I see, I remember, I imagine

CW: Suicide

I see

Washing that has been hanging on the clothes horse for nine days. It speaks to my skill as a housekeeper – now that I live alone, only the barest minimum gets done. The dishes get rinsed, but they pile for three or four, or maybe five or six, days before I wash them. The floor that I lie on gets vacuumed perhaps once in a month.

Summery air flows around me, slowly turning cool with the evening darkness. The taste of Port Royal lingers in my mouth, a reminder of a habit I keep swearing I’ll break, until the next crisis comes along. I sigh, and roll another . . .

The air out on the porch is cooler, and the darkness wraps around me like good dark chocolate around a ripe strawberry. I smoke a slim cigarette, rolled deliberately thin to conserve tobacco. Taxes on tobacco are getting wildly out of hand, but still I keep the habit. The comfort of half a lifetime is hard to break.

I see the lights of the west of the city, stretching right back to the hills. The trig point on the top of the hills flashes red. On, off, on, off, I have no idea why. The men watching over me do not come out to accompany me. They both hate smoking equally. I don’t care much. It gives me space from their difficult and overpowering presences.

The men in my living room are a mass of past and present. They look quite alike, ten years apart, and are similar in many ways. One is my ex-husband. The other is the boy I’m sort-of-not-really seeing. They are both here for one reason only. To see that I live through the night. You see, I’m a suicidal wreck.

My ex-husband knows me well. He knows that he cannot sleep until I am asleep, because I will not be safe. The boy, not so much. He cares for me deeply, but he’s not got much of a grasp on what he’s putting himself in the middle of.

I finally wander back into the living room, to find them discussing politics and online voting. The boy is being thoroughly schooled by his elder. I try to stretch out on the floor and do a writing exercise, but I can’t stop the floods of memories. So I go back to my room and lie in the dark, and let the memories come.

I remember

Hours upon hours of men sitting in my lounge, drinking beer and discussing all sorts of things. The faces and the topics change, whirl, meld into one long string of regrets. These are all men I have cared about in some way, all gone from my life, mostly through poor choices in periods of unwellness on my part. I have been more a spectator in most of these discussions – I do have a bit of a shy streak in me. Plus, men tend to talk over me anyway.

Tears flood down my cheeks as I remember all the people who have passed through my life. I have loved so many of them so dearly, and they are all gone. Gone, because I’m so messed up. I make terrible decisions, I push good people away, and I lose everything. Over and over again. My bipolar disorder is a reason, but not an excuse. I have to take some responsibility.

I sob.

It takes the men a good ten minutes to notice that I’m gone, so absorbed are they in their discussion. There’s a moment of panic – not a long one though, as the apartment is so tiny that it takes all of thirty seconds to locate me. The boy sits on the bed beside me, momentarily at a loss, before wrapping his body around me. My ex-husband turns away.

“I’ll be in the living room if you need me”

The boy holds me until the flood of memories passes and the sobs still. It’s sweet of him, and the comfort is welcome. I turn to face him, kiss him, draw a deep breath, and return myself to calm. We return to the living room, and I calm myself further by rolling another cigarette. Pulling out the paper, wiggling the filter out of the little hole at the top of the bag, pinching out the bare minimum of tobacco, patting it into shape, rolling, placing the filter, licking the gum, rolling it all together, all the while concentrating only on this task and breathing steadily . . . peace returns to me.

Again I smoke, and again the men do not follow me, but I am included in their conversation this time as I stand close to the door. As the cigarette burns down, I realise that I am weary beyond belief. I have been holding this pose of being fine, being ok, being normal, for so long, and it’s starting to break down.

The boy and I tuck up in bed, but my ex-husband stays in the living room. I return to the living room a couple of times for various things, and in that time the boy falls asleep.

The pose breaks.

I don’t remember much. I remember sobbing, screaming, begging, over and over,

“Let me go. Let me die. Please”

To which, the answer was always,

“No.”

Eventually I take some lorazepam and fall asleep. I don’t know if my ex-husband slept at all that night.

The next night was similar, except that the boy was not present. I begged, I pleaded.

“Let me go”

Lorazepam gave me sleep again. My ex-husband sat on the bed and watched over me until the drugged sleep came to me.

The next morning, Thursday 2nd March, I was admitted to the ICU of the Auckland City Hospital psychiatric unit under Section 10 of the Mental Health Act 1992. I was transferred to the main psychiatric ward the next day, and I have been there ever since.

I imagine

Being free from here. I’m allowed leave now, two hours at a time out in the world, and I die a little inside every time I walk back through the doors of Te Whetu Tawera (the Maori name for the ward). I know that discharge is only a few days away now, maybe around a week or so, but my soul is being crushed. I cry every day in frustration, wanting my own things around me, my own bed, my own damn unvacuumed floor. Out there are many pressures, but at least I have some control over my life out there. In here is regimented and my soul is dying.

There are plenty of people that worry about me leaving this place and just killing myself. It’s not going to happen. I’m reminded every day how much I mean to people, and how much it would hurt them if I died, so I will continue on in spite of my problems, for everyone else. It’s not ideal reasoning, but I am not a selfish person and it’s enough to keep me alive until I find my own joy in living again – something that I’m never going to find inside the confines of Te Whetu Tawera.

 

Memories and dreams

A tiny desk light sits recessed deep into the wall. So deep that it is pretty ineffectual, really. Thick plastic protects it. It is firmly bolted to the wall. The desk is scattered with unopened food packages, wordless gifts of caring people. Pringles, Ferrero Rocher, the good things in life, gifted to keep me going.

The walls are covered with fragments of blu-tack and tacky areas of glue that someone has attempted to peel off. Places where former residents have personalised their space. Not me. I don’t want it to be mine.

I hear the sounds of the city, the motorways and the train lines, but also the sparrows and the cicadas celebrating the end of summer. There is a peace here, stashed out the back of the hospital.

I am in Te Whetu Tawera, the Auckland DHB Adult Acute Mental Health Unit.

————————————————————————–

Rolling a cigarette at my table at home. It’s the little rituals you miss when you’re sectioned under the Mental Health Act. Smoking is prohibited on all hospital grounds, even psychiatric wards, and that is a rant for a whole new day. They break the routine and the rolling and the breathing and the release, but “poor health outcomes” trump all. Shortsighted? No, that’s the wrong word. They see the distance clearly, but the up-close reality is lost on them. What does lung cancer at 50 mean to people who on average live to about 32?

I rolled, relaxed, wandered out onto my balcony in the glorious evening sun, lit up, inhaled deeply. Bright and dark tobaccos, soaked in port, brought peace as I exhaled the geyser of spent smoke.

The sun set over the Waitakeres, shifting tones of orange and pink and lilac and violet and all the half-colours and tenuous shades in between. The ranges stained deep mauve against the shifting light as the sun sinks down.

All this I saw from my balcony, my sanctuary. It was a tiny apartment, it had black mold, there was no extractor fan in the bathroom, and it was mine. It was always a bit messy. I am not a clean freak, though I tried not to keep a complete pigsty.

Sweet lovers and dear friends passed through in their times, nourished by my renowned cooking. There was laughter and passion and comfort and joy.

I remember.

Depression is not forever.

————————————————————————–

I will walk through my front door, wrestling with the ridiculous Patient Property bags that they release you from the hospital with. The house will smell good – Mum always goes on a cleaning binge when I get sick, and cleans my apartment thoroughly.

They tend to let you out in the late morning, so I can watch the sun as it creeps across my living room. The arc of the sun’s path is altering from high summer to slower, slumbering autumn. The light slides slower, more sensually, with less scorching heat. I will lie on the freshly vacuumed carpet. I will roll around in pleasure. I can be free.

Depression is not forever.

 

And the shit sprayeth further still

TW – suicide

When I wrote my last blog post, I at least had a head space that was fairly strong. Well, that’s dissolved to the point that my ex-husband says I’m more fragile that he has ever seen me. I’m millimetres from being inpatiented, after a stint in respite last week. I can’t keep myself safe any more. They took my stash of medication, so I’ve come up with a couple of much more lethal plans.

I planned to end my life on October 31st, but I broke down and told my partner, and he convinced me to seek help, which led to the stint in respite. But he’s not around to save me from myself again. So today, after a medication change set me to less than five hours sleep, I decided to make a go of dying.

I made a series of promises of what I would do before I died, and I started on the checklist. I called the Taylor Centre, my local community mental health centre. I was trying to tell them that I was going to go and step in front of a train as soon as I’d completed my required steps. I was advised to make a cup of coffee, have something to eat, and read a book, and they’d call in a couple of hours.

Ahem. What?! Apparently this is something to do with distress tolerance, but I was beyond sitting with my distress and letting it subside. I’ve been doing that for a good month now. I’m beyond that capacity, I was reaching for help, and I was told to make a fucking cuppa. So I made a cuppa, and went on to Stage Two – writing to the people I love and telling them they are loved, individually and personally. That’s where I’m currently at – it’s a longish process.

Meanwhile, my partner, who’s overseas now, knew what was going on and convinced me to reach out – to Mum, and to my ex-husband. Both came through for me – my ex called and didn’t hang up until he was on my doorstep, and didn’t leave until Mum arrived. He supported me, good man that he is. Meanwhile, Mum called the Taylor Centre and repeated verbatim what I had said to her, which was that I was going to write what I needed to, make the calls I needed to, and then go kill myself. The Taylor Centre, to their credit, decided to send someone over in the next couple of hours. And so the process with them begins again.

When the Taylor Centre people arrived, Nigel was there. I spoke to them, and they started talk of how I needed to practice more problem solving. Nigel intervened and told them that he had never seen me so fragile before, and that keeping myself safe was just not going to be practical. It was only when he spoke that they took me seriously.

What is it with mental health services and minimising the voice of the patient unless they have an advocate?

They Taylor Centre said they would talk about my case and get back to me in the evening. Which they did, but they smoothly talked me out of the hospital where I would be safe, and elected to give me enough benzos to knock a horse off its feet. I took those benzos at 9pm, and here it is, midnight, and I’m writing this to distract myself from writing goodbyes.

I don’t know what to do here. All that’s in me screams to keep writing, so I can check that off the list and it’s shorter so I can through more of it next time the impulse and the opportunity arise.

It’s very simple really. I want to die. Life’s downs are far more common that its ups, and the ups that I get, the hypomanic highs, destroy my life over and over. What does it matter whether this low is the one that kills me, or the next, or the next? I may as well go before I hurt more people. Yes yes I know, dying will hurt people, but it’s inevitable sometime and living is hurting a fair swathe of people too.

I’m going through all the motions of rebuilding my life, but I don’t believe in any of it. The black dog alternates between sitting on my shoulder and gripping me by the throat with iron jaws, shaking and trying to rip that throat out. One day he’ll win. Why not now?

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.

Friendships you never doubt

They say true friends go long periods of time without speaking and never question the friendship.

It’s true, I think. But I only think, I don’t know, because for me, crippling anxiety surrounds most interactions I have with people, and friendship is one of the hardest things to feel confident about.

People scare me, because of what they might say or do a lot more than what they actually say and do. I’m forever fearing what I might do to offend or hurt people, and trying my best to avoid doing things wrong, and forever feeling that I fail. The reality of living with mental illness is that your interactions with other people just aren’t like those of ‘normal’ people. You interact differently – people with anxiety will identify with what I feel when I interact with people, the hopes and fears I have, much more than a typical person, who might feel passing rather than crushing anxieties.

In my purely logical mind, I know that there are people who are part of my life who would pick up where we left off as if we’d seen each other only yesterday. Meeting up with a person like that, though, is a morass of what my rational mind knows are baseless fears. Logic and rationality don’t protect me from a mind that wants to tell me that I’m a failure at interpersonal communication, and that people just don’t like me.

I have friends that I do see regularly, good friends. It’s not fair that I can’t shake the feeling that they don’t really care for me all that much. The things depressed and anxious brains tell us are cruel and untrue, but they’re so believable in the moment.

Depression has spent Sunday chewing on me, so things are a bit hazy and rambly at the moment. I feel the effects of it a lot more on weekends because theres no strict routine to keep me going, unlike weekdays. I worked for a chunk of Saturday, and that helped me engage the healthy part of my brain. My unhealthy brain took over for the rest of the weekend though, and it’s thrown me into a bit of a spin. I hope the weekday routine will pull me up.

Being young and unemployed

I read an article about being young and unemployed today, and it raised an issue that I don’t think is discussed enough in relation to unemployment – the effects of unemployment on developing mental illnesses.

Everyone knows that having mental illnesses puts you at higher risk of unemployment. It’s just logical – if you’re seriously unwell in any way then your risk of struggling to find or keep work is much higher. Mental illness has a lot of stigma attached to it, making it hard to get work, and the illnesses themselves make it hard to keep work at times.

So it’s not a great surprise that the mentally ill are somewhat overrepresented in the ranks of the unemployed. But how many perfectly healthy people found themselves on the dole, and became unwell because of it? There are anecdotes in the article of a couple of people that had that experience – of suffering depression and anxiety related to being unable to find work. I would hazard a guess that this is not an unusual experience, and that even the most mentally healthy individuals have periods of unwellness if they are unemployed for a protracted length of time.

What kind of provisions do we make for this? Oh, that’s right. None. Because unemployed people suffering mental illness are doubly derided by society. Not only are you lazy and incompetent, goes the narrative, but you’re also crazy. Stay away, kids!

It’s worse than just having the psychological struggles of the unemployed ignored, though. WINZ processes actively make people unwell. The struggle of trying to get your entitlements, the constant losing of paperwork and other little errors, the unending pressure to get a job and get off the dole (I’m trying, miss, but there aren’t any jobs!), all these things cause stress that can turn into illness. Being unwell already and having to jump through the WINZ medical exemption process is even worse, and no more mercy is shown than to the least co-operative of recalcitrant beneficiaries.

WINZ is a recipe for mental ill health. Unemployment is a potent ingredient all on its own. The melting pot of financial pressure and debt turn it all into hot mess of psychological distress. But support is offered only to the most unwell of people, leaving people easily treated to get worse and worse. They could go to their GP, of course, and be referred for counselling or given anti-depressants – except they chose their GP back when they had a job, or access to student services, and now they can’t afford to go. Tough luck, kid.

The situation for the unemployed actively seeking and not finding work is dire.The stress brings their mental health under pressure, and there’s little out there for them to get support or help from.

Mental health in Christchurch

An article came out today, telling me some things that I thought everyone must know about post-earthquake Canterbury, and some things that I didn’t know, things that make me both angry and sad.

Mental health issues have become more prevalent in Christchurch since the quakes, something that is entirely expected, at least from where I stand. People who have been through a major traumatic event, like a huge earthquake, are more likely to have PTSD relating to the event, but are also more likely to have other mental health issues like anxiety or depression triggered by the circumstances and the pressure they are under. Zero surprises here.

The statistics are startling but not surprising:

– 43 per cent increase in adult community mental health presentations.
– 37 per cent increase in emergency presentations.
– 69 per cent increase in child and youth mental health service presentations, which would be higher without CDHB’s schools programme.
– 65 per cent increase in rural mental health presentations.

Canterbury District Health Board has a lot on its plate to deal with. In addition to the increase in mental health presentations following the quakes, 30,000 people moved into the area post-quake to help with the rebuild, and those people have a range of mental health issues, just like any other population. The problem here is that mental health services in Canterbury have received less than a puny 1% increase in funding, with even the growth in population ignored, never mind the increase in the incidence of mental illnesses in the area.

The lack of funding makes me angry and sad. At bare minimum, there should have been a funding increase in line with population growth. To present themselves as having even a scrap of humanity, the architects of the health budget needed to have acknowledged the effects of the quakes on people’s mental states and provided at least a token gesture toward relieving the pressure on an overstretched service. But none of that has happened, and it is disgraceful.

Where now for CDHB’s mental health service? Well, it’s the same as everywhere else in the country, scrambling to try and make things work on a shoestring budget. It’s worse for them than many others, but two things they have going for them is a well-performing service before the quakes, and the amazing resilience that people, communities, and institutions have shown in the last four years. They shouldn’t be struggling with this, though. We can do better, damn it, and why don’t we?

We’ve prioritised a bloody convention centre over so may more important projects. Health services of all kinds go without. Social housing has been 98% destroyed, and the shortfall has not been addressed in any useful measure. There are still people living in garages and tents, struggling through the winter, because their houses are written off and their insurance hasn’t come through. There is overcrowding due to a lack of suitable and affordable housing in the area. Why on earth would we need a conference centre, which will be empty for significant stretches of time, when there are so many other, more urgent needs? The misguided waste of it all is painful.

The Canterbury region has suffered mightily these past four years, and yet still the carry on. We should be supporting them in any way we can, not letting them down as attention drifts away from their needs due to the passing of time and the waning of urgency.

Taking responsibility for your thoughts and emotions

Today I saw one of those ‘suggested posts’ on Facebook from a bunch called Corlight Programmes, dealing with the idea of thoughts and emotions. Let me quote it to you:

You are in charge! Yes, that’s right – YOU are in charge of your emotions. And in charge of your thoughts. If you are not happy with the bulk of thoughts and emotions that are swirling around in your head and your body (about 60,000 a day by some estimates!) then it is UP TO YOU to change that. Even Anxiety – an emotion driven by our number one driver – the Fear Response – can be changed, reduced or generally removed. Emotions are not something that ‘happens to us’; they are our own body reacting to stimuli in a particular way. That stimuli is often our thoughts.

But where do we start? It’s easy to say “I want to feel different”, or “be different”, but how do we DO that?

It has to begin with YOU deciding that you are willing to take responsibility for your thoughts, emotions and actions – from this moment on you are WILLING to learn – learn where they come from, learn which ones you actually want to keep, and learn which ones no longer serve you and you are willing to let go.

ll that’s left then is to learn the techniques and specific skills that allow you to do just that. But it all has to begin with the choice to be different, AND accepting responsibility for your life moving forward. This may sound like a no-brainer but many people are actually not willing to accept responsibility and will forever continue to blame something ‘outside’ for their current inner turmoil. However we feel we may have been hurt / damaged in the past; waiting for THOSE people to ‘fix’ us or ‘heal’ us …. well, I think you can see you’ll be waiting a long time.

So take responsibility for your own thoughts and emotions as a path of healing for yourself. Are you willing to take this first step?

This is a wonderful mix of great advice and utter tripe, depending on who the audience is. It is true that much of what we feel originates in our own heads, in the thoughts and reactions we have to the things that happen around us. We can even learn to change some of these thinking patterns and emotional responses through learning different techniques to deal with them. It can be life-changing.

Say this stuff to a mentally ill person and you can crush the hope out of them. To think that you are responsible for the horrors going on in your mind, for the anxiety and depression, even the hallucinations, is soul-destroying. The truth of the matter is, there are some illnesses that will not respond to any kind of positive thinking. Some people are actually too unwell to work with programmes like these, and telling those people that their illnesses can be “generally removed” if they are “willing to learn” is doing them a great disservice. It’s saying to them that they’re unwell because they’re not trying hard enough/the right way to get better. It’s another condemnation.

I hate these kind of ads. Passionately. They’re designed for people that have some issues, not people who are truly suffering with serious illnesses, yet they disproportionately affect the people with serious illnesses that see them. It’s another confirmation that your illness is your own fault, and that’s crushing.

Mental illness is not about responsibility for your own feelings and thoughts. It’s about acknowledging that actually, you’re not in control of them, and you need some combination of therapy (real therapy, not this bullshit) and medication to try and live a normal, fulfilling life. This responsibility tripe is not helping.

People like this don’t get mental illness, and they think they’re helping. They may be helping some people, but others are being dragged deeper into their mental prison by things like this.

Further suicidal behaviour

Those individuals who have displayed suicidal behaviours that did not result in death are markedly more at risk of a later suicide attempt and suicide. Amongst those New Zealanders who make a serious suicide attempt, almost half will make at least one further attempt and one in 12 will die as a result of suicide within five years. – NZ Suicide Prevention Strategy,  p.17

Being suicidal is a state that one would think only had two outcomes – either death, or no longer being suicidal. It’s not that easy though. There are people who stay suicidal, but never attempt it for some reason. There are people who will stay suicidal, and just try and try and try until they make it. There are people who seem to have recovered, but go on to become suicidal again. It’s not a matter of dying or getting better,

The way we treat suicidal people directly affects their life outcomes. It’s not just in saving or losing their lives – there is also the question of the quality of life bequeathed to them by their care and treatment. Treating a failed suicide well could be the difference between recovery and continued psychiatric disability. Taking a potential suicide seriously could be the difference between a course of successful treatment and a suicide attempt.

These truths do not seem to be self-evident to many of the people involved in mental health care, both as frontline staff and as policymakers. Policymakers emphasise the need for good care for failed suicides, but frontline medical staff treat them poorly. Frontline psychiatric staff push for good treatment for potential suicides, but policymakers simply don’t allocate enough funding for the treatment needed. The strengths of each seem to be foiled by the weaknesses of the other.

The treatment of failed suicides especially distresses me. I cannot remember the number of attempts that I failed. Maybe half a dozen? Maybe more, maybe fewer. I’m not really sure. One of my failings is that I have a very poor long-term memory, so there are three or four episodes that I remember clearly, but there are more in the murk somewhere. Whatever the number is, it’s much greater than the ideal zero.

The key themes of my treatment by the hospitals and psychiatric teams that I dealt with were disrespect and poor follow-up. Emergency and medical ward staff had no time and no respect for someone like me, someone who wanted to die but seemingly didn’t try hard enough. Maybe I was seen as an attention seeker, someone who was deliberately wasting hospital time and resources in order to fulfil some psychological need for people to look at me. I can’t pretend to know what they thought, but I can know what their attitudes felt like. It felt like I was worthless, a waste of space, a failure, an attention-grabber and time-waster. It felt crushing. All I wanted was for the agony I live with to be over, and not only was it not over, but it was so much worse because people were angry at me, judging me, hurting me more. It made me want to die.

Hospital experiences left me feeling awful, and this is the point where psychiatric services step in. The should take a battered person, and help them and build them up and surround them with the things they need to become well again . . . Ha. Let’s see. The first time, when I was still very much a minor, the follow up involved my entire family being called in for an interview – not an environment conducive to opening up. Even if I didn’t have an abusive stepmother crushing my wrist in warning, I couldn’t say anything in front of my beloved little brother, and my adored father. I couldn’t hurt little bro, and I couldn’t admit to dad how bad things were. The entire venture was a failure, at a time in my life when intervention could have changed everything.

Other incidents included being sent home with no follow-up beyond a referral to the food bank because we had so little to eat (never mind that I had a serious mental illness showing up) and a vague promise to get in touch with an appointment at community mental health (An hours’ walk from my home, at a time when I had no car). Even when follow up appointments were made, they would be cancelled by one side or the other and never rescheduled.

What did I need? I needed hospitalising and treating properly the day I first presented, vomiting and crying, to an ED with a terribly worried boyfriend in tow. I needed someone to identify and deal with the fact that I was being abused, that my brother was being abused, and that I was developing a very serious mental illness and needed intervention immediately. What I did not need, and what I believe very few patients need, is to be released to the care of my family. In my case my family was part of the cause of my problems, but in almost every case, families are not equipped to deal with the aftermath of a suicide attempt. The truth is that going home is just not the best thing for many, if not most, people.

What are the bare minimums that I think need to be in place for failed suicides? Compassionate treatment. Immediate psychiatric treatment, with a strong bias toward inpatient treatment if there is any indication that it may be useful. Thorough follow-up on leaving either medical or psychiatric hospital treatment, with a real effort toward making sure people don’t slip through the cracks. Wrap-around services – WINZ assistance, social workers of whatever stripe is most helpful, referrals to charities and social services that actually happen, generally the things that make life easier to live.

Suicide costs us $1.4 billion per year. Dedicate some resources to prevention and treatment, and harvest some of that money back for the economy.

Causes of death – and what we do to prevent those deaths

Every year, around five hundred people in New Zealand die by suicide. By comparison, in the last five years the road toll has not been above 375. In fact, it has not been over 500 since 1999.

As long as I can remember (which goes back to the late 90s in NZ) there have been road safety campaigns running, trying to tackle a road toll that peaked at 843 in 1973. It was a terrible problem then, and these campaigns have evidently had a positive effect. Putting across the message that drink driving and speeding and driving tired all kill has made such a difference to the road toll, and the police and Land Transport should rightly be proud of their efforts.

Around five hundred people have died by suicide in New Zealand every year for at least the last decade. What have we been doing in the area of suicide prevention?

There’s the National Depression Initiative, which is a good step, but it has nothing like the penetration of the drink-driving and speeding campaigns. Depression is still a cultural minefield, and it’s going to take more than just John Kirwan talking about it to change the way we think about it. It’s a step in the right direction, but what’s next?

The truth is, we don’t have anything anywhere near equalling the road safety campaigns in terms of expenditure or effectiveness. Maybe it’s not fair, because suicide prevention is so much more expensive. The most important thing that helps prevent suicide is good mental health care, something that we straight-up do not have. Other measures to help prevent suicide, such as good social health and welfare programmes, are equally expensive.

It’s not just the expense, though. There’s not the same will to reduce the suicide rate that there is to reduce the road toll. There’s not the same awareness of the reality of suicide, not the same public horror at its toll. It’s not reported much, not highlighted. It’s swept under the rug. Is that wise? Does it prevent more suicide if we just don’t talk about it? I don’t know the science, but I do know that people are just not aware of how bad the situation is.

I wonder if hiding suicide away is something that we do because we’re still ashamed of it, because it’s still some dirty family secret. That attitude needs to change, and if it’s being perpetuated by the official policy about how suicide is reported, maybe that needs to change as well.

I’ve always felt like suicide needs to be addressed in a more frank and honest manner, with less secrecy and shame. Knowing that we lost several people one weekend to suicide could be treated like a bad weekend on the roads – a message to look after yourself and those you love. Maybe I’m wrong, maybe the science says that hiding away the hard truths of suicide keeps the rate lower. I don’t know. I just feel the need for more honesty in the process.

Preventing suicide is complicated and difficult, and I don’t think we’re doing enough toward it. It’s a social dirty secret, and it needs bringing to light.