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CANTERBURY SUICIDE PROJECT

TEEN SUICIDE and YOUTH SUICIDE

This paper summarises current information about youth suicide in New Zealand.
The paper distinguishes between teen suicide and youth suicide, provides current
statistics about youth suicide in New Zealand, information about the risk factors
and causes of youth suicide, and appropriate points of intervention to reduce and
prevent suicide.

It is important to distinguish between ‘youth suicide’ and ‘teen suicide’.

Youth suicide includes suicides in the age range 15 to 24 years; Teen suicide is
13-19 years. The data which are commonly presented for New Zealand youth
suicide 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 year
olds than 15-19 year olds. The information below applies to youth suicide, ages
15-24 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 for
20% of all suicides that occur in New Zealand every year.

Good News 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 100,000
in 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 and

provided a framework for youth suicide prevention. This will be replaced on
June 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 suicide
issues in the last 10-15 years.

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

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Age and Youth Suicide

• Youth suicide includes all young people aged 15-24.

• Suicide among children <15 years is extremely rare.

• The majority of young people aged 15-24 years who die by suicide are not
school students. Only approximately 15% of young people aged 15-24 who
die by suicide are high school students. The clear majority of youth suicides
occur in young people who are aged 18 and older who have left school.

• Suicides amongst young people under 25 years account for approximately

20% of all suicides in New Zealand each year.

Figure 1 shows rates (per 100 000) of youth suicide in New Zealand each year
from 1990 to 2003, which is the year for which we have most recent data.
Separate figures are given for males, females and the total population. The
numerical rates are given in Appendix 1. The figure shows:

• For male youth, annual rates of suicide have declined by 50% since 1995.

• However, for females there has been a small but steady increase in suicide
rates over the last decade.

Figure 1. Youth suicide rates, New Zealand, 1990 to 2003

50 Rate per
100 000

40

30

20

10

0
90

91

92

93

94

95

96

97

98

99

00

01

02

03
19

19

19

19

19

19

19

19

19

19

20

20

20

20

Male Female Total

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Youth Suicide and Ethnicity

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

Figure 2. Youth suicide rates by ethnicity and gender in New Zealand, 1996 to
2002

35 Age-standardised rate (per 100,000) Māori Male

Non Māori Male

30
Māori Female

25 Non Māori Female

20

15

10

0
1996 1997 1998 1999 2000 2001 2002

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THE SPECTRUM OF SUICIDAL BEHAVIOUR

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

Suicidal Ideation

• 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 15-24
years, up to one quarter of young people will experience suicidal thoughts
and 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 suicide
attempt. Most of these attempts are of minor medical severity, do not require
medical attention, and are not undertaken with serious intent to die.

• Nevertheless, a small group of young people with persistent suicidal ideation

and serious suicide attempt behaviour are at high risk for further suicide
attempts and for suicide.

Suicide

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

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GENDER AND YOUTH SUICIDAL BEHAVIOUR

Figure 1 illustrates gender differences in youth suicide. The relationships between

gender and suicidal behaviours are complex.

• Young females make more suicide attempts than young males but young
males 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 attempts
because 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 make
more suicide attempts, because males tend to use more lethal methods
(including carbon monoxide poisoning from vehicle exhaust gas, hanging and
gunshot) of suicide attempt than females.

• Young females typically choose drug overdose for suicide attempt, and this
method, 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:female
youth suicide ratio in New Zealand is decreasing substantially and rapidly
because the male youth suicide rate is declining while the female rate is
increasing. This change would appear to largely reflect method choice, with
young females now more likely to choose the more lethal methods of suicide
which males have traditionally used.

• Further information about gender differences in suicidal behaviour is available

in this paper:

Beautrais AL. Gender issues in youth suicidal behaviour. Emergency

Medicine, 2002, 14(1):35-42.
Please contact us for a copy of this paper: suicide@chmeds.ac.nz

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SUICIDE RISK FACTORS AND CAUSES

Psychiatric Illness

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

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

• Other mental disorders which are associated with increased risk of suicidal
behaviour are psychotic disorders (including schizophrenia) and eating
disorders.

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

• Frequently, young people with serious suicidal behaviour have co-morbid (or
co-occurring) mental disorders. Most commonly, the disorders which co-occur
are depression and substance use disorder. Those with more than one
disorder, compared with those with a single disorder, tend to have markedly
increased risks of suicidal behaviour.

• Young people with serious suicidal behaviour often have a history of previous
suicide attempts, and/or of inpatient or outpatient care for mental health
problems.

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 backgrounds
characterised 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 abuse

problems, 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 multiple
problem family backgrounds in which several of these family risk factors are
commonly present for enduring periods of time.

Personality Disorders and Traits

Certain temperaments, personality traits, psychological vulnerabilities, cognitive

and coping styles may act as predisposing factors in suicidal behaviour. The
common thread in these psychological constructs linked with suicidal behaviour is
that they all predispose the individual to react in negative ways to perceived
stressful situations. For example, individuals scoring high on measures of
impulsivity or aggression may be more prone to engage in self harm behaviours
when exposed to adversity.

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

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

Three important psychological traits associated with suicidal behaviour are

discussed below:

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

• Impulsive Aggression
Individuals with aggressive and impulsive temperaments are at increased risk
of suicide and suicide attempt. In these individuals suicidal behaviour may
occur in the absence of a mood disorder and may be associated with
antisocial behaviours and conduct disorder, alcohol and substance abuse,

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impulsive behaviour, high scores on measures of novelty-seeking, and

histories of childhood adversity.

• Neuroticism
The neurotic (depressive, withdrawn) temperament is linked to increased
risks 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) and
disciplinary or legal crises.

• These probably act as precipitating factors for suicidal behaviour only when
they occur in those individuals who are vulnerable to suicidal behaviour
because 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 in

suicide rates with rises in unemployment. However, rather than
unemployment leading to suicidal behaviour, it seems that suicidal behaviour
and unemployment are outcomes which arise from common adverse social,
family and personal factors.

• Sexual orientation: Within the last decade, an increasing number of well

designed 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 to
school, 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 or
family support. The risk of suicide is increased amongst those who drop out
of school or who have a period of absence from school. Young people who
live away from their parents have an increased risk of suicide. These
“alienated” youth are likely to have other risks for suicidal behaviours which
have been the reason for their becoming alienated from family, dropping out
of school and not being in the workforce.

• Physical illness and disability: Young people with poor physical health and/or
disability 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 who
have health risk behaviours including binge drinking, cigarette smoking,
binge eating, carrying weapons, and having unprotected sex. These health
risk behaviours share common causal factors with suicidal behaviour in
childhood adversity, poor relationships with parents and association with
deviant peers.

Genetic and Biological Factors

There is evidence that suicidal behaviour runs in families, suggesting a possible

role of genetic factors in risk of suicidal behaviour. This genetic factor is likely to
be related to impulsive, aggressive behaviour.

Contextual Factors

There are a series of contextual or societal circumstances which may influence

suicide risk. These include:

• Media reporting: There is generally consistent evidence to suggest that

particular types of media depiction and coverage of suicide are associated
with increased rates of suicide and suicide attempt. The risk of imitative
suicidal behaviour is increased if the publicised suicide is someone who is a
celebrity or is notorious, if details of method are provided and/or if news
coverage is repetitive. Media depiction may increase suicide risk by both
encouraging imitative responses amongst those vulnerable to suicidal
behaviour, and by normalising suicide as a common and acceptable response
to resolving personal difficulties and life crises. Given this evidence, many
countries have developed guidelines for reporting and portrayal of suicide.
New Zealand’s media reporting guidelines and resources may be accessed at:
http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E
9/$File/suicideandthemedia.pdf

Access to Methods of Suicide

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

• The recent introduction of more restrictive firearm legislation has resulted in

a reduction of 66% in rates of youth suicides by firearms. This example, and
similar 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 method
which 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 young
people with greater exposure to risk factors are at substantially higher risk of
suicidal behaviour than those with fewer, or no, risk factors. Useful reviews on
risk factors and causes of suicidal behaviour among young people are provided by:

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

Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive
interventions: 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

Warning Signs

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

A person might 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

What to Do

Here are some ways to be helpful to someone who 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. Don’t debate whether suicide is right or wrong, or
feelings are good or bad. Don’t lecture on the value of life.
• Get involved. Become available. Show interest and support.
• Don’t dare him or her to do it.
• Don’t act shocked. This will put distance between you.
• Don’t 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 Aware of Feelings

While quite a lot of people, at some time in their lives, think about committing
suicide, the clear majority decide to live, because they eventually come to realise
that the crisis is temporary and death is permanent. On other hand, people having
a 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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• Can’t stop the pain

• Can’t think clearly
• Can’t make decisions
• Can’t see any way out
• Can’t sleep, eat or work
• Can’t get out of depression
• Can’t make the sadness go away
• Can’t see a future without pain
• Can’t see themselves as worthwhile
• Can’t get someone’s attention
• Can’t seem to get control

(adapted from the American Association of Suicidology)

If you experience these feelings, please get help!

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

Medical and Hospital 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 and
other resources.

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YOUTH SUICIDE PREVENTION

There is comparatively little evidence- based information at either a programme or

intervention level, or at a national strategy level, about programmes that are
successful in reducing or preventing suicidal behaviour. However, we can identify
likely points for preventive interventions from knowledge about risk and protective
factors for suicidal behaviour. We can also review current knowledge about suicide
prevention strategies to identify those that show effectiveness, or promise of
effectiveness.

Means Restriction

• Restricting access to methods of suicide is an often undervalued approach to

suicide prevention.

• Research from a number of countries suggests reducing access to particular

means of suicide reduces suicides by that method, and sometimes, reduces
total suicide rates.

• Findings span a range of means including: domestic gas; guns; CO (car)

emissions; analgesics; barriers; and clinically safer drugs.

Community Gatekeeper Programmes

• 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-risk
individuals.

• Such programmes in the US Air Force and the Norwegian Army have reported
reduced suicide rates.

• Generally, however, few such programmes have been evaluated.

Screening Programmes

• 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 Awareness Education and Mental Health Literacy

• Improving mental health literacy is an important public health goal which

may contribute to suicide prevention by changing public recognition and
attitudes towards mental illnesses, e.g. public awareness of depression may
lead to better recognition, treatment seeking and support.

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

Treatment and Support for Mental Illness and Suicide Attempts

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

• Current treatment approaches include:

o Psychological interventions
o Psychopharmacological treatments
o Psychosocial interventions

Psychological (Behavioural) Therapies

A series of behavioural therapies and approaches has been shown to reduce

suicidal behaviour, hopelessness and depressive symptoms, and increase
compliance with treatment (compared with treatment as usual):
o Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy
(IPT), Dialectical Behaviour Therapy (DBT) and problem-solving
therapy.

• However, no psychological therapy has proved to be effective for all patient

groups.

Psychopharmacological Treatments

• A limited number of treatments for specific mental illnesses have been shown
to 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) that

mood-stabilising anticonvulsant drugs reduce suicidality in mood disorders
(this may reflect methodological difficulties of research in this area; e.g. low
base rate, failure to systematically record suicidal outcomes, exclusion of high
risk patients).
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• Growing evidence from population based studies suggests the recent

widespread use of the newer class of antidepressants, Selective Serotonin
Reuptake Inhibitors (SSRIs) may have contributed to a reduction in suicide
rates.

• Patient studies show decreased rates of suicide attempts for those treated
with anti-depressant drugs, and in adolescents treated with anti-depressants
for 6 months rather than <2 months.

Follow-up Care after Suicide Attempts

• Mental illnesses, including depression and suicidal behaviour are often

recurrent and chronic. Further, compliance with medication and treatment
regimes is often poor. Thus, improved acute and long-term care has the
potential to decrease rates of suicidal behaviour.

Therapies that show effectiveness or promise include:

• Psychiatric hospitalisation

• Multidisciplinary chain-of-care networks.

• Emergency cards guaranteeing access to services.

• Postcard mailings.

• Suicide intervention counsellor to co-ordinate long-term care.

Restricting Access to Alcohol

• National strategies which seek to improve control of alcohol may reduce

suicidal behaviour by decreasing the risk of acute alcohol intoxication (which
increases the risk of impulsive behaviour), and by reducing the fraction of the
population with alcohol use disorders.

• For example, decreased suicide rates have been observed in Iceland and in
the former USSR following the introduction of strong anti-alcohol policy.

Media Coverage of Suicide

• Certain ways of presenting and portraying suicide in the media appear to

provoke suicidal behaviour in vulnerable individuals. This evidence has led to
most national suicide prevention plans developing media guidelines to assist
reporters and journalists to present stories about suicide in a muted, cautious
way to minimise risks of imitative behaviour.

• There are few evaluations of the impact of such guidelines. However, the
introduction of media guidelines in Switzerland is reported to have resulted in
fewer sensationalised stories about suicide.

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School Based Suicide Awareness and Peer Support Programmes

• A range of school-based programmes which claim to reduce or prevent

suicidal behaviour have been developed, based on the premise that youth are
more likely to divulge suicidal ideation to peers than adults.

• However, these programmes have been controversial - with findings

suggesting that few programmes are evidence-based, report current
knowledge, or assess safety and effectiveness in preventing suicidal
behaviour.

School Based Skills Promoting Programmes

• Skill-enhancing, competency-promoting programmes have been introduced

as an alternative to suicide awareness programmes in schools, because of the
difficulties outlined above.

• These programmes are based on the premise that enhancing self-esteem,

coping and problem solving skills may protect vulnerable young people
against a range of adverse psychosocial outcomes including suicidal
behaviour.

• Evaluations of these programmes tend to show that improving these skills

enhances 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 which

multiple prevention programmes are developed in a number of different areas
which contribute to suicide risk, with, perhaps, small gains in each of these
areas aggregating to make a substantial overall impact on suicide rates.

• However, the potential to include multiple prevention approaches should be

tempered by research evidence about the relative contribution of specific risk
factors to suicidal behaviour.

• Evidence thus far suggests the most promising interventions (with further
evaluation) 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 restriction
o 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 ZEALAND DOING TO PREVENT AND REDUCE

YOUTH SUICIDE?

In 1998 the Ministers of Youth Affairs, Health and Māori Affairs launched the New
Zealand 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 to
Māori youth), it focussed on a range of government and community actions on
reducing suicide among young people.

Since the establishment of the NZYSPS a number of guidelines and programmes

have 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 prevention
initiatives that have been undertaken in recent years. Many of the initiatives
outlined in the Stocktake may support the broad goals of suicide prevention, but
they are not directly linked to the NZYSPS nor do they directly address suicide
prevention per se. A copy of the Stocktake is available at the website:
http://www.moh.govt.nz/moh.nsf/0/EF2AE42E266C7FFECC2570610016AC2B/$Fil
e/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 Schools
called: 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, about
young 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 called
Youth Suicide Prevention in Schools: A Practical Guide (2003). Its key aims were
to:

• Provide practical advice for schools concerning their role in suicide

prevention. For example to establish a system to help identify students in
emotional 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 criteria
that 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 role
in suicide prevention because:
o Schools offer consistent, direct contact time with large populations of
young people.

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o Schools with responsibility for the education and socialisation of

young people have the potential to moderate the occurrence of risk
behaviours and to identify and secure help for at-risk individuals.
o Schools are in an optimum position to be involved in the primary
prevention of suicide by implementing student focussed programmes
that enhance mental health and well-being.

• Suggest where schools can go for further information and support.

Towards Well Being

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

Guidelines for General Practitioners

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, and
student health nurses can play a key role in reducing youth suicide, particularly
because a significant percentage of young people who die by suicide are likely to
have had one or more recognisable mental health disorders at the time of their
death.

The aim of the guideline was to help primary health providers recognise young
people at risk of suicide, manage their care, and make well-informed referrals to
secondary services. A key part of the guideline was to support primary health
workers 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 to

encourage muted, cautious reporting of suicide in order to minimise risks of
imitative suicidal behaviour by vulnerable individuals. These guidelines are
available at:
http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$Fil
e/suicideandthemedia.pdf

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Guidelines for Emergency Departments and Mental Health Service Acute

Assessment Settings

These guidelines were developed in 2003 as a resource for clinical staff in

Emergency Departments and for mental health clinicians to use when assessing
and 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 these
settings. The guidelines are available at:
http://www.nzgg.org.nz/guidelines/0005/ACF50E.pdf#page=55

Suicide Prevention Information NEW ZEALAND (SPINZ)

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

Kia Piki te Piki te Ora o te Taitamariki

Kia Piki is a specifically Māori component of the National Youth Suicide Prevention
Strategy.

Kia Piki can be accessed through the Ministry of Health website:

http://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$Fil
e/nzyouthsuicidepreventionstrategy-kiapiki.pdf

A large number of studies, evaluations and needs assessments have been

conducted as part of the development and ongoing operation of Kia Piki, including
the establishment of Public Health Kia Piki Community Development projects. The
Stocktake of Government initiatives reported that the current status of the
implementation of Kia Piki involves the employment of a full-time project officer at
the Ministry of Youth Development (2004/5) to “identify ways to more effectively
implement Kia Piki and to gather information to inform advice about best practice
across the government and the community. In addition MYD, and the Ministry of
Health co-funded a national wananga to help build networks amongst service
providers 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 and

response to increased suicide risk.

• The expansion of child and youth mental health services.

• Implementation of best practice guidelines for Mental Health Services and

Emergency Departments on suicide prevention.

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• Increased funding for Youthline to enable Youthline’s telephone service to

move 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 document
entitled, A Life Worth Living: New Zealand Suicide Prevention Strategy, on 27 April
2005.
http://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$Fil
e/suicidepreventionstrategy.pdf

The information gained from submissions about this draft strategy was used by
the Ministry to further develop the strategy.

The National Suicide Prevention Strategy is due to be released on June 29

2006 and will provide a framework within which to plan and implement suicide
prevention activities for people of all ages, including young people.

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FURTHER READING

Suicide Prevention Strategies and Related Documents

Beautrais, A. (1998). A Review of Evidence: In Our Hands - The New Zealand

Youth Suicide Prevention Strategy. Wellington: Ministry of Health.
http://www.moh.govt.nz/moh.nsf/0/890E3286841AF565CC256B4F0074A4B7/$Fil
e/inourhands-areviewofevidence.pdf

Lawson-Te Aho, K. (1998). A Review of Evidence: A Background Document to

Support Kia Piki te Ora o te Taitamariki. Wellington: Te Puni Kōkiri Ministry of
Māori Development.
http://www.moh.govt.nz/moh.nsf/0/8469966F84AFBD82CC256B4B0078B442/$Fil
e/kiapiki-areviewofevidence.pdf

Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri (Ministry of Māori
Development) (1998). In Our Hands - New Zealand Youth Suicide Prevention
Strategy. Wellington: Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri
(Ministry of Māori Development).
http://www.moh.govt.nz/moh.nsf/0/60D848B6CE1B7289CC2570A6006F6951/$Fil
e/nzyouthsuicidepreventionstrategy-inourhands.pdf

Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri (Ministry of Māori
Development) (1998). Kia Piki te Ora o te Taitamariki Strengthening Youth Well
Being. Wellington: Ministry of Youth Affairs, Ministry of Health & Te Puni Kokiri
(Ministry of Māori Development).
http://www.moh.govt.nz/moh.nsf/0/7088A0A61C280BC7CC256BB50003D936/$Fil
e/nzyouthsuicidepreventionstrategy-kiapiki.pdf

Stanton, T (2003). Phase One Evaluation of the New Zealand Youth Suicide
Prevention 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 Two
Evaluation. 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/$Fil
e/youthsuicidepreventioninschools.pdf

Associate Minister of Health (2005). A Life Worth Living: New Zealand Suicide
Prevention Strategy: Consultation Document. Wellington: Ministry of Health and
Ministry of Youth Development.
http://www.moh.govt.nz/moh.nsf/0/AC2DD0C557C226BBCC256FF00004A418/$Fil
e/suicidepreventionstrategy.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/$Fil
e/suicideprevention-areviewoftheevidence.pdf

Beautrais, A. (2003). Life course factors associated with suicidal behaviors in

young 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 and
prevention. 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 Health
http://www.moh.govt.nz/moh.nsf/0/A72DCD5037CFE4C3CC256BB5000341E9/$Fil
e/suicideandthemedia.pdf

Royal New Zealand College of General Practitioners (RNZCGP) (1999, reprint

2004). Guidelines for Primary Care Providers: Detection and Management of
Young People at Risk of Suicide. Wellington: Royal New Zealand College of General
Practitioners (RNZCGP)
http://www.nzgg.org.nz/guidelines/0029/Youth_Suicide_Book.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

Canterbury Suicide Project