Everybody hurts...sometimes

Hundreds are gathered at a Wellington church to farewell a loved one. Many mourners are teenagers. The music is by the Black Eyed Peas, Justin Timberlake and James Blunt. And the tragedy is all too real for one school community.

Youth suicide is one of the greatest social burdens on Western nations.

Debate over the media's right to report suicide has captured headlines, while the country's commitment to battling the issue has moved out of focus. But well-intentioned efforts to combat the issue have resulted in a Government-v-community struggle. The experience of community groups trying to prevent suicide has not matched academic evidence. A simple fact remains: one suicide is too many.

"The greatest number of [my] inquiries relate to suicide," says Napier coroner Warwick Holmes, who has spent two decades in the job. "The youngest [suicide victim] was 9 years old, but older youth are common. Out there, people are going to be surprised in the next few months when a young member of their family takes their life. For years, parents have told me they were the last people to recognise that there was a problem."

New Zealand has the highest suicide rate in the OECD for young males and the second-highest rate for young females. Male rates are declining, but female rates are rising.

Eighty per cent of people who die by suicide are over 25, although young New Zealanders have the highest hospitalisation rates for self-harm.

In 2003 95 youths between 15 and 24 committed suicide. Even so, figures have dropped since a peak in the 1990s.

Dr Annette Beautrais, principal investigator of the Canterbury Suicide Project, says researchers will never find one crucial statistic: the number of lives saved from suicide.

"People have argued that [the decline in youth suicide] reflects the introduction of newer, clinically safer anti-depressant drugs," she says. "But it's not easy to prove or show. [Historically] suicide [has] acted as a marker for a range of youth psycho-social disorders."

When asked how the Government has translated suicide research into solutions, Beautrais is circumspect. "No one has achieved that yet," she says. "Until now, our knowledge base has not been consolidated. Everyone, internationally, is now converting [research] into prevention."

The Government has been guided by a national youth suicide prevention strategy since 1998 to reconcile two schools of thought. One side suggests that discussion is necessary for raising awareness to fight the issue. The other argues that discussion can be counter-productive, sparking curiosity and heightening the risk of "cluster" or "copycat" suicides.

The Ministry of Health's evaluation of the youth suicide strategy shows that though it was well-formulated, a lack of planning before its release meant it was difficult to reach its goals.

John Tamihere, former Minister of Youth Affairs, said he did not agree with the Government's stance on the issue, but had to promote it because it was a portfolio responsibility.

"A lot has happened outside the management of youth suicide that has advantaged us in a way that bureaucrats will have difficulty in pinpointing," says Tamihere.

"We rely too heavily on academics. I don't suggest that their work is pointless and irrelevant. [But] the weight we are giving to it is irrelevant. These do-gooders, experts and know-it-alls overrate suicide; you need to be very careful about an industry that feeds off the failure of others."

Beautrais counters, saying, "We have political leadership that denigrates research in a country where we are supposed to be aiming for a knowledge economy. You need a knowledge base to prevent suicide, but you need political leadership and will to have [prevention] as a priority."

The Government is about to launch a suicide-prevention strategy, to set targets for the next decade. Associate Health Minister Jim Anderton says this will be "a more systematic opportunity to identify key priorities and areas that require new investment". The now-defunct Yellow Ribbon Trust was New Zealand's largest community body for fighting the fatal trend, but imploded under the pressure of bureaucracy and public criticism last year, after lasting seven years. Along with the Project Hope programme, Yellow Ribbon was slammed by a 2003 Government-commissioned report.

Yellow Ribbon's former chairman Marco Marinkovich worries that while research goes on, practical work is lacking.

"Once you have debates on an academic level, you need to turn it into pragmatic, deliverable processes," he says. "The research says we need to do more research. It's like a parent with a troublesome kid who does more reading and by the time they have finished, the kid is off the rails. Do these people believe [they are] saving lives? Or just [lining] their pockets with Government money?"

Marinkovich's notion that academics are disconnected from the issues riles Beautrais. When told the Weekend Herald could not present a one-sided report, she asks: "Why can't you? Why can't you give an informative, accurate story about youth suicide? I know the way journalists write. You need to give weight to the research from the people who work in the field. I object to the fact that you can find anyone in the community who has an opinion on suicide, and then you ring me up and give my opinion equal weight."

Tamihere believes the trust suffered because the Government "hates the rise of community solutions to community problems".

"Instead of cutting Yellow Ribbon off, why [did we] not do robust community-based research? The whole issue is bureaucratic and government-driven."

One key ideological difference is that the Government favours targeted prevention programmes, many of which relate to at-risk youth. Many community groups, however, advocate population-based initiatives, aiming to prevent suicide's effects on all youth.

Project Hope founder Rick Stevenson lost a son to suicide, and contemplated it himself. This week his team begin a nationwide tour, taking their message to the streets. The tour is to be bankrolled by businesses, trusts and lottery grants.

Stevenson's programme, unlike Yellow Ribbon, survived a tumultuous period under the microscope. These days, though, its founder is not welcome in many secondary schools.

"Teachers and principals are lost," he says.

"It's the old Kiwi attitude: if it's in the too-hard basket, we shove it under the carpet. How can you not want change when kids are dying? It's beyond our psyche to handle the situation, so it's getting worse. Suicide is killing more people than road deaths; look at the amount we spend campaigning against that."

For every piece of evidence on one side of the youth suicide debate, there is almost certainly another one to counter it. International bodies like the New York State Psychiatric Institute and Columbia University have found that discussion about suicide with young people is safe and beneficial.

The Ministry of Education is reviewing its guidelines for schools on youth suicide and awareness programmes, but was not willing to disclose its work prior to release.

Anderton says there is "no difference in our approach" to that of Australia. Yet Australian Prime Minister John Howard supports school-based awareness programmes, and has said Yellow Ribbon is "a valuable and timely contribution to the fight against youth suicide".

Coroner Warwick Holmes thinks his Australian colleagues have a lot to teach New Zealand.

"The public's perception of [New Zealand] coroners is that they splutter away and protest, but people don't have to pay heed to them. [Australia], on the whole, is doing a great deal more about a phenomenon that is equally a concern to them."

Six years ago Anderton said: "If we forever tried to avoid the issue of reaction [to debate on suicide] we would simply be burying the issue. We should be confronting the issue openly and honestly as a community.

"The issue is too real to pretend otherwise."

This was a period in which the Government supported the dramatisation of suicide for a TV documentary. Since then Anderton's perspective has changed sharply. "It is tempting to believe that simple solutions such as talking more about suicide will help because that seems to work with other social problems," he says. "The evidence encourages us to be more cautious and take care about the way we have debate. Programmes encouraging discussion must [be] guided by more than good intentions."

The concern of many community groups is that if they do not manage to co-operate with the Government, or find other funding, they could end up sharing Yellow Ribbon's fate.

"Jim [Anderton] is a lovely guy; he means well, and he has issues too," says Marinkovich, "but the way he spoke to us was a demonstration of 'we know better than you'. We tried to [work with them], but there was animosity and professional jealousy. They felt their territory was threatened."

The Government has earmarked $10.3 million for suicide prevention for all ages over a four-year period, and $6 million for the National Depression Initiative.

Anderton praises people in all areas of suicide prevention - policy work, research, and delivering services.

Youth suicide numbers have dropped, but it is unclear whether efforts to further combat youth suicide are effective. The question is whether a united front will be achieved.

"There needs to be a collection of minds to put a solution in place," says Marinkovich. "So much has been duplicated across community groups that push their own barrel. But you need some visionary to stand up and pull them all together.

"The idea that talking about suicide might make more of us go and do it is the reason that we have suicide rates.

"I am not out to slam the Government, but I've become a thorn in their side. I know they are spending millions trying to address the issue, but they need to be responsible for how they deliver. While they are mucking around, Rome is burning."