Calling for action on suicide prevention in Aotearoa

Every year almost 600 people die by suicide in Aotearoa New Zealand (NZ), and 75% of them are men¹ (see Figure 1 below and Appendix for key epidemiological trends).  Yet suicides are preventable.² Suicide results from a complex interaction of systemic, societal and individual factors. Traditional suicide prevention has been ineffective and narrowly focused on mental illness and clinical interventions, while overlooking broader social determinants.  

Central principles for suicide prevention 

We consider that a whole-of-society approach³  to suicide prevention has two principles. First, it acknowledges that the solutions are broad and far-reaching, should be developed across government agencies and portfolio boundaries and move beyond the health sector. This principle supports global calls to shift suicide prevention towards a universal, long-term population-based approach.⁴ It requires a policy shift, extending prevention responsibility beyond health departments to all areas of government.^5-7 Second, it requires the government and suicide prevention leadership to engage all relevant stakeholders beyond the public sector including communities, non-governmental organisations, civil society, academia, media and the private sector to address the challenges of suicide prevention.⁸ 

While interventions delivered through the mental health sector remain vital for individuals in crisis, upstream prevention is long overdue and urgently needed to address determinants at a population level and reduce suicides in the long term. These drivers include income, poverty, education, unemployment, housing, gender; ⁷ structural determinants including macroeconomic/social policies, racism, discrimination, impacts of colonisation; ^{9 10} and commercial determinants including products that increase suicide risk and/or access to means.^{6 11} 

A second principle is that suicide prevention must also draw on the existing evidence base for which universal, targeted, and selective interventions are demonstrated to be effective in addition to addressing the underlying societal determinants ¹² 

This holistic vision should form the foundation of our Suicide Prevention Action Plan.

Our call to action 

An effective Suicide Action Plan would include: 

Stronger leadership and cross-society collaboration

Progressing suicide prevention requires strong, sustained, collective leadership with strategic vision. We support the global call from international suicide experts that leadership is needed to build a whole of government and society approach that addresses the social determinants that have the greatest links to suicide.^5-7 This requires addressing the upstream causes of suicide through a public health lens and a policy re-set in which the responsibility of suicide prevention shifts to all of government.

Leadership needs to be properly resourced financially and with appropriate expertise to undertake critical functions associated with suicide prevention, including developing and reviewing the national strategy and implementation plan; monitoring progress, evaluating outcomes, and building the necessary data and evidence infrastructure.

Leadership should foster and promote cross-society collaboration, especially in areas with high suicide rates. For example, recent efforts by MATES in construction show a strong commitment to preventing suicides within their sphere of influence.^{13 14} WorkSafe’s recent investigation into work-related suicides highlights the growing role of industry and employers' suicide prevention efforts.¹⁵ 

Māori suicide prevention and the Turamarama Declaration

In tandem, Māori leadership is required.¹⁶ Māori, particularly rangatahi and tanē, have some of the highest rates of suicide in Aotearoa.^{10 17} (See Appendix.) Māori suicide prevention needs to be led by Māori for Māori and should follow the principles outlined in the Turamarama Declaration – a global declaration supporting indigenous-led suicide prevention.¹⁸ It acknowledges the cultural, historical, and social factors affecting Māori wellbeing, including the impacts of colonisation, historical trauma, and health care inequities.¹⁹ The Declaration also advocates for a holistic approach to prevention, recognising the importance of cultural identity, community, access to te reo Māori and connection to land and whakapapa. In this respect, non-Māori and Crown agents need to partner with Māori to honour our Te Tiriti o Waitangi commitments.  

A funded Suicide Research Strategy with access to robust high-quality data 

The current evidence on suicide prevention reflects a Western, individualised, and often psychiatric perspective on suicidal behaviour¹² and there is a lack of evaluative studies.²⁰ Endorsing a previous call to develop a suicide research agenda and set priorities for Aotearoa is essential.²⁰  A repository or suicide research hub is needed for researchers and practitioners to exchange knowledge and build partnerships across the prevention spectrum.  

Robust research and evaluation are essential, requiring dedicated funding and resources to ensure effective and fit-for-purpose interventions. Non-government organisations, iwi and hapū, and not-for-profits need funding, expertise and access to data to be properly resourced for evaluation.

Building a local evidence base has been thwarted by lack of access to robust high-quality suicide related data and absence of a funded research strategy. Improved national data systems would enable this evidence base to be established including data linkage studies²¹ and evaluation studies.²² 

While the current strategy includes a data-sharing service within the health system,²³ we need a suicide register, as our Australian counterparts have.²⁴ Suicide registers and other monitoring systems are critical for addressing suicide mortality and evaluation activities.²⁵ Our in-depth coronial suicide data is only accessible through the Australian New Zealand Coronial Information System, and is costly and onerous to obtain.  An essential feature of our strategy and action plan should be that Māori and New Zealanders have sovereignty over and ease of access to our own suicide data. Meanwhile, Māori-led research into experiences of suicide, and effective prevention and postvention at the whānau, hapū and iwi levels is urgently needed and should be resourced.²⁶   

Authors details 

Dr Sarah McKenzie, Suicide and Mental Health Research Group, Department of Psychological Medicine, Ōtākou Whakaihu Waka | University of Otago, Wellington

Assoc Prof Clive Aspin, (Ngāti Maru, Ngāti Whanaunga, Ngāti Tamatera) School of Health, Te Herenga Waka | Victoria University of Wellington

Dr Chris Bowden, School of Education, Te Herenga Waka | Victoria University of Wellington

Angie Hoskin, Suicide and Mental Health Research Group, Department of Psychological Medicine, Ōtākou Whakaihu Waka | University of Otago, Wellington

Moko Kairua, Kaanaka Maoli, Kūki Āirani Maori, Ngapuhi-nui-tonu Te Iwi Professional Lead of Lived Experience:  Peer Supports & Consumer/Tangata Whaiora Advisors. Consumer Family Whaanau Centred Care Team (CFWCC), Mental Health & Addiction | Counties Manukau District, Middlemore Hospital. 

Dr Trevor Best, School of Forestry, Te Whare Wānanga o Waitaha | University of Canterbury

Barry Taylor, Principal Consultant, TaylorMade Training & Consulting, Wellington. 

Assoc Prof Gabrielle Jenkin, Suicide and Mental Health Research Group, Department of Psychological Medicine, Ōtākou Whakaihu Waka | University of Otago

Appendix: Key epidemiological trends in suicide in Aotearoa New Zealand