Monthly Archives: June 2015

Suicide attempts in the elderly

The New Zealand Suicide Prevention Strategy had a little to say on suicide among the elderly. It says

While suicide rates in the elderly have been declining over time, they remain relatively high, and the risk is often overlooked in this population. This is a concern because elderly who attempt suicide usually have a strong intent to die and are more likely to make attempts that are fatal; elderly people who attempt suicide usually choose more lethal means and more often live alone, which decreases their chances of being discovered. Because of their physical frailty, an elderly person may be less able to survive or recover from a physically serious suicide attempt (p.19)

Suicide in the elderly seems to me to be a complex problem. Much of the ‘problem’ may be a simple case of checking out before the pain gets any worse, before the confusion takes over, before they have to go into a home. Should we be trying to prevent that?

Suicide due to mental illness should be fought at any age, because dying before your time when things could get better is a tragedy at 17 or at 70. Intervention strategies for mental illness should be designed for people of all age groups, and screening for mental illness should be applied to the elderly as much as it should to any other age group. Losing anyone to mental illness is tragic, and it should be actively prevented if possible.

What should we do about people who are making the calculated and conscious choice to check out? I think we should be respecting that decision, not finding ways to make people who have lived their life and have a reason to go live on against their will. Sure, it’s probably impossible to make someone who really wants to die safe, especially one who has made a logical conscious decision to die, but interventions can make it more difficult, can change minds that were made up for good reasons. When someone wants to die on their own terms rather than waste away to a cancer that will cause them debilitating pain and disability, who am I to say that their choice is wrong? Or someone in the early stages of Alzheimer’s wanting to die before they become a shell of themselves, alternately blank and distressed, and no longer the person their loved ones remember.

In short, instead of preventing elderly suicides that are not the result of mental illness, I believe that we should give them the choice to die with dignity, on their own terms. Not putting barriers in their way, not judging their reasons for dying and finding them wanting, but allowing and even facilitating a good death. Perhaps a thorough mental health check – one that does not include ‘wanting to die’ as an automatic symptom of mental illness – but then, freedom and means to die on their own terms.

Assisted dying campaigns focus on allowing the terminally ill to end their lives gracefully. I think that being old and intensely aware of your mortality, as well as the reality of the way your life and death will play out, is reason enough to allow people to die in the time and place of their choosing.

I have no practical answers for how this would work, having not thought about it in much depth before now. I do know, though, that I want to be able to die rather than lose my body or mind to disease or frailty. I want to live a good life, and have a good death.

Society conditions people to be disgusted by suicide

I read that quote, that ‘society conditions people to be disgusted by suicide’ somewhere recently (but failed to write down where). It really resonated with my experience of suicide. People really are disgusted by suicide, and that’s a shitty reaction – but it’s the one we’re groomed to have by our society.

I do not feel disgust at people who commit suicide. There’s a deep sadness, sometimes anger if they’re close to me, but disgust just isn’t on the radar. I don’t think it should be, either. Someone being so unwell, so desperate, so sad, or so angry that they cannot see another way out if tragic, not disgusting. Why is there so little compassion?

I feel like I should have some deep insight into why people are conditioned to react with disgust, but I don’t. I’m just disappointed in society for having such a stupid and useless reaction. When I lost a friend to suicide several months ago, I resented people who thought of it as the easy way out, who showed that disgust. They have no idea what that place is like, and yet they spit on it. For shame.

When someone is suicidal and they see the reaction of disgust to another’s suicide, or just ot the topic in general, it communicates to them that because they have these thoughts, they are disgusting too. It’s not often going to be a deterrent – if you’re having disgusting thoughts anyway, then you are disgusting, and what does it matter any more? It’s just another layer of self-loathing to add to a person who is already very unwell.

People who die by their own hand are a tragedy, and a lesson. Not an object of disgust. Our society needs to grow up and gain some empathy around the matter.

Dealing with barriers to employment

Reading around the web today, I came across a Ministry of Social Development working paper on the barriers to employment for long-term beneficiaries. There’s plenty to unpack, but one quote stood out to me.

A comprehensive understanding of the employment barriers faced by long-term beneficiaries requires attention to personal, family, community and institutional factors, as well as their interactions. A comprehensive approach to addressing these barriers requires a mix of services and individualised case management.

Attention to personal, family, community and institutional factors. A mix of services and individualised case management. That’s what it takes to help long-term beneficiaries find long-term employment. They’re not easy things, but they’re simple enough to grasp. We need a good understanding of a range of factors that affect long-term unemployed people, and a personalised approach to overcoming these things.

So how does that leave us with a government bent on pushing as many beneficiaries off the dole as they possibly can, as fast as they can. with no follow-up as to their positions and outcomes anywhere down the track. I know that we don’t have that data, because it has been requested by researchers and nothing is available. OIA requests mean that if that data existed, they would have to at least say it was withheld for whatever reason. The data just doesn’t exist.

People are not being assisted off the dole into stable suitable employment. They’re forced to take whatever jobs comes along, whether they can practically work it or not, whether it’s short- or long-term, there are no choices and no logic to it.

It;s a scheme that’s really designed to get people off the benefit, not to keep them off. Forced to take whatever job around, people start and then find that, unsurprisingly, they aren’t fit for the job, and within their 90 days they’re off again, back to the benefit. Or they’re punished so often, and made to jump through so many hoops that they drop off, only to have to sign up again when things get really desperate.

The way forward is to understand the things that stop beneficiaries from working, and to work through those things in a way that is best for the beneficiary – whether that’s continuing income support while they raise their children, or a skills course that readies them for work, or family therapy, or a grant to get them work clothes – the permutations of help needed are endless, but we could step up and make it work for people. Instead? Well, let’s not compare the possible with the real. It gets depressing.

Why can’t we trust them?

There is one great need in a poor person’s life, and that is money. With money, all the problems of hunger, of cold, all those things go away, because money solves them all. So what do we give poor people? As little money as we can! Instead, there are all sorts of assistance programmes, and homelessness, hunger and misery where those fall short. Instead of giving poor people money, we try to give them food, or clothes, or cheap doctor’s visits. I think this approach is both wrong and insulting.

The idea behind giving poor people stuff instead of money is that if we give them the things they need rather than dollars, they can’t spend their money on wasteful or frivolous things, and they will actually get what they need. And I say that’s a crock. It’s incredibly patronising to assume that poor people will go and spend their money on ‘bad’ things like they don’t know the needs they have. For all the fringe cases that are appealed to, of drug addicts and gamblers who spend money they don’t have on their vices, there are thousands of people who know exactly what they need and would go and get those things if they only had the resources.

Stop painting poor people as irresponsible, as children who can’t be trusted with more than their wee bit of pocket money. Poor people are expert budgeters and bargain hunters, wringing every last drop of value from every penny they have. It’s demeaning to force them to use food banks and other such initiatives. It’s an insult to their skills, giving them money only in the form of emergency chits that can only be spent in certain places on certain things. It’s humiliating, and it’s wrong

Who are policy-makers to say that they know better than people living in the trenches? What rich person understands what resources a poor person needs? There are times when food is nice, but money would have been better, because you can live on rice for a few days while you pay the power bill so the lights stay on. Having Weet-bix and milk in that time is really nice, but it’s not essential, and you could have used that resource to be eating hot rice in the light, instead of cold Weet-bix in the dark. Other times, subsidised power is nice, but you could have sat in the dark a bit more and made rent this week, rather than sitting in the dark on the pavement, surrounded by your belongings.

Budgeting an inadequate income is a balancing act, one that many poor individuals and families are very good at. Why do we not trust them with enough money to make the balancing act a little less precarious? What kind of smug superiority complex says that people with adequate resources know what’s best for people without adequate resources?

People know what they need, and if they have money they can buy it. It’s really that easy. Give poor people money, and watch them thrive, and pump it back into the economy. 

Bizarre claims about choice

I’m struggling to write at the moment, between falling asleep in the evenings instead of writing like I usually do, and being so busy during the day that I’ve just had no spare time. This weekend I might try pre-writing several days worth of material to smooth things over a bit when I’m particularly tired or run off my feet.

Today it’s an American nugget of stupidity that’s caught my eye. The article is a few months old, but the stupidity glows bright through time. A Florida state Representative wants to restrict people to using the bathroom of their biological sex at birth (no word on the fate of intersex people. Unisex bathrooms for those of ambiguous sexual characteristics only?). This is a fairly normal state of affairs, with all the usual claims of public safety and won’t you think of the poor women subjected to the men in women’s clothing in their bathrooms? No word on what happens when trans men go to use female bathrooms under this law. That would probably bother quite a few women – to have someone who looks and thinks like a man in their bathrooms. Anyway.

What really stands out about this guy is his claim that

People are not forced to go the restroom. They choose to go to the restroom.

That’s some pretty deep bullshit that you just felt yourself land in there. It’s a biological need, which everyone feels, and it is not optional! But people like this man are so desperate to justify their bigoted points of view that they will make all sorts of ridiculous claims that fall apart when held up to the light. They’re counting on people not questioning anything.

I am not trans, and so my word on trans issues is only that of a bystander. Trans men and women, in my opinion, have the right to identify as the gender they believe they are, and a right to use the facilities meant for that gender. I trust them to do so as much as I trust anyone else – because they are anyone else. They’re not more dangerous than the average person, or more depraved, or anything like that. They’re just people.

Trans issues are difficult for this cis writer to talk about because they are not my issues, and I can never understand them fully. I can only say that trans people are people, an deserve every human right afforded to the most affluent straight cis white man. The reality is a long way off, but the groundwork is laid when people begin to see trans rights as human rights.

More on cold, damp housing

A lot has been written in the last few days about sub-standard housing in the wake of the deaths of Emma-Lita Bourne and Soesa Tovo. Today I’m just picking out a few of the more interesting things that have been said.

From Judith Collins, government minister, who has never, as far as I can tell, known what poverty is like:

I think the best place to start is in social housing. This area provides housing for the most vulnerable New Zealanders who realistically have the least choice of all when it comes to housing. If Parliament expects private landlords to improve their houses, surely Parliament and Government should lead by example, rather than by law.

Tell me, how many landlords are going to look at well-maintained social housing and go ‘look, they’re doing it all right and getting bugger in rent. How about we increase our standards and accept low rent too!’. They’re not going to do it. Leading by example only works when people have some motivation to follow you. There’s no motivation to spend money that can conceivably be held on to until the last possible moment, for no real reward other than ‘yay we did what the government does’ and possibly ‘yay our tenants are happy’ . . . or not, when you hike the rent to cover the cost of the renovations. Leading by example just isn’t going to work. There needs to be some incentive.

From one Against the Current blog, rather left-leaning I would say:

The answer cannot be just to wave our fists at Nick Smith but to campaign for the nationalisation of the power companies so they can be managed as social utilities providing affordable power to all. They should be brought back into public ownership, and run democratically in the interests of workers and consumers. Then, prices can be controlled, bills made affordable, and profits invested in cheaper, cleaner and safer energy supplies, rather than in shareholder dividends.

I don’t know if public ownership with the right solution, but the way it’s put here sounds pretty bloody tempting really. Running it as a social enterprise and knocking prices down to where people can actually afford to run their heaters sounds like a very good idea right now, as one in ten face a winter where they will not run their heater at all. It’s five degrees out there in Wellington right now. Ten percent of people out there, give or take, are shivering through it. It’s not good enough. Maybe public ownership is the answer, maybe some sort of regulation is better, I don’t know, but the price of power is just too high, and the current model is not working.

Finally, Pete George of YourNZ, a right-leaning blog that claims to be ‘Reason, Reasonable, Robust’, has this gem for us:

But no matter what the Government does they cannot ensure everyone heats their house adequately, or ventilates their house adequately, or keeps their carpets and beds relatively free of allergens, or budgets effectively, or the many other things that can contribute to a family’s well-being.

Can we stop blaming the victims of economics for their own deprivation? It’s not a matter of choosing to run your heat pump and dehumidifier, or vacuuming, or watching your pennies. If it were, then there are a whole lot of people who were a whole lot healthier! These people. Cannot. Afford. To. Run. A. Heater. I suppose that the government really can’t ensure that everyone runs their heater – because there are people who look at whatever heating is provided in their home and laugh bitterly, knowing that it will never be turned on. They live in damp areas where opening your windows every day will do precisely nothing for the damp, except maybe exchange your inside, slightly warmer damp, for outside, slightly colder damp.

Keeping their carpet and bedding ‘relatively free of allergens’ has got to be one of the more ridiculous things I’ve seen. Ho do you keep your carpets free from allergens? Well, you vacuum  with one of those HEPA thingies, right? That required owning a vacuum cleaner, and bags for it, and so on. Those that can afford such things use them at about the same rate as richer people, I would wager – some just don’t but many do. But vacuum cleaners are luxuries. And what about the bedding? You keep that allergen free by washing sheets often – which poor people do as much as they can, but getting the only set of sheets you own for the bed washed and dried in one day in winter is a challenge sometimes. A dryer is WAY out of the question, and a trip to the laundromat to dry them off can mean no milk for breakfast that week. Then there’s the blankets and duvets and so on – things which need dry-cleaning. Ha! That’s bloody expensive. It just doesn’t register as high on the needs list as food and rent and power.

And then, there’s ‘budgets effectively’. If I had a penny for every person that has blamed poor people’s budgeting for their poverty, I would start a programme of insulating homes, and get a good way through the crappier areas of Wellington without blinking. How do you get it through people’s heads that you cannot budget effectively without the first tool of budgeting – money. When your money runs out before the end of the list of essentials, you cannot budget for the less urgent things. You just don’t have the resources. You can ask any budgeting advisory service in the country what they see most, and they will tell you – people whose money runs out before their needs do, who don’t even get into their list of wants.

There has been some sensible dialogue around this issue, and some stuff that just makes me rant. I think there are some people that need a short sharp dose of reality around this.

A day off

A man’s day off is his day off. A woman’s day off is time to catch up with the housework.

That quote flew past me the other day on Facebook. I can always tell what material I’m getting from Facebook and what’s from Twitter – Twitter gives me good solid reality-based journalism to work from, Facebook gives me shirt snappy stupid quotes. I thought that Twitter was for short and snappy, but people there know the joys of the link. Anyway. I digress.

This kind of junk gets fancy titles like hetero-normative gender essentialism. It has a basis in historic reality, it is true, but it reinforces gender roles in a way that should just not be happening. It should be held up as the bullshit it is, emblematic of outdated thinking and only brought up to laugh at or learn from. Instead, it’s paraded out with a knowing ‘right, ladies’ and a wink. It’s embarrassing.

I like to live in my little progressive Twitter bubble, where stuff like this is frowned upon and looked down on. But stepping out into a more real-world Facebook, with a more diverse group of people, it reminds me that we still live in the era of cave-men in some ways.

This has been a rambling way of saying that men do not exist to do man-things, and women do not exist to do chores. People of all genders relax and do chores in varying measures, and those measures should not be expected to be defined by old-fashioned gender constructs.

A cold response

Over the last week, it has come to light that at least two, and probably more, people have died partly as a result of cold, damp Housing New Zealand houses. It’s pretty shocking that it’s happening in a country with the resources to prevent that. We’re not a third-world country! We can and should do better.

Our housing minister doesn’t think so, though. His response, when questioned on the issue?

People dying in winter of pneumonia and other illnesses is not new.

How can he be so callous? It’s true that people have been dying of preventable cold-related illnesses right through the history of human existence, but that is not the point. The point is, we have the capacity to help, to prevent these occurrences – they are called preventable diseases for a reason – and we just aren’t.

Who are we if we take the minister’s stance? We are cold, we are heartless, and we are not fit to run a country. Especially not one that is supposed to support those down on their luck. Leaving them to die in the cold is reprehensible.

A couple of nights ago here it was cold, about 5 degrees. I needed many blankets to stay warm enough to sleep – I couldn’t sleep through the cold. I thought of all the kids with not enough blankets – poor people aren’t usually investing what money they have in lovely thick warm blankets – and not enough money to turn the heater on. They’re not sleeping well. What blankets they have are damp from their dreadful housing. There’s no hope of drying them in the sun in the depths of winter. It’s bleak.

We. Can. Do. Better. We’re not spending the full amount allocated for HNZ maintenance. 60%, Bill English boasts, is being spent, like this cost saving is a good thing instead of something that is literally killing New Zealanders. We’re spending on flag referendums, on subsidies to conference centres, on things that Don’t Matter. How about we spend on something that does matter – spend the money that’s already budgeted for it. It’s not a hard concept.

The pressures NGOs face

Yesterday I wrote a bit about NGOs providing essential social services. Today, I’m looking at the rest of the article I referenced there, on the funding issues that NGOs currently face. This government not only pushes essential social services off onto NGOs – it also underfunds them. Badly.

The author, Richard Wood, notes that even services which are ‘fully specified’ (which I think means fully funded for the services specified in their contracts, but it’s a piece of government jargon that Google wasn’t keen on giving up the definition of) are underfunded. If the government is short-changing the services which are supposed to be fully funded, how is it for partly-funded services? Pretty dire, would be my guess.

None of the funding for NGOs has been inflation adjusted since 2009, and even further back the inflation adjustment has not kept pace with actual inflation (which is about 30 percent in the last 12 years!). As the services struggle, and fall further and further behind, the government gets to look at them and tut-tut over their budgeting and fiscal responsibility. It’s rubbish.

At the same time as this government underfunding, philanthropists have signalled to the government that it’s not their job to fund essential social services, that these should rightly be funded by the government. So, with not enough government funding and little philanthropic money, core services are struggling badly.

Why on earth are essential and critical social services being treated like this? I suspect that it’s because the government doesn’t see them as essential or critical. They see them as a money pit that brings no tangible returns – despite the billions that mental and physical illness, criminal behaviour, homelessness and the like cost the economy annually.

We’re talking about social needs in economic terms again, and it’s wrong. It’s a people cost, and people are worth more than money. Perhaps the next government will see some sense.

NGOs providing essential social services

For reasons previously unknown to me, successive governments have farmed out the provision of critical social services to non-governmental organisations (NGOs). This always struck me as shifting the responsibility away from the government, and I never understood why. Recently, the New Zealand Herald ran an article that mentioned why the government has utilised NGOs.

An effective, properly funded social services sector is crucial for the support of vulnerable children and their families. Most of the social services we need to achieve Government priorities are services best delivered by NGOs. There are many good reasons for this.

From the client perspective, NGO services are more trusted, accessible and private. From the community perspective NGOs are better networked into the community, both at agency and front line worker levels, and more likely to collaborate with others in the community.

From the Government perspective, using NGOs allows it to control the money it invests in social services while reducing the need for the employment of public servants who are not only more highly paid but get annual pay rises.

I agree with the client perspective. It’s much easier to trust the Sallies or Relationships Aotearoa than the Ministry of Social Development. There’s less of a sense of impending screwing over looming in the near future. While this is true, I think some rehabilitation of the government’s persona that it presents to people is important, rather than pushing all the work onto NGOs in order to cover up that reputation sinkhole.

I’m not sure what to think about the community perspective. I guess they’re better networked. I feel though that it’s because they’ve put in the work that government departments don’t feel like doing.Government departments could actually do the work and make the contacts and have the same advantages that the NGOs have there if they really wanted to.

From the government perspective. Well. Controlling the money it invests in social services? That sounds very much to me like code for ‘under-funding services and then blaming them for any failures due to lack of cash flow’. Any time the government talks about controlling costs it means that someone is going to lose out, and that the government is going to do all they can to make it seem like it was the most responsible thing it could have done.

The reason all this has come up is that a big NGO, Relationships Aotearoa, has just closed down due to funding deficits. The government blames RA, while RA say that the government didn’t come to the table with anything realistic. Whatever the reasoning, the upshot is that a bunch of counselling, including court-ordered counselling, has abruptly ended. That means that a bunch of ex-violent criminals have just lost their counsellors, people essential for their transition into functional community life.

It also reduces the need to pay public servants, who are guaranteed a good wage. Shall we say it plainer, and tell people that they just want to be able to pay people minimum wage for providing some of the most important social services to the most vulnerable groups in the country? Even if it’s not minimum wage, they still want to pay far less than people are worth to work far harder than the government deserves from them.

So why NGOs? People trust them more, yeah, but mostly we don’t have to give them much money, and we can shift the blame when thing so wrong. I love our government.