Why the NZGovernment needs to get on with the job of suicide prevention
December 1, 2018
A lot of people have asked me why it did not participate in the New Zealand Government’s Mental Health and Addictions Inquiry and it is a very legitimate question to ask. Several years ago when the National Party was in Government I spent a lot of time meeting with Ministry of Health Officials, service providers and politicians to put forward a comprehensive plan on where I thought change was needed in order to bring the rate of suicide in New Zealand down. Those views, and that plan, came from two areas. The first was as a result of my own experience as a Director of the Board of Suicide Prevention Australia, Chair of Australia’s National Coalition for Suicide Prevention, someone with my own lived experience and someone who has been immersed in the sector for the last decade. The second were the hundreds and thousands of New Zealanders I had met throughout 2016 and 2017 as I made my way around the country – listening to their stories and how suicide had impacted them. On another front I had sat in a number of forums to do with suicide prevention and mental health both as a talker and a listener (mostly listening). Above all else it is what I saw and heard first hand thanks to Mike King as I joined him on his journey.
In 2016 I became ever more critical of the Ministry of Health who appeared to be frustrating change and who presided over a very broken mental health model. The now infamous interview with Dr John Crawshaw, Director of Mental Health Services at the Ministry of Health, summed it up – he could not even remember, when asked, what the suicide rate was. Between that and the absence of any coherent and evaluated suicide prevention strategy the scene was set for action. But; for those in power and decision making roles there would be no action. In November of 2016 I met with then Minister of Health Jonathan Coleman and put it to him the that suicide rate was on the increase and something needed to be done urgently. I listed a series of things that could turn the tide but all the while the meeting was again frustrated by the continued interference of Dr Crawshaw. When I said the suicide rate had gone up I was corrected that so too had the population and by weight of numbers it had averaged out. In disbelief I said that “what you are trying to tell me is that one plus one no longer equals one.” It was obvious to me, in the meeting, that Dr Crawshaw had lied to the Minister about the level of engagement he had with me and after a while I asked all of those present to leave so that myself and the Minister could talk one on one. Yes; it is not a myth. I really did kick the officials and my own side out of the Ministers office and in doing so went toe to toe. I again reiterated to Coleman what needed to be considered and I left with the belief that he had heard me. I was wrong. Even though Dr Crawshaw told the Minister and I that we would meet again soon we never did – and to this day no meeting has taken place.
Ahead of the General Election I met with a number of politicians and their staffers – pushing the action plan for reform. With New Zealand First I felt we had made real progress as I did with Te Ururoa Flavell, the then co-leader of the Maori Party. Over on the Labour side I prosecuted the argument with former Health Minister Annette King, Clare Curran, Damian O’Connor and others. I was hopeful that if there was a change in Government action would be taken to address the ever increasing tide of suicide. So; what were the key points of the plan? Pretty straightforward:
Reform and review of the current Mental Health Act to ensure it was fit for purpose for todays New Zealand
The establishment of a stand alone Mental Health Commissioner – not as a commissioning agency but as a person who could sit a top the sector and provider co-ordination, develop strategies and work on an interagency and community basis
Reform of Coronial legislation to ensure it was culturally appropriate and understandable to all New Zealanders
The development of a national workforce plan to meet demand on service providers – as we campaigned to say its okay to reach out for help we needed to ensure there was supply of workforce to meet the demand
Consolidation and focus on a coordinated campaign for suicide prevention and mental health help seeking instead of multiple campaigns
The development of a new five year strategy for suicide prevention
The development of an evaluation framework to ensure that programs were not only fit for purpose depending on need and location but were measured against outcomes. Instead of being audited to ensure finds were expended for the intended purpose, that the intended purpose had achieved an outcome
A review of the District Health model and the role of hospitals when it came to admissions, care and post discharge
A dedicated suicide prevention plan and strategy for youth
A dedicated suicide prevention plan and strategy for Maori
A dedicated suicide prevention plan for white males between the ages of 24 and 65
All of these things needed to be done before the questions of investment and more money was on the table. My reasoning then, as it is now, was that just throwing more money into something before we knew what needed to be done and how it should be done was the wrong thing to do.
When the new Government came to power I was extremely hopeful. Many hundreds and thousands of New Zealanders were. As the months wore on people were waiting for action and they believed it came in the form of the Mental Health and Addictions Inquiry. For my part I met with the new Health Minister, David Clark, and his officials with insights into what was beginning to shape in other jurisdictions. As the Inquiry went on they received thousands of submissions both on paper and in person – momentum, or so many believed, was building.
But then something quite remarkable happened, without a large number of people and organisations knowing, the Ministry of Health, led by Dr Crawshaw, formed a leadership group of more than twenty organisations to prepare a response to the Inquiry when the report was handed in and the recommendations made. It would be more than a month after that group first met that the Inquiries report would be handed to the Minister and the Minister would indicate that he would not be releasing the report until the end of the year and any Government responses would not happen for another up to six months. He said this was because the report was detailed and needed to be cross checked with first to ensure no sensitive information was released by mistake and that it took time to develop responses to recommendations.
Here is the thing – on average nearly two New Zealanders take their lives every day. Based on the suicide rate of 2017 a further 334 New Zealanders would have taken their lives and an estimated 6680 would have made an attempt before the Government responses. Its already been more than a year since the Government has been in power, its been more than two years since the last national suicide prevention strategy was replaced and it will be years still until any recommendations begin to take hold.
This come back to why I didn’t participate in the Inquiry – because we didn’t need to have an Inquiry to know what needed to be done. We have wasted two years of talk, two of years of political game playing, two years of an inept and useless Ministry of Health, a profoundly frustrating period of leadership from Dr John Crawshaw and the stupidity of inaction. In actual fact this is not a failure of this current Government wanting to honestly do something – more so the point must be made that the previous Government let us get to this point through doing nothing and that is the risk the Ardern Government now finds in its court. To delay, to hinder and not to act will be a foley of their own making.
The first thing that should be done now is to establish the independent Office of a National Health Commissioner and entrust the recommendations to them for implementation. As I have said time and time again to allow the foxes to being charge of the chook house would be a mistake and it would disrespect those who have passed and those who are left behind trying to make it sense of it all.
New Zealanders deserve better than this. Those who have died by suicide deserve better than this. Their whanau and loved ones, mates and communities deserve better than this.
*numbers quoted in this article are estimates based on average rates of suicide as published by the New Zealand Chief Coroner
About the author: Matthew Tukaki is the Chairman of the National Maori Authority, Chairman of the Tamaki District of New Zealand Maori Council and Chairman of Suicide Prevention Australia.
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