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| Journal of the New Zealand Medical Association,
23-March-2007, Vol 120 No 1251
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Suicide prevention in New Zealand
Roger Mulder
We have seen
increased activity in suicide research and prevention in New Zealand and
internationally during the last decade. The article from the New Zealand Suicide
Research Network, published in this issue of the Journal (Beautrais A,
Fergusson D, Coggan C, et al. Effective strategies for suicide prevention in
New Zealand: a review of the evidence; http://www.nzma.org.nz:8080/journal/120-1251/2459),
raises a series of important points for debate and discussion. These issues are
discussed in the context of suicide prevention but they have wider application
for the translation of research findings to clinical practice and preventive
interventions.
New Zealand’s contribution to suicide researchThe formation of
the Suicide Research Network (SRN) highlights New Zealand’s significant
contribution to the world literature on suicidal behaviour. This contribution
has included longitudinal studies;1,2
case/control research;3 cross-sectional
population surveys;4 time series analyses and
census linkage research;5 behavioural
genetics;6 and qualitative
research.7 In addition, there has been research
that has focussed on suicidal behaviours in schoolchildren as well as
Māori8 and Pacific
populations.9
The net result
of these efforts is that New Zealand has a rich body of evidence on which to
base the development of effective policies for reducing the high rate of
suicidal behaviours within the New Zealand population.
The importance of research networks and collaborationThe SRN was developed to provide a collective research voice
on suicide. Researchers from different disciplines and with differing
perspectives have come together to provide a common voice to advocate for
evidence-based suicide prevention.
The problems of translational researchThe article by
the SRN provides a landmark contribution to the development of suicide
prevention in New Zealand, but the problems of translating good evidence into
effective policy should not be underestimated.
In the first
decade of the 21st Century there has been
increasing awareness of the exponential growth of knowledge in the health
sciences and the need to translate this knowledge into effective policy that
benefits the public. The translation of knowledge to practice is a complex and
uncertain process, and is not aided by the series of hurdles that have to be
overcome in the New Zealand context.
In particular,
the application of knowledge on suicide in New Zealand is compartmentalised into
a series of groups that include the:
This
system creates a number of barriers that hinder the translation of evidence into
policy and make the process slow and inefficient.
There is a strong case for a radical reconsideration of the
ways in which knowledge is translated to policy. This is probably best achieved
via a Research and Development (R&D) approach that integrates the efforts of
the research community, Government agencies, service providers, and evaluators.
The significance
of the paper by the SRN is that it provides the foundations of such
collaboration by developing a consensus that provides a firm evidential
foundation for the development of effective policy.
The interface between evidence and advocacyWhile evidence
plays some role in policy development, policy directions are also shaped by the
politics of advocacy which may over-rule or distort the representation of
evidence.
An example of
this process has been the recent series of attacks in some New Zealand print
media on the views of the lead author of this article (Dr Annette Beautrais). In
recent weeks, a series of articles and editorials (e.g. Dominion
Post,10 The
Press;11,12
The Southland Times13)
have questioned Dr Beautrais’ views on the role of media
reporting in suicide prevention.
These
contributions have variously argued that Dr Beautrais’ views have been too
influential in determining policies regarding the media reporting of suicide;
that restrictions on media reporting have contributed to New Zealand’s
high rates of suicide; and that since there is no conclusive New Zealand
evidence on this topic, no clear conclusions may be drawn.
These viewpoints
are not sound, and have acted as a smokescreen that obscures two major
conclusions about all international research on the linkages between media
reporting and suicidal behaviours. First and foremost, there is no evidence that
suggests that media reporting is beneficial in reducing suicidal behaviours.
Second, there is substantial evidence to suggest that incautious reporting of
suicidal behaviours may increase rates of suicide amongst vulnerable
individuals.
Dr
Beautrais’ position simply reflects the current consensus on media
reporting and suicide held by most organisations involved in suicide prevention
in New Zealand, and internationally.
Of greater
concern is the way in which Dr Beautrais has been singled out for attack by the
media. The views she presents are not her personal belief: they are widely held
by those knowledgeable about the nature and causes of suicidal behaviours and it
is less than fair or reasonable for the press to mount personal attacks on her
to further a media agenda.
Suicide is an
issue that arouses strong views, opinions, and emotions—and the recent
responses of some sections of the media reflect the conflicts that will
inevitably arise when strongly held opinions are challenged by well-collected
evidence.
What is needed
to resolve such issues is the careful working through of both evidence and
opinion to develop a consensus. In preparing this article, the SRN have made an
important contribution by setting out both the evidence on suicidal behaviours
and developing a well-specified policy agenda.
The important
next step for New Zealand is the translation of this body of evidence into
effective, well-implemented, and well-evaluated policy.
Competing interests: Professor Mulder
is a member of the Suicide Research Network and Head of the Department of
Psychological Medicine where the Canterbury Suicide Project is located.
Author
information: Roger Mulder, Professor of Psychological Medicine,
Department of Psychological Medicine, Christchurch School of Medicine and Health
Sciences, University of Otago, Christchurch
Correspondence:
Professor Roger Mulder, Department of Psychological Medicine, Christchurch
School of Medicine and Health Sciences, University of Otago, PO Box 4345,
Christchurch. Fax: (03) 372 0407; email: georgina.brooks@chmeds.ac.nz
References:
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