Introduction
Suicide, intentional self-harm, and suicidal thinking form a wide spectrum of treatable thought patterns and behaviours. Together suicide and intentional self-harm are often known as “suicidal behaviours” and can be emotionally confronting. Intentional self-harm commonly presents as an event, such as taking an overdose of prescribed tablets or deliberate cutting of the skin. However, it is usually part of an ongoing story with themes that may include past abuse, relationship conflicts, employment difficulties, personal illness and especially mental illness, bereavement, and substance misuse. Intentional self-harm behaviours are usually associated with suicidal thinking or intent of varying frequency, intensity, and chronicity.
Self-harming behaviours are widely stigmatised. The national identities of both Australia and New Zealand (NZ) include notions that they are healthy and peaceful societies with fewer apparent reasons for despondency than in many other parts of the world. Yet suicidal behaviours are significant problems in both jurisdictions. The topic is a highly emotional subject for many people, reacted to on the basis of simple moral precepts regarding self-conduct and personal responsibility.
In Australia, about 2500 people die by suicide each year, around 1.7% of all deaths, with an age-standardised rate of 11/100 000 in 2012 (Australian Bureau of Statistics [ABS], 2010). It is the leading single cause of death from age 15–34 years, in 2013 accounting for over one-quarter of all deaths in that age band, and similarly for those aged 35–44 years, accounting for almost 16% of all deaths (ABS, 2015).
In NZ, each year more than 500 people die by suicide, with an age-standardised rate of 12.2/100 000 in 2012, the most recent year for which official figures are available (Statistics New Zealand, 2016). Suicide deaths in NZ peaked in 1998, with 577 deaths (age-standardised rate of 15.1/100 000; Statistics New Zealand, 2016). In 2012, young adults aged 15–24 years had the highest suicide rates, with males significantly more likely to die by suicide than females (Ministry of Health NZ, 2015a, 2015b).
Suicide is a topic of great societal concern. Often the deaths themselves are difficult to understand. Every suicide death has significant emotional impacts on friends, family, health professionals, and witnesses, often for many years. While the effects of suicide can be great, it is actually a statistically rare event.