Paper for the Ministerial Committee on Suicide Prevention by CS0IGqB

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									19/09/2012


                                                                         Appendix 5



Paper for the Ministerial Committee on Suicide Prevention

Suicide Prevention for Pacific people
Introduction
The Ministerial Committee on Suicide Prevention monitors and oversees the
implementation of the New Zealand Suicide Prevention Strategy 2006-2016.
Members of the Ministerial Committee include the chair Hon Peter Dunne, Associate
Minister of Health with the delegated responsibility for Suicide Prevention, and other
Ministers with portfolios relevant to suicide prevention.

At its March 2010 meeting the Ministerial Committee requested that a paper be
prepared on Suicide Prevention for Pacific people.

This paper has been prepared by the Ministry of Health with input from a range of
agencies associated with suicide prevention. It provides:

      facts and figures on suicide, suicide attempts and self harm amongst Pacific
       people
      information about Pacific peoples’ cultural attitudes to mental illness and
       suicide
      information on what may need to be done in the future
      information on current policies and service provision.

The appendix contains demographic information on Pacific people in New Zealand.

Information has been obtained from a number of other agencies and sources
including the following papers which are available on the Ministry of Health’s website
http://www.moh.govt.nz.

      Te Orau Ora - Pacific Mental Health Profile – 2005, Ministry of Health,
       Wellington
      Te Rau Hinengaro – The New Zealand Mental Health Survey, 2006, Ministry
       of Health, Wellington
      Pacific People and Mental Health – a paper for the Pacific Health and
       Disability Action Plan Review, 2008, Ministry of Health, Wellington
      New Zealand Suicide Prevention Action Plan – 2008-2012; The Evidence for
       Action, 2008, Ministry of Health, Wellington
      New Zealand Suicide Prevention Action Plan – 2008-2012; Report on
       Progress: Year One, Ministry of Health, Wellington
      ‘Ala Mo’ui – Pathways to Pacific Health and Wellbeing, 2010-2014

In this report the terms ‘Pacific people’ and ‘Pasifika’ refer to people living in New
Zealand who define themselves as being of Pacific Islands ethnicity (for example
Samoan, Tongan, Cook Island Maori, Fijian, Niuean, Tokelauan or Tuvaluan).



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Pacific people in New Zealand and mental health
Suicide deaths and self-harm hospitalisation figures

Suicide deaths

Suicide deaths of Pacific people are recorded at a lower rate (population adjusted)
than for the population as a whole.

                 Total all NZ     Rate     per    Pacific        Percentage
                                  100,000         people         of total
                                  population                     deaths
        2007         483            11.0                25            5%
        2006         526            12.3                21            4%

       Suicide amongst Pacific people was most common in 2006 and 2007 among
        those aged 15-44 years and rare over the age of 45 years.

       In 2007 there were 20 male deaths by suicide and 5 female deaths. In 2006
        there were 17 male deaths and 4 female.

It is difficult to draw conclusions from these figures because the numbers of suicides
are small and there can be considerable variation over time.

Given the youthfulness of the population it is probable that Pacific suicide numbers
will increase in the medium term.

Suicide Attempts and Intentional Self-harm

New Zealand born Pacific people have higher rates of suicide planning and attempts
than Pacific people who migrated to New Zealand as adults.

Although national data indicates that Pacific people have lower rates of suicide than
Māori and the general population, there are particularly high rates of suicide attempts
among Pacific young people 16-24 years.1

Hospitalisations for intentional self harm

                   Total all NZ    Rate     per     Pacific       Percentage
                                   100,000          people        of total
                                   population                     admissions
        2007           2679                64               75          2.5%
        2006           2868                70               70          2.4%

The data on Pacific people hospitalised for self-harm is too small to be able to draw
conclusions or to identify trends.2

Pacific people are however, the only ethnic group where male hospitalisation for self
harm is similar to, or exceeds that, of female hospitalisation. In 2007 males
accounted for 48% of hospitalisations for self-harm and in 2006 for 51% of


1
 Te Rau Hinengaro
2 Suicide facts, 2006 and 2007


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hospitalisations. This is in comparison to the general population where male
hospitalisations for self harm are half that of females.

Analysis of self-harm hospitalisations3 by deprivation quintile shows that males and
females living in the most deprived areas had significantly higher rates of intentional
self harm requiring hospitalisation. Statistics New Zealand data identifies that 40% of
the Pacific population live in 10% of the most deprived areas of New Zealand.

It is possible that more people present to hospitals with intentional self harm than is
recorded by official figures. Research into self harm presentations to four District
Health Boards showed that Pacific peoples made up 7.4% of presentations.4 This
rate is high in comparison to 2.5% of admissions nationally. The researchers
counted all presentations, whereas data in Suicide Facts counts only those
presentations resulted in admissions of two days or more. The research showed that
Pacific peoples were most likely to present having taken an overdose of drugs (66%
of presentations) followed by hanging (7.4% of presentations). Within those four
DHBs, self harm for Pacific peoples was most common in the 20-24 year age group
(27%) followed by the 15-19 age group (23%) and 20-29 age group (nearly 15%).

Young People

Data from Youth ’075 into the health and wellbeing of secondary school students,
reports the following findings on the emotional health of Pacific students:

 Emotional health indicator                             Pacific                  General
                                                                                 population
                                                        Female      Male         Female Male
 reported     significant  symptoms        of           15%         7%           15%      7%
 depression
 deliberately harmed themselves over the                29%         17%          25%         16%
 last year – most of this was relatively
 minor and did not require hospitalisation
 had thought seriously about suicide over               27%         10%          19%         9%
 the past year
 had made a suicide attempt in the last                 14%         5%           7%          3%
 year

Dr Jemima Tiatia6 researched youth suicidal behaviour of NZ born Samoans for her
doctorate in community health in order to advance knowledge to prevent the
incidence of suicide. One of the unusual features Dr Tiatia identified was that 43% of
the Pacific young people who attempted suicide were employed. This is in contrast
with non-Pacific people who are at greater risk of attempting or committing suicide if
they are unemployed.

Comment



3 ‘hospitalisations’ includes patients who stayed in hospital for two days or more.
4 Simon Hatcher, Cynthia Sharon, Nicola Collins, Epidemiology of intentional self-harm presenting to
four district health boards in New Zealand over 12 months, and comparison with official data, University
of Auckland reported in Australian and New Zealand Journal of Psychiatry 2009.
5
   Helu S, Robinson E, Grant S, Herd R and Denny S (2009). Youth ’07 The Health and Wellbeing of
Secondary School Students in New Zealand: Results for Pacific Young People. Auckland: The
University of Auckland.
6
  Jemima Tiatia, doctorate thesis, University of Auckland 2005.


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Research reported in Te Rau Hinengaro found that 1 in 20 Pacific people reported
having made a suicide attempt in their life time. The report noted that Pacific people
experience mental disorders at higher levels than the general population but are less
likely to access health services including access to drug, alcohol and gambling
addiction services.

Figures show that only 25% of Pacific people with a mental health disorder made a
visit to a mental health service compared to 33% of Māori and 41% of all other New
Zealanders. Pacific people born in New Zealand are more likely to access services
than Pacific migrants.

Many Pacific people use traditional Pacific medicine and healing practices either
before or instead of, accessing health services. The NZ Health Survey7 reported that
28% of Pacific people (30% men and 27% women) had seen a traditional healer in
the previous year.


Cultural attitudes of Pacific people to mental health and suicide
Census 2006 figures show that just over half of all people identifying as being in the
Pacific people group were born in New Zealand. These people may have different
attitudes to mental health and suicide than people who have migrated to New
Zealand from the Islands. In addition, there are increasing numbers of Pacific people
who identify with more than one ethnic group and this may impact on how they view
mental health issues.

Pacific people are not a homogeneous group; there are differences in social
structures, languages and customs between the various Pacific nations. Within
these differences however, there are some commonalities about how mental illness
is viewed.

Traditional Pacific approaches to health and wellbeing are based on the concept of
balance between mental, physical, family and environment elements. Illness is seen
to occur when these factors are out of balance. According to traditional beliefs
mental illness may also occur from a breach of custom or other offences against
sacred places and symbols, traditions, practices or family. It is believed that such
offences cause the person to be possessed by spirits.

In traditional Pacific communities there may be a stigma associated with suicidal
behaviours. Families may feel ashamed or embarrassed that they did not do enough
to support the individual and individuals may feel ashamed, and hide suicidal
thoughts from their families. The shame and stigma may hinder individuals from
seeking support and families from seeking support for the individual.

Attitudes to suicide may be summarised in the Samoan term for suicide, Pule I le ola
which means ‘control the right to life’. That is, God gives and takes away life; it is not
right for the individual to take on that role. Certain religious beliefs deem the act of
suicide to be the ultimate sin. These families therefore can feel a deeper sense of
guilt and remorse.




7
    New Zealand Health Survey 06/07, Ministry of Health, Wellington 2010


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The Fonofale8 model of health developed by Fuimaona Karl Pulotu-Endemann
explains key features that Pacific people consider important for maintaining good
health and which are distinct from approaches to health within mainstream New
Zealand. In the Fonofale model, these features include cultural values and beliefs
seen as a shelter for life, with family forming the foundation. Connecting culture and
family are four inter-related dimensions; spiritual, physical, mental and ‘other’ (such
as socio economic factors), which contribute to an individual’s wellbeing.

Research contracted by the Mental Health Foundation as part of the Like Minds, Like
Mine programme, Walk a Mile in Our Shoes 9 looked at discrimination towards and
within families and whānau of people diagnosed with mental illness.

Pacific participants in the research regarded discrimination and the use of
discriminatory language in relation to mental illness within their families and Pacific
communities as particularly marked.

They talked of the experiences unique to being a Pacific person, being from a
particular Pacific nation, and/or belonging to a particular Pacific community. Some
people in the Pacific focus group reported that the notion of mental illness was alien
within a historical cultural context. Instead a spiritual understanding prevailed.
Significant negative cultural meaning was attributed to mental illness.

Mental illness was regarded by many participants as bringing shame to families.
Beliefs that the family had been ‘cursed’ had meant families hid mental illness, and/or
shunned and rejected the family member who was experiencing mental illness.

Comment

Traditional views on the cause of mental illnesses can make it difficult for people to
seek the help they need in a timely manner. It is important that these beliefs are
respected and acknowledged by health professionals and others while encouraging
the use of medication or other treatment to control symptoms of mental ill health.

There can also be difficulties where families feel shame about the mental illness of a
family member and either cannot support that family member or refuse to accept
what is happening.


Suicide and self-harm prevention among Pacific people in New
Zealand
Research into what works for the prevention of suicide and self-harm among Pacific
people identifies a number of issues and strategies relating to cultural expectations
and attitudes.

Church elders provide Pacific community leadership and churches often provide the
social environment for the maintenance of culture and language. As cultural beliefs
and values change and evolve, other community structures, families and activities


8
 Described in Pacific People and Mental Health
9
 Barnett, H and Barnes, A. (2010) Walk A Mile In Our Shoes. He tuara, ngā tapuwae tuku iho ō ngā
Mātua Tüpuna. Exploring Discrimination Within and Towards Families and Whānau of People
Diagnosed with ‘Mental Illness’. Auckland, New Zealand: The Mental Health Foundation of New
Zealand, Auckland 2010.


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become more important.10 Any work in the area of suicide and self-harm prevention
needs to take place within the context of the social environment important to Pacific
people.

The extended family is the essential structure of most Pacific societies. The family
incorporates concept of genealogy and lineage which are very important to Pacific
cultures. These concepts link people together and to a particular place. Successful
suicide and self-harm prevention therefore should not be focused solely on the
individual but should involve the whole family including extended family members.
This may also important in regard to postvention initiatives when a wider group of
family members may need to be supported.

The NZ Suicide Action Plan identifies two key approaches that are most likely to be
effective in the area of suicide prevention for Pacific people:

     i.    Community development approaches to strengthen proactive factors and
           reduce risk factors for suicide – such as programmes to enhance youth
           confidence and sense of well-being

     ii.   Building family support and social support systems such as church and
           cultural networks – to strengthen family member’s abilities to support each
           other.

Te Orau Ora - Pacific Mental Health Profile, comments that in planning services for
Pacific people, consideration should be given to those issues that impact specifically
on Pacific mental health. These include:
    the Pacific view that mental health and wellbeing also include all other
        aspects of health, social, cultural and spiritual wellbeing
    the relatively young Pacific population
    isolated communities (outside of the main centres) throughout New Zealand
    socio-economic considerations, including the possible cultural isolation of
        high socio-economic status environments
    the values and experiences of New Zealand born versus Island-born people,
        and people of mixed ethnicity
    the risks inherent in alcohol and drug use.

Services need to be culturally appropriate and engage Pacific peoples in identifying
and developing effective approaches that will work for them. This may require
mental health services developing networks with Pacific organisations and groups to
advise on culturally acceptable methods of suicide prevention and treatment. Pacific
participation helps to increase wider knowledge and understanding of Pacific health
issues and ownership of action on health issues11. In this context, some District
Health Boards have already developed, or are in the process of developing, cultural
competencies across a range of Pacific ethnic groups.12

Research funded by the Ministry of Health in 2009 through Le Va (Pasifika within Te
Pou, the National Centre of Mental Health Research, Information and Workforce
Development) looked at delivery approaches and experiences of Pacific mental
health service providers, mental health service users and family members13.

10
   ‘Ala Mo’ui
11
   ‘Ala Mo’ui
12 Cited in Te Orau Ora
13
   Suaalii-Sauni T, Wheeler A, Saafi E, et al 2009. Exploration of Pacific perspectives of Pacific models
of mental health service delivery in New Zealand. Pacific Health Dialog 15(1): 18-27


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Participants identified eight different models of mental health care that they perceived
as holistic and therefore culturally more appropriate, taking into account physical and
spiritual health. Participants also talked about the importance of group therapy and
the use of Pacific languages and hospitality practices.

Five ethnic-specific workshops on Pacific cultural competency in mental health were
held in Auckland in 200414. Five key themes emerged from those workshops, the
importance of: language; family; tapu considerations; worker’s skills and
organisational policy. Addressing these themes was seen as important to take into
account when building and strengthening the capacity and capability of mental health
services to meet the needs of Pacific individuals, families and communities.

‘Ala Mo’ui – Pathways to Pacific Health and Wellbeing 2010-2014 sets out the priority
outcomes and actions towards achieving better health, including better mental health
outcomes for Pacific people. The guiding principles of ‘Ala Mo’ui are: respecting
Pacific culture, valuing family, quality health care and working together.

Young People

Research carried out by Natalie Leger for the Waitemata District Health Board15
identified the concerns that some Pacific young people have about accessing health
services. The young people interviewed had three main concerns. Firstly, that any
discussions they had about their health issues would be confidential. Secondly, that
people they talk to would understand their culture and the issues that they
experience being raised in New Zealand by parents who are mainly Island born and
raised. Thirdly, that services are accessible and designed for them. The ethnicity of
health workers was of less importance than their understanding of Pacific culture.

Comment
In summary, research shows that the most important factors in helping to prevent
suicide and self harm include:
     having skilled health workers with knowledge and understanding of the
        cultural beliefs and values of Pacific cultures
     recognition of and working with, traditional health practices
     understanding that young Pacific people born in New Zealand to Island born
        parents have the added stress of living with their family’s cultural expectations
        and also living within the different values of New Zealand culture
     working with families and community agencies such as churches, schools and
        cultural groups to provide support, information and links to services.


Issues
New Zealand’s Pacific population is growing at a rate around three times faster than
the New Zealand population. Auckland is home to about 70% of the Pacific
population, Wellington to 13% with Waikato and Christchurch having about 4% each
of the Pacific population.



14
   Kathleen Seataoai Samu and Tamasailau Suaalii-Sauni, Exploring the ‘cultural’ in cultural
competencies in Pacific mental health, Pacific Health Dialog Vol 15, No. 1 2009, University of Fiji.
15
   An Investigation Into The Health Needs Of Pacific Youth Living Within The Waitemata District Health
Board District, Natalie Leger, Tapu Services, Auckland. Published in New Zealand Addiction Treatment
Research Monograph 2006.


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For policy makers and service providers the greatest challenge is expected to be in
providing services for Pacific youth aged 10-30 years. This age group is increasing
at the fastest rate and these are the years when intentional self-harm and suicide
actions are most likely to occur.

An ongoing challenge will be to ensure that service providers and the health
workforce understand Pacific cultural values and can develop good functional
relationships with families and Pacific organisations.

Programmes designed to help people at risk of suicide and self-harm need to be
developed in association with Pacific people to ensure that they are culturally
appropriate and also meet the complex cultural needs of young people.


Changes in suicide prevention policy 1998-2009
There have been several shifts in suicide prevention policy over the last decade, with
some having a direct impact on approaches to Pacific people mental health and
suicide prevention. Below is a timeline of suicide prevention policy in New Zealand.

 1998 ‘New Zealand Youth Suicide Prevention Strategy’ released including ‘In our
      hands’ (a framework for youth suicide prevention).
 2003 Evaluation of ‘New Zealand Youth Suicide Prevention Strategy’ released.
      The evaluation recommended the development of a strategy for all ages as
      75 percent of suicides occurred in those aged over the age of 24. This
      recommendation was accepted and as a reflection of this, the lead agency
      for suicide prevention changed from the Ministry of Youth Development to
      the Ministry of Health.
 2005 Draft all-age suicide prevention strategy released for consultation.
 2006 All-age ‘New Zealand Suicide Prevention Strategy 2006-2016’16 launched
      (superseding the ‘New Zealand Youth Suicide Prevention Strategy’)
      Te Kōkiri – the Mental Health and Addiction Action Plan 2006-2015 released
      - includes consideration of Pasifika needs 17.
 2008 ‘New Zealand Suicide Prevention Action Plan 2008-2012’ launched.
 2009 ‘New Zealand Suicide Prevention Action Plan 2008-2012 Report on
      Progress: Year One’ released by Hon Peter Dunne at Suicide Prevention
      Information New Zealand (SPINZ) symposium on 11 September.
      The report includes information about targeted initiatives for Pacific people
      including the development of resources, research and primary mental health
      initiatives for Pacific people.
      Serau the PPWDF’s Programme of Action for 2009/10 to 2011/12 released.
      This guides the disbursement of the fund.
 2010 Release of ‘Ala Mo’ui – Pathways to Pacific Health and Wellbeing 2010-2014




16
  Identifies issues relating to Pacific people
17
  Te Kōkiri: the Mental Health Action Plan 2006-2015, Wellington: Ministry of Health 2006. Te Kōkiri
includes action to provide services for Pacific people affected by mental illness and/or addiction.


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Programmes and services contributing to the prevention of suicide
and intentional self-harm for Pacific people

Initiatives targeted to suicide prevention for Pacific people
Le Va - Pasifika within Te Pou

Te Pou is New Zealand's National Centre of Mental Health Research, Information
and Workforce Development and funded by the Ministry of Health. Its key objectives
are: to build a strong and enduring workforce to deliver mental health services to all
people; and to develop a culture of continuous quality improvement in which
information and knowledge is welcomed and used to enhance recovery and service
development.

Te Pou is charged with creating a mental health hub for New Zealand. Le Va –
Pasifika within Te Pou, is the national Pacific health workforce development
programme within Te Pou. Its focus is to enhance the quality of services for Pacific
people and their families.

Le leo o Le Va (the voice of Le Va in Tokelauan and Samoan) is an advisory body for
issues related to developing and implementing the projects and related work of Le
Va. It provides advice, cultural leadership and community perspectives to Le Va and
also provides feedback to Pacific communities to enhance awareness of mental
health, workforce development, research and information issues in the sector.

Le Va - Projects
La Va has a number of projects underway including:

      Aka Putuputu - stock take of the Pacific mental health and addiction
       workforce
      Fakatu’amelie - showcasing Pacific innovations and new ways of working in
       the New Zealand mental health and addictions sector
      Teuane - recruitment strategy to increase the capacity of the Pacific mental
       health workforce, with a focus on pathways to nursing in the mental health
       and addiction sector
      Seitapu - enhancing the Pacific cultural competency of the mental health and
       addiction workforce. Real Skills plus Seitapu outlines a foundation cultural
       competency framework that people working with Pacific service users and
       their families can use.
      Matutaki - long-term recruitment strategy engaging with Pacific communities
       and secondary school students to promote mental health as a career option.
      Drua - enabling Pacific people to meet for workforce development. Given the
       severe shortage of Pacific mental health and addiction workers in various
       geographical locations, and the fragmentation of services, it is often difficult
       for them to meet to share clinical and cultural expertise, strive towards
       consistency in models of service delivery, and support existing training and
       development.
      Le Tautua - developing the capacity of Pacific leadership in management.
       The concept of tautua includes the notion that in order to lead, one must also
       serve. This is characteristic of many Pacific leadership styles, where
       leadership is not necessarily about leading from the front but about status
       through service.



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Samoan suicide prevention resource
Paolo: Embracing our Samoan Communities: Suicide prevention for people working
with Samoans in Niu Sila 18 developed by Suicide Prevention Information New
Zealand (SPINZ) in partnership with the Samoan community and funded by the
Ministry of Health.

This resource provides information for Samoan community leaders, people working
with the Samoan community in New Zealand and other concerned and interested
people. The resource is published in English and Samoan.

Primary mental health access to services by Pacific people
Primary mental health initiatives have been established in 80 PHOs and aim to better
meet the needs of people with mild to moderate mental health and substance abuse
disorders. An evaluation last year found that there was under utilisation of those
services by Pacific people. The evaluation report recommended further work to
understand the barriers to access for Pacific people. Some suggested solutions
included targeting health information and recognising that Pacific people and
communities may be reluctant to address or acknowledge mental health issues.19


Other initiatives that contribute to Pasifika suicide prevention and
mental health
Ministry of Health funded initiatives:

     Serau - Pacific Provider and Workforce Development Fund (PPWDF)
     This initiative aims to develop Pacific providers and the Pacific health and
     disability workforce by providing funding to:
      support the development of a qualified Pacific workforce (‘the right people
         with the right skills in the right place’) by assisting individual Pacific people to
         gain health qualifications and further skills and experience
      strengthening Pacific providers to continue to deliver quality health services
         so that they are a viable first choice provider
      facilitate the diffusion of clinically and culturally competent Pacific models of
         care for both Pacific and non-Pacific providers to increase the capability of all
         health professionals in effectively interacting with Pacific people.

     National Depression Initiative20
     The National Depression Initiative (NDI) began in 2006 and aims to reduce the
     impact of depression on the lives of New Zealanders, by aiding early recognition,
     appropriate treatment, and recovery. It is part of the Government’s commitment
     to addressing suicide prevention, as well as to improving the mental health and
     wellbeing of all New Zealanders.




18
   Faleafa M, Lui D, Afaaso B, Tuipulotu M, and Skipps-Patterson S, (2007). Paolo ‘O o’u Paolo out e
malu ai” “It is my people that give me shelter”: Embracing our Samoan communities: Suicide prevention
information for people working with Samoans in Niu Sila, Auckland: Mental Health Foundation of New
Zealand.
19
   Dowell AC, Garrett S, Collings S, et al. 2009. Evaluation of the Primary Mental Health Initiatives:
Summary report 2008. Wellington University of Otago and Ministry of Health.
20
   National Depression Initiative, (www.depression.org.nz) and the Lowdown website
(www.thelowdown.co.nz).


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  The campaign aims to strengthen family and social factors that protect against
  depression and improve community and professional responses. Television
  advertisements featuring former All Black John Kirwan have been particularly well
  received. There is good recall of key messages designed to increase community
  understanding about depression and encouraging help-seeking, appropriate
  treatment and recovery.

  A new internet-based self-management programme ‘The Journal’ for people with
  depression, fronted by John Kirwan alongside three mental health professionals,
  Dr Lyndy Matthews, Dr Simon Hatcher, and Dr Elliot Bell has just been released.
  The programme is based on a form of cognitive behaviour therapy (problem
  solving therapy) which has been demonstrated to be effective in helping people
  with mild to moderate depression and anxiety. The programme may also be
  helpful for people in recovery from depression or as a complementary activity to
  clinical treatment.

  The Lowdown
  The Lowdown is a New Zealand website developed by the National Depression
  Initiative to help young New Zealanders understand and recover from depression.
  The website launched on December 3, 2007. The Lowdown provides online,
  telephone and text support services depression-related fact sheets and contact
  lists, as well as online self-tests. New Zealand celebrities and musicians
  (including Pacific people) talk about how they or someone they know made it
  through depression. Users can also add their own stories by submitting video or
  text.

  Like Minds Like Mine
  This is the first comprehensive campaign internationally to address discrimination
  and stigma associated with mental illness. It combines community action at a
  local level with nationwide strategies and media work to bring about social
  change. People who live with mental illness (including Pacific people) share
  personal and positive accounts of their experiences, challenging unhelpful
  stereotypes and asking people to form their views based on real experiences
  rather than on the stigmatised depiction seen in the media.

  Research shows that the programme has brought about significant change in
  people's perceptions of mental illness. Reducing stigma and discrimination
  means that people are more likely to recover full social, family and economic
  participation. For example, research undertaken by Auckland University has
  indicated that the increased economic participation brought about reducing the
  stigma and discrimination associated with mental illness has a tangible financial
  benefit for New Zealand of over $13 saved for every dollar spent.

  District Health Board suicide prevention coordinators
  The District Health Board (DHB) Suicide Prevention Coordinator Pilot was set up
  in 2007 to lead, facilitate and enhance cross-agency DHB level. Suicide
  prevention coordinator positions in five DHBs (Auckland, Lakes, Counties
  Manukau, Wairarapa, and Nelson Marlborough) work with a range of local
  agencies working in suicide prevention.

  The evaluation of the Pilot was completed in early 2010. Overall the results of
  the evaluation demonstrate the service is making inroads into suicide prevention
  and is able to coordinate regional and local efforts in suicide prevention. Funding
  has been allocated to continue the suicide prevention coordinator service for a
  further two years from 1 July 2010 to 30 June 2012.


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  The aim of this programme is to ensure suicide prevention services are
  integrated, in order to improve the quality and continuity of care for local
  communities. This includes coordinating between primary and specialist mental
  health services, across community organisations and different sectors
  contributing to suicide prevention at a local level.

  Suicide prevention coordinators are expected to contribute to reducing suicide
  and suicidal behaviour by ensuring the specific needs of population groups with
  the highest need in local communities are being adequately addressed.
  Coordinators are responsible for developing district suicide prevention action
  plans based on the national suicide action plan and a needs analysis of their
  district. This includes data on suicides and self harm in their district.

  From 1 July 2010 the service will be focused on the implementation of the district
  action plans and integrating suicide prevention into the primary mental health
  care sector.

  Suicide Prevention Information New Zealand (SPINZ)
  SPINZ is part of the Mental Health Foundation of New Zealand and contracted by
  the Ministry of Health to support best-practice suicide prevention, through the
  provision of evidence-based information. SPINZ is also contracted to host a
  biennial national suicide prevention symposium and to recognise World Suicide
  Prevention Day (10 September).

  Mental Health Literacy Programme
  The Ministry of Health is funding the development, implementation and evaluation
  of a programme to increase knowledge and improve attitudes about mental
  health and mental illness (‘mental health literacy’). The programme aims to
  improve people’s knowledge and attitudes about mental health and mental
  illness. It will target adults who in their day-today work have contact with people
  experiencing emotional distress and who are well placed to respond (for
  example: ACC, Work and Income and Housing New Zealand case managers,
  secondary school counsellors, police and non-governmental social agencies).

  Given the associations between mental illness and suicide, increasing mental
  health literacy has the potential to help prevent suicidal behaviours. This is
  through increasing participant’s abiliy to recognise that there is a problem,
  resulting in early intervention, treatment and recovery.

  Postvention Support Initiative
  Suicide postvention is the term used for community-based support after a suicide
  that aims to reduce the negative impact of the death and the potential for further
  suicidal behaviours. The key objectives of postvention initiatives are to maximise
  resilience and coping and to minimise risk and distress, and to establish
  structures and networks to deal with the suicide and its impact.

  The Postvention Support Service (PSS) is funded by the Ministry of Health to
  support activities and programmes that are intended to assist those who have
  been bereaved or otherwise affected by suicidal behaviour. PSS is delivered
  under contract by:
      Clinical Advisory Service Aotearoa (www.casa.org.nz)
      Victim Support (www.victimsupport.org.nz)




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   LivingWorks - ASIST (Applied Suicide Intervention Skills Training)
   LivingWorks is partly funded by the Ministry of Health to provide programmes that
   help caregivers play a role in preventing suicide. Programmes have been
   developed in response to a growing concern about suicide and recognise that
   many people who consider suicide might be assisted if they could find support to
   stay safe and deal with painful problems.

   LivingWorks focuses on increasing the awareness, knowledge and skills of
   caregivers by giving them the skills to play a more informed, active suicide
   prevention role.

   The focus of the two-day ASIST training workshops is on increasing carers' ability
   to promote the immediate safety of someone who may be at risk of suicide and
   link them to appropriate professional services.

   ASIST has recently established cultural and clinical reference groups to help in
   the development of workshops tailored specifically for Pacific and Māori people.

   Travellers - secondary school programme
   Travellers is funded by the Ministry of Health to help build resilience and enhance
   connections for young people in their first year of secondary school. The
   programme is designed and delivered by Skylight, a not for profit organisation
   providing specialised support for New Zealand children, young people, adults and
   their families/whānau who are facing change, loss, trauma and grief.


Other agency initiatives:
Ministry of Education

   Trauma support
   The Ministry of Education’s Special Education Service provides information on
   how to manage suicide risks as well as training and support for schools to plan
   for and manage a traumatic event.

Child Youth and Family (CYF)

Towards Wellbeing Programme
   The Towards Well-being Suicide Consultation and Monitoring Programme is a
   risk assessment, consultation and monitoring process established to support
   social workers in assessing and responding to suicide risk among young people
   in contact with CYF. The CYF population was selected because their rate of
   death by suicide is approximately 15 times greater (for those under 17 years)
   than for their non-welfare peers.

   The Towards Well-being programme guidelines were developed with strong
   Pacific Peoples representation. As a result of this collaboration there are specific
   cultural considerations when working with Pacific People threaded throughout the
   handbook.

Social Workers in Schools (SWiS)
   Social workers are based in low decile (mainly decile 1-3) primary and
   intermediate schools with high Māori and/or Pacific student rolls. The



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     programme began in 1999 and in 2009 there were 122 social workers funded by
     the scheme and working in 330 schools.



Pacific Action Plan – O Au O Matua Fanau
   The Action Plan has been developed in consultation with Pacific communities
   and aims to ensure that “all Pacific children and young are safe from harm and
   well cared for, strong as part of a loving family, and able to thrive by helping them
   be the best they can be."

     This has special relevance for Pacific young people in care and Pacific
     teenagers; groups that are at higher risk of suicide than the general population.


Pacific Island Mental Health network                         21


     The World Health Organisation’s Pacific Island Mental Health Network is in its
     third year of activity. It incorporates 18 countries from around the Pacific region,
     and is funded through Overseas Development Aid Funding from New Zealand’s
     International Aid and Development Agency. New Zealand is an active member,
     and the Director of Mental Health is the national focal point in New Zealand.

     Its purpose is ‘to facilitate and support cooperative and coordinated activities
     among member countries, to contribute to better health outcomes for people with
     mental illness.’




21
  Information from: Ministry of Health. 2009. The Office of the Director of Mental Health: Annual Report
2008.


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APPENDIX

New Zealand’s Pacific Population
Note:
It is likely that the Pacific population is under counted and it is larger than census
data shows. This may be because some people have stayed in New Zealand for
longer than their visa allows and may therefore avoid being counted at census time.22

Demographic Profile
Information from the 2006 Census23 shows that people who identify as being in the
Pasifka group have the following characteristics:

        they represent nearly 7% of the total New Zealand population
        over half were born in New Zealand and two-thirds live in the Auckland
         Region
        they represent 13 cultures and languages; primarily Samoan, Cook Islands,
         Tongan, Niuean, Fijian and Tokelauan groups, with smaller numbers from
         Tuvalu, Kiribati, Papua New Guinea, Vanuatu, the Solomon Islands, Rotuma
         and the small island states of Micronesia
        Samoans make up almost half of the Pacific people population with Cook
         Islanders as the next largest group at 22% and Tongans at 19%
        they are a young population with a median age of 21 years compared to 36
         years for the population generally
        38% percent of Pacific people are under 15 years compared to 22% for the
         general population and only 4% of the population are older than 65 years
         compared to 12% for the general population, most of these older Pacific
         people were born in the Pacific Islands
        almost half of them speak more than one language compared to only 18% for
         the general population
        of the Pacific children born between 2002 and 2004, over half (54%) had
         more than one ethnicity and almost a quarter (23%) had more than one
         Pacific ethnicity.

Socioeconomic
        Pacific people in general have lower incomes, with average hourly earnings in
         2006 of $16.38 compared with $20.84 nationwide
        they tend to have fewer school qualifications although this is changing. In the
         year ended December 2007, 50 percent of Pacific adults aged 25–64 years
         held at least upper secondary qualifications (Level 3 and above), compared
         with 80 percent of Europeans
        Pacific people tend to live in more crowded housing than other New
         Zealanders.
        over 40% of Pacific people live in the most deprived 10% of areas in New
         Zealand
        83% of Pacific people identified with a religious denomination compared with
         56% of the general population



22
   Ministry of Health. 1997 Mental Health in New Zealand, Chapter 4: Pacific People in New Zealand,
Wellington
23
   http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats/quickstats-about-a-
subject/pacific-people


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     an increasing but still small group of mostly New Zealand born young people
      state they have no religious affiliation (14%), compared with 35% of the
      general population.

New Zealand in the Pacific region- the bigger picture
     Cook Islanders, Niueans and Tokelauans are New Zealand citizens
      regardless of where they are born. If they are residents in the Cook Islands,
      Niue or Tokelau and travel to New Zealand, they are entitled to the same
      health care and treatment as other New Zealanders
     the movement of Pacific people both long-term and short-term, coming and
      going between New Zealand and Pacific Islands is high.
     in many Pacific countries, the annual population growth rate is 2% or higher
      and this is likely to have an impact on immigration into New Zealand.
     many Pacific people in New Zealand (including New Zealand-born Pacific
      people) are strongly linked with the Pacific Islands – through family, culture,
      history, language and dual residence
     these links can influence beliefs about health and illness, access to health
      services in New Zealand and usage of health care, including Pacific
      traditional healing
     there are significant current and emerging health, social and economic issues
      in the Pacific region (such as non-communicable diseases, and emerging and
      remerging communicable diseases) which can also have implications for
      Pacific people in New Zealand.

Looking ahead
     the age structure of the Pacific population is young and will remain more
      youthful than the total New Zealand population over the next 50 years
     Pacific populations in New Zealand are growing at a faster rate, (15.3%) than
      Maori (6.5%) and European (4.5%) and will continue to grow rapidly for some
      time
     the current New Zealand Pacific population of 7% of the population is
      expected to grow to around 8.3% by 2021 and to around 12.1% by 2051.
     New Zealand Pacific births are expected to increase from 8,600 in 2005 to
      10,300 in 2021. The number of Pacific children aged 0-14 years is projected
      to increase by 53,700 to 164,000 in 2026
     by 2026, the number of older Pacific people is projected to increase to 32,700
      from 11,500 in 2006




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