The government’s response to the mental health inquiry accepted 38 of its 40 recommendations – but opted against the introduction of a suicide reduction target. There’s a good reason for that, writes Kyle MacDonald.

Does the idea of losing 534 people to suicide in New Zealand feel better than losing 668? Does it feel like success to lose 134 fewer people to suicide in a year?

What is an acceptable number?

How many people close to you are you prepared to see die by their own hands?

To this question, there is only one answer because – as we heard at the release of the official Government response to He Ara Oranga yesterday – every life matters.

We at the Key to Life Trust have long advocated for a national target of zero suicide, because when you really think about it, it is the only target. If you think targeting zero is too ambitious, then ask yourself: what number are you comfortable with?

Quite apart from the ethical and compassionate reasons to set no target that accepts any number of suicide deaths, global evidence isn’t clear whether setting targets is even an effective approach.

Scotland set a clear target of a 20% reduction in 2002, and saw a reduction of 18% in the ten years to 2012. But they also invested in a comprehensive nationwide strategy aimed at helping people “Choose Life”. The target may have helped plan and focus resources, but the World Health Organization (WHO) is clear: it isn’t possible to say if it is the act of setting a “target” that made the difference.

Targets are useful for focusing governments and policy makers – and that has its value – but are they useful for focusing the public? Of course not, and they tell us nothing about what we can all do to help turn around the growing number of people we lose each year.

To be pragmatic for a moment, there are two problems to be solved: those who are suicidal and reach out, seek help and want to engage in treatment and support; and those who are suicidal and never ask for help. As a result their death is a shock and a mystery to those around them.

For those who do reach out, the 38 accepted recommendations of the He Ara Oranga form a large part of the answer: people in distress need a range of options, but most important is access to help, when and where they need it.

For the group of people who don’t reach out, or aren’t already engaged with support services, prevention is much harder.

The Centre for Disease Control in the USA recently found that over half (54%) of people who died by suicide didn’t have a diagnosable mental health condition.

We’re also told that people who attempt suicide have clear plans, and the presence of a plan is a “risk factor.” Clinicians are routinely trained to ask about this.

However around half of people who die by suicide attempt it impulsively, with another study suggesting that around one quarter of people consider suicide for only five minutes before attempting.

Suicide is often impulsive, which is of course the problem with youth suicide. That is the age when human beings are, on average, at their most impulsive.

How do we then set a target when we can’t even accurately predict who is at risk?

Simple: we don’t. We make service access universal, fit for purpose and easy to access.

We recognise that early intervention, and availability of help and support to people before they reach crisis point is key. We help people overcome addiction earlier, address trauma as soon as they are able, and support them as soon as they experience difficulties.

Because when our funding only addresses crises, we get more crises. The acceptance of the 38 recommendation by the government acknowledges not just the need for more services, but a radical overhaul of how we think about treatment, including a plan that allows 20% of the population to require support at any one time.

This plan, and the move away from only funding acute services, is only part of the solution.

It isn’t up to just the government, it’s up to all of us. Every day in our words and actions we can all make it clear that every life matters. That we are all responsible for those struggling, because at some point in our lives, any of us could be at risk and need help.

Because it’s not just true that every life matters, it’s also true that what we all do – every single one of us – matters.

Kyle MacDonald is a psychotherapist, NZ Herald columnist and co-host of Nutters Club on NewstalkZB. He is a board member of the Key to Life Trust, the charity behind Mike King’s: I am Hope campaign and Gumboot Friday.

Where to get help

Need to talk? Free call or text 1737 any time for support from a trained counsellor.

Lifeline – 0800 543 354 or 09 5222 999 within Auckland.

Samaritans – 0800 726 666.

Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO). Open 24/7

Depression Helpline  – 0800 111 757 or free text 4202. This service is staffed 24/7 by trained counsellors

Samaritans  – 0800 726 666

Healthline – 0800 611 116

Counselling for children and young people

Youthline – 0800 376 633, free text 234 or email talk@youthline.co.nz or online chat. Open 24/7.

thelowdown.co.nz – or email team@thelowdown.co.nz or free text 5626

What’s Up – 0800 942 8787 (for 5–18 year olds). Phone counselling is available Monday to Friday, midday–11pm and weekends, 3pm–11pm. Online chat is available 7pm–10pm daily.

Kidsline – 0800 54 37 54 (0800 kidsline) for young people up to 18 years of age. Open 24/7.

For more information about support and services available to you, contact the Mental Health Foundation’s free Resource and Information Service on 09 623 4812 during office hours or email info@mentalhealth.org.nz