Suicide in New Zealand – a reflection
Suicide is a major cause of death and a significant problem worldwide.
It has been described as “a complex behavioural endpoint reflecting the tragic synergy between failed coping mechanisms, proximate and historical life stressors and, in the overwhelming majority of cases, major mental illness including depressive and bipolar disorders, schizophrenia, borderline personality disorder and substance use disorders” (see A Scaffer & M Sinyar, “Building an evidence base for national suicide prevention strategies”, (2017) 50(2) Australian and New Zealand Journal of Psychiatry, 175). Australian figures show that in 2013, 2,522 people died by suicide and an estimated 65,000 made an attempt. In New Zealand, in 2014, 504 people died by suicide. This represents an age-standardised rate of 10.7 per 100,000. Australia’s suicide rate is approximately 11 per 100,000.
The high incidence of mental distress in the population is a cause of great concern for governments worldwide, both on account of the social impact on families and communities and on account of the high financial cost associated with each suicide. As long ago as 2002, the 460 suicides and 5,095 attempted suicides in that year were estimated to cost nearly $1.4 billion annually. At that time, each suicide was estimated to cost a total of $2,931,250. This has led governments to invest substantial resources in the development of suicide prevention interventions.
In New Zealand, where suicide continues to be a significant health and social problem, the Government has had a long-term commitment to suicide prevention. Current activity is guided by the New Zealand Suicide Prevention Strategy 2006-2016, which sits within the context of government-led mental health promotion and service development. This is accompanied by a wide range of initiatives that contribute indirectly to reducing suicide risk factors at both national and local levels (Ministry of Health, 2016).
The New Zealand Suicide Prevention Action Plan 2013-2016 supports the seven goals of the Suicide Prevention Strategy. These include:
- promoting mental health and well-being, and preventing mental health problems;
- improving the care of people experiencing mental disorders associated with suicidal behaviour;
- improving the care of people who make nonfatal suicide attempts;
- reducing access to the means of suicide;
- promoting safe reporting and portrayal of suicidal behaviour by the media;
- supporting families/whanau, friends and others affected by a suicide or suicide attempt; and
- expanding evidence about suicide rates, causes and effective interventions.
The Government has committed $25 million over four years to implement the Action Plan – funding that will be supplemented by a number of other activities directly or indirectly contributing to the prevention of suicide. Included are mental wellbeing and resilience-building initiatives and improving access to mental health care. However, given that suicide prevention is already a major priority for the mental health sectors in both Australia and New Zealand, the question arises as to what more can be done to reduce suicide deaths.
Some have argued in favour of a multi-systems approach to suicide prevention, involving multiple strategies implemented simultaneously in a region (A Jorm, “A month for reflecting on suicide prevention”, (2016) 50(2) Australian and New Zealand Journal of Psychiatry, 109-110). Other researchers have argued that hospitals and mental health services should routinely assess lifestyle factors in people presenting with suicidal behaviours. It is suggested that assessing these factors will “enable people at a low point in their lives to make changes in their health-related behaviours with the potential to substantially improve their physical and mental health into the future” (cited in Jorm, above, at 110).
Of course, such suggestions have direct implications for the legal profession, amongst whom there are high levels of mental distress leading to suicidal behaviour. In a recent article by CNN reporters Rosa Flores and Rose Marie Arce entitled “Why are lawyers killing themselves?” (January 20, 2014), it was noted that in the US, lawyers are ranked fourth when the proportion of suicides in the profession is compared with suicides in all other occupations in the study population (adjusted for age), following dentists, pharmacists and physicians.
A recent article in the Louisiana Bar Journal (see JE Stockwell, “Lawyers Assistance – Suicide in the Legal Profession”, 60 (4) Louisiana Bar Journal, 323) cited a Johns Hopkins scientific study that found that lawyers and judges suffer depression rates up to three times that of the general population, and alcohol and addiction rates of up to twice the general population.
Interestingly, “adversity” and “aggressive tendencies” in the legal profession are identified as suicide risk factors, together with such factors as depression and anxiety, alcohol and substance abuse, hopelessness, job or financial loss, lack of social support and sense of isolation.
The reality is that the common stresses of legal practice are high-risk factors for depression and suicide. While the profession is aware of problems associated with stress and the importance of developing strategies to encourage and enhance mental wellbeing amongst its members, much has still to be done. The legal culture of adversarialism comes at a cost and needs to be accounted for in any strategy to address the associated problems of stress, isolation, and workaholism that seem to be endemic in legal practice.
These issues need to be addressed at many levels and in a range of legal contexts if our profession is to emerge from the worryingly high-risk profile for vulnerability to suicide and suicidal behaviour to a place of healthy professional practice, where practitioners feel relationally connected, supported and integrated with the valuable enterprise of which they are a part.
Note: The Oakley Mental Health Research Foundation resolved at a recent Board meeting to offer targeted funding on suicide prevention. Applications for funding related to this topic will be considered separately from general funding applications.