Failing suicide prevention

Caught in a strengthening wave of suicide and suicidality in New Zealand, politicians, public servants and mental health advocates have been increasingly vocal about the need to address the problem.  Once more, though, the public service has risen to its usual dismal standards of managerialism and doublespeak, in a new Strategy that speaks vaguely of wellbeing, and the things that make us happy.  Here is a typical gem: ‘We want a New Zealand in which everyone is able to have a healthy future and see their life as worth living. Reducing suicidal behaviour will help us become this kind of country.’  That sort of tautological nonsense is just what will ensure this strategy is as unsuccessful as the last.  No surprise, then, that comedian and mental health activist Mike King today tendered his resignation from the panel responsible for the strategy, noting its bland noncommittal approach will do nothing to help those who most need it.

Let’s be honest about the rationale behind this Suicide Prevention Strategy.  The trend, in public health and across public services–in New Zealand as elsewhere–is to deliver interventions at the lowest level possible.  (The ‘pyramid’ is paradigmatic: billboards and ads for the general public, low level interventions (chats and SSRIs) for a smaller number and, if you’re really bloody lucky, targeted treatment–but given that you have probably attempted suicide by this point, luck isn’t a word to use.)  Following on from interventions to reduce speeding and improve tax compliance, nudge tactics and awareness raising are the go-to interventions for everything from smoking cessation, exercise, and nutrition to depression and family violence.  The goal, and the gold standard, is the notion of ‘wellbeing’, a catch-all umbrella term intended to denote the good life (health, wealth and happiness). Behind this, though, are two less beneficent forces.

The first is the idea, of course, that wellbeing is our own responsibility: diabetic? Should have laid off the cakes.  Stressed at work? Should have attended the 8am mindfulness sessions. Lung cancer? Burn in the far reaches of hell, you nicotine-addicted satan.  This is reaching new lows in New Zealand: beyond the shaming attendant to not participating in mountain to surf fundraisers at work, there are hints that it can also be used for cultural shaming.  This article suggests that speaking te reo and doing kapa haka can help stave off dementia in Māori.  The science, of course, suggests bilingualism and exercise may be helpful, but framing it in specifically Māori contexts risks giving rise to feelings of inadequacy and, yep, irresponsibility.  Dementia? Not Māori enough.  As if people don’t have enough stresses.

One of those stresses is the precariousness of contemporary life, to borrow from Butler.  In health strategies, this is an easy tactic to win for managerial neoliberal administrations: worse, for sure, in the US right now, but still apposite in New Zealand and elsewhere, where our heightened levels of anxiety have us biking to work and hammering weights to stave off ill-health that leads to absence from work that leads to being fired that leads to reduced access to healthcare, no welfare, losing our homes, our children and, ultimately, our deaths.  It’s an easy greasy slope and anxious despair has us panicking at the top of it, in lycra and trainers, chanting and mindfully noticing how many dead bodies there are at the bottom of the slide.

None of these states of mind are conducive to suicide prevention, and yet they are the very states that public health strategies aim to foster in us.  Focusing on exercise and employment and diet and mindfulness in the pursuit of suicide reduction is a vicious cycle, and will do absolutely nothing to prevent people from taking their own lives.  What is required is a targeted programme of education delivered in appropriate contexts, responding to the particular needs of different population groups.  What is required is a sea change in the attitudes of many healthcare practitioners to the extent that, whilst they may be committed to the sanctity of life in most of their practice, there are times that people cannot see the value in their own lives.  And, more than anything, what is required is a substantive investment over the long term into the delivery of mental health care services across the board.  The last thing suicidal New Zealanders need is a billboard and a badge reminding them of the virtues of ‘wellbeing.’