Warning: This article is about suicide and may be distressing to some readers.
There has been much negative coverage of the proposed NZ Suicide Prevention Strategy since Mike King left the suicide advisory group a few months ago saying that it was “a master class in butt covering”. We have recently heard that the government has removed a target of a 12 deaths per year reduction in the suicide rate from the draft strategy because of worries about its own accountability.
Equally worryingly Health Minister Jonathan Coleman has said that the Cabinet had already received a paper about how new spending will be made. Submitters would feel justified in thinking that their time and goodwill has been wasted as this paper effectively pre-empts the analysis of the submission process which closed only recently. Minister Coleman said that the government’s proposed actions would include new innovative approaches. “We do need to do things differently” he said. “So it’s the social investment approach, it’s across departments, it’s a focus on resilience, early intervention and promoting wellness.”
There is a problem here. These ideas are highly unlikely to be the same as those proposed by the public and experts. If the strategy is indeed reframed into so-called social investment then approaches using predictive modelling to identify those at risk are on the cards. While no-one would object to interdepartmental co-ordination, the use of personal data shared between government departments to target services to individuals has only just been consulted on; many participants were worried about unlimited data sharing and guidelines for use are awaited.
Coleman’s other proposals – building “resilience” and “promoting wellness” describe approaches that give people information to support them to change their attitude towards their situation. But mental health awareness strategies as a means to improving mental health are in their infancy, results are mixed and the international literature proposes multiple inter-related and coordinated approaches are needed. While awareness raising has been shown to have an impact in schools, people in distress generally can’t “pull themselves up by their own bootstraps” using a low cost phone app or a resilience workshop.
The draft strategy is problematic in any case. It has no budget, few absolute commitments and, as mentioned above, no over-riding goal of reduction. There are lengthy lists of “motherhood and apple pie” activities the strategy “could include”. The over-riding sense is a touching belief that a little bit of innovative coaching here, a bit of information about the aetiology of depression there, would prevent someone in distress from attempting to take their own life. Low cost “Social Investment” approaches, such as mentoring and coaching, could simply trivialise the despair of people who are at risk especially when there are no corresponding commitments to building up core services.
But here is where the real problem lies. Coleman’s comments and the draft strategy differ markedly from the first round of feedback in 2016. Innovative approaches were not lauded at the expense of core services. Nor is so-called “social investment”. Nor did anyone advocate handing the problem to a new Social Investment Agency. Approaches that place responsibility on the already vulnerable and their families for developing resilience or receiving instruction to promote their own wellness were mentioned but were not favoured by submitters and especially not at the expense of access to other traditional services being made to work well.
The participants in the 2016 consultation, which included members of the public, researchers and medical people advocated for improvements to, and funding of, basic, universally available, publicly funded health services. They wanted those services to be accessible, responsive and effective. They wanted increased funding for mental health services to widen access and reduce waiting times. They wanted integration of suicide prevention to be solidly within the public services such as the health, social welfare and education services that support people more generally. They wanted services to be joined up, affordable and they didn’t want people to be let down or only able to address a problem after a crisis has occurred. They wanted equal access to care in rural and urban areas and for services to be available for longer hours. Finally they didn’t want people to avoid seeing their GP because it is too expensive. Where innovative new services are mentioned they are at the margins – phone apps, for example, are regarded as useful but mainly because they could provide information about access to services.
Given Coleman’s comments we can have little confidence that when the final strategy is completed it will meet these needs. If, as seems likely, the cabinet paper has pre-empted the analysis of submissions the resulting “social investment” strategy will not repair failing mental health services. This may not matter to the government who have avoided committing to a goal but it will matter to the professionals who know what services are needed, to researchers who understand the international evidence about successful intervention, to people who are desperately seeking help and to those who have been bereaved by suicide.
To get advice if you or someone you know are in distress https://www.mentalhealth.org.nz/get-help/in-crisis/helplines/