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World Suicide Prevention Day webinar 2012

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Prof G Luke Larkin and Dr Annette Beautrais discuss strengthening protective factors & instilling hope in a webinar to mark World Suicide Prevention Day 2012. More information and video: …

Prof G Luke Larkin and Dr Annette Beautrais discuss strengthening protective factors & instilling hope in a webinar to mark World Suicide Prevention Day 2012. More information and video: http://www.spinz.org.nz/page/239-events-archive+webinar-for-world-suicide-prevention-day-2012


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  • 1. RLD SUICIDE PREVENTION DAYSTRENGTHENING PROTECTIVE FACTORS INSTILLING HOPE Gregory Luke Larkin MD MS MSPH FACEP Lion Foundation Chair of Emergency Medicine Annette Beautrais PhD Senior Research Fellow The University of Auckland, South Auckland Clinical School l.larkin@auckland.ac.nz, a.beautrais@auckland.ac.nz
  • 2. AGENDA Magnitude of the Problem The Problem of Suicide in New Zealand Risk and Protective Factors  Micro–level (Individual)  Meso-level (Community, Organisation)  Macro-level (State, National) Your questions
  • 3. MAGNITUDE OF THE PROBLEM
  • 4. WORLD SUICIDE RATES
  • 5. MAGNITUDE OF THE PROBLEM >1 million deaths worldwide EVERY year - an under- estimate  51% of all violent deaths  More deaths than all wars & homicides combined In any one year - 4% have thoughts of suicide, 1% plan (WMHS) Overall rate of suicide has NOT declined in the past decade;
  • 6. SUICIDE Under-counted Under-recognised Under-funded (prevention) Under-addressed Poorly understood PREVENTABLE in many cases
  • 7. A DIFFICULT PUBLIC HEALTH PROBLEM In top 10 causes of death worldwide In top 3 causes of death in 15-35 age group Annual global rate - 16 per 100,000 people (3-4X higher in men) Despite considerable research & new knowledge, relatively little progress in developing effective interventions By contrast, reductions in CVD, stroke, MVA, HIV/AIDS, homicide, cancers Suicide is a more difficult, complex problem than these issues.
  • 8. PREDICTIONSBy 2020  depression will be the 2nd major cause of YPLLs & DALYs (after CVD)  Suicides - estimated 1.5 million p.a. worldwide
  • 9. SUICIDE IN NEW ZEALAND
  • 10. NZ suicide deaths and rates 2004 2005 2006 2007 2008 2009 2010NumbersTotal 486 511 524 483 497 506 522Male 379 380 386 370 366 391 380Female 109 131 138 113 131 115 142RatesTotal 11.7 12.2 12.2 11.0 11.2 11.2 11.5Male 18.6 18.6 18.5 17.4 16.9 17.8 16.0Female 5.2 6.0 6.3 4.9 5.8 5.0 6.4
  • 11. 0 5 10 15 20 25 30 1948 Rate 1950 1952 1954 1956 1958 1960 1962 1964 1966 1968 1970 1972 1974 1976 1978Year 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 Males 2008 Females Suicide age-standardised rates, by sex, 1948-2010 2010
  • 12. Suicide as a percentage of all deaths in that age group 2010 Percent 45 Males Females 40 35 30 25 20 15 10 5 0 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+ Five-year age group
  • 13. Suicide age-specific death rates, by 5-year age group, 2010 Rate 60 Males Females 50 40 30 20 10 0 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+ Five-year age group
  • 14. Māori and non-Māori suicide rates, by sex 1996-2010 Rate35 Māori males Māori females30 Non-Māori males Non-Māori females25201510 5 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year
  • 15. Methods of NZ suicide deaths 2010 Submersion (drowning) 1.5% Firearms and explosives 8.0% Cutting and piercing instrument 1.7%Hanging, strangulation Jumping from high place and suffocation 1.7% 60.5% Other and unspecified means 3.3% Poisoning – liquids and solids 11.9% Poisoning – gases and vapours 11.3%
  • 16. New Zealand Suicide Prevention Strategyhttp://www.moh.govt.nz/moh.nsf/indexmh/suicideprevention-strategyandplan#strategy
  • 17. NZ - SUICIDE PREVENTION STRATEGYNZSPS – 7 goals  promote mental health & wellbeing  improve care of people with mental disorders associated with suicidal behaviours  improve care of attempters  reduce access to means of suicide  promote safe reporting & portrayal of suicidal behaviour by the media  provide postvention support  expand evidence about rates, causes & effective interventions.
  • 18. RISK & PROTECTIVE FACTORS19
  • 19. MICRO-LEVEL RISK FACTORS Genetic vulnerabilities Psychiatric illness Impulsivity Aggression Hopelessness Previous suicide attempts Poor coping skills Physical illness/injury, TBI, PTSD Sexual orientation
  • 20. MICRO-LEVEL PREVENTION STRATEGIESIndividual interventions  Psychotherapy, medication, psychosocial support  Diet, exercise  Building coping skills, resiliency (e.g. anger/conflict management), optimism, wellness  Impulsivity/anger management  Cyber, phone, txt msg interventions  Medication, appointment reminders  Tailored safety planning
  • 21. PROTECTIVE FACTORS – HEALTHMicro-level (Individual) activities Acute distress or crisis  Engage with health services  Keep appointments  Take medications and follow treatments as prescribed  Have a safety plan, & follow it when you encounter difficulties  Ensure you are safe  If things don’t get better, ask for help  Ask for help and support from family, friends, health services  Go to the ED or local Psych Emergency Services  Call helplines - Free 0800 543 354;  If immediate danger - call 111
  • 22. PROTECTIVE FACTORS - PSYCHOLOGICALMost people exposed to difficult life experiences do not die bysuicide. Likely explained by differences in protective factors: Resilience - ability to cope with, and adjust to adversity A sense of self-worth and self-efficacy Effective coping and problem-solving skills Outward focus (serving others) Adaptive help-seeking behaviour Life satisfaction A positive therapeutic relationship
  • 23. PROTECTIVE FACTORS – HEALTHMicro-level (Individual) activities Specific daily wellbeing practices  Diet  Keep a gratitude journal  Keep a hope box  Make plans, set challenges for yourself  Volunteer activities – help others  Pets - responsibility/exercise  Ensure social contact  Take up hobbies, exercise, interests
  • 24. PROTECTIVE FACTORS – HEALTHMost people who die by suicide are depressed but not takingeffective antidepressants Many not diagnosed Of those diagnosed, many are untreated or under-treated Many more do not take their meds as prescribed.YET There are effective medications and therapies Educate primary care (GPs) to assess, treat and manage depressed & suicidal patients Encourage help-seeking, adherence with treatments & meds
  • 25. PROTECTIVE FACTORS - INDIVIDUAL & SOCIAL  Social connectedness, good relationships with friends, colleagues and neighbours  Social support from other people  Marriage - men; children for women (but cannot prescribe!)  Religious/spiritual beliefs
  • 26. MESO-LEVEL RISK FACTORS Relationship, legal, financial, disciplinary problems Physical and emotional abuse, neglect, bullying Family violence Parental psychopathology Unemployment Social isolation Academic pressures Institutional settings (prisons, services, schools) Clusters and contagion Healthcare settings (inpatient units)
  • 27. MESO-LEVEL STRATEGIES Institutional strategies  Education, screening, skills building, gatekeeper support Psychosocial interventions  Anti-bullying, IPV screening, parenting/family support, crisis lines, social support Primary care screening, assessment, education Healthcare settings (EDs, inpatient units) Community settings  Cluster management, postvention/bereavement support, workplace support
  • 28. MACRO-LEVEL RISK FACTORS Public laws/policies (e.g. drug & alcohol access) Season/weather Disasters (long term) Media over-reporting Cyber-exposure; cyber bullying; Social disintegration, individualism, materialism Globalisation, macro-economic restructuring Cultural differences/isolation
  • 29. MACRO-LEVEL STRATEGIES Community, state, national policy interventions  Means restrictions  Drugs/alcohol policies  Media guidelines Health & wellness promotion Social policies & employment Health literacy, destigmatisation Public service messages Media and cyber-based programmes
  • 30. PROTECTIVE FACTORS – MEANS RESTRICTION  Suicidal behaviour is often ambivalent & impulsive, and/or contemplated when someone is intoxicated  May not be pursued if access to a favoured method or a particular site of suicide is thwarted.  Therefore restricting access to means of suicide is a very effective protection against suicide  Shown for domestic gas, VEG, metro railway systems, guns, bridges, jumping sites, medications - prescribed & OTC
  • 31. RE-INSTALLING BARRIERS33 Grafton Bridge, Auckland, New Zealand  Removal of safety barriers in place 60 yrs led to a 5.6-fold increase in Ss from the bridge – 3 Ss in the 4 years prior to removal, 19 Ss in 5 yrs after removal.  Reinstatement of barriers eliminated Ss from the bridge and appears to have decreased Ss by jumping the city. No increase in Ss by jumping from other sites. Beautrais et al, 2010
  • 32. SUICIDES AT GRAFTON BRIDGE34 19 3 0 1992-1995 1997-2001 2002-Present
  • 33. STRENGTHENING PROTECTIVE FACTORS & INSTILLING HOPE WINNING WAYS TO WELLBEING
  • 34. ADVANCING SUICIDE PREVENTION INSTILLING HOPE We now have a sufficient body of evidence and data about risk & protective factors for suicide. The time to convert that evidence into effective programmes is NOW. Requires sustained investment in funding, training & development of a suicide research & prevention workforce, and in IT, regulatory & funding infrastructures which support suicide prevention The present absence of strong evidence for effective programmes is a call for action
  • 35. KEYNOTE SPEAKERSCONFERENCE SPEAKERS Professor Sir Peter Gluckman Professor Jane Pirkis Prime Ministers Science Adviser, New Zealand University of Melbourne, Australia Professor Eric Caine Professor David Fergusson University of Rochester School of Medicine University of Otago, Christchurch New Zealand Rochester, NY, USA Professor G Luke Larkin Paul Kelly The University of Auckland, New Zealand CEO, Console Ireland Assoc. Professor Sally Merry Dr John Crawshaw The University of Auckland, New Zealand Director of Mental Health, Ministry of Health, New Zealand Dr Shyamala Nada-Raja University of Otago, Dunedin, New Zealand Di Grennell Te Puni Kokiri, New Zealand Dr Jemaima Tiatia Centre for Pacific Studies The University of Auckland, Professor Helen Christensen New Zealand Executive Director, Black Dog Institute, Sydney, & Professor of Mental Health, University of New South Sandra Palmer & Eliza Snelgar, Wales, Australia Community Postvention Response Service (CPRS), CASA, New Zealand Professor Simon Hatcher University of Ottawa, Canada Dr Nik Coupe
  • 36. CONFERENCE TOPICS TOPICS  The science of suicide  New Zealand suicide prevention prevention policy  Suicide clusters  Pacific suicide prevention  e-health and suicide  The Emergency Department prevention as a site for suicide prevention  Suicide as a public health problem  Pathways to suicide  Postvention  Public/private partnerships in suicide prevention  Māori and suicide prevention
  • 37. SUICIDE PREVENTION 2012: IDEAS, INNOVATION, IMPLEMENTATION FRIDAY SEPTEMBER 28TH, 2012 8.30am to 5pm ELLERSLIE EVENT CENTRE www.suicideprevention2012.weebly.com