Health promotion plan

Suicide is defined by the World Health Organization as the act of deliberately killing oneself. It affects individuals most frequently among those aged 15-44 years. Risk factors include undiagnosed and untreated depression, alcohol or substance abuse, family history, previous suicide attempt. Another major risk factor psychologists have recognised for some time that a person’s occupation shows a significant role. Suicide rates have tended to be remarkably high in professions that provide easy access to lethal drugs and poisons among medical practitioners, guns or open water, such as in military, farming and maritime careers. Worldwide, approximately one million die by suicide each year this is based on the data from the World Health Organization. This corresponds to one death by suicide every 40 seconds. In New Zealand, every year approximately 500 New Zealanders die by suicide; more than the number who die in road traffic crashes. Five times as many people will be hospitalised after making an attempt on their life (Ministry of Health in press).

While suicide disproportionally affects young adults, approximately 80 percent of suicides now occur in the 25 years and over age group (Beautrais et al 2005). Those who live in the most deprived areas of New Zealand have higher rates of suicide and hospitalisation for suicide attempts than those living in the least deprived areas. There are also gender disparities, with more males dying by suicide than females, yet more females are hospitalised for suicide attempts than males (Ministry of Health in press). Another high risk group are the professionals, wherein physicians are among the top suicidal. There are several studies recommended that physicians have a higher rate of attempting and committing suicide. In general population, the overall prevalence of suicide is 1-2%; however, in physicians this rate can be as high as 2- 4%. Among the top 5 professions where most likely to kill themselves are physicians, dentists, veterinarians, chiropractors and finance workers. (New Health Guide Org).

All suicidal behaviours, regardless of medical severity, are indications of severe emotional distress, unhappiness and/or mental illness (Beautrais et al 2005). Moreover, every suicidal behaviour can have a huge impact on others. Like in New Zealand, since it is a small country the suicide of just one person can have a long lasting and profound outcome on their family/whänau, friends and the whole community. For Mäori, the grief and impact is often felt beyond the whänau to the hapü and iwi, viewed not only as a tragedy, but also as a loss to the continuation of whakapapa which is the founding stone of hapü and iwi. Professionals are vital in a nation’s economic growth and their occupational activities are usually source of personal development, however it has been perceived that certain occupations are associated with a fairly high rate of suicide due to emotional and psychological stressors and too much job pressure.

According to research conducted by the National Institute of Occupational Safety and Health (NIOSH) in 1995, which concluded that there is a higher suicide rate in the medical field due to easy access to drugs and poisonous substances. Medical and nursing students’ educational overload may cause distress as well, while the things that may help include doing physical exercises, getting help from nursing assignment writers or seeking a psychologist’s assistance. In the other hand, financial advisors are often depressed because of so much responsibility for other people’s finances. And when their clients are losing money because of bad investment they become guilty, then people starts to threaten and scream at them which made them depressed and will lead to suicide. Another risk factors that was linked to suicide among professionals was due to the changing nature of work (Benach et al 1999). During labour market changed, some are losing their jobs for life and they’ll start again from the beginning, and some have to work more than one job to gain sufficient income to live.

Apart from that, for those with jobs of any kind will be expected to work tougher, more competently and for longer hours. Those changes in nature of work and the labour market environment have been shown to have detrimental effect on the person’s mental health. Inequalities in health is one of the major problem here in New Zealand. The first health inequality is the ethnic identity wherein suicide rates are usually high among young men, Māori, and those living in depressed areas. In addition, younger people and those with lower income, or education or living in more deprived areas have high prevalence of mental disorder.

Another health inequality is an unequal distribution of social determinants such as income, housing conditions, and employment. New Zealand’s suicide rates reflect patterns of inequalities in the broader determinants of health, such as socioeconomic status, ethnicity, gender, age and geographical region. Despite all the health inequalities that ascended and the alarming suicide rates, the primary health workers such as social workers, community nurses, MD’s, volunteers and specialists work hand in hand to reduce inequalities in suicide and suicidal behaviour. Midstream level, through media the government is able to promote their work and raise awareness of mental health and wellbeing. There is Mental Health Awareness Week every October wherein they provide seminars with spokespersons for interview who are specialist on field of mental health as well as people with experience of mental illness. There are also websites that talks all about suicide such as www.spinz.org.nz where you can see depression helpline that is working 24 hours.

For emergency cases, you can also phone 111 if you feel you or someone else is at risk of harm. Brochures and pamphlets are also spreading around the city especially in clinics and hospitals. With all these media promotion the government also make sure that there is safe reporting and portrayal of suicidal behaviour through monitoring media coverage and providing up to date information about suicide. For the upstream level, the government created and implemented the New Zealand Public Health and Disability Act 2000 to address the health inequalities as a whole. In addition, New Zealand Suicide Prevention Strategy 2006–2016 (the Strategy) was also created that will serve as a guide for suicide prevention. It provides a framework for prevention efforts over the next 10 years. This is to reduce the rate of suicidal behaviour and its effects on the lives of New Zealanders, while taking into account that suicide affects certain groups more than others.

To support this plan the government has committed $25 million dollar over four years to implement the action plan. Moreover, one of its seven goals of this strategy focuses on mental health promotion to prevent mental health problems Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. (Ottawa Charter, 1986). In connection with this, as a health promoter my aim is to help reduce the rate of suicide here in New Zealand by increasing awareness among people and educating them all about suicide.

The best method to use is the Holistic Approach Model. According to this model in order to attain healthy wellbeing a clinician would focus on all aspects of person’s life. Educating the target population is the first step of this concept. Mental Health education increase person’s knowledge and skills towards health. It hopes to encourage them with whatever interests they may have in improving their living conditions. Moreover, its purpose is to develop in them a sense of responsibility for health conditions for themselves. The best and easy way to educate people through creating awareness in spreading information through brochure/pamphlet regarding suicide to be distributed not only to my target population but also to the whole community. Suicide among professionals is a topic that is not usually given attention here in New Zealand.

Most of the brochures are talking about suicide in general. And as a professional too, I want to give importance and emphasis to that because majority of the professionals who are suffering in depression and mental disorder are very discreet and usually they keep it to themselves. My brochure is entitled Suicide among Professionals: Struggling in Silence. It contains statistics of suicide here in New Zealand, risk factors focusing among professionals, signs and symptoms, interventions, common misconceptions and hotlines/helplines numbers. This will be placed in different workplaces and given to the counselling department of each company so that during their meeting or general assembly this matter maybe tackled. Another way is to distribute at the health centres of each community through that people may see it every time they visit the clinic and they can readily talk to their MD’s if they have concerns. After educating the client, the next step is to change their behaviour or attitude.

However, changing one’s attitude or behaviour is never an easy task. One should go through a process which may take months or even years which may prove successful or otherwise. Our role is to present options in order for people to have more choices that will have positive outcome. Also to encourage them to seek professional advice when they feel down or depressed instead of just keeping it to themselves. The next step is working hand in hand with the client. This is very crucial step because as we all know in our society there is a powerful stigma attached to mental illness. To communicate with them it is important to be respectful and not to judge them. Since my target population are the professionals it best to talk with them personally and face to face in order to build rapport and to show with them that you can be trusted.

In that way, they will be able to share their true feelings and emotions with you. Giving them the right ways how to manage depression to avoid suicide. Another point is to work with the whole community in order to reduce the stigma of mental illness, social inequality, violence, discrimination and abuse. Another dimension of Holistic approach is treating the symptoms and improve the care of people who make non-fatal suicide attempts. This step includes easy access to healthcare professionals, free medications and counselling. Furthermore, improving the care of those who make suicide attempts will involve doctors, families/whänau and community agencies, including hapü, iwi and Mäori providers, creating and evaluating more effective methods of after-care and support. Lastly, environment plays an important role in mental health.

This is the overall guiding principle for the world, nations, regions and communities alike, is the need to encourage mutual maintenance- to take care of other, our communities and our natural environment. (Ottawa Charter for Health Promotion). In line with this, it is important to assess the environment of the client whether they have a support system to assist and help them. Among professionals, the aim is to reduce access to the means of suicide. In New Zealand the introduction of the amendment to the Arms Act in 1992 was associated with a dramatic reduction in firearm-related suicides. Hospitals and other related institutions should also impose strict compliance to its drugs regulations and policies to reduce access amongst its workers to lethal drugs and poisonous substances.

People from different races and ethnicity may have different ways and beliefs in handling stress. In order to serve their needs it is important to consider also the cultural factors. According to research analysis revealed occupational stress experiences related to organisational constraints, responsibility overload and interpersonal conflict were common to all staff, however that experiences of institutional racism and a lack of cultural safety were unique to Māori. Therefore, before dealing with Maori or any other race for that matter, one should know the ins and outs of that particular culture. Many things should be taken into consideration like close family ties, coping mechanisms and cultural practices. In conclusion, suicide rates here in New Zealand is very alarming, more and more New Zealanders are becoming depressed as the time goes by.

Occupational activities also imposed a great risk for suicide among professionals. Health inequalities also exist wherein there is unequal distribution of health determinants such as income, housing, and employment. With all these statistics and facts, we cannot just simply dismiss this kind of problem. The best way to deal this problem is by approaching the problem holistically that focuses on the physical, mental, emotional and spiritual wellbeing of individuals, families and communities. In order to know if the said health promotion program is effective, several evaluation assessments will be done. This includes decrease in suicide morbidity and mortality rate in New Zealand, more people are participating during seminars about mental health/suicide, change in behaviour of the people in the community, and more professionals are seeking treatment whenever they feel down or depressed. Through organized efforts of the whole community we will be able to make a difference and even save a life.

References:
http://www.spinz.org.nz/file/downloads/pdf/file_188.pdf
http://www.apa.org/monitor/jan01/suicide.aspx
http://www.newhealthguide.org/Highest-Suicide-Rate-By-Profession.html http://www.iasp.info/wspd/pdf/2012_wspd_facts_and_figures.pdf http://www.phac-aspc.gc.ca/ph-sp/docs/charter-chartre/pdf/charter.pdf www.health.govt.nz/system/files/…/suicidetrendsandsocialfactors.doc http://www.nzma.org.nz/sites/all/files/Marmot_factsheets.pdf http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949986/

http://www.mentalhelp.net/poc/view_doc.php?id=9730&cn=353
http://www.mentalhealth.org.nz/page/33-Welcome
http://www.health.govt.nz/publication/new-zealand-suicide-prevention-action-plan-2013-2016 https://knowledgex.camh.net/amhspecialists/promotion/Pages/mental_health_promotion.aspx