Some studies have shown association between some specific illnesses(including diabetes, neurological disorders, epilepsy) and suicidal behaviour.



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Health risk behaviours: Suicidal behaviour often occurs in young people whohave health risk behaviours including binge drinking, cigarette smoking,binge eating, carrying weapons, and having unprotected sex. These healthrisk behaviours share common causal factors with suicidal behaviour inchildhood adversity, poor relationships with parents and association withdeviant peers.

Genetic and Biological Factors

There is evidence that suicidal behaviour runs in families, suggesting a possiblerole of genetic factors in risk of suicidal behaviour. This genetic factor is likely tobe related to impulsive, aggressive behaviour.

Contextual Factors

There are a series of contextual or societal circumstances which may influencesuicide risk. These include:

Media reporting: There is generally consistent evidence to suggest thatparticular types of media depiction and coverage of suicide are associatedwith increased rates of suicide and suicide attempt. The risk of imitativesuicidal behaviour is increased if the publicised suicide is someone who is acelebrity or is notorious, if details of method are provided and/or if newscoverage is repetitive. Media depiction may increase suicide risk by bothencouraging imitative responses amongst those vulnerable to suicidalbehaviour, and by normalising suicide as a common and acceptable responseto resolving personal difficulties and life crises. Given this evidence, many

countries have developed guidelines for reporting and portrayal of suicide.New Zealands media reporting guidelines and resources may be accessed at:http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdf

Access to Method s of Suicide

The most common methods of suicide in young people in New Zealand arehanging and vehicle exhaust gas.

The recent introduction of more restrictive firearm legislation has resulted ina reduction of 66% in rates of youth suicides by firearms. This example, andsimilar examples, suggest that, if it is possible to restrict access to means of suicide, then suicides by that method may be reduced, and if the methodwhich can be restricted had previously accounted for a significant fraction of all suicides, then restriction may decrease total suicide rates as well.

Accumulative Risk of Suicidal Behaviour

Often, risk factors for suicidal behaviour act accumulatively, so that those youngpeople with greater exposure to risk factors are at substantially higher risk of

suicidal behaviour than those with fewer, or no, risk factors. Useful reviews onrisk factors and causes of suicidal behaviour among young people are provided by:

http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdf


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Bridge J, Goldstein TR, Brent DA. Adolescent suicide and suicidal behavior. Journalof Child Psychology & Psychiatry 2006;47(3/4):372-394.

Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventiveinterventions: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry 2003;42(4):386-405.



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HELPING SOMEONE WHO MIGHT BE AT RISK OF SUICIDE

W arning Signs

There is no typical suicide victim. However, there are some common warning signswhich, when acted upon, can save lives. Here are some signs to look for:

A person migh t be suicidal if he or she: Talks about committing suicide Has trouble eating or sleeping Experiences drastic changes in behaviour Withdraws from friends and/or social activities Loses interest in hobbies, work, school, etc. Prepares for death by making out a will and final arrangements Gives away prized possessions Has attempted suicide before Takes unnecessary risks Has had recent severe losses Is preoccupied with death and dying Loses interest in their personal appearance Increases their use of alcohol or drugs

W hat to Do

Here are some w ays to be helpful to someone w ho is threatening suicide: Be direct. Talk openly and matter-of-factly about suicide. Be willing to listen. Allow expressions of feelings. Accept the feelings. Be non-judgmental. Dont debate whether suicide is right or wrong, or

feelings are good or bad. Dont lecture on the value of life. Get involved. Become available. Show interest and support. Dont dare him or her to do it. Dont act shocked. This will put distance between you. Dont be sworn to secrecy. Seek support. Offer hope that alternatives are available but do not offer glib reassurance. Take action. Remove means, such as guns/ropes/hoses or stockpiled pills. Get help from persons or agencies specialising in psychiatric or mental

health services, crisis intervention and suicide prevention.

Be Aw are of Feelings

While quite a lot of people, at some time in their lives, think about committingsuicide, the clear majority decide to live, because they eventually come to realisethat the crisis is temporary and death is permanent. On other hand, people havinga crisis sometimes perceive their situation as inescapable and feel an utter loss of control. These are some of the feelings and things they experience:



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Cant stop the pain Cant think clearly Cant make decisions Cant see any way out Cant sleep, eat or work Cant get out of depression Cant make the sadness go away Cant see a future without pain Cant see themselves as worthwhile Cant get someones attention Cant seem to get control

(adapted from the American Association of Suicidology)

If you exp erience these feelings, please get help!

If someone you know has these symptoms, please offer help or get helpfor them. Contact:

Medical and H ospital Services

Local General Practitioner or medical centre. Local psychiatric emergency service (may also be known as crisis centre or

crisis team). Hospital emergency departments or private emergency clinics. Psychiatric hospitals and psychiatric units within general hospitals. Youth mental health services.

Mental health agencies

Local mental health sector base. Psychiatrists. Psychologists. Counsellors. Social workers.

Schools, Polytechnics, Universities

Special Education Service (SES) psychologists and counsellors. Campus health/medical centres. Counsellors. School nurses.

Relevant Government agencies

Children, Young Persons and their Families Service (CYPS).



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Telephone services

Childline. Gambling Crisis Hotline. Helpline. Lifeline. Samaritans. Youthline.

For other counselling/advice/crisis telephone services refer to the Blue Pages of the local telephone directory

Suicide Services

Bereaved by Suicide Support Groups.

The list above is not exhaustive. We suggest you add local phone numbers andother resources.



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YOUTH SUICIDE PREVENTI ON

There is comparatively little evidence- based information at either a programme orintervention level, or at a national strategy level, about programmes that are

successful in reducing or preventing suicidal behaviour. However, we can identifylikely points for preventive interventions from knowledge about risk and protectivefactors for suicidal behaviour. We can also review current knowledge about suicideprevention strategies to identify those that show effectiveness, or promise of effectiveness.

Means Restriction

Restricting access to methods of suicide is an often undervalued approach tosuicide prevention.

Research from a number of countries suggests reducing access to particularmeans of suicide reduces suicides by that method, and sometimes, reducestotal suicide rates.

Findings span a range of means including: domestic gas; guns; CO (car)emissions; analgesics; barriers; and clinically safer drugs.

Community Gatekeeper Program mes

A range of programmes focus on enhancing the skills of community,organisational and institutional gatekeepers (e.g. clergy, schools, prisons,workplaces, caregivers for the elderly, etc) to identify and refer at-riskindividuals.

Such programmes in the US Air Force and the Norwegian Army have reportedreduced suicide rates.

Generally, however, few such programmes have been evaluated.

Screening P rogrammes

Either screen directly for suicide risk, or for depression or substance abuse.

Applied: youth in general, schools, juvenile detention centres.

Screening programmes are reliable and valid in identifying at-risk individuals.Screening programmes double the number of identified at-risk individuals.

No evidence that screening increases risk of suicidal thinking or behaviour.



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Public Aw areness Education and Mental Health Literacy

Improving mental health literacy is an important public health goal whichmay contribute to suicide prevention by changing public recognition andattitudes towards mental illnesses, e.g. public awareness of depression maylead to better recognition, treatment seeking and support.

Studies from the United Kingdom, Germany, Australia, and New Zealandhave found modest impacts on attitudes to mental illness (especiallydepression) for these campaigns, but no reductions in suicide attempts, orsuicide and no increased treatment seeking or use of antidepressants.

Treatment and Support for Mental I llness and Suicide Attempts

90% of those who die by suicide have at least 1 mental disorder when theydie, and 80% are untreated. Most depression is untreated or under-treated,even after suicide attempts. A suicide attempt is a strong risk factor forfurther suicidal behaviour. These findings provide the rationale for focusingon treating mental illness and providing long-term management and supportfor those who have made suicide attempts, as major approaches to suicideprevention.

Current treatment approaches include:o Psychological interventionso Psychopharmacological treatmentso Psychosocial interventions

Psychological (Behavioural) Therapies

A series of behavioural therapies and approaches has been shown to reducesuicidal behaviour, hopelessness and depressive symptoms, and increasecompliance with treatment (compared with treatment as usual):

o Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy(IPT), Dialectical Behaviour Therapy (DBT) and problem-solvingtherapy.

However, no psychological therapy has proved to be effective for all patientgroups.

Psychopharmacological Treatments

A limited number of treatments for specific mental illnesses have been shownto reduce suicidality:

o long term maintenance therapy with lithium.o antipsychotics (clozapine, and perhaps olanzapine).o ECT for selected patients, acutely suicidal.

Currently, there is no evidence from randomised controlled trials (RCTs) thatmood-stabilising anticonvulsant drugs reduce suicidality in mood disorders(this may reflect methodological difficulties of research in this area; e.g. lowbase rate, failure to systematically record suicidal outcomes, exclusion of highrisk patients).



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Growing evidence from population based studies suggests the recent

widespread use of the newer class of antidepressants, Selective SerotoninReuptake Inhibitors (SSRIs) may have contributed to a reduction in suiciderates.

Patient studies show decreased rates of suicide attempts for those treatedwith anti-depressant drugs, and in adolescents treated with anti-depressantsfor 6 months rather than


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School Based Suicide Aw areness and Peer Support P rogrammes

A range of school-based programmes which claim to reduce or preventsuicidal behaviour have been developed, based on the premise that youth aremore likely to divulge suicidal ideation to peers than adults.

However, these programmes have been controversial - with findingssuggesting that few programmes are evidence-based, report currentknowledge, or assess safety and effectiveness in preventing suicidalbehaviour.

School Based Skills Pr omoting P rogrammes

Skill-enhancing, competency-promoting programmes have been introducedas an alternative to suicide awareness programmes in schools, because of thedifficulties outlined above.

These programmes are based on the premise that enhancing self-esteem,coping and problem solving skills may protect vulnerable young peopleagainst a range of adverse psychosocial outcomes including suicidalbehaviour.

Evaluations of these programmes tend to show that improving these skillsenhances factors hypothesised to protect against suicide.

However, evaluations have not included assessments of the impact of programmes on suicidal behaviours.

Conclusions from Research Findings

A multicompartmental approach to suicide prevention is needed in whichmultiple prevention programmes are developed in a number of different areaswhich contribute to suicide risk, with, perhaps, small gains in each of theseareas aggregating to make a substantial overall impact on suicide rates.

However, the potential to include multiple prevention approaches should betempered by research evidence about the relative contribution of specific riskfactors to suicidal behaviour.

Evidence thus far suggests the most promising interventions (with furtherevaluation) are:

o Physician education (to increase identification and treatment of depressed, substance abusing and suicidal patients).

o Pharmacotherapy (further RCTs of SSRIs)o Gatekeeper education (extension into other areas, develop outcome

measures)o Means restrictiono Screening (cost-effectiveness, instrumentation)o Psychotherapy (with pharmacotherapy; assess long term outcome)o Chain-of-care (identify effective elements)o Media (however, need to evaluate the impact of guidelines)



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WHAT IS NEW ZEALA ND DOING T O PREVENT A ND REDUCE

YOUTH SUICIDE?

In 1998 the Ministers of Youth Affairs, Health and M ori Affairs launched the NewZealand Youth Suicide Prevention Strategy (NZYSPS). Consisting of In Our Hands

and Kia Piki te Ora o te Taitamariki (a component of the Strategy that is specific toM ori youth), it focussed on a range of government and community actions onreducing suicide among young people.

Since the establishment of the NZYSPS a number of guidelines and programmeshave been set up for various organisations to address youth suicide prevention.

A Stocktake of Government initiatives was prepared in 2005 by the Ministry of Youth Development (MYD) and outlines a large number of suicide preventioninitiatives that have been undertaken in recent years. Many of the initiativesoutlined in the Stocktake may support the broad goals of suicide prevention, butthey are not directly linked to the NZYSPS nor do they directly address suicideprevention per se. A copy of the Stocktake is available at the website:http://www.moh.govt.nz/moh.nsf/0/EF2AE42E266C7FFECC2570610016AC2B/$File/stocktake.pdf

The following are some examples of how the NZYSPS has been put into practice:

Development of Guidelines for Schools

An important document to arise from the Strategy was the Guide for Schoolscalled: The Prevention, Recognition and Management of Young People at Risk of Suicide. This guide aims to increase the awareness of boards of trustees,principals, teachers and other adults in schools including administrators,psychologists, counsellors, nurses, social workers and other allied staff, aboutyoung people who experience emotional distress and who may then be at risk of suicidal behaviour such as seriously contemplating, planning or attempting suicide.

Another document has extended these School Guidelines. This document is calledYouth Suicide Prevention in Schools: A Practical Guide (2003). Its key aims wereto:

Provide practical advice for schools concerning their role in suicideprevention. For example to establish a system to help identify students inemotional distress and encourage a mental health promotion approach.

Outline criteria that schools can use to assess external providers of suicide-related programmes or activities (the guideline provides a checklist of criteriathat external providers should meet).

Summarise the key findings of a research report on student focused school-based suicide prevention. The report found that schools can have a key rolein suicide prevention because:

o Schools offer consistent, direct contact time with large populations of young people.

http://www.moh.govt.nz/moh.nsf/0/EF2AE42E266C7FFECC2570610016AC2B/$File/stocktake.pdfhttp://www.moh.govt.nz/moh.nsf/0/EF2AE42E266C7FFECC2570610016AC2B/$File/stocktake.pdfhttp://www.moh.govt.nz/moh.nsf/0/EF2AE42E266C7FFECC2570610016AC2B/$File/stocktake.pdfhttp://www.moh.govt.nz/moh.nsf/0/EF2AE42E266C7FFECC2570610016AC2B/$File/stocktake.pdf


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o Schools with responsibility for the education and socialisation of young people have the potential to moderate the occurrence of riskbehaviours and to identify and secure help for at-risk individuals.

o Schools are in an optimum position to be involved in the primaryprevention of suicide by implementing student focussed programmesthat enhance mental health and well-being.

Suggest where schools can go for further information and support.

Towards W ell Being

A quarter of young people between the ages of 14-16 years who die by suicide ormake serious suicide attempts will have been in contact with Child, Youth andFamily services. As a result of the need to address mental health disorders andsuicide risk among young people accessing Child, Youth and Family (CYF) services,the Department of Child, Youth and Family have prepared a guide to inform socialworkers working for CYF or Iwi Social Services of the current best practice forrecognising and providing effective interventions for young people at risk of adverse outcomes (including suicide). This guide has the same name as thesuicide prevention programme in CYF: Towards Wellbeing. This guide wasextended to develop and implement a national monitoring, case audit and casemanagement system for young people in contact with CYF who were assessed asbeing at risk of suicidal behaviour.

Guidelines for General P ractitioners

One of the aims of the NZYSPS was to improve information on suicide prevention

for people who are in the position to help young people who are at risk of suicide.It was recognised that General Practitioners, and practice, public health, andstudent health nurses can play a key role in reducing youth suicide, particularlybecause a significant percentage of young people who die by suicide are likely tohave had one or more recognisable mental health disorders at the time of theirdeath.

The aim of the guideline was to help primary health providers recognise youngpeople at risk of suicide, manage their care, and make well-informed referrals tosecondary services. A key part of the guideline was to support primary healthworkers to provide a youth friendly practice, establish positive relationships with

young people, and to ensure confidentiality.

Media Guidelines

The Ministry of Health developed guidelines for journalists and reporters toencourage muted, cautious reporting of suicide in order to minimise risks of imitative suicidal behaviour by vulnerable individuals. These guidelines areavailable at:http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdf

http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdf


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Guidelines for Emergency Departments and Mental Health Service AcuteAssessment Settings

These guidelines were developed in 2003 as a resource for clinical staff inEmergency Departments and for mental health clinicians to use when assessingand working with people who have made a suicide attempt or are at risk of

making an attempt. The guidelines are now (2006) being implemented in thesesettings. The guidelines are available at:http://www.nzgg.org.nz/guidelines/0005/ACF50E.pdf#page=55 Suicide Prevention Information N EW ZEALAND (SPI NZ)

One activity of the NZYSPS was the establishment and funding of SuicidePrevention Information New Zealand (SPINZ). SPINZ is a national initiative togather, manage and disseminate information about youth suicide. However, anevaluation report prepared by Coupe (2002) noted that the SPINZ database of information, services and programmes is lacking and SPINZ has been unable tomeet the goals set out in the NZYSPS.

Kia Piki te P iki te Ora o te Taitamariki

Kia Piki is a specifically M ori component of the National Youth Suicide PreventionStrategy.

Kia Piki can be accessed through the Ministry of Health website:http://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdf

A large number of studies, evaluations and needs assessments have beenconducted as part of the development and ongoing operation of Kia Piki, includingthe establishment of Public Health Kia Piki Community Development projects. TheStocktake of Government initiatives reported that the current status of theimplementation of Kia Piki involves the employment of a full-time project officer atthe Ministry of Youth Development (2004/5) to identify ways to more effectivelyimplement Kia Piki and to gather information to inform advice about best practiceacross the government and the community. In addition MYD, and the Ministry of Health co-funded a national wananga to help build networks amongst serviceproviders and share information about training and best practice.

Other Work

Other work under the Strategy includes:

The publication of resources for parents and caregivers on recognition of andresponse to increased suicide risk.

The expansion of child and youth mental health services.

Implementation of best practice guidelines for Mental Health Services andEmergency Departments on suicide prevention.

http://www.nzgg.org.nz/guidelines/0005/ACF50E.pdf#page=55http://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.nzgg.org.nz/guidelines/0005/ACF50E.pdf#page=55


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Increased funding for Youthline to enable Youthlines telephone service tomove to 24 hours a day, 7 days a week.

Future New Zealand Activities

In recognition of the need of a broader response to suicide across all age groups

the Associate Minister of Health launched a draft strategic consultation documententitled, A Life Worth Living: New Zealand Suicide Prevention Strategy , on 27 April2005.http://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdf The information gained from submissions about this draft strategy was used bythe Ministry to further develop the strategy.

The Nationa l Suicide Prevention Strategy is due to be released on June 292006 and will provide a framework within which to plan and implement suicideprevention activities for people of all ages, including young people.

http://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdfhttp://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdfhttp://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdfhttp://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdf


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FURTHER READING

Suicide Prevention Strategies and Related Documents

Beautrais, A. (1998). A Review of Evidence: In Our Hands - The New ZealandYouth Suicide Prevention Strategy. Wellington: Ministry of Health.http://www.moh.govt.nz/moh.nsf/0/890E3286841AF565CC256B4F0074A4B7/$File/inourhands-areviewofevidence.pdf Lawson-Te Aho, K. (1998). A Review of Evidence: A Background Document toSupport Kia Piki te Ora o te Taitamariki . Wellington: Te Puni K kiri Ministry of M ori Development.http://www.moh.govt.nz/moh.nsf/0/8469966F84AFBD82CC256B4B0078B442/$File/kiapiki-areviewofevidence.pdf Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri (Ministry of M ori

Development) (1998). In Our Hands - New Zealand Youth Suicide PreventionStrategy . Wellington: Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri(Ministry of M ori Development).http://www.moh.govt.nz/moh.nsf/0/60D848B6CE1B7289CC2570A6006F6951/$File/nzyouthsuicidepreventionstrategy-inourhands.pdf Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri (Ministry of M oriDevelopment) (1998). Kia Piki te Ora o te Taitamariki Strengthening Youth WellBeing. Wellington: Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri(Ministry of M ori Development).http://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdf Stanton, T (2003). Phase One Evaluation of the New Zealand Youth SuicidePrevention Strategy. Wellington: Ministry of Social Development.http://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-one.doc Dowden, A. (2005). New Zealand Youth Suicide Prevention Strategy: Phase TwoEvaluation. Wellington: Ministry of Social Development.http://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-two.doc Ministry of Youth Affairs, Ministry of Health and Ministry of Education (2003).Youth Suicide Prevention in Schools: A Practical Guide . Wellington: Ministry of Youth Affairs.http://www.moh.govt.nz/moh.nsf/0/567A24EE4A6EB85ACC2570A7000C1C45/$File/youthsuicidepreventioninschools.pdf Associate Minister of Health (2005). A Life Worth Living: New Zealand SuicidePrevention Strategy: Consultation Document . Wellington: Ministry of Health andMinistry of Youth Development.

http://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdf

http://www.moh.govt.nz/moh.nsf/0/890E3286841AF565CC256B4F0074A4B7/$File/inourhands-areviewofevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/890E3286841AF565CC256B4F0074A4B7/$File/inourhands-areviewofevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/8469966F84AFBD82CC256B4B0078B442/$File/kiapiki-areviewofevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/8469966F84AFBD82CC256B4B0078B442/$File/kiapiki-areviewofevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/60D848B6CE1B7289CC2570A6006F6951/$File/nzyouthsuicidepreventionstrategy-inourhands.pdfhttp://www.moh.govt.nz/moh.nsf/0/60D848B6CE1B7289CC2570A6006F6951/$File/nzyouthsuicidepreventionstrategy-inourhands.pdfhttp://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-one.dochttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-one.dochttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-two.dochttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-two.dochttp://www.moh.govt.nz/moh.nsf/0/567A24EE4A6EB85ACC2570A7000C1C45/$File/youthsuicidepreventioninschools.pdfhttp://www.moh.govt.nz/moh.nsf/0/567A24EE4A6EB85ACC2570A7000C1C45/$File/youthsuicidepreventioninschools.pdfhttp://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdfhttp://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdfhttp://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdfhttp://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$File/suicidepreventionstrategy.pdfhttp://www.moh.govt.nz/moh.nsf/0/567A24EE4A6EB85ACC2570A7000C1C45/$File/youthsuicidepreventioninschools.pdfhttp://www.moh.govt.nz/moh.nsf/0/567A24EE4A6EB85ACC2570A7000C1C45/$File/youthsuicidepreventioninschools.pdfhttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-two.dochttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-two.dochttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-one.dochttp://www.msd.govt.nz/documents/publications/csre/youth-suicide-prevention-strategy-evaluation-phase-one.dochttp://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$File/nzyouthsuicidepreventionstrategy-kiapiki.pdfhttp://www.moh.govt.nz/moh.nsf/0/60D848B6CE1B7289CC2570A6006F6951/$File/nzyouthsuicidepreventionstrategy-inourhands.pdfhttp://www.moh.govt.nz/moh.nsf/0/60D848B6CE1B7289CC2570A6006F6951/$File/nzyouthsuicidepreventionstrategy-inourhands.pdfhttp://www.moh.govt.nz/moh.nsf/0/8469966F84AFBD82CC256B4B0078B442/$File/kiapiki-areviewofevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/8469966F84AFBD82CC256B4B0078B442/$File/kiapiki-areviewofevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/890E3286841AF565CC256B4F0074A4B7/$File/inourhands-areviewofevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/890E3286841AF565CC256B4F0074A4B7/$File/inourhands-areviewofevidence.pdf


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Suicide Risk Factors and Prevention

Beautrais A., Collings S., Ehrhardt P., et al. 2005. Suicide Prevention: A Review of Evidence of Risk and Protective Factors, and Points of Effective Intervention .Wellington: Ministry of Health.

http://www.moh.govt.nz/moh.nsf/0/0B29A0980B9748B9CC256FFF000B5221/$File/suicideprevention-areviewoftheevidence.pdf

Beautrais, A. (2003). Life course factors associated with suicidal behaviors inyoung people. American Behavioural Scientist, 46 (9), 1137-1156.

Beautrais, A. (2003). Suicide in New Zealand I: Time trends and epidemiology.New Zealand Medical Journal, 116 (1175), url:http://www.nzma.org.nz/journal/116-1175/1460/ .

Beautrais, A. (2003). Suicide in New Zealand II: A review of risk factors andprevention. New Zealand Medical Journal, 116 (1175), url:http://www.nzma.org.nz/journal/116-1175/1461/. Ministry of Health (1999). Suicide and the Media: The Reporting and Portrayal of Suicide in the Media. A Resource. Wellington: Ministry of Healthhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdf Royal New Zealand College of General Practitioners (RNZCGP) (1999, reprint2004). Guidelines for Primary Care Providers: Detection and Management of

Young People at Risk of Suicide. Wellington: Royal New Zealand College of GeneralPractitioners (RNZCGP) http://www.nzgg.org.nz/guidelines/0029/Youth_Suicide_Book.pdf

http://www.moh.govt.nz/moh.nsf/0/0B29A0980B9748B9CC256FFF000B5221/$File/suicideprevention-areviewoftheevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/0B29A0980B9748B9CC256FFF000B5221/$File/suicideprevention-areviewoftheevidence.pdfhttp://www.nzma.org.nz/journal/116-1175/1460/http://www.nzma.org.nz/journal/116-1175/1461/http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.nzgg.org.nz/guidelines/0029/Youth_Suicide_Book.pdfhttp://www.nzgg.org.nz/guidelines/0029/Youth_Suicide_Book.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$File/suicideandthemedia.pdfhttp://www.nzma.org.nz/journal/116-1175/1461/http://www.nzma.org.nz/journal/116-1175/1460/http://www.moh.govt.nz/moh.nsf/0/0B29A0980B9748B9CC256FFF000B5221/$File/suicideprevention-areviewoftheevidence.pdfhttp://www.moh.govt.nz/moh.nsf/0/0B29A0980B9748B9CC256FFF000B5221/$File/suicideprevention-areviewoftheevidence.pdf


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Appendix 1.

New Zealand Suicide Statistics 1993-2003

Youth (15-24 years) Total Population

Year Male Female Total Male Female Total

1993 39.4 5.9 22.9 18.7 4.9 11.7

1994 39.9 9.7 25.1 21.7 5.2 13.1

1995 44.1 12.8 28.7 22.5 5.9 14.1

1996 39.1 14.3 26.7 22.2 5.8 13.8

1997 41.1 10.8 26.2 22.3 6.0 14.0

1998 38.5 13.3 26.1 22.3 6.5 14.3

1999 30.6 14.2 22.6 18.9 6.4 12.6

2000 29.9 5.8 18.1 18.7 4.0 11.2

2001 32.2 8.7 20.6 18.4 5.4 11.7

2002 22.8 11.0 17.0 16.6 5.2 10.7

2003 21.9 11.0 16.5 16.9 6.2 11.5