MidCentral District Health Board Suicide Prevention and Postvention Action Plan 1 Year 2018 2019
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MidCentral District Health Board Suicide Prevention and Postvention Action Plan 1 Year 2018 – 2019 1
He Mihi Community E ngā pae maunga o Ruahine o Tararua, o Tararua, e tu ake nei E ngā wai o Manawatu, o Ōroua, o Rangitikei e rarapa mai ana Karanga mai, karanga mai, karanga mai E ngā mana, e ngā karanga maha huri āwhiotia i ngā tōpito o te aotūroa nei tēnā koutou katoa Tena koutou i runga i ngā āhuatanga e uruhia mai nei i a tātou katoa, ahakoa ko wai, ahakoa nō hea Kei āku nui, kei āku rahi, e ngā iwi kainga, arā, Rangitāne o Manawatu, Ngāti Kauwhata, Rangitāne o Tamaki Nui a Rua me Ngāti Raukawa ki te tonga, karanga mai, karanga mai. 2
Background The original MDHB Suicide Prevention Postvention Action Plan was from 2015-2017. As the Ministry of Health is working through the best possible way to progress with a national suicide prevention strategy, and with the Mental Health Enquiry taking place, the MoH have asked all DHBs who do not have a current Suicide Prevention Plan in place to move forward with one. The options were to do either a 1 year interim plan, or a 3 year plan. In consultation with the MDHB Suicide Prevention Postvention Response Team, a 1 year plan was decided upon due to time constraints and the impact this would have on the ability to consult widely. During 2018-2019 work will commence on developing a long-term plan. The MDHB Suicide Prevention Postvention Response Team’s role is to coordinate a response to suspected suicides, as well as engage in suicide prevention initiatives. Membership consists of representatives from central and local government agencies and from appropriate health and social service agencies that can assist with the purpose of the team. Also, when a person on school age dies by suicide there is the Critical Incident Response Team available. In late 2017, a Tararua Local Response Team was established to increase coordination and capacity of suicide postvention management, as well as to support community wellbeing and development initiatives in the areas of mental health promotion and suicide prevention, within the Tararua district. It consists of representatives from central and local government agencies and from community based health and social service agencies This team provides a local response in partnership with the MDHB Suicide Prevention Postvention Response Team. A Horowhenua Local Response Team is in the process of being created, with Local Response Teams for other areas of the community to also be developed in the future. The MidCentral Mental Health and Addiction Network, called Unison was established in 2017, and aims to deliver better services by providers for mental health and/or addiction service users and their families/whānau. Unison is a network of providers and stakeholders representing the complete continuum of service delivery across all age ranges. The combined coordinated input of all representatives aims to create an integrated system of care which includes input from intersectoral agencies and all other providers. Unison will play a role in supporting the implementation of mental health programmes, including the suicide prevention strategy, and 3
ensuring connectivity between providers who have input to suicide prevention. The combined group of providers in the Unison Network work together to identify and resolve the mental health and addiction needs of consumers who use their respective health, support and social services. MDHB Locality plans in Tararua, Horowhenua and Manawatu have been developed in response to community needs. These include Mental Health & Addictions initiatives for the year 2018-2019. Population Suicide rates In the 2013 census the MidCentral DHB population was assessed to be 162,564. The defined area is based on territorial authority and ward boundaries, and for MidCentral DHB these include Manawatu, Tararua, Horowhenua, a part of Kapiti district (Ōtaki Ward), and Palmerston North city. The gender split of the MidCentral population is 52% female and 48% male. MidCentral District Population by Ethnicity at 2006 Census and 2013 Census (percentages): 4
Suicide rates From 2004 to 2014, the average suicide rate for MidCentral DHB was 16.2 per 100,000. This compares to the national rate of 12 per 100,000 over the same time period. It is important to note that the rate for MidCentral tends to fluctuate to a large degree. As an example, 2005 had a rate of 22 per 100,000 people, while 2012 was 12.5 per 100,000. Age Using the same 2004-2014 time period, MidCentral is over the national average for most age groups. Unlike nationally, MidCentral has a peak in the 40-44 year old (28.2 per 100,000) and 45-49 (29.2 per 100,000) demographics. This means those in middle age are a demographic that require targeted initiatives. As with the national average, MidCentral rates also peak for 20-24 year olds (29.5 per 100,000), meaning they are also a significant area that requires targeting. Gender Men outnumber women in suicide statistics, and MidCentral is no exception. Data shows that men take their lives at three times the rate of women. In particular, middle aged men are a key demographic that are over represented in MDHB. No data is publicly available to show rates for those who are gender diverse. Ethnicity No public data sets show suicides by ethnicity on a DHB level. Nationally Maori have a higher rate of suicide than non-Maori. 5
Locality MidCentral is made up of four territorial authorities, Tararua District, Manawatu District, Palmerston North City, and Horowhenua District. The Otaki ward of the Kapiti District is also part of MidCentral. From 2004-2014 Tararua and Otaki were the areas that had the highest rates, although their smaller populations do mean that a small number of suicides can dramatically shift their rate. A Local Response Team was established in Tararua in early-2018, and another is being established for Horowhenua/Otaki. 6
Key achievements of the previous action plan Established pathway for Coronial data, received from Clinical Advisory Services Aotearoa on behalf of the Minsitry of Health; and a response for all suspected suicides in MDHB region is undertaken. Development of a Tararua Local Response Team. Initiatives that support an inclusive environment for the rainbow community have been rolled out such as Gender & Sexual Diversity @ Work Trainings. Contracted the iwi Māori service provider Best Care Whakapai Hauora for Kaupapa Māori Suicide Prevention Services. Comprehensive report completed by YOSS and the Palmy Youth Network about young people’s experiences of cyber bullying in Palmerston North. The report found that over a third of the young people surveyed had been victims of cyber bullying. Cyberbullying workshops delivered across the region for schools and professionals working with young people. A cyberbullying resource was also developed and distributed, which lists key resources. ‘Coming together to remember those we have lost to suicide’ community gatherings held yearly, in collaboration with ACROSS Social Services. This was identified as a need from the community. A range of education and training workshops delivered to various attendees, examples of these are: Wellbeing presentation to rural community; Children, Tamariki, Whanau and Families Forum which included presentations from a variety of services (CAFS, MSF, ACROSS, Child Health, Barnados, Child Development, Gateways); and perinatal mental health and wellbeing forum. In collaboration with CAFS, mental health/wellbeing session for employees at a construction materials company; training on anxiety delivered to RTLBs, PHNs; and The Detection and Management of People at Risk of Suicide Seminar, delivered to a wide variety of participants including front-line workers, tertiary education sector, and the NGO sector. A wide variety of mental health, wellbeing and suicide prevention postvention resources and service information distributed to agencies and the community, such as the ACROSS bereaved by suicide support group. Resources and information also disseminated in regards to current affairs/media, as appropriate. Implemented Vintage Parties for older people with the Palmerston North City Council to address social isolation and enhance well-being. Implemented specific approaches to support initiatives for Māori suicide prevention; particularly wananga in Foxton, Shannon and Levin (paepae wananga and safe talk forums). Implemented resource Toolkit for whanau and people working with families, under Supporting Parents Healthy Children initiative. Engaged with the local media to ensure awareness of media guidelines ‘Guidelines and Reporting Suicide’. 7
Kaupapa Maori suicide workshop held March 2018 to develop initiatives from a kaupapa maori response to suicide prevention and intervention using the turamarama declaration (launched by Dr Mason Durie in 2016). Liaison and information now occurs between mental health and addiction services and suicide prevention coordinator. Emerging trends can be identified from data. Coronial data on suspected suicide now collected and analysed in terms of trends and planning needs in the district. 8
Action Area 1: Promote Mental Health and Wellbeing and Prevent Mental Health Problems Activity/Objective Action Performance Partners Key Lead Measure/Milestone Support mental health Support a coordinated approach Develop appropriate initiatives Public Health Service, Public Health Services and wellbeing for to youth wellbeing and safety Netsafe, people experiencing Schools, Youthline, bullying CAFS, WellStop Build community Identify effective models of Effective resiliency programs Youth One Stop Shop, Public Health Services, resilience resilience for youth, young adult and Secondary Schools, YOSS older persons identified Massey University, Lesbian and Gay Rights Effective programs for the Association, G.P. youth Rainbow community. Practice teams, Rainbow community - gender Age Concern, Federated and sexual diversity inclusivity Farmers, Rural Support initiatives and trainings Networks, Employers Federation, Kia Piki Te Kaha Suicide prevention Coordinators, Sport Manawatu, Central PHO, Implement Youth Leadership Implemented Te Tihi o Ruahine Mental Health Services, Programmes Mana o te Tangata Trust, CPHO 9
Develop a 5 Ways to Wellbeing Suicide Prevention style resource for young people Resource is developed Postvention Response Central PHO, Te TiHi Team, Mental Health Foundation To coordinate key To support the coordinated Establishment of Unison sub- Ministry of Social Service Director MH&AS, government and social response committees which address Development, Housing MDHB UNISON service agencies wider health determinants e.g. NZ, Public Health Unit, initiatives to address housing, employment. City Council, UCOL, identified service users issues Increase capacity & Facilitate workforce Suicide Forums held annually across Clinical Mental Health Public Health Services, capability of mental Prevention Forums to discuss the region. Focus on Services, NGO Project Coordinator health addictions ongoing suicide prevention to Horowhenua and Tararua Iwi/Māori, Pacific, workforce around include update on current Refugee Services, NGOs, suicide prevention and research, activities, issues, new Extra community meetings Kia Piki Te Kaha Suicide postvention resources held if a suicide cluster or prevention Co- contagion develops ordinators, G.P. Practices, Pharmacies, GP Practice Education Seminars A series of 9 GP Education Specialist Child Central PHO Seminars per annum Adolescent and Family Mental Health Service, Trainings delivered that cover Public Health Services, 10
suicide prevention, identification, Central PHO CAFS and Public Health screening, management, referral pathways Increase the Trainings delivered in settings Trainings are delivered Child Adolescent Mental Public Health Service, confidence, skills and that may be not be commonly throughout the region Health team, Ministry of CAFS, knowledge of the accessed e.g. rural community. Health (workshop NGO Project Coordinator community around trainings) suicide prevention, as Provide national community well as mental health trainings e.g. LifeKeepers wellbeing Community led-initiatives are supported Support mental health Identify effective and evidence Initiatives Suicide Prevention Suicide Prevention and wellbeing based initiatives/programmes for supported/implemented Postvention Response Postvention Response initiatives for men men Team Team Build mental health Provide Mental Health Awareness Communities are informed Supporting Families in NGO Project Coordinator, literacy and depression Training workshops e.g. Mental about availability of Mental Illness, Marae, Public Health Services awareness Health 101 and workshops workplaces, rural Depression Awareness workshops support agencies, Information on referral NGO’s, Social Services, QPR Suicide Training Tool pathways for help seeking is PHO, pharmacies, Gatekeeper Training shared Age Concern ASIST Training Tool 11
Activities documented and evaluated Support mental health Community suicide prevention Relationship with Suicide Iwi Services, Kia Piki Te Kaha Māori and wellbeing initiatives Prevention Coordinators and Central PHO, Suicide Prevention initiatives for Māori are supported by (Kia Piki Te Kaha Iwi Providers are strengthened Community Nurse for Coordinators, Public and Pasifika Service) and initiatives supported Pasifika Health Services, Pasifika Initiatives documented Advisory Group Establish/strengthen relationships Assistance with initiatives and Pasifika Advisory Group with Pasifika Community resources provided on request Levin Kaupapa Maori Suicide Assistance with establishing Iwi Services, NGO’s Kia Piki Te Kaha Maori Prevention Roopu strengthen initiatives aligned with Mana o te Tangata Trust Suicide Prevention Turamarama Declaration Turamarama Declaration. Central PHO NGO Coordinator initiatives. Initiatives documented Ministry of Education Mana o te Tangata Trust Support mental health Further strengthen relationships Mental Health/Wellbeing Public Health Nurses, Public Health Services and wellbeing with refugee services and offer presentations delivered to Red Cross Refugee initiatives for refugees assistance with identified refugees as part of the Service, activities orientation programme for Multicultural Council, new families are implemented Central PHO and evaluated Support mental health Provide education on link Training delivered re screening MDHB Family Violence MDHBFamily Violence and wellbeing between violence, sexual abuse for family violence in primary Intervention Intervention Coordinator, 12
initiatives for people and mental health care Coordinator, NGO Project Coordinator, experiencing Family violence screening and Public Health Service Public Health Services violence/domestic referral processes to be more Promoters, CPHO, violence fully implemented Manawatu Abuse Intervention Network, Support agencies working in Te Aroha Noa (Men’s family violence and sexual abuse Staff of these agencies receive Group), Police, QPR or other appropriate Community Corrections, Encourage health professionals to community based training Women’s Refuge, Kia use opportunities to engage with Piki Te Kaha Service, patients about domestic violence Information disseminated to Kauri Integrated Family e.g. 6 week post-natal check health professionals Health Centre Support mental health Work with Age Concern and Programs are provided and Age Concern, MDHB Family Violence wellbeing for older MDHB Star ward to identify issues evaluated Police, City Council’s, Intervention Coordinator, people experiencing and coordinate a response Housing NZ, Primary NGO Project Coordinator, elder abuse Mental Health Service, Public Health Services Health Promotion Advisers 13
Action Area 2: Improve the Care of People who are Experiencing Mental Disorders Associated with Suicidal Behaviour Activity/Objective Action Performance Partners Key Lead Measure/Milestone Recognition and support Disseminate “help seeking” Two workshops a year are Supporting Families in Public Health Services, for people experiencing information through non advertised, delivered and Mental Illness, Kia Piki Te NGO Project Coordinator mental health &alcohol mental health sector e.g. Work evaluated Kaha Coordinators and drug problems and Income, workplaces Public Health Services, Health Promoters Dissemination of information Iwi Providers, YOSS, recorded via the NGO Primary Mental Health Workforce Development Service, Specialist AOD Coordinator Service, Youthline, MASH Trust Raise awareness of signs Deliver Mental Health 101 Training delivered and Mental Health Services, NGO Project Coordinator, and symptoms exhibited Workshops, documented by existing Skylight, Public Health Services by people experiencing Mental Health Awareness workforce development Kia Piki Te Kaha Service mental health, alcohol & Workshops, monitoring frameworks drug addiction problems Information provided on among health bereaved by suicide support Training requirements Training Providers professionals and other identified and provided front line workers Identify specific training needs where requested for G.Ps practice Teams Number of participants completing training are documented Refugees/immigrants Strengthen relationships with Programs and workshops English language Public Health Services, 14
with mental health issues refugee/immigrant services provided as identified and partners, Red Cross Central PHO are well supported and provide opportunities to requested by Refugee Refugee Services, support refugees experiencing Services/Manawatu Mental Health Services, mental health and alcohol & Multicultural Centre Manawatu Multicultural drug addiction problems Centre, Central PHO, G.P Access to refugee/Immigrant Practice Teams, support services/information Pharmacies Improve the care for Public Health Service to Initiatives are Suicide prevention Kia Piki Te Kaha, Public Māori who have mental support and work alongside supported/strengthened as per Coordinators, Clinical Health Services health, alcohol & drug Suicide Prevention Te Whakauruora Resource e.g. Mental Health Services, issues associated with Coordinators advocate for a choice of Central PHO, suicidal behaviours in the delivery & support for services to be available and Iwi Services, marae, whānau and Māori appropriate for whānau to Whānau/family Advisor, communities access help when required Māori Women’s Welfare League, Pharmacies 15
Action Area 3: Improve the Care of Service Users Who Make Non-fatal Attempts Activity/Objective Action Performance Partners Key Lead Measure/Milestone Provide appropriate Establish follow up support for Follow up strategies identified ACROSS Social Service, Supporting Families in support for service family/ whānau of a person and recorded Clinical Mental Health Mental Illness Service users, parents family, who has attempted suicide or Services, Emergency whanaū (including Māori self-harm e.g. individual/group Department, and Pacific) who have support, support from GP Practice Teams, children who have agencies, information and NGOs, attempted suicide/ self- education Ministry of Education, harm Youth One Stop Shop, Supporting Families in Mental Illness, Oranga Tamariki, Kia Piki Te Kaha Suicide prevention Coordinators, Safe Community Coordinator-Palmerston North City Council Improve communication Continued collaboration Follow up processes are Specialist Mental Health Specialist Mental Health and referral processes between ED and Mental Health documented Services, Services, between GP Practice Services on follow up of clients Central PHO, Central PHO, Teams, Specialist Mental after a suicide attempt or Emergency Department, Emergency Department Health Services and serious self-harm Mental Health Emergency Emergency Department Team , following a person’s A prompt online notification is IT/Emergency 16
self-harm attempt provided to GP Practice Team’s Establishment of WEBPAS Department, following an attempted suicide or self-harm Support improved referral Strategy for improving pathways from GP Practice timeliness of assessment Teams interface with clinical identified Mental Health Service Suicide and suicide Support Māori Suicide Māori and Pacific people are Suicide Prevention Kia Piki Te Kaha Suicide attempt rates among Prevention Coordinators to able to access the service of Coordinators Kia Piki Te Prevention Co-ordinators, Māori and Pacifica are assist people to navigate their choice Kaha Service, Iwi and Public Health Service reduced through the mental health Māori Services, system to receive culturally DHB Pacific Mental Health appropriate help Liaison Coordinator 17
Action Area 4: Reduce Access to Means of Suicide Activity/Objective Action Performance Partners Key Lead Measure/Milestone Reduce access to potential Monitor coronial data that Evidence of action is Suicide Prevention Public Health Services, suicide methods in order to looks at method of suicide to documented and reported to Postvention Response Suicide Prevention reduce suicide risk determine action for Community Prevention team Postvention Response prevention e.g. firearms Postvention Reference Group Primary Mental Health Team storage Services, Police, Federated Work with local councils, Repetitive sites/methods for Farmers, institutions and businesses, suicide attempts are identified Public Health Services, for any recognized repetitive and the appropriate TA’s suicide methods e.g. jump authority/business are NGO Sector, sites supported to take action Clinical Mental Health Services, Advise those caring for Ensure information is Central PHO, people at high risk of suicide available for distribution to Public Health Services to remove potential means to carers, family/whānau suicide e.g. toxic substances, firearms Increase awareness for Provide information to Information provided to Primary Mental Health Public Health Services, community about ways to friends/family of people to friends/family about reducing Services, Specialist Suicide Prevention reduce access to means of limit possibility of future suicide means as a prevention Mental Health Services, Postvention Response suicide suicide attempts strategy NGOs, Team, NGO Project e.g. pathways to helping community agencies, Coordinator agencies Crisis Intervention Response Team, Kia Piki 18
Te Kaha Suicide Coordinators, Public Health Mental Promotion health Advisors Safer Work with GP Practice Teams Action documented Central PHO, NGO Project Coordinator dispensing/prescribing of on providing information of Pharmacies, medications dangers of over prescribing Integrated Medicine medication to those who Management Leadership have attempted suicide or are Alliance, at risk of suicide Specialist Mental Health Services, Clinical Services & Pharmacy Reduce access by Māori to Support and work alongside Support and strengthen Iwi and Māori Providers, Public Health Service, Kia means of suicide Iwi/Māori Providers to initiatives as per Te MidCentral Health, Piki Te Kaha Māori Suicide provide information to Whakauruora Plan e.g. NGOs, Primary Mental Prevention Coordinators families/whānau to remove Provide choice and access to Health potential means services including tohunga, Māori healers 19
Action Area 5: Promote Safe Reporting and Portrayal of Suicide Behaviour by the Media Activity/Objective Action Performance Partners Key Lead Measure/Milestone Agencies and community Resources and information Resources and information Suicide Prevention Public Health Services have appropriate disseminated in regards to disseminated as needed Postvention Response information and resources current affairs/media Team in regards to current affairs/media Action Area 6: Support Family/Whānau, Friends and others affected by Suicide or Suicide Attempt Activity /Objective Action Performance Partners Key Lead Measure/Milestone Establish/strengthen Promote and support Information about Suicide Prevention Response Public Health Services, relationship services for those bereaved supportive agencies Team, ACROSS Social Service, ACROSS Social Service, Kia with agencies that will by suicide distributed Kia Piki Te Kaha Suicide Piki Te Kaha Suicide offer support to those through general practice, prevention Coordinators, Prevention Coordinators bereaved by suicide media, churches, funeral Public Health Services, including supporting the directors, social services, Facilitators of Bereaved by Supporting Families in Mental capacity and capability marae, workplaces, clubs, Support Groups feel well Illness, of facilitators of sports groups and supported Iwi Services, specialist suicide- community groups Victim Support, prevention programs Funeral Directors, Support for suicide Workplaces, 20
bereavement facilitators Sports Clubs, MidCentral Health , General Initiatives untaken as Practice, identified and appropriate Family/Whanaū Advisor, Skylight, Mental Health Engage with tertiary sector Tertiary sector are Foundation, to ensure good supported following an Youthline, Manawatu Police, coordination following a event Specialist Mental Health Services suicide Ensure those bereaved Liaise with Victim Support, Resources and agency Victim Support, Suicide Prevention by suicide have Police and other mental information is provided ACROSS Social Services, Postvention Response appropriate knowledge health stakeholders to Police, Kia Piki Te Kaha Suicide Team of identify and provide up to Prevention Coordinators, self-help agencies date resources NGO sector 21
Action Area 7: Expand the Evidence about Rates, Causes and Effective Interventions Activity/Objective Action Performance Partners Key Lead Measure/Milestone Respond to Coronial Identify opportunities for Opportunities identified and Clinical Advisory Services Suicide Prevention Data for all suspected intervention implemented Aotearoa (CASA), Specialist Postvention Response suicides in the district Mental Health Services, Team, Public Health Debrief meetings held as Findings from evaluation will Community Suicide Prevention Services identified be feedback to services with Reference Group, Public Health recommendations Services , Mental Health Clinical Executive, Mental Health Serious Adverse Events Review Group Child Youth Mortality Member of MidCentral Attendance at meetings and Child Youth Mortality Review Public Health Service, Review Committee - region Child Youth Mortality contribute as appropriate. Committee Group Child & Youth Mortality Review, to identify Review Committee with Review Coordinator opportunities for information provided as prevention/modification. requested, and attend meetings Increase Research is undertaken Research report/findings is Mental Health Services Mental Health Services evidence/research produced on high end users and high risk populations in contact with mental health and addictions services 22
Action Area 8: Increase the Coordination and Capacity of Suicide Postvention Management for at Risk People Activity/objective Action Performance Partners Key Lead Measure/Milestone A coordinated A Suicide Support Model is Procedure of support Community Suicide Public Health Service, Suicide response to suicide is developed including the following a suicide to prevent Prevention Reference Prevention Postvention implemented for all formation of Governance contagion or cluster is in Group, Public Health Response Team identified at risk Group, and Local Response place Services, Local Response groups teams across the district Team, CASA A governance group is Note: a protocol formed. already exists between MidCentral Health CAMHS, Public Health Service and Ministry of Education for traumatic events such as suspected suicide involving early childhood centre and school children Local Response Team is Liaise with communities to Local Response Team for Youth One Stop Shop, Public Health Service, Suicide developed for discuss development of a Horowhenua region is Tararua REAP Team, Tararua Prevention Postvention Horowhenua district Local Response Team established Youth Service, Strengthening Response Team Families Network, Minsitry Continue to support the of Social Development, Tararua Local Response Oranga Tamariki, Levin 23
Team Community Networks, Horowhenua Strengthening Families Liaise with Clinical Emerging trends are Emerging trends are notified Prevention Postvention Public Health Service, Mental Mental Health Services identified from data to Suicide Prevention Response Team, Clinical Health Service and community to map Coordinator for any follow up Mental Health and suspected suicide actions Addictions services, Victim clients and identify Clinical Mental Health Support, trends Services An appropriate response is Public Health Services notified of Coronial Data to developed e.g. a trend is identify whether suspected identified as a workplace Mental Health Services suicide is under Clinical therefore help-seeking Adverse Event Review Group Mental Health Service’s information and support is provided to the workplace Information is shared with Mental Health Services Adverse Event Review Group and actioned as per processes 24
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