Pae Ora/Toi Ora – Optimum Health and Wellbeing
Total DHB Completed Suicides Per Annum
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- Taranaki DHB Completed Suicides 2007-2015 by Gender
- Pae Ora/Toi Ora – Optimum Health and Wellbeing
- Taranaki DHB Completed Suicides 2007-2015 by Maori/Non-Maori
- Taranaki Police Call-outs to a Suicide Attempt (2014-15)
- Count of Repeat Admissions by Female Count of Repeat Admissions by Male No. of people Admissions % of Total
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Total DHB Completed Suicides Per Annum (2007-2015) Pae Ora/Toi Ora – Optimum Health and Wellbeing 10
The highest number of suicides fall within the 25-44 year age band, 46 (39% of the total) followed by those in the 45-65 year age band 39 (31% of the total). Within these two age groups female suicides are slightly higher at 13% of the total.
Plymouth District is 68% of the total Taranaki population (2013 Census), Stratford 8% and South Taranaki 24%. The numbers of suicides by TLA are New Plymouth District 90, (71% of the total), Stratford District 9 (7% of the total) and South Taranaki District 28 (22% of the total). This shows the New Plymouth District (which is predominantly urban) is 3% higher as a proportion of the total suicides than the percentage of the overall population. This figure is in contrast to the national picture where completed suicides were greater per 100,000 population in rural areas.
0 5 10 15 20 25 2007/08
2008/09 2009/10
2010/11 2011/12
2012/13 2013/14
2014/15 Taranaki DHB Completed Suicides 2007-2015 by Gender Male
Female 0 2 4 6 8 10 12 14 16 18
2015 Pae Ora/Toi Ora – Optimum Health and Wellbeing 11
Geographic Spread of Suicides in Taranaki in 2007-2014.
New Zealand Māori represented 19% of the suicides in Taranaki for the eight year period.
0 5 10 15 20 25 Taranaki DHB Completed Suicides 2007-2015 by Maori/Non-Maori Non-Maori Maori
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Suicide Attempts Suicide Attempts Suicide Attempts Suicide Attempts Taranaki Police iii
record the number of suicide attempts that Officers are called out to. When reading this section it is noted there are some limitations with how Police data is coded therefore there is a level of inaccuracy. The data also does not provide an indication of the severity of the attempt. Between January 2014 and April 2015, Police attended 518 suicide attempts across the region between Mokau in the north and Patea in the south. Two hundred and fifty six of attempted suicides were recorded as female, 245 were recorded as male (there was no gender information for 17 of the call outs). This is a similar percentage for both genders.
The Police call out data is recorded against the attending Police station. The Taranaki Police area does not extend as far south as Waverley which forms part of the District Health Board and District Council boundary, so the numbers for South Taranaki may be marginally higher than shown below. The chart below does reveal a larger number of call outs per head of population in the Stratford District (Stratford represents 12% of the regional population, Census 2013), and
a marginally higher number in the New Plymouth area (which represents 67% of the regional population, Census 2013.
Self Self
Self Self----harm harm harm
harm In New Zealand in 2012 there were 3031 intentional self-harm hospitalisations. Two thirds of these were female, one third of which were from youth aged 15- 24 years, and one fifth were by Māori. At a national level in 2012, there were 71 intentional self-harm hospitalisations per 100,000 population. In Taranaki we have the eighth lowest rate out of the 20 DHBs in this age group. In Taranaki between 2010 and 2012 there were 78.3 intentional self-harm hospitalisations per 100,000 population, which is higher than the national rate of 71.0. When disaggregated by gender there were 99.7 occurrences per 100,000 of the female population. Between 2012 and 2015, Taranaki admitted 370 people for a total of 809 self- harm incidents. Two thirds of the total self-harm acts in this period occurred amongst females. 0 5 10 15 20 25 30 35 40 45 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Taranaki Police Call-outs to a Suicide Attempt (2014-15) 2014
2015 Pae Ora/Toi Ora – Optimum Health and Wellbeing 13
There was also a particularly high prevalence of repeated self-harming, with many people being admitted for three or more episodes in one year. The largest admission for repeated self-harming in one year was 18 times.
The most common type of self-harm amongst females and males was intentional self-poisoning. Of the 370 people who were admitted for self-harming, the youngest age was 11 years, and the oldest 85 years. The split according to age is shown below.
Māori were statistically over represented according to their overall population numbers in the region.
The data only tells a partial picture, as there will also be data and information held at a General Practitioner level and with schools. Within Taranaki there is a strong reason to believe that the rates of self-harming are high in particular with our young people. Future
Future Future
Future D D D Data ata
ata ata N
N N Needs eeds eeds
eeds The Advisory Group recognised the limitations with the current data, and has prioritised the need to improve surveillance systems and methods of data recording and sharing as part of their suicide prevention and postvention responses.
96 1 40% 71 1 54% 77 2 32% 37 2 28% 28 3 12% 11 3 8% 19 4 8% 5 4 4% 4 5 2% 0 5 0% 6 6 3% 3 6 2% 2 7 1% 2 7 2% 3 8 1% 0 8 0% 0 9 0% 1 9 1% 3 10 to 18 1% 1 10 to 18 1% 238 132 Pae Ora/Toi Ora – Optimum Health and Wellbeing 14
Stakeholder Engagement Proce Stakeholder Engagement Proce Stakeholder Engagement Proce Stakeholder Engagement Process ss ss
Engagement Process Engagement Process Engagement Process Engagement Process During June 2015, the Taranaki District Health Board facilitated a plan development process. Engagements took place in three main ways: •
•
Multi-agency engagement via four Advisory Group meetings. •
One-on-one / small group conversations. The stocktake survey was sent to Taranaki agencies, organisations and iwi working within, or with an interest in the area of suicide prevention and postvention. This included stakeholders who deliver education, health and social services to individuals and communities. Kaupapa Māori health providers and support groups were actively engaged. Ten agencies provided information to support the population of the current service status. The stocktake survey also sought information about the actions and priorities that have informed the development of the Action Plan. Four dedicated meetings were undertaken to support the development of the Plan identifying the key themes, priorities and action planning and the approach towards information. The meetings involved a wider group of representatives including the Taranaki District Health Board, Ministry of Justice, Ministry of Social Development, Child Youth and Families, Ministry of Education, New Zealand Police, Māori Health Providers, Suicide Prevention Taranaki, Corrections, New Plymouth Injury Safe, counsellors, Tui Ora and Ngati Ruanui Health. In addition, a number of one-on-one engagements and smaller group conversations were undertaken to help gain an understanding of what work was currently occurring in suicide prevention and postvention. Insights were gathered from specialist and targeted providers working with youth, Māori, rural and men.
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Current Status Current Status Current Status Current Status
As part of the process to develop the Taranaki Suicide Prevention and Postvention Plan, agencies and organisations were invited to provide information about their current suicide prevention and postvention activities. There was limited data received, indicating limited activity in this area. Responses were received from 11 individual organisations. A summary of the stated activities is detailed below. While the services provided do cover both some agency activity, NGO’s and community interest groups, there is more work that will be done as part of implementation to understand how the services/programmes that are being delivered are resulting in positive outcomes to our communities. Taranaki has a significant strength in supporting rural populations, in particular rural farming communities. The proactivity of community interest groups over recent years has resulted in a decline in suicides of Farmers. Objective 1: Strengthen the infrastructure Objective 1: Strengthen the infrastructure Objective 1: Strengthen the infrastructure Objective 1: Strengthen the infrastructure for suicide prevention. for suicide prevention. for suicide prevention. for suicide prevention. a)
Supporting access to subsidised or free training in suicide intervention for families. b)
c)
Liaison and networking between service providers, understanding the gaps in service provision. d)
Reducing stigma and discrimination about mental illness and suicide. e)
Promoting training to up-skill the community (making sure people know what to say and do if they are around a suicidal person).
f)
Helping the community to understand how to access and navigate their way through to the right services for them. g)
about services that are available. Provisions of a suicide prevention handbook.
Objective Objective Objective Objective 2 2 2 2: Supporting families, wh : Supporting families, wh : Supporting families, wh : Supporting families, whānau, nau, nau,
nau, hap
hap hap
hapū, iwi, and communities to prevent , iwi, and communities to prevent , iwi, and communities to prevent , iwi, and communities to prevent suicide. suicide.
suicide. suicide. a)
social worker and bereaved family member with facilitation training. Monthly Peer Support Group has speakers from Police, Lifeline, and Psychologist etc. b)
Supporting access subsidised or free training in suicide intervention for families. c)
isolation. d)
Fortnightly shopping service for older people to support the person to remain physically, emotionally and mentally engaged in their community. e)
minimise loneliness. Pae Ora/Toi Ora – Optimum Health and Wellbeing 16
f)
Providing relevant targeted expert support to farmers and rural communities. g)
Early intervention programme where coordinating meetings will support whānau/family through their mental health journey. h)
i)
Counselling, education and information to persons at risk of suicide. j)
Website offering information and guidance about how to prevent suicide. Objective 3 Objective 3 Objective 3 Objective 3: Supporting families, wh : Supporting families, wh : Supporting families, wh : Supporting families, whānau, nau, nau,
nau, hap
hap hap
hapū, iwi, communities after a suicide , iwi, communities after a suicide , iwi, communities after a suicide , iwi, communities after a suicide . a)
Monthly Peer Support Group facilitated by a combination of counsellor, social worker and bereaved family member with facilitation training. Monthly Peer Support Group has speakers from Police, Lifeline, and Psychologist etc. Objective 4 Objective 4 Objective 4 Objective 4: Improve services and support : Improve services and support : Improve services and support : Improve services and support for people at high risk of suicide who are for people at high risk of suicide who are for people at high risk of suicide who are for people at high risk of suicide who are receiving government services. receiving government services. receiving government services. receiving government services.
a)
Supporting access subsidised or free training in suicide intervention for families using services. b)
Supporting people with mental health or are affected by a person close to them experiencing mental health problems. c)
isolation.
Pae Ora/Toi Ora – Optimum Health and Wellbeing 17
Governance and Leadership Governance and Leadership Governance and Leadership Governance and Leadership Integrating Clinical Leadership with Integrating Clinical Leadership with Integrating Clinical Leadership with Integrating Clinical Leadership with Communities as Partners Communities as Partners Communities as Partners Communities as Partners Response to Suicide Prevention and Postvention is a whole of Taranaki response. Proposed partners to the Action Plan include, but are not limited to:
•
Community •
Iwi •
Taranaki District Health Board •
Midlands Health Network •
Victim Support •
Rural Support Trust •
New Plymouth Injury Safe •
Suicide Prevention Taranaki •
Ministry of Social Development / Work and Income •
Ministry of Justice •
Ministry of Education •
Schools •
Tui Ora •
Ruanui Health •
Community Health and Social Services •
Territorial Local Authorities What What
What What N
N N Needs to eeds to eeds to
eeds to H H H Happen? appen?
appen? appen? The Suicide Prevention and Postvention Advisory Group has identified the need to develop an overarching governance structure to support Taranaki’s approach to suicide prevention and postvention. The Advisory Group explored a number of models that could work, and in the short term has resolved to continue with the current membership of the Suicide Prevention and Postvention Advisory Group during the early stages of Plan implementation. There is a need for multi-agency, whānau and community centred governance/representative structure that can serve a number of functions.
- Clinical leadership -
-
Advocacy and education -
Plan implementation and monitoring -
Agency coordination and cooperation The Advisory Group are continuing to explore whether there is a need for an independent governance structure i.e. a trust model, or whether the current collaboration is the most effective and efficient means of developing and implementing the plan. The interim structure is set out below.
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Proposed Proposed Proposed Proposed Interim Governance Structure Interim Governance Structure Interim Governance Structure Interim Governance Structure
Pae Ora/Toi Ora – Optimum Health and Wellbeing 19
Forward Plan Forward Plan Forward Plan Forward Plan
Overarching Priorities Overarching Priorities Overarching Priorities Overarching Priorities The Suicide Prevention and Postvention Advisory Group have endeavoured to create an Action Plan that is future focused and innovative. In doing so, it has identified that a number of infrastructure changes and improvements need to take place that can facilitate improved interagency connection, support enhanced service delivery and build a workforce that is knowledgeable and responsive to the risks of suicidal and self-harm action. The Action Plan provides a response and a commitment to support communities and individuals to be able to build their resilience and wellness. However, the region recognises that there is a strong need to provide support structures for those whose lives are touched by self-harm, a suicide attempt or a completed suicide. Taranaki has identified that targeted and appropriate responses are needed for at risk groups and vulnerable populations. A ‘one approach fits all’ will not work, and there is a need for agencies to draw upon their strengths with particular population groups, and for broader services and support systems to provide individualised response programmes. The overarching priorities span each of the outcome/objective areas: •
postvention support. •
Community wellbeing is promoted and supported. •
Leadership and commitment exists across Taranaki to prevent suicide attempts and support those after a suicide or suicide attempt.
Families/whānau and communities have access to appropriate services and supports. •
Support for high risk groups and populations are culturally and socially appropriate, coordinated and available. •
delivered. •
Referral pathways are clear and service responses are efficient and effective. •
prevention is encouraged. •
Resources are coordinated to ensure effectiveness of outcomes. Priority Populations Priority Populations Priority Populations Priority Populations The suicide (completed and attempted) and self-harm statistics provide a picture of those groups and life stages which may increase a vulnerability to suicide, but the quantitative data collected by agencies only reveals some of the story. There are other intentional acts that may in fact have been a suicide, but it is difficult to know for sure, as the data does not tell the story. In order to develop a community response to suicide attempts and acts, the community needs to know the stories to understand the problem and get to the right solution. Within Taranaki, the Advisory Group who developed this Plan have drawn upon both the agency data and their expert knowledge to identify community groups in Taranaki, who are vulnerable, and who will be prioritised in the Plan.
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