Support to address drug abuse and prevent youth suicide will feature in Budget 2003 says Progressive Leader and Associate Health Minister Jim Anderton, who chairs the Government’s Ministerial Committee on Drug Policy.

At the sixth Annual New Zealand Australia Conference on Addictive Diseases in Wellington today, Jim Anderton announced community action initiatives to combat drugs and the establishment of programmes for intervention for families where there has been a suicide or attempted suicide. “Budget commitments announced today were part of the Progressive Party’s budget bids made as part of the constructive role we are playing within the Coalition Government,” Jim Anderton said.

“The 2003 Budget includes 15 community action initiatives, six in rural areas and nine in urban centres which will help combat the effects of cannabis and other illicit drugs. These initiatives are based on the successful Community Action Projects located in Kaitaia, Hokianga, Whangaruru, West Auckland, Opotiki and Nelson.

“The 15 initiatives will be located where the use of drugs is highest. Local teams from key agencies will be brought together to develop action plans. There will also be national development meetings for the local teams involved.

“These 15 community initiatives will receive funding totalling $2.55 million per year.

“There will also be $150,000 per year for a national drug information analyst to provide accurate comprehensive and accessible information for the National Drug Policy.

Jim Anderton also has responsibility for the Youth Suicide Prevention Strategy. “We need to give more assistance to families and whanau where there has been a suicide or attempted suicide.

“Families and whanau can be particularly vulnerable when they have lost someone to suicide. Where a suicide has been attempted family members can end up being very distressed and vulnerable themselves. On the other hand, with the right support and information they can play a very positive role in helping someone who is suicidal towards recovery. Budget 2003 provides $1.3 million for each initiative - $2.6 million over four years.

“In addition the Youth Suicide Prevention Strategy which has an existing operational budget of only $40,000 per year will receive an additional $150,000 in 2003/4 and 2004/5 and another $75,000 next year to review the effectiveness of the Youth Suicide Prevention Strategy.

“Although youth suicide seems to be declining and is now less than 100 a year, every suicide is a failure and a human tragedy. We need to talk and do more with parents, caregivers and teachers on how to identify youth at risk and address their problems,” said Jim Anderton.

Backgrounder For the Progressive Budget Announcements In Relation to Youth Suicide and the National Drug Policy

1. Youth Suicide

   Postvention
   Support for Families/Whanau where a Suicide has occured
   There is a high level of awareness that New Zealand lacks adequate support services for those bereaved by suicide. This proposal represents an opportunity to address that concern. It also represents an opportunity to establish and evaluate a service with the potential to prevent suicide, and to expand the knowledge base in this field.

   The initial phase will involve an analysis of the needs and appropriate evidence based interventions for the identified client group, and the development of resources. The following years assume the establishment of appropriate services in specified locations. These services will be provided by pre-established services with a good record of service delivery and will have close links with primary care and specialist mental health services, but will be independent of them.

   Benefits
   The proposed project is supported by the relevant body of literature, and by expert opinion. Evidence clearly demonstrates that the effects of suicide on survivors is significant and that family members, friends and associates exposed to suicide can be at increased risk of suicide themselves.¹ Therefore suicide postvention (support for those bereaved by suicide) is in fact an effective preventative approach.

   While the research is limited in demonstrating clear outcomes of particular approaches, expert opinion referenced in the literature clearly identifies community support and internally focussed support mechanisms as important postvention approaches.² This literature therefore supports the need to develop appropriate support services and resources to assist more internally based support.

   There are limited services currently available in New Zealand to support people bereaved by suicide. Accordingly, there is significant community support for addressing this area of unmet need.

   Goal 4 of the New Zealand Youth Suicide Prevention Strategy: Crisis Support and Treatment aims to give effective support to those who are bereaved or affected by suicide, and to reduce the potential for further suicides. Until now, limited support has been available to people bereaved by suicide.

   Support For Families/whanau and Significant Others of Those Who Have Made a Serious Suicide Attempt

   The purpose of this project is to build on the implementation of the Guidelines for Assessment and Management of People at Risk of Suicide in Emergency Departments and Mental Health Settings, which are about to be published by the Ministry of Health. This initiative will provide support for families/whanau and significant others of those who have made a serious suicide attempt.

   The initial phase will involve an analysis of the needs and appropriate evidence based interventions for the identified client group, and the development of resources. The following years assume the establishment of appropriate services in specified locations. These services will be provided by pre-established services with a good record of service delivery and will have close links with emergency departments and specialist mental health services, but will be independent of them. Note that these services would not be limited to youth and would be provided to an all age population.

   Benefits
   One of the major risk factors for death by suicide is having a history of a prior suicide attempt. Thus, a key suicide prevention approach is to ensure that all those who have made suicide attempts are effectively assessed by skilled professionals and are actively followed up with appropriate care and support. The forthcoming publication of Guidelines for Assessment and Management of People at Risk of Suicide in Emergency Departments and Mental Health Settings provides best practice advice to clinicians to optimise care and to reduce subsequent suicide attempts. While this guideline primarily focuses on the actions of emergency department personnel and mental health service clinicians, the family and friends of people who have made a suicide attempt also need advice, to develop skills and receive support in their roles as carers. This proposal focuses on addressing that need. As well as the significant role family and friends can play in reducing the suicidal risk of the person who has made an attempt, a serious suicide attempt can cause significant emotional distress for family members and friends. It can lead to these people feeling helpless and unsure of how to help, and can result in them being at an increased risk of suicidal behaviour themselves.

   Although the primary client of the emergency department and mental health service will be the person who made the suicide attempt, clinical guidelines³ are clear that the emotional and support needs of the family also need to be catered for.

   The key benefits from effective support for familiy/whanau and significant others will include:

   • Increased competence to effectively support the person who has attempted suicide.
   • Improved ability to assess critical factors which may indicate increased risk of a further suicide attempt, and how to respond appropriately.
   • Greater understanding of the roles of various helping agencies and how to access them.
   • Greater understanding of the nature of mental illnesses and suicidal behaviour.
   • Improved emotional environment for the at risk individual.
   • Reduced emotional distress and improved coping skills of the family/whanau and significant others.

   Ultimately the initiative has the potential to reduce the risk of subsequent suicide attempts (including potential fatal attempts) by the individual and to reduce the risk to the family members themselves of mental distress and suicide attempt.

   Youth Affairs' Youth Suicide Prevention Project Budget

   Youth Affairs has responsibility for leading and co-ordinating implementation of the NZYSPS. This role has expanded within Youth Affairs and there is strong support from the Inter-Agency Committee on Youth Suicide Prevention (IACYSP) for the work that Youth Affairs is undertaking. While a number of opportunities have been identified for Youth Affairs to increase and enhance this leadership and co-ordination role, there has been significant capacity and financial constraints that prevent this from occurring.

   Now the new funding is available to :

   • Build on and enhance the work undertaken by Youth Affairs, progressing key policy areas.
   • Give implementation of the NZYSPS increased emphasis and focus, and maintain the decline in New Zealand's youth suicide rate.
   • Signify further commitment from the government to the prevention of youth suicide.

   Strategy Evaluation

   Scoping work for the evaluation of the Strategy began in late 2002 and is an inter-agency study, led by the Ministry of Social Development. The aim of the multi-phased evaluation is to determine the impact of the Strategy on the achievement of its goals. The first phase of the evaluation has been funded by the Ministry of Social Development, with financial input from the Ministry of Education, and will present contextual information about the formation of the Strategy, Strategy implementation and the perceptions of key stakeholders about Strategy use and impact.

   The second phase of the evaluation will be informed by the findings of Phase One, and will focus on determining the extent to which the Strategy (including both frameworks 'In Our Hands' and 'Kia Piki Te Ora O Te Taitamariki') has achieved it primary aims. It is likely that in-depth interviews and hui will be carried out with programme providers and those directly working with youth at risk of suicide.

2. Drugs

   Community Action Initiatives on Illicit Drugs
   Evidence indicates that the greatest potential for successful public health strategies is in a comprehensive and integrated, intersectoral community action approach.
   Overseas evaluations of alcohol-related community action projects have shown a wide range of benefits including decreases in inner city crime rates, more effective police enforcement and utilisation of resources, reductions in court costs and decreases in accident and emergency admissions.

   There is little evaluated community action work in the illicit drug area. However, a recent New Zealand piloted (and on-going in five locations nationally) community action project, Community Action on Youth and Drugs (CAYAD) showed considerable potential over a two and a half year period. Indicators of success were increased uptake of proactive school drug-incident management practices, more integration of school-community activity, engagement of marginalized groups, increased Mäori workforce development, and increased youth development activities (Conway et al 2000).

   The Ministry of Health currently funds CAYAD projects in Opotiki, Nelson, Hokianga, Whangaruru and Kaitaia. The Nelson and Opotiki projects work closely with their local Councils. Nelson has focused on alcohol and youth issues and promoting collaborative youth events and activities, with young people involved at the forefront of organising and running these. Opotiki have continued to work with marginalised groups of Mäori, young people and their whanau/hapu by taking them on cultural journeys of discovery and change, including addressing the place of alcohol and drugs in their lives. Opotiki have also been involved with liquor licensing in addressing alcohol issues in public spaces and events.

   The Alcohol and Public Health Research Unit (APHRU) team of Auckland University undertook further impact evaluation work with the community action projects in the Hokianga, Whangaruru and Kaitaia during 2001. Overall the CAYAD initiative was viewed by key informants as making an important contribution to promoting social change in the three Northland communities. Broad impact measures included decreases in drug-related school suspensions and stand-downs in these areas, decreases in reported incidence of youth crime, changes in attitudes and behavior related to excessive drug use, and greater co-ordination of services for young people and their families.

   Particular activities that these projects are involved in include a strong sporting focus and host responsibility promotion. In Whangaruru, which has the highest unemployment amongst these three areas, economic development to provide jobs and a future for young people in the area is emphasised.

   Community action initiatives are designed, developed and delivered in partnership with communities. They build community capacity to initiate, mobilise and sustain initiatives for long-term social and structural change and self-reliance. This can be achieved through an integrated combination of health promoting strategies such as:

   • school education
   • parent and peer education and support
   • family based strategies
   • ethnic action approaches
   • media and communication strategies integrated with the community
   • developing drug free activities for youth
   • environmental improvement
   • regulatory policy and law enforcement.

   How will this approach make a difference?

   Interventions targeted and tailored to specific community issues in specific community contexts are needed to assist in providing medium and long-term solutions, with a comprehensive range of collaborative multi-sectoral strategies. There is a growing evidence-based literature on this approach (Casswell 2000).

   Reductions in alcohol-related harm have been achieved through collaborative community action research partnerships implementing strategic, systematic community interventions (Treno and Holder 1997; Waaganer et al 1999).

   Community action approaches have demonstrated their effectiveness in building community capacity and a local skills-base. They also have an important multiplier effect in adding value to the work of all sectors and agencies involved across diverse health and social issues (Bush 1997; Bush and Mutch 1999; Hawe et al 1997; Harachi et al 1996)⁴.

   Drug Information Analyst

   To achieve effective policy to reduce drug-related harm, policy must be based on accurate, comprehensive and accessible information covering the drug and alcohol sector. For example, it is crucial to have good information on the nature and extent of the drug problem (e.g. through Accident & Emergency admission data or drug seizure rates) to ensure resources are directed to address the real problem issues.

   A wide range of drug-related data is already collected by agencies. For example, Health collects death and hospitalisation data, Police collect data on the scale of drug-related activity - e.g. clandestine methamphetamine laboratory discoveries, Customs collect data on drug seizures at the border, and Justice collect arrest and conviction data.

   Currently, however, there is no real 'home' for coordination and reporting of drug-related information including law enforcement, health and social information, or a dedicated analyst capacity to manage National Drug Policy (NDP) reporting. Ideally, drug-related information from the various agencies in the sector should be collated at least annually and presented in a consolidated report for Ministers, government and NGO agencies.

   It is envisaged that the drug information analyst will lead production of an annual drug-related report (with the potential for more frequent sub-reports) covering a variety of drug-related data from the Health, Police, Customs and other sectors represented in the IACD. A model for the report could be the annual Australian Bureau of Criminal Intelligence Australian Illicit Drug Report report, but focussed more widely than the enforcement sector. This dedicated NDP drug information analyst, will be located within the National Drug Intelligence Bureau.

   Footnotes

   1. Davidson L., & Gould, M.S. (1989) "Contagion as a risk factor for youth suicide". In Alcohol, Drug Abuse and Mental Health Administration: Report of the Secretary's Task force on Youth Suicide. Washington, DC US Government Printing Office

      Martin.G, Kuller.N.S, Hazell.P. (1992) "The effects on adolescents of completed suicide of another student". Youth Studies Australia. 11, 21-23

   2. Dunne, E.J. (1992) "Following a Suicide: Postvention" In Suicide: Guidelines for Assessment, Management, and Treatment. New York: Oxford University Press, p 221-234
   3. National Health and Medical Research Council, 1997. Depression in young people. Canberra. Commonwealth of Australia
   4. Casswell, S. (2000) A decade of community action research. Substance Use & Misuse, 35, 55-74.

      Casswell, S. (2001) Community capacity building and social policy - what can be achieved? Social Policy Journal of New Zealand, 17, 22-35.