suicide rates - are they "shocking?"

A “yellow ribbon” suicide support group meets in April last year at offices of the prime minister in Avarua.

OPINION - COMMENT Six months after a youth poured petrol straight from the pump over himself and then flicked a lighter, trainee nurses have released a report detailing “shocking” levels of suicide in the Cook Islands. The young man died of his wounds at Rarotonga hospital within 24 hours. No inquest was held into his death despite promises in 2002 from the coroner to investigate all sudden deaths. Now a report for the country’s main mental health organisation, Te Are Pa Taunga, has put some statistics to years of headlines about suicide. Forty one people attempted suicide between 1996 and January 2006, with 11 dying – two females and nine males. Of the remaining 30, there was an even gender split between females and males, with 15 attempts each. Report authors, Maria Tekake and Tepore Hewitt, are student nurses. They are calling for urgent mental health funding including for a psychiatrist, psychiatric nurse and a proper clinic to provide confidentiality. Tekake said statistics came from records provided by the ministry of Health, Are Pa Taunga and daily newspaper Cook Islands News, which headlined the report “Nurses reveal shocking CI suicide statistics.” Are they? FIVE TIMES HIGHER Given a resident population of 15,000 – and statistics are unreliable on exactly how many people live in the Cook Islands – and an average suicide rate of 1.1 per year, this translates to 7.3 suicides per year per 100,000 people, a common international measure. Five times higher are rates experienced by the top 10 listed countries in the world, with Lithuania recording 42 suicides per 100,000 people each year, with Russia in second place at 37.4 per 100,000. In fact, all top 10 countries for suicide are former Communist countries, with China, the Cook Island’s latest diplomatic partner, still ruled by a Communist regime. More women than men killed themselves in China, with 195,000 deaths in one year, according to BBC news online. Around the world, nearly one million kill themselves each year, reports the BBC, more than are murdered or killed by war – equal to one suicide every 40 seconds. Closer to home, the World Health Organisation reports New Zealand in 2003 has a rate of 23.7 suicide deaths for males and 6.9 per cent for females, a combined total of 30.6 people killing themselves per 100,000 of population. GOOD NEWS That’s more than four times higher than the Cook Islands rate – and nearly twice as high as the rate in China. It used to be even worse. “In New Zealand, 460 people died by suicide in 2002, the year for which we have most recent data,” reports CSMHS, the Canterbury School of Medicine and Health Sciences. “This represents very positive trends in suicide reduction from the high numbers of the mid-1990s. Particularly pleasing is the reduction in the male youth (15-24 years) suicide rate which halved from 1995 to 2002. The suicide rate amongst older adults (65 and over) also halved over this time, and rates amongst adults 45-64 years reduced by 20%.” But CSMHS warns against doom and gloom reporting on suicide. “These significant reductions, and the gains made in identifying causes of suicide from New Zealand and international research conducted during the last two decades are ‘good news’ stories about suicide. “Unfortunately, stories about suicide tend not to report this encouraging news. Rather, New Zealand news reports about suicide tend to frame stories in a negative, dramatic or despairing way which conveys to the public that suicide is prevalent, increasing and that it is an issue about which little is known. REGIONAL OUTLOOK “This is far from the case,” states the Canterbury School of Medicine. “Suicide rates have reduced in New Zealand, significant world-class research about suicide has been conducted in New Zealand and New Zealand is currently developing a national suicide prevention strategy which will hopefully provide a framework and funding for suicide research and prevention for at least the next decade.” From a regional view the outlook is not so positive. In 2003, the Forum secretariat’s Noel Levi said a review of the Forum was timely, mentioning suicide first among a list of concerns facing the region. “We now find ourselves in a whirlpool of change in the Pacific and in the world, which threatens to cast adrift our nations and our peoples if we do not respond effectively. Our region is struggling to deal with the fact Pacific Island Countries have some of the highest suicide rates in the world, an extremely high rate of diabetes, obesity and other lifestyle diseases, spiralling incidence of alcohol and drug use, increasing unemployment and poverty accompanied by a rising number of sex workers, growing incidence of STI/HIV/AIDS etc, political instability and transnational crime.” “The list goes on. These indicators signal that we are still far from where we want to be despite our achievements.” MORE WOMEN? In the Cook Islands, a gender angle to suicide has been discovered in the country report recently approved by cabinet for CEDAW, the Convention for Elimination of Discrimination Against Women. “There are significant mental health issues for some women in the Cook Islands,” reads the report, not yet publicly released. “For example, information from Are Pa Taunga shows that between 1998 and 2003, more women than men attempted suicide and more women than men sought assistance for dealing with stress, particularly stress related to their care-giving roles. CEDAW report authors suggest this might be because “Cook Islands women carry significant care-giving responsibilities, in addition to caring for young children, particularly people with intellectual disabilities and the elderly. NGOs remain concerned at the low government budget in this area and are also concerned that mental health issues should be given a higher government priority.” If that is true, the government is far from alone in under-funding mental health services. POLICY BULLYING? Through its often unreliable website, WHO reports that as many as 20 countries in its 100 country survey spend less than 1% of their health budget on mental health. “This is in stark contrast to WHO’s estimate that 13% of all disease burden is caused by the wide range of neuro-psychiatric disorders,” states Dr Benedetto Saraceno, Director of Mental Health and Substance Abuse at WHO. “Public health planners and decision-makers need to take the mental health needs of their populations more seriously.” As do other frontline ministries, including police. One woman told Avaiki News Agency that the man who burnt himself to death last year had come straight from police headquarters in Avarua. She accused the police of bullying tactics while trying to get a confession about alleged crimes. Friends said the young man was always friendly and always good-humoured, still teasing friends even as he lay in hospital, dying. GOOD START It is astonishingly hard to get a comprehensive list of country suicide rates in order of seriousness. WHO lists countries alphabetically, but not by rate. Last week’s report from the trainee nurses should be praised as a first step towards a more comprehensive look at suicide in this country. Are Pa Taunga does not venture any guesses as to why suicide should be as much of a problem as it is in the Cook Islands. Commentators – like this blogsite – will no doubt be quick to point to the societal stresses brought about by a massive increase in tourism. Just 32 years after the opening of the international airport – less than two generations – tourism has sky-rocketed from a few dozen visitors a year, fast closing on 90,000 a year. Children who used to call out “papa’a! papa’a” to visitors walking the roads now have children of their own who have never known anything but mass tourism. As well as obvious environmental impacts, there are less obvious problems being caused by our rapid adaptation to world markets. We need more studies like that conducted by Are Pa Taunga and the trainee nurses. Or our suicide rates may climb higher.