Let. Us. Smoke.

Smoking in mental health units is in the spotlight at the moment, as a family and community grieve a woman who went AWOL from MidCentral DHB’s Ward 21 after being let out for a cigarette. She died, missing and alone.

When I was first at Te Whare Ahuru at Hutt Hospital as a day ptient in 2004, the octagonal courtyard was assigned as a smoking area for both inpatients and day patients. It was completely enclosed by the building, and it was a safe place for smokers. Fast-forward to 2010, and my short inpatient stay. The courtyard was now smoke-free in accordance with hospital regulations, and smokers had to hid down the side of the building. To get there they had to be let out of the locked ward and trusted to not do a runner.

I remember one day, I was feeling very intense suicidal feelings. I told the nurse, just like I was supposed to, and said that I probably shouldn’t be let out alone. As a result, I was not let out unless there was a nurse available to take me, and I waited a good ten hours for a nurse to come free. It wasn’t intentional – they were just so understaffed. My agitation built and built – the nicotine patch simply didn’t help. The ritual was my addiction – lighting up, inhaling, relaxing.

I spent the rest of the day and into the night highly strung and unable to rest, until they got so sick of me floating around that they gave me a lorazepam at 3am. It was Waitangi day, the 6th of February, and the next day my daughter turned six. I was too out of it to celebrate with her, wrapped in a benzodiazepine haze.

Meandering forward to 2017, I spent three weeks in Te Whetu Tawera, Auckland City Hospital’s mental health ward. The first week, I was first in ICU, where all smoking paraphernalia was banned, and then in Ward A, which had no smoking area. I had no leave. I was trapped, and the nicotine patch wasn’t helping. I needed my ritual. All I wanted to do was sleep to get through my hospitalisation, and it wasn’t til I was given my first escorted leave with  nurse that I turned a corner and started looking at living again. That leave was ridiculous – we went straight to the dairy so I could buy cigarettes and get my fix.

Ward B, which I was moved to after twelve days in the unit, had a smoking area. This small mercy made it a much nicer place to be. It meant that I didn’t have to leave the ward and the hospital grounds to smoke – a matter of about 10 metres, but an essential according to the DHB.

I understand the push toward a smokefree New Zealand. I really do. It’s a terrible habit, and it takes 8-10 years off a heavy smoker’s life. On the other hand, serious mental illness takes 10-20 years off the average sufferer’s life, and honestly? We have bigger things to worry about than our smoking habits.

Nicotine withdrawal is the pits, but nicotine isn’t the only chemical in cigarettes – however, it’s the only one dealt to be nicotine replacement therapy. Even with nicotine patches, or gum, or inhalers, or whatever, withdrawals are hell. What I find hard, though, isn’t the chemical addiction. It’s the social and ritualistic addiction that I have built around my habit. Roll, light, inhale, relax. Chat. Socialise. Be a member of a socially unacceptable club.

I know that many people who have a cigarette addiction get incredibly jittery and anxious when they can’t smoke. Why add that pressure to someone already in the terrifying ordeal of a psych ward? Especially someone in the ICU, where everything is so frightening. Zombies all around, demons in your head, and no ritual to banish the fear. Paper-pushers and box-tickers simply have no idea what it’s like.

When we come to hold someone to account for the deaths of people who are pushed outside the ward for a cigarette and go off to die, we need to start with lawmakers and the Ministry of Health and work our way down. This policy is putting vulnerable people at risk, and it’s taking away the basic human rights of people who are held against their will.

Let’s go on about those basic human rights for a minute. Smoking may be frowned upon, but it’s not illegal. It is a solace to the involuntarily incarcerated of our mental health facilities. Why on earth are we depriving them? What fucked up stupid idea is it to make being in a psych ward even harder than it already is? I have every right to smoke in the real world. How dare the state take that right away from me when they take away my freedom? I’m not a felon; I’m not incarcerated due to breaking any laws. I’m locked up already – what right do they have to make it worse?

One of these days I may be the one you hear about in the news, the one who’s gone missing after being let out for a smoke. For my sake, for the sake of people like me, review this policy. Aren’t people’s lives worth more than an auahi kore sticker? Aren’t the immediate concerns of the rights and lives of real people more important than the long-term risks? Isn’t the right to choice more important than bureaucracy?

Let. Us. Smoke. If you’re going to take our freedom, at least protect our lives.

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.

 

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?

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.

How long is the road to death in the mental health unit?

Erica Hume, a 21-year-old student at Massey in Palmerston North, died in May 2014 in Ward 21 (the mental health unit) at Palmerston North Hospital. Her file reads as a train wreck of rejection from services she desperately needed and of inadequate care when she finally received ‘help’.

How do you end up dying in what’s supposed to be a safe place for mental health patients to recover? These are the questions that surround her care in the unit, and how things went so horribly wrong there, but the thing is, Erica could have lived, without even needing her last hospitalisation, if she had received adequate care. She could have lived a good life if she had received good care.

She was referred from Bay of Plenty DHB, so someone at her home DHB evidently thought that she needed care, and they weren’t wrong. But MidCentral DHB said she didn’t meet criteria, and turned her away.

Hold the line. She was directly referred from another DHB, and MidCentral said, ‘Sorry, she’s not sick enough’. What are we saying about MidCentral’s level of care here? Oh wait, I know exactly what we’re saying. MidCentral was the DHB that “cared” for me while I was at Massey, as well as some of my friends while I was living in the area, and they are a downright failure. They are, without question, the worst mental health team that I have ever had the privilege to have to deal with.

I’m not saying that there’s anything wrong with the staff there, or at least not systematically. There are always the odd less-than-ideal staff member at any service, and I don’t hold that against them. No, what’s wrong is the systems and the resourcing of the service there. The systems are a failure and the resourcing is so inadequate that you have to laugh at it – otherwise you’d cry over it. At times I’ve done both.

Suicide attempts are so far out of what they have the resources to deal with that they’re sent home after talking to an assessor with a vague promise of a follow-up, one that is never chased up if it is missed (as is possible if they have the wrong address for you – no phone call to check, no nothing). I’m sure that if they thought you were an imminent threat to yourself or others that they would hospitalise you . . . wait, no I’m not sure. They are so under-resourced that I have no faith in their capability to do such a thing.

In Erica’s case, she was seen in the emergency department more than eight times. MORE THAN EIGHT TIMES!! I cannot underline enough how bad that is. She was capable of killing herself – there’s some pretty convincing evidence of that. But more than eight times she was seen for self-harm, and could have been helped, and just bloody wasn’t! That’s a massive failing. She was also hospitalised at least once for self-harm and overdose. How did this not trigger intervention? Because MidCentral DHB mental health team has either so few resources or has their resources so poorly focused that they simply cannot care.

It was recommended more than once that Eric receive DBT*. But DBT, a core treatment for many mental illnesses, was not available. Whether they were missing the staff or the funding doesn’t matter. What does matter is that here was one girl who might still be alive if that treatment was available, and more people that would be experiencing a better quality of life.

Erica’s care was characterised by responses to crises, rather than any coherent plan. This is not surprising, in a place that has plans only for the most seriously unwell. She was not falling through the cracks. She was hanging out in the massive pits in the care coverage of MidCentral DHB’s mental health team.

Maybe the experiences of my friends and I, and Erica, are not typical of MidCentral’s care. But I rather doubt it. The pattern seems fairly consistent across all the people I know who have been cared for at Palmerston North Hospital. They fail people, and in this case, Erica Hume died because of it. Well done, MidCentral District Health Board Mental Health Services.

*dialectical behavioural therapy

How could you not know?

One of the things that I’ve always questioned about my teenage years was how anyone could know about what was happening to me, the abuse that I was living through, and not do anything about it. There was one incident that I remember where the school administration were told about what was happening, and I will always feel like the follow up from that was completely inadequate, but in general I think there was a significant problem.

They didn’t know. These were people that I saw every day, and as I’ve got older I have questioned over and over again why they didn’t help me, and I’ve finally come to that conclusion. I didn’t often come to school with the marks of a beating on me, and so I wasn’t an obvious victim.

I think that many of them worked out things were not right when I was kicked out of home and then moved out into a boarding situation, but by then it was a bit late. I was sixteen and my more vulnerable brother was out of the country. He was safe, and I was surviving. What more could be done?

But for much of the rest of the time, I think that it just passed under the radar. My deteriorating mental health was a sign, but I don’t think it was recognised. The plain truth was, no-one helped me because no-one knew. No-one was looking for problems, maybe. I don’t know. Maybe they were and I was just not showing the signs that things were wrong.

How could they not know? Well, my own father missed the fact that I was so desperate to get out of my situation that I attempted suicide. Things just aren’t that obvious when you’re mentally distressed in the way I was. It wasn’t a lack of caring on their part. It was just hidden from view.

I used to ask over and over again why no-one helped. I think now I wonder why I didn’t ask for help over and over again until someone listened.

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.

The costs of suicide

The costs of suicide to society are high. There are not only the ‘intangible costs’; the grief and bereavement of family, whänau and friends, and the lost potential of lives cut short, but also the direct economic costs of suicide. The annual economic cost of suicidal behaviour to New Zealand society is estimated to total $1,381,492,000 – nearly $1.4 billion. – NZ Suicide Prevention Strategy, p.4

Suicide, then, is expensive business. I hate that we measure it in dollars when the more important measures are those of human cost, but human costs just aren’t important enough to people with budgets and calculators on their desks. The devastation that suicide causes to people should be reason enough to throw anything we could at prevention, but we live in a world of pennies and pounds.

$1.4 billion is a lot of money. What if we threw a bunch of that at decent suicide prevention? If the bean-counters really think that we could pull back $1.4 billion if we prevented suicide in NZ, then why aren’t we throwing money at this? Good suicide prevention tends to involve good mental health care, and that would reduce the burden of disease that depression, anxiety, and other mental illnesses place on society.

There are plenty of good economic reasons to treat mental illness before it becomes suicide. Why on earth aren’t we doing it? I believe it’s partly because those in power don’t actually believe the costs of mental illness and suicide. If they really understood how much mental illness cost society, they would absolutely pour some cash into prevention and cure. The numbers are meaningless to them though, just figures on paper. There’s no visceral awareness of how much mental illness and suicide cost, in dollars and in pain.

Suicide prevention is neglected, because it’s seen as expensive and ineffective, while the real expense is leaving suicidal people untreated. It’s neglected because suicide is still seen as shameful. It’s neglected because of a lack of understanding, and a lack of compassion. We can do better, and the government’s own figures tell us that it would be a logical investment.

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.