Warning: This article is about youth suicide and may be distressing for some readers.
Former chief coroner Neil MacLean says breaking the silence on suicide could curb the "horrifying" number of young New Zealanders killing themselves.
"This is a drum I've been beating for a long time. We cannot ignore the sheer numbers and rate - it's bigger than the road toll," said MacLean, who retired from the post in 2015.
New Zealand has the worst teen suicide rate (officially those aged 15-19) in the world and the second worst youth suicide rate (25 and under). Our annual number of deaths has shown no signs of abating in the past 20 years.
• Listen: Former chief coroner Neil MacLean talks to Newstalk ZB about suicide
In a special series called Break the Silence, the New Zealand Herald is aiming to bring youth suicide out of the shadows. MacLean has been one of the country's biggest crusaders in this area and said suicide was one of the most difficult issues he faced during his almost 40 years as a coroner.
"Any unexpected death is going to produce a different type of grief, but with a suicide, particularly as it gets younger, there's a new intensity of grief," he said. The youngest suicide MacLean was aware of in New Zealand was that of an 8-year-old boy.
"There's a feeling of waste, blame and anger. Everybody struggles to understand why it is when, generally the will to live is so strong, that a significant proportion of people get to the end where there is no option."
Misunderstanding breeds fear. "It's almost as if there's a fear suicide is something you can catch, almost like an infection, and that if you stomp it out or ignore it, it will go away.
Some think it's best to bury our head in the sand. Not me," MacLean told the Herald.
During his time as chief coroner, MacLean controversially kickstarted the release of New Zealand's annual provisional suicide statistics, allowing the public to see the number of suspected suicides for the first time.
Silence on suicide has been orthodox in New Zealand since the mid-1990s, largely because of a school of thought that talking about the issue could lead to suicidal ideation, copycat deaths or suicide contagion.
MacLean received swift criticism for releasing the statistics at the time, but stands by his decision.
"If people know what's going on there is a better chance to do something about it. Like start talking about what we can do to help these kids."
As part of the Herald's Break the Silence series, we will be publishing a number of first-person pieces from academics and experts. Today, Neil MacLean shares his view. In his own words:
"Being asked if I would provide some thoughts on the commendable exploration and discussion by this newspaper into youth suicide gives me cause to reflect, in retirement, on the many apparently self-inflicted deaths I investigated as a coroner in Canterbury in the last three decades of the last century and eight years as chief coroner between 2007 and 2015.
"I don't think our general approach of curbing discussion for fear of bad consequences can be justified. For that reason I am supportive of the concept of breaking the silence and people like Mike King and others who are urging the demystification of this topic and facing up to what is really happening.
"I am supportive of the initiative of this newspaper in running this current discussion. For too long it has been regarded as a taboo topic.
"Not all self-inflicted deaths will be determined by a coroner to be suicide. Suicide has a legal meaning in most jurisdictions derived from the English Common Law. Essentially; suicide means 'self-murder' and requires proof of the deliberate taking of one's own life.
"It was, until relatively recently, a crime and involved consideration not only of the fatal act (i.e. was it solely the act of the person who died) but also the question of intent, namely whether it was done with 'felonious intent' and not the product of mental illness or accident.
"The consequences were severe if it was the former, including forfeiture of property of the deceased and not allowing the body to be buried in consecrated ground. Because of that outcome it became the rule that to be a suicide there must be no room for doubt, and that there was the necessary conscious, voluntary, intent, and only if no other reasonable possibility existed, could a coroner make a finding of suicide.
"The ramifications of that have lingered on. For example, the Accident Compensation Act provides that no entitlements arise as a result of a self-inflicted personal injury or suicide unless from a covered mental injury.
"These issues become especially problematic when the person dying is young. Agonising difficulties can arise for a coroner, or the ACC, when a young person, possibly affected by depression, or other impairment, is found to have done what to an objective outsider, might appear stupid, hazardous or without a rational reason.
"The often impulsive reaction of a person as young as 8 through to perhaps 25 when subjected to disciplinary action, real or imagined, slight, or bullying is something that coroners see from time to time.
"Applying the legal test of whether the actions that have been taken with the deliberate intent and awareness of the likelihood of death becomes more problematic the younger the age.
"Suicide is not just an issue for youth. It covers the spectrum, rich, poor ethnicity, employment and age. However, there is an additional poignancy about youth suicide, a sense of terrible waste and lost opportunity.
"Adults who are involved in the aftermath investigation are usually unaware, or have largely forgotten what it is like to be young.
"The youthful brain has yet to fully develop, and while capable of astonishing feats of intelligence and perception, often struggles to process what experience hopefully gives us, i.e. an ability to accept the rough times will pass, and to learn and cope with life's vicissitudes.
"Despite the alarms from time to time, coupled with the reality that the New Zealand statistics indicate our youth suicide rate is high in comparison with other compatible jurisdictions, it is still quite rare and the vast majority of young people do not kill themselves.
"We need to treat comparisons of suicide rates with other countries with some caution. We have an efficient coronial, Police and pathology-supported system which seriously investigates any violent or unnatural death, so our figures are robust, whereas in other jurisdictions there is not necessarily the same independent objective investigation. This raises questions of understating because of cultural, religious or other community attitudes.
"This is an area rife with misunderstanding and rumours. That was one reason why, in my time as chief coroner I started releasing up-to-date provisional figures and an early warning system to inform the Ministry of Health promptly of any suspected suicides.
"That was in response to an approach from concerned frontline representatives in Auckland and Northland who were troubled by misleading anecdotal reports of suicide by young people, which meant that when a real cluster occurred that was often lost in the confusing and misleading 'noise'.
"It became apparent to me and many other coroners that there was an urgent need to appraise the public of the reality. There was, at the time, a lot of criticism and warnings of dire consequences which have not been borne out.
"Youth suicide is not something new. Professor John Weaver of McMaster University, in his seminal book Sorrows of a Century, noted that while mental illness (in particular depression) was a leading motive for young adults, there were many other factors.
"They included stress, anxiety, low self-esteem and what he described as, 'the hazardous lifestyles of marginalised youth'. He also noted family dysfunction, the sexual revolution and a faltering economy as some of the other complex causal factors.
"The reality is, that although there are various theories of sociologists, psychologists and other disciplines, we are no closer to understanding why it is when the substantial majority of the population, including youth, do not commit suicide, and life is seen as precious, a small minority do not see life as precious.
"Despite my long experience in this area, neither do I. However, one thing I am very clear on through contact with thousands of New Zealanders, whether at inquests, lectures, talks, seminars or the like, is that our understanding in this area is still plagued with misinformation, and reluctance in some circles to open up the discussion and to face the reality of this puzzling phenomenon.
"I know from personal experience, most people want more information, particularly when someone they know is involved. What are the signs to look out for and how can they help?
"There are some encouraging signs of a willingness to open up the whole area of self-harming and self-inflicted death in New Zealand. I believe that done properly, such discussion can be beneficial and that to dismiss such discussion as dangerous and unwise is not helpful."
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757