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
1. RLD SUICIDE PREVENTION DAY
STRENGTHENING 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
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. PREDICTIONS
By 2020
depression will be the 2nd major cause of YPLLs & DALYs
(after CVD)
Suicides - estimated 1.5 million p.a. worldwide
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
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 Strategy
http://www.moh.govt.nz/moh.nsf/indexmh/suicidepr
evention-strategyandplan#strategy
17. NZ - SUICIDE PREVENTION STRATEGY
NZSPS – 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.
22. PROTECTIVE FACTORS – HEALTH
Micro-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
23. PROTECTIVE FACTORS - PSYCHOLOGICAL
Most people exposed to difficult life experiences do not die by
suicide. 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
24. PROTECTIVE FACTORS – HEALTH
Micro-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
25. PROTECTIVE FACTORS – HEALTH
Most people who die by suicide are depressed but not taking
effective 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
26. 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
28. 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
29. 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
30. 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
31. 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
32. RE-INSTALLING BARRIERS
33
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
36. 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
37.
38. KEYNOTE SPEAKERS
CONFERENCE SPEAKERS
Professor Sir Peter Gluckman Professor Jane Pirkis
Prime Minister's 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
39. 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
40. SUICIDE PREVENTION 2012: IDEAS, INNOVATION, IMPLEMENTATION
FRIDAY SEPTEMBER 28TH, 2012
8.30am to 5pm
ELLERSLIE EVENT CENTRE
www.suicideprevention2012.weebly.com