Politics Surrounding Suicide
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Suicide has become politicised and there is disagreement over "best practice". Differing organisations are working through the issues.
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Suicide is lethal, therefore recommendations for effective prevention or support, need to be based on thorough research and safe practises.
This is where the issue becomes "politicised". Suicide experts commissioned by Government agencies collaborating with Suicide Prevention Information New Zealand (SPINZ), have developed "best practice" strategies and guidelines, and professionals are expected to follow them.
These are:
- Friends or peers should not be resourced in helping colleagues seek help.
- No-one should raise the awareness of suicide, either directly or indirectly.
- Suicidal thoughts should only be discussed with a counsellor or mental health professional.
- People at risk to be identified
- Referred to appropriate professional help
- Tools that identify and filter at-risk people for counselling
SPINZ's focus is on building community resilience to suicide.
Private agencies, Yellow Ribbon (now defunct)and Project Hope shared the same focus, but disagreed about "best practice", particularly the prohibition on talking about suicide and building "awareness" in schools.
They argue that their peer-based initiatives are well received by the community, schools and professional groups.
The Government took the initiative and in November, 2002, a letter signed by Howard Fancy (Ministry of Education), Ann Carter (Ministry for Youth Affairs), and Karen Poutasi (Ministry of Health) was sent to schools and guidance counsellors insisting that their "best practice" methods should be given precedence.
It became government policy that programmes that trained students in assisting peers to develop help-seeking behaviour, should be avoided.
The claim is that the other groups, while well intentioned, employ strategies that conflict with the findings of academic research.
In response, Yellow Ribbon said that academics and centres of research are themselves divided over what constitutes "best practice", citing findings by the Center for Disease Control in the United States. Yellow Ribbon commissioned it's own academic study and evaluation in early 2003.
Draft Report critical of Youth suicide groups
On May 11th, 2003, the Sunday Star Times published a lead story entitled: "Youth suicide groups slammed as 'dangerous'".Draft sections of a deeply critical report commissioned by the ministries of youth affairs, health and education, had been leaked to the newspaper. The research on Yellow Ribbon and Project Hope had been carried out by the Injury Prevention Research Centre (IPRC) at Auckland University.
The key criticisms in the IPRC report were:
- use of celebrities with little knowledge of suicide prevention
- "toxic" branding
- a lack of qualified coordinators
- dangerous raising of awareness of suicide among young people
- lack of valid and vigorous support for the programme, potentially unsafe
- groups being unaware of recent philosophical and practical approaches to mental health promotion in schools
REPORT ON DRAFT CASE STUDY CONDUCTED BY THE INJURY PREVENTION RESEARCH CENTRE AUCKLAND UNIVERSITY
Yellow Ribbon is an initiative of the Youth Suicide Awareness Trust.
The Trust was established in 1998 with the objective of raising awareness of the shocking incidence of youth suicide in the 15 ? 24 age group. In 1998, statistics showed three people in this age group were taking their lives each week. Of these, 80 percent were male. The statistics also showed more people died by suicide than were killed on New Zealand roads that year.
A pilot of the Yellow Ribbon peer support programme, "It's OK to ask for Help", was introduced to MacLean's College in Howick, Auckland, in October 1999. Since then it has spread to cover much of the country ? in 2003 Yellow Ribbon was working with 156 schools.
Earlier that year (2003), the Injury Prevention Unit of Auckland University was commissioned by the Ministries of Youth Affairs, Health and Education, to conduct research into the criteria for Suicide Programmes in Schools. Yellow Ribbon volunteered to become part of the Study.
The research comprised five case studies of five different organisations that work with schools comprising: Project Hope, Project K, Travellers and Kiwi RAP as well as Yellow Ribbon.
Because Yellow Ribbon supported the concept of setting Criteria for Suicide programmes in schools, it was disappointed that this research was seriously under-funded. With a total budget of $5,000 any such project must necessarily be restricted in its parameters of research.
Under thse constraints, the value of the study from a scientific viewpoint must therefore be limited. It also brought into question its validity as a nationwide guideline for schools, or as a yardstick upon which to base any conclusions about any peer support programme.
Yellow Ribbon actively supported properly-funded, scientifically-based research and wished to work in partnership with Government, to prepare a thorough evaluation that is national in its influence and impact.
On 11 May 2003, the Sunday Star-Times published an article damning work undertaken by youth suicide programmes based upon the Draft Case Study, which formed part of the research. In view of constraints imposed by its funding and methodology, the Study contained inaccuracies that adversely affected its conclusions.
Yellow Ribbon wished to clearly disassociate itself from both the Study and the leaking of information from the draft to the media.
Yellow Ribbon had specific concerns about the content of the Draft Case Study, which through the Sunday Star-Times article, may have provoked concern and misconceptions.
In April, Yellow Ribbon was provided with a copy of the Case Study by the Auckland Injury Prevention Unit and invited to comment only upon any factual inaccuracies, in an extremely limited timeframe. The draft was reviewed by Professor Ian Evans (i) and Narelle Dawsonb>(ii) on behalf of Yellow Ribbon.
It is upon their review that the following commentary was made:
1.The study was conducted in only a limited number of schools in South Auckland ? and, therefore, cannot be considered representative of a national review.
2.There appeared little evidence as to whether or not the various Ministry informants, quoted in the draft report, supplied valid factual information, rather than their own, personal, subjective opinions.
3.The methodology described indicated that providing quotes from transcripts was a major source of information or data. Informants were described as coming from the following groups:4. No information was provided as to who had selected the informants and, indeed why they had been chosen to take part in the study.
- Schools principals
- School guidance counsellors
- Representatives from Ministry of Youth Affairs
- Representatives from the Ministry of Health
- Representatives from the Ministry of Education
- Representatives from community agencies (unspecified)
5.In the case study, a total of 60 quotes from these informants were provided in the following distributions:Thus essentially well over 50 percent of all comments quoted in the draft case study came from unspecified "Ministry representatives"
- None from school principals, although three were from unspecified "school representatives" who might or might not have been principals
- 10 were from school counsellors
- 35 quotes came from "Ministry representatives". In no instance was it specified which Ministry had provided the quote
- Five quotes came from community agencies
- even further quotes came from unspecified "respondents" or "informants"; their connection with the designated groups is unknown.
6.In addition to what appears, to Yellow Ribbon's expert advisors, to be obvious bias and selectivity of quotation, the case study uses the misleading device of using quotes such as "several". Other pseudo-quantitative phrases throughout the case study are "general agreement", "a number of concerns", "high degree of concern", "serious concerns", "strongly questioned".
From their review, Yellow Ribbon's experts concluded that the "Case Study" has no scientific value and is not a professionally responsible document. It uses no acceptable social science methodology, either qualitative or quantitative. It is a collection of totally unsubstantiated opinion, from an unknown and not appropriately selected group of individuals. In addition, to label any peer support programme as being "dangerous" without evaluation, is unethical.
b>(i)Professor Evans holds a PhD in Psychology from the University of London. Currently Professor and Head of the School of Psychology at Massey University, he has extensive clinical and professional experience working primarily with children and adolescents as consultant psychologist in the United Kingdom and United States.
He was particularly active in working with school-based programmes in New York State, designed to prevent social, emotional and educational problems in young people in schools and also in carrying out evaluation research.
(ii)Narelle Dawson is a registered Clinical Psychologist, a clinician and Australasian Youth Suicide Consultant. She has worked for 22 years as a Clinical Psychologist for Specialist Education Services (SES). During that time, she became a National Professional Consultant for SES, instigating several initiatives for at-risk youth, that were later implemented at national level. Her PhD research involves investigation of outcomes and protective factors for suicidal youth placed on government benefits.
New Research Challenges Government Policies on Suicide
Yellow Ribbon in March 2003, were citing two studies that challenged the Government's "best practice" approach to youth suicide."Is Suicide contagious?", a 2000 study conducted by the US-based Center for Disease Control and Prevention (CDC), found that in some cases, being acquainted with someone who had committed suicide, or being exposed to suicide in news, books or films, may actually decrease the risk of suicidal behaviour.
CDC researchers conducted first-person interviews with individuals who survived nearly lethal suicide attempts. These cases included persons 13 to 34 years of age, who probably would have died without emergency medical intervention, or who used a highly lethal means of attempting suicide. Researchers found no evidence that exposure to the suicidal behaviour of others, is a risk factor for nearly lethal attempts.
"Suicide is a complex public health problem. Evidence exists that in some circumstances suicidal behaviour may be 'contagious'. However, we found that exposure to the suicidal behaviour of friends, actually reduced the likelihood that those who were exposed, would engage in very serious suicidal behaviour.
Our findings also suggest that this reduction in risk was most prominent when study participants did not feel emotionally close to the person to whose suicidal behaviour they were exposed," said Jim Mercy, Ph.D., of the CDC's National Centre for Injury Prevention and Control, and primary author of the study.
The study's full title is: "Is Suicide Contagious? A Study of the Relation between Exposure to the Suicidal Behaviour of Others and Nearly Lethal Suicide Attempts." Published in the American Journal of Epidemiology, 2001 (Vol 154, No2)
Comments on the CDC "Is Suicide Contagious?" Study
The US Surgeon General, David Satcher:
"Findings from this study are important, because the research is based on first-person interviews with people who survived a suicide attempt. Other studies have relied on information in official records such as death certificates, or accounts provided by surviving friends, or relatives of the victim."
Marco Marinkovich of Yellow Ribbon:
"There is a perception that talking about suicide, or widespread reporting of suicides may lead to 'copycat' behaviour. This latest research is important, as it challenges that belief."
"The information we have received, is that suicide is an issue young people discuss with their peers. We believe it is best to be open with young people, providing awareness and support, rather than sweeping the issue under the carpet. Educating young people that ask for help in times of need, is actually a strength and not a weakness."
In a recent "Media Alert" press release, Yellow Ribbon make these points about the division of perspectives:
Clinical Experts suggest that: (quote)
- Talking and being able to ask for help is the most important preventative skill
- A sense of hopelessness, isolation and not feeling comfortable talking about your thoughts of suicide, are crucial factors that characterise and discriminate between those who only think about suicide and those who attempt.
- That talking to an adult or counsellor when you are suicidal is less desirable then talking to a friend.
- Friends/peers should not be trained in helping colleagues seek help or to solve problems. Nor should they be trained in helping a peer seek help from an adult.
- No one should raise the awareness of suicide either directly or indirectly.
- Up to 90% of all suicides involve a mental health disorder.
- The only time it is appropriate to talk about suicidal thoughts is in a one-to-one situation with a counsellor or a mental health professional.
- Suicide must never be discussed within a large group context.
NZ study on Youth Confiding in Friends
The second study cited by Yellow Ribbon is entitled: "Abuse in Dating Relationships: Young People's Accounts of Disclosure, Non-disclosure, Help-seeking and Preventative Education" by Sue Jackson of Victoria University and published in the New Zealand Journal of Psychology, December 2002.Sue Jackson studied who it was that school students prefer to confide in over problems associated with "dating". She commented:
"To summarise, these findings suggest that students will be unlikely to seek help directly from school counsellors, or skilled workers in the community. They do talk to their friends. It makes sense therefore to provide programmes to develop helping skills for students, so that when friends do talk to them about abuse, they are able to listen, respond appropriately and make suggestions about what to do, or who to see.
"Above all, the strongest message for those committed to engaging prevention work, is that any education programme needs to happen in small discussion groups to ensure that all students have the opportunity to participate."
Political Correctness chokes Suicide Funding
http://www.wordworx.co.nz/SOSADeditorial.htm
SOSAD (Save Our Sons And Daughters) is a web-based resource that aims to bring together the bulk of youth suicide resources in New Zealand and link to all the major help organsations. An article by SOSAD reads:
In an ill conceived and heavy-handed move the Government has put political correctness ahead of positive efforts to educate and help young people at risk of adding to New Zealand's reputation as the country with the highest youth suicide statistics in the developed world.SOSAD says this kind of heavy handed approach seeks to curb discussion about one of our most urgent social problems.
In May 2003 the government directly interfered with efforts by independent, privately funded efforts designed to get young people in schools talk through a important issues of life and death and seek help.
The bureaucratic bungle which saw three government departments write to schools raising doubts about the effectiveness of suicide awareness and prevention programmes was done without consultation with the groups involved and with no compelling evidence.
The government claimed it had received reports suggesting some programmes were harmful and could increase suicide risk. After "anecdotal" reports the Ministries of Health, Education and Youth Affairs warned schools at least two school-based programmes were being investigated.
While the Government departments refused to name the programmes, the Yellow Ribbon Trust which distributes cards saying "it's okay to seek help" was immediately put under suspicion, along with Project Hope. However two months later in July 2003 the Yellow Ribbon organisation was commended for its schoolyard training as having a positive effect on youth.
The study by Auckland University's Injury Prevention Research Centre also indicated there was a desire among Yellow Ribbon's teenage 'ambassadors' to have more training. The group conducted the first major study into the organisation's "It's OK to ask for help" campaign fronted by youth ambassadors who are supposed to direct troubled youth to adults for assistance.
The survey of 562 young people involved in the programme said however the biggest drawback was lack of research and funding to determine the outcomes of what it was doing. The report was welcome confirmation that the organisations were on the right tracks after being accused by government agencies which had slammed the use of celebrities with little knowledge of suicide prevention, the branding used, the lack of qualified co-ordinators and the fact that the groups served to raise awareness of suicide among young people.
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This government smear campaign smacks of earlier attempts to try and sweep concerns about youth suicide under the carpet. Newspapers and media in general were asked not to write stories about suicide cases and strict guidelines were produced.
"The mere suggestion that youth shouldn't talk to each other about suicide related issues or how they feel is an attempt at censorship. Youth need to talk among themselves in an environment where they feel comfortable and should be provided with helpful information and contacts pointing them in the right direction for further help.
The government letter recommends schools don't encourage students to talk about suicide directly or indirectly. SOSAD warns this is not only an attempt to curb freedom of speech but to bottle up the frustrations of youth which can only be safely tackled by open and sensible dialogue.
The Government letter says students shouldn't be encouraged to take responsibility for those who may be at risk. Rather, according to a report in The Sunday Star Times, students should only seek help from responsible adults.
Surely, this should be a matter for youth to decide themselves. Youth are far more broad in their thinking than we give them credit for. Putting the right information in their hands and encouraging them to talk about their hurts and frustrations can be an important part of getting their thinking back on track and realising they are not alone," says SOSAD.
Andrew Kay, executive director of Here for Life, a suicide prevention campaign in Australia, said hat international research destroyed the "myth" that raising awareness of suicide led to it.
He was disappointed government departments were not working with and supporting prevention organisations like Yellow Ribbon.
According to an OECD report released in February 2003 comparing statistics across the 30-nation organisation New Zealand had the highest youth suicide rate based on 1998 figures. These numbers have improved in ensuing years. Government figures show youth suicide peaked at 28.2 suicides for every 100,000 people aged 15-24 in 1995 and dropped to 18.1 in 2000
2005 Auckland University Study
In a Press Release on 28 April 2005, an Auckland University study, published in leading U.S. scientific journal "Suicide and Life-Threatening Behavior", reported that the most commonly cited causes of suicide were: pressure to conform and perform, financial worries, child abuse and neglect, and problems with alcohol or drugs. (Only 1% cited mental illness.)Dr John Read, senior lecturer in psychology at Auckland University and one of the authors of the study, said:
"Explaining suicide in terms of ?depressive disorders' medicalises what is a social problem, and begs the question of why so many people are depressed these days. The increase in the percentage of New Zealanders taking psychiatric drugs is a cause for concern not celebration (except for drug companies)."
Dr Read explains that international studies indicate that mental health problems are caused by social rather than biological factors.
The study recommends solutions that include "crisis support services located in schools and youth centres, more youth activities, educational programmes to assist young people to discuss feelings and to bolster self-esteem, and financial aid. Neither increasing mental health services, nor reducing media coverage of suicides, were considered solutions."