David Fisher's interview with Health Minister David Clark, over NZ's terrible youth suicide rate. / Mark Mitchell
Warning: This article is about youth suicide and may be distressing for some readers.
People at risk of suicide were not properly supported by the previous government and the lack of help resulted in more deaths, says new Health Minister Dr David Clark.
That's a damning statement from the new minister, especially when his predecessor is a medical doctor.
But Clark, who is not a medical doctor but a doctor of theology, is promising change and that help is on its way.
He has kept the mental health portfolio for himself - it is usually held by an associate minister - and is preparing to launch a mental health inquiry.
The nation will also - once again - have a Mental Health Commission, which National disestablished in 2012. This is what a change of government looks like.
Big promises and willing interview subjects - Dr Jonathan Coleman spent months avoiding interview requests as the Herald investigated then launched its Break The Silence campaign calling for a debate on youth suicide.
While Coleman eventually agreed to be interviewed, Clark welcomed the Herald into his office and pledged to address an issue which claimed 606 people last year. Of those, 130 were aged under 25 and of those, a disproportionate 47 young people were Maori.
Clark said: "I think we need a public conversation about this. We can't avoid it as a country. We have a problem and we need to talk about it."
New Zealand ranks second worst in the developed world for suicide of those aged 25 and under. Our teen suicide rate - officially those aged 15-19 - is the worst.
Asked where we should be in 20 years, he said: "One suicide is one suicide too many and I think we have to acknowledge that up front. There is no suicide that is acceptable."
Clark referred to Prime Minister Jacinda Ardern's vision of zero suicides in New Zealand - a goal Clark said was right.
Was that realistic? Clark said the ministerial inquiry - terms of reference still being worked out - will "give us some really strong direction".
"That review will cover prevention. It will also cover primary and secondary."
Everyone will be asked to contribute, said Clark. That means families of those struggling, or having lost a struggle, with mental health, those with mental health issues, those working in health, emergency services and anyone else with a contribution.
It's a big, broad inquiry - not only hearing "a variety of voices" but Clark said it would likely be a roving inquiry. "The answers sit in the community as much as they do with the experts."
Broad, too, in the sense of building a picture of where our mental health problems come from and how to solve those problems.
"It won't take a Labour Government nine years to realise mental health is an issue. The suicide strategy ran out at the end of last year. I think it speaks volumes that there isn't another one in place now.
"That to me is a concern because we know we have the worst youth suicide rate in the Western world and to not have a plan in place is a worrying thing."
Asked if he quizzed officials on why there was no suicide prevention strategy, he said: "The officials I've spoken to so far have expressed some frustration that consultation finished a long time ago on a new suicide plan and that nothing has been done."
Clark has not been kind to Coleman when their positions were reversed. He's not keen to go there now their roles are reversed.
"I feel the burden of the office I have picked up. I personally, of course like most New Zealanders if not all New Zealanders, have had personal experience of people I have cared about who have suicided, and I want to be sure we as government are in a position to find solutions."
In Clark's case, his grandmother made repeated attempts on her life. He has worked as a Youthline counsellor, where all in the service find themselves exposed to young people harbouring or surviving suicidal thoughts.
And as a funeral celebrant and parish cleric - he's a former Presbyterian minister - gives further exposure to those rocked by mental ill-health or who have taken their lives.
"I don't think that's unusual. I think many New Zealanders have had experience of dealing with people who have had suicide among their loved ones, people they care about.
"And what's plain out of all that is that we have to change the way we do things. We have got to make a difference. Right now, too many of our young people, too many people across New Zealand, are dying because we don't have the right solutions."
Clark is right about how common this is - 12 people a year for every 100,000 people in New Zealand. Coleman, too, talked of knowing people who had taken their lives. Such is the incidence of suicide that, as the years piles tragedy upon tragedy, it leaves few or none of us untouched.
And right, it seems, that current "answers" aren't working. Suicide rates dropped from the highs of the 1990s but those reductions halted with little change since 2007.
Government does not have "all the answers", Clark said. "It really does not. We need to work and partner with communities, with families, with the sector, with medical experts - especially taking into account the experiences of those who have interacted with the sector - to find a way of doing things better.
Sure, Clark said he has thought himself - on a personal level - about what went wrong and how it could be fixed.
"Part of it at some level has to do with the kind of society we have become. We are a more atomised society. People are not as engaged, in many cases, with their communities, partly driven by a lack of financial resources. They are working long hours, in jobs where they are isolated.
"Partly it is communities that are experiencing hardship, or the after-effects of colonisation, or trauma in their own lives or personal histories. All those things feed into a picture and that's just something we have to deal with."
Talk of the impact of colonisation will raise questions with some but the suicide rate among Maori (along with every other dire statistic) is markedly higher.
Broken down by gender it remains disproportionate but figures for girls and women were especially awful - of every girl aged 10-14 who took her own life last year seven were Maori. Half of all female youth suicides were Maori.
Such is the incidence of suicide that, as the years piles tragedy upon tragedy, it leaves few or none of us untouched. Photo / Mike Scott
"It's always hard to quantify what is causing these things. If there were exact answers we could unpick - or that had already been unpicked - we would have the solutions in front of us.
"But I think colonisation is a part it. I don't think we can avoid that conclusion. I'm expecting when we have the inquiry that story will come out. We will hear from those people who have been affected in many ways over a long period of time through generations of families."
There is the impact of poverty, too. "The evidence seems to be pretty clear that deprivation is a factor in suicide. There are people from middle-class, middle-income backgrounds that take their own lives too - too many do - but the evidence points strongly towards other social determinants affecting the rate of suicide."
Clark pointed to Maori showing strongly among poverty statistics. There is crossover, he said, and the picture is layered.
"I'm quite sure a Labour-led Government will want to make a difference in housing, make a difference in incomes, make a difference in accessibility for education and healthcare. All of those things have a part to play.
"I can't pre-empt the findings of our review but I have a hunch all of those things will come into the conversation because all of those things contribute to the picture of those people who are more likely to take their lives."
New governments arrive with pledges and "100 day" plans designed to show change and energy.
Some solutions will be immediate - the "nurses in schools" programme was in decile 1-3 schools and "makes a real difference". Expand that, he said. About 1300 nurses a year get trained - with some mental health training - but only 800 are placed. There's a potential workforce, he said.
A visit to a GP for mental health issues will be free. And there will be "mental health co-ordinators" in primary care, starting with the 400,000 living in our "most vulnerable communities" who were most in need.
But always the machinery of government is complex and there are delays in putting plans into action.
Clark would have it this is compounded by what he calls the previous government's "inaction" on health.
Coleman's last term was marked by arguments over health spending - he claimed more money than ever was being spent while Clark said it hadn't kept pace with need and population growth.
The argument is usually won by the person in the minister's chair, and the solution for what Clark calls our "mental health crisis" is not immediate.
Part of that he puts at Coleman's feet. "We need more people with the expertise."
He said Labour's commitment - his commitment - should let "people who want to train in this area, there are going to be jobs there for them".
But that means years. "We've had an underfunded health system under the previous government - nine years of neglect, really, both in terms of infrastructure but also in terms of workforce development.
"There are pockets where there is not the expertise available. Pockets is putting it mildly. We have a stretched workforce across the country.
"There is a workforce pipeline issue. I do not deny that. But we are signalling clearly there is going to be workplaces available for people to train but we also want to make sure those pathways are there for people to develop that specialist expertise because we need it."
Clark points again to the 500 nurses who qualify but don't go into fulltime jobs. And there are others who are being trained but not placed.
Detail, though, on those who will save New Zealand from its "mental health crisis" are thin - as is the workforce necessary to meet the ambitious change he has forecast for mental health, or how to get those people into provincial areas which feature strongly in suicide statistics.
There's a lot of catching up to do, "in particular the last nine years".
"Let's not beat around the bush. Health funding just has not kept up with demand. There's been a 60 per cent increase in the number of people accessing mental health services in the past decade and funding for all those services has gone up less than half of that.
"If more people are coming forward and you have less resource going in, I think it's a reasonable hunch that workforce is not adequately supported."
Money is not just the answer "but money is part of that picture". The inquiry will identify what is needed to support people with mental health and "I think we will find that will require further resource".
So if that's it, we asked: "Are there young people who have died because the previous government did not prioritise or fund mental health properly?"
Clark: "It's very hard on an individual level to say that somebody died because of a lack of funding for particular mental health support. I would leave that up to a clinical opinion rather than my own."
Well, with a higher priority and more funding, do more people will have a chance at life?
"Yes."
Isn't that the same as saying people have died because it wasn't funded enough? "The proposition you've put is one that seems reasonable to me, that if you don't support people, more people are going to take their own lives. I don't think we can deny that."
If Coleman takes that personally, it's understandable. That's how serious this is - lives are in the balance.
We asked Coleman, but - again - he would not be interviewed. Instead, he emailed through a spokeswoman: "Dr Clark has made it clear for some months that he believes the Minister of Health is accountable for New Zealand's suicide rate. It's now up to him to set targets and to meet them."
Clark knows. "There is a burden that comes with this office of responsibility for oversight of the health sector. I take this responsibility incredibly seriously. I, too, have been frustrated with the previous health minister and I can but pledge to do my very best because I personally care about this issue, to make a difference, to give more people that chance of life."
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
