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Suicide, not just a mental health issue

Lanieta Matanatabu
Thursday, December 20, 2012

The most tragic manifestation of poor mental health in Fiji is the high, and rising, suicide rate.

Studies have identified Fiji as having a rising rate of suicide relative to global statistics (Booth, 1999; Pridmore, Lawler A., & Couper, 1996; Waqanivalu, 2005).

In the WHO's latest list of countries with the highest rates of suicide, they listed Lithuania as the country with the highest rate — at an average of 31.6 suicides per 100,000 people.

The rates in Fiji appear to be much higher in the high risk communities.

One study found the standardised suicide rate for Fijian Indians to be 34 per 100,000, rising to 57 for those between 15 and 24 years old (Booth, 1999).

In 2007 (the year for which the most recent population statistics compiled by the government of Fiji are available) there were 59 suicides and 109 attempts in a total population of just over 837,000 (Fiji Bureau of Statistics, 2009a).

In 2008 Fiji reported an increase to a total of 102 suicides and 116 attempted suicides for that year.

The global rates average 14.5 per hundred thousand, which indicates that Fiji's young indo-Fijian population are at least 3-4 times more likely to kill themselves than the global average, and almost twice as high as the country rated by WHO as having the highest suicide rates in the world.

Suicide in Fiji cannot be seen as entirely a mental health issue (Forster et al, 2007). It has broader socio-economic and ethic implications.

What is clear however is that suicide is a very significant public health issue in Fiji. It has profound impact on community, family and individual resilience.

Given that the highest rates of suicide are amongst young educated Fijians, it also has a potential impact on the socioeconomic productivity and strength of communities and families.

Published research on Empower Pacific suicide data over a one year period (2010) and found that those in the attempted suicide group were more likely to be non-Indigenous, Fijian race, male, younger age, unmarried and to have higher education.

The most predominant triggers identified by those attempting suicide were: loss, including interpersonal, identity and financial as well as family instability.

Over half of the people who had attempted suicide in this sample acknowledged having low self-control, which was consistent across age, race and gender.

Over 10 per cent acknowledged a previous attempt.

There is clear evidence that people who have attempted previously should be considered to have a higher and more chronic risk of suicide (Joiner, Walker, Rudd, & Jobes, 1999).

This means that intervention at the point of an attempted suicide is critical for preventing future attempts and the increasing likelihood of suicide completion (death).

Henson et al (2012) cited evidence that there are consistencies between the warning signs of suicide in Fiji and those elsewhere in the world, and stated that warning signs are the most reliable indicator of further suicide attempts and completion.

Henson et al (2012) went on to compare suicide clients and control group clients to determine the effectiveness of the Empower Pacific model of suicide intervention, and established that there were significant differences in the presence of warning signs between the beginning and end of counselling by Empower Pacific staff.

This is a very positive indication that the work that Empower Pacific does to prevent suicide with people who have previous made an attempt is effective.

Suicide rates in Fiji are on the rise and cannot be ignored if community resilience is to be achieved.

The Ministry of Health National Suicide Prevention Policy (2008-2013) specifically acknowledges the work provided by Empower Pacific (then PCSS) as the only provider of counselling services for suicide.

No other organisation or agency in Fiji is as well equipped or experienced in addressing this issue as Empower Pacific.

Ministry of Health Suicide Prevention Policy points out that: "The best response to the issue of suicide is a community-based response" and goes on to say that "Throughout community consultations it was agreed that an effective response required close collaboration between government agencies and the community including NGO's...".

The policy further recommends the "need for a greater number of trained counsellors and psychologists in Fiji".

Ministry of Health do not have the resources to effectively address the issue.

NCOPS (National Council on the Prevention of Suicide) have repeatedly raised concerns about the low rates of reporting of suicide attempts between Police and DSW, and have had to rely on Empower Pacific to gather official data for suicide mapping in Fiji.

We have been working with suicidal clients since 1994, and currently all people who are admitted to hospital for attempted suicide are referred to Empower Pacific.

During 2011 PCSS attended to 156 clients who were referred after having attempted suicide.

Demographic variables differed slightly in some districts, but the majority of clients who were suicidal were Indo-Fijian (80 per cent), female (62.7 per cent) and young; with 61.8 per cent under 25 years old and 1.7 per cent below age 15.

All clients reported affiliation with one of the three main religions in Fiji; 48.3 per cent Hindu, 33.9 per cent Christian, and 17 per cent Muslim.

Level of education tended to be high with the majority reporting either secondary (47.5 per cent) or tertiary education (36.4 per cent), and less than one per cent reporting little or no education.

The income level of client attempting suicide was lower than the overall sample of general counselling clients.

Most (66.1 per cent) clients reported incomes below $200 per week, 42.4 per cent reported incomes below $100 and 26.3 per cent indicated their weekly income was below $50. Nearly half (48.3 per cent) were married.

The method of attempted suicide was identified in most of the cases using ICD 10 criteria. Self poisoning of one type of another was by far the most common method identified, at 67 per cent, being largely biological substances, pesticides, unspecified chemicals, solvents and over-the-counter or prescription drugs.

Attempted suicide was most often related to a trigger of interpersonal loss (78 per cent), but was also linked in some cases with family conflict or instability (26.3 per cent), loss of personal identity (20.3 per cent), significant financial loss (12.7 per cent), and acute or chronic health problems (5.9 per cent).

The suicidal behavior was associated with alcohol use in 9.3 per cent of cases, and with drug use in 5.9 per cent.

Empower Pacific counsellors conduct one month follow up interviews with all suicidal clients and the results show unequivocally strong evidence for the efficacy of the counselling provided. Example outcomes from 2012 include :

At initial assessment 23 per cent rated themselves as higher than 5 out of 10 for level of current suicidal intent (18 per cent rated themselves at a 9 or 10 out of 10).

At the post counselling follow up, not one client indicated that they still had any level of intention to attempt suicide.

At the point of assessment, 32 per cent of clients rated themselves 5 or higher out of 10 for having a "sense of hopelessness", with 14 per cent rating themselves at a 9 or 10 out of 10. At post counselling follow up not one client assessed indicated that they were feeling any level of hopelessness (0 per cent).

At the point of counselling intake 34 per cent indicated that family instability was a contributing stressor.

At the post counselling follow up only 2.4 per cent indicated that they were experiencing family instability; 78.5 per cent indicated that they had experienced a significant relationship/interpersonal loss prior to their suicide attempt, whereas only 5 per cent indicated that they were still experiencing interpersonal relationship related issues at the one month post counselling follow up.

These results are a small selection of a range of evidence that is available to support the profound impact that Empower Pacific counselling services have in preventing further suicide attempts, and death from suicide.

nLanieta Matanatabu is a staff of the

Research Department at Empower Pacific.

For further information, contact Ms. Rhianon Vichta (Chief Executive Officer) on 6650 482 or

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