Transcript Slide 1

Supporting Families in Mental Illness NZ
Friday 31 October 2014 - Wellington
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Statistics
Role of the Coroner
Overview of suicides in NZ
Historical perspective
Making a finding of suicide
o Evidence
o Intent
Mental health
Suicide prevention and postvention
Reporting on suicide
Amendments to Coroners Act 2006
Year (June-July)
Number
2007-08
540
2008-09
531
2009-10
541
2010-11
558
2011-12
547
2012-13
541
2013-14
529*
* Lowest number by 2 since 2007-08 year
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Specialist Judge
Legal responsibility to investigate
certain deaths
Receives reports of sudden,
unexplained deaths and deaths in
special circumstances
Makes findings as to cause and
circumstances of death
Makes recommendations to prevent
deaths in similar circumstances
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All suicides must be reported to the Coroner
Coroner must open an inquiry into self-inflicted
deaths
Majority of suicide findings now made ‘on the papers’
Suicide is the largest class of death by external
causes seen by Coroners (roughly 540 deaths
annually)
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Historical role of determining if a death is a
suicide
Finding of suicide had significant social and
property ramifications
Historically function of Coroner was on
protecting the pecuniary interests of the
Crown
Social stigma attached to suicide (continues
to some extent today)
‘The Death of Socrates’
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Coroner must be satisfied that
death was self-inflicted with
intention of taking one’s own life
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Ordinarily a ‘balance of
probabilities standard’ however to
make a finding of suicide need
greater cogency of evidence
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Suicide must never be presumed
Police act as Coroner’s agents at scene
• Witness statements
o Behaviour and state of mind of deceased
• Detailed scene examination
• Cell-phone and computer records
Coronial Services Unit seeks further info
• DHBs contacted to see if any contacted with MH
services
• Reports from GPs and other health professionals
• Other inquiries may also be made
Drawing reasonable inferences from established facts
• Notes or messages left behind
• Scene examinations
• Contextual background (eg. emotional upheavals or
stress)
• Clinical/psychological history
An open finding may be made where suicidal
intention can not be established
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Research suggests mental disorders a factor in up to
70% of suicides and suicide attempts
Risk of ‘medicalising’ suicide?
Suicide multi-factorial and social factors relevant
Not uncommon for MH services to become focus of a
Coroner’s inquiry
Mandatory inquests must be held if the person was a
‘patient’ as defined in Mental Health Act
Mental health professionals often requested to
provide information and give evidence at inquest
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Extent to which Mental Health Act was invoked
Should/could suicidal behaviour have been
predicted?
Sharing of information with family and whanau
regarding the deceased’s risk of suicide
Continuity of care issues (particularly interrelationship between crisis and community teams)
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Coroners look at individual cases
Not well equipped to identify and comment on
patterns and trends associated with suicide as a
whole
Recommendations will be based on particular
circumstances of a case:
o Fencing a known suicide spot
o Specific policies of a certain MH service
o Restricting access to suicide methods
o Encourage people to seek assistance if someone
expresses suicidal thoughts or threats to them
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Immediate information-sharing about suicides
between Coronial Services and DHBs through
CASA.
Aim is to stop the spread of suicide “contagion”.
Allows DHB Traumatic Incident teams to be present
when schools open the next morning (though
postvention not solely focused on youth suicide).
Recently formalised through MoU – secure email
process to share the highly sensitive information.
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Effective and prompt postvention can be effective
prevention
Circle of persons touched by suicide particularly
youth or school
As this develops – ability to get quicker and more
accurate background to connections with other
suicides
Provides better understanding of causative factors
in the lead up to suicide
Sometimes this info no easily discovered by Police
Proponents of media restrictions
• Point to international evidence that supports
concern that media portrayal of suicide may
precipitate suicidal behaviour
• No evidence that media publicity as form of
education does any good
Opponents of media restrictions
• Concerned with restrictions on freedom of
expression
• Advocate public interest in knowing extent of
problem in NZ
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Reporting restrictions in Coroners Act – particulars
of suicides cannot be reported without a coroner’s
authority
Coroner can only give authority if making
particulars public is “unlikely to be detrimental to
public safety”
‘Making public’ defined in Act
Concern of ‘copy cat’ suicides, a contagion effect,
or normalising suicide
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Reporting restrictions apply only to individual cases
Guidelines of suicide and media reporting
Restrictions apply both prior to a finding of suicide,
and after a finding is made
Once finding is made only details that can be
published are:
o Name
o Address
o Occupation
o Fact that Coroner found death to be self-inflicted
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Law does not cover reporting of suicides occurring
outside NZ (eg. high profile celebs)
NZ has some of most restrictive provisions re.
publication of suicide, yet one of highest youth
suicide rates in OECD
Difficulties enforcing breaches of the law, even
where law deliberately flouted
Social media an unstoppable force and is largely
untouchable by these laws
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To an extent s 71 acts as a deterrent to mainstream
media
Risk that restrictions may be muting appropriate
discussion as well
Encouraging appropriate discussion could
potentially model the way young people deal with
subject on social media
A possible way forward – encouraging development
of robust media guidelines to encourage and
educate responsible reporting?
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Coroners must determine whether allowing
publication is ‘unlikely to be detrimental to public
safety’
o No legislative or internal guidance
o Expert advice sometimes sought
o Countervailing public interests also to be taken into
account (ie. public interest in deaths occurring in
institutional setting)
o Also strong privacy interests at stake
View of Chief Coroner: if Coroner is satisfied that
public good may come from permitting publication,
that may outweigh any detriment to public safety
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Restriction on reporting method
(and place if suggestive of
method).
Chief Coroner to have ability to
grant exemption if satisfied risk of
copycat behaviour is small and
outweighed by the public interest.
Media may use the term
“suspected suicide” before a
coroner makes a finding if the
facts support that term.
Law Commission – Suicide Reporting
• Govt has announced they have agreed to all the
recommendations made by the Commission
• Media will be able to report a suicide or a
suspected suicide has occurred – but won’t be
able to name method or infer method
• Coroners could allow these details to be reported
on case by case basis
• Changes will be included in Coroners
Amendment forthcoming this year…