Part 2: Suicide prevention strategy, action plans, and reporting

Collecting and using information about suicide.

2.1
In this Part, we discuss how suicide information is used for:

Suicide prevention strategies and action plans

2.2
Information from many sources – including research and evaluation in New Zealand and overseas – is used for suicide prevention by many people and organisations. Our audit focused on the health sector's use of information for suicide prevention.

2.3
In 2005-06, the Ministry of Health used the best available research, data, and other information to prepare a national strategy for preventing suicide. The New Zealand Suicide Prevention Strategy 2006-16 (the Strategy)8 provides a framework to guide national efforts during the period and help government agencies and others understand how various activities in different sectors fit together to prevent suicide. The Strategy replaced the New Zealand Youth Suicide Prevention Strategy9 and extended suicide prevention efforts to all age groups. The Ministry of Health plans to complete its work on updating the Strategy in 2016/17.

2.4
The Strategy has been implemented through two national suicide prevention action plans running from 2008-1210 and 2013-16.11 We did not audit the plans' implementation.12 Each action plan sets out priorities and actions to achieve them:

  • The first action plan's focus was on providing accessible services to help families, whanau, and communities respond to people with suicidal behaviour. The plan had five priority areas, 23 key action areas, and 53 actions.
  • The second action plan is more focused on supporting families and communities and helping them to prevent suicide, and on suicide prevention for Māori and Pasifika. It has five objectives, 11 sub-objectives, and 30 actions. As the lead agency for the plan's implementation, the Ministry of Health reports to Cabinet six-monthly on progress in implementing the 30 actions; they have now been implemented by several government agencies.

2.5
With national plans in place and more information on suicide prevention available, the Ministry of Health has extended suicide prevention work to the local level. In 2015, the Ministry brought together the most up-to-date suicide prevention information into a "toolkit"13 and issued it to DHBs. The toolkit also included guidance to help DHBs prepare, for the first time, local suicide prevention and response plans.

2.6
DHBs led the plans' preparation and work with stakeholders. The Ministry of Health expected DHBs to focus on current risks, but also to pre-empt risk (by considering the effects, for example, of proposed closures of firms employing many workers). DHBs are expected to work with government agencies and community groups to carry out the plans from July 2015 to June 2017. We did not audit the DHBs' plans. In Part 3, we discuss one element of the local plans, which is the DHBs' response to suspected suicides.

2.7
The Ministry of Health plans to complete a new national suicide prevention action plan in 2016/17.

Monitoring the effectiveness of suicide prevention actions

2.8
It is common practice to monitor the effectiveness of suicide prevention by monitoring the suicide rate (deaths for every 100,000 people) and the suicide toll (the number of deaths in a year). However, these high-level measures are only useful over the long term. They have limited value for assessing the effectiveness of suicide prevention activities in the short and medium terms. This is because it can take years for changes to show at the population level, and it is difficult to establish cause and effect at that level.

2.9
In the late 1990s, for example, suicide prevention actions were targeted at 15-24-year-olds. About 20 years is needed for population data to show whether the suicide rates for the target groups are going down. Currently, primary school children are being taught about feelings and how to talk about them. It remains to be seen whether they will have lower suicide rates when they are older.

2.10
The 2013-16 suicide prevention action plan tasked the Ministry of Health with preparing, for the first time in New Zealand, an outcomes framework for suicide prevention. A main aim of the framework is to show whether specific suicide prevention actions are effective in the short and medium terms. If actions are not as effective as expected, changes can be made. The framework will have a set of indicators, which may help to decide priorities.

2.11
The Ministry of Health has prepared the framework and aims to have the corresponding set of indicators ready in 2016/17. We understand that decisions about the framework's implementation, and whether it will be reported on publicly, will be made by the Ministry as it updates the Strategy and prepares a new national suicide prevention action plan.

Reporting progress in reducing suicide

2.12
The current Strategy explains how progress in reducing suicide is to be reported. The plan was to produce a special trend report on suicide showing three-year moving averages over the long term. (We show three-year moving averages in Figure 1.) A special trend report was published in 2007, showing three-year moving averages, but one has not been published since.14 The Ministry of Health's Suicide Facts reports should report trends showing three-year moving averages, but they do not.

2.13
We discussed this with the Ministry of Health during our audit. We suggested that the Ministry change the focus of its annual Suicide Facts reports to focus on trend reporting, and to show trends as three-year moving averages.15 Moving average trend lines smooth out annual variations, making it easier to spot trends. They also help to ensure that any single year's data is considered as part of a bigger picture.

2.14
The Ministry of Health agreed with our suggestion. It plans to implement the new approach in Suicide Facts 2014, which is scheduled for publication in 2017. This means that Suicide Facts 2013, to be published in 2016, will be the last report in the existing format.

2.15
In the last couple of years (2013/14 and 2014/15), the Ministry of Health has reported on two suicide-related outcomes measures in its annual reports to Parliament. The measures were that:

  • the youth suicide rate is reduced; and
  • the suicide rate for all ages is reduced.

2.16
We suggested to the Ministry of Health that the measures would be clearer if they were more detailed. For example, they might specify the period over which the rate should be reduced (such as a rolling twenty years) and whether changes should be measured using annual or average suicide rates. The Ministry has agreed that more detailed measures would be useful.

Conclusions

2.17
The Ministry of Health has used and is using data and analysis from a range of sources to prepare:

  • a toolkit to help DHBs to prepare local suicide prevention action plans;
  • a national suicide prevention strategy; and
  • a series of national suicide prevention action plans.

2.18
The DHBs' new local suicide prevention action plans are in the first year of implementation.

2.19
The Ministry of Health plans to update the national suicide prevention strategy and release a new national suicide prevention action plan in 2016/17. We support this intention, and encourage the Ministry and DHBs, as lead agencies for suicide prevention, to work with government agencies and community groups to implement their plans.

2.20
The Ministry of Health has recognised that population-level data is useful for showing progress in reducing suicide long term, but has limited value for monitoring the effectiveness of suicide prevention activities in the shorter term. To address this limitation, the Ministry has prepared a new suicide prevention outcomes framework to link the long-term measures with new short-term and medium-term indicators. The Ministry is in the process of picking indicators for the framework and plans to complete this work in 2016/17. We support the Ministry's introducing such a framework, which is a complex piece of work and may take time to fine tune.

2.21
The Ministry of Health has been publicly reporting on progress in reducing suicide using population-level data in recent annual reports to Parliament and annually in Suicide Facts. We are pleased that the Ministry has agreed with our suggestion that it change its Suicide Facts reports to focus on trends.

8: Associate Minister of Health, Wellington: Ministry of Health, www.health.govt.nz.

9: Ministry of Youth Affairs, Ministry of Health, Te Puni Kōkiri (1998), The New Zealand Youth Suicide Prevention Strategy: In Our Hands and Kia Piki te Ora o te Taitamariki, Wellington, www.health.govt.nz.

10: Ministry of Health (2008), New Zealand Suicide Prevention Action Plan 2008-12: The Summary for Action, www.health.govt.nz.
Ministry of Health (2008), New Zealand Suicide Prevention Action Plan 2008-12: The Evidence for Action, www.health.govt.nz.

11: Ministry of Health (May 2013), New Zealand Suicide Prevention Action Plan 2013-16, www.health.govt.nz.

12: Nor did we audit the value of actions in the Strategy and suicide prevention action plans.

13: Ministry of Health (February 2015), Suicide prevention toolkit for district health boards, www.health.govt.nz. The Ministry of Health describes its approach to working with DHBs as one of "learning and sharing". The toolkit is a "living document" and will be updated as the results of further research, evaluation, and in-depth reviews become available. For example, the DHBs can share their experiences with other DHBs and agencies, and some of their experiences are available on the Ministry's website.

14: Ministry of Health (2006), New Zealand Suicide Trends: Mortality 1921-2003, hospitalisations for intentional self-harm 1978-2004, www.health.govt.nz.

15: The current approach is to include some trend data in each report, but most of the data gives an in-depth look at the latest year. We discuss the Suicide Facts reports in more detail in Part 5.