A forward-thinking Levin GP says that a big chunk of what he deals with are mental health issues, and that in his experience, suicide is the tip of a distress iceberg that is growing.
Glen Colquhoun said suicidal thoughts are not an uncommon disclosure by patients at Youth One Stop Shop (YOSS), a free youth health care clinic based in Horowhenua where he works.
After digging deeper and asking questions, many have emotional, spiritual or mental health issues, often affecting their physical health as well.
"Just about everyone at some point would have considered suicide, from a fleeting thought through to planned out actions or attempts," he said.
"It's always tricky because there are some things in medicine that are black and white, it is or it isn't, it's a broken bone or it isn't."
Glen said that in his experience suicidal risk comes in waves, which also makes it difficult for him to predict.
"You have to make fine judgements. It's much more of an art than a science.
"When people are fragile around depression, sadness, anxiety, fear, or people who have been through trauma and carry horrible memories all the time, they get overwhelmed sometimes, and have a bad few hours, they can act impulsively and kill themselves," he said.
Glen said his response is to take it all seriously and to talk about it openly with the patient, to bring it out of the closest.
"It soon becomes apparent for those young people whether or not it's a fleeting thought or they think sometimes it's a way of expressing their unhappiness, they just want the sadness, the frustration or fear to stop," he said.
"Then there are those who have a strong desire to die, or very little strength left to fight that and feel like they are going to be overwhelmed."
He said it was the act of talking about it that brought about understanding to both patient and doctor.
"Talk about it, maintain contact with somebody, create plans of what to do if they get the wave going through, put small teams of connections around them, embedding them in a soft cushion so if they fall they get caught and they know what do to," he said.
"Talking is a way of putting a cushion around people."
Glen said a cushion should be a long-term thing and it's important to keep eyes on that person.
"Put cotton wool around somebody and keep it there for a long time, not for a week or three months, but a couple of years sometimes, or for longer," he said.
"Most of us survive because of our cotton wool, but we often take that cotton wool for granted. Take it way and we rapidly get unhappy."
Glen said the problem is that often people who are at risk of serious suicidal thoughts are coming from families that are disconnected.
"Not always. I wouldn't rush to that generalisation but probably most of the time they are coming from backgrounds where they are not connected and this is part of the reason they are feeling as bad as they are," he said.
"It's painstaking. We will try really hard to maintain connection with them if we think they are really at risk, then we are obliged to break confidentiality to put people around them and refer them acute to mental health services," he said.
Glen said from what he sees, suicide is the tip of the distress iceberg, but actually a lot of people are not committing suicide but are still ending up in really bad situations, entrenched in dysfunction and failed by a broken health system.
"[Suicide is the] most dramatic and distressing to our society but there are plenty who end up in the criminal justice system, or who end up with chronic drug and alcohol problems, or having children they hurt and don't support."
He said most of New Zealand society ticks along well and it's not all doom and gloom, however he sees society becoming more and more a tale of two cities.
"There is a body of dysfunction, families badly, badly broken, and in pain ... generating children [and that] pain is sewn back into them, sexual abuse, physical abuse, yelling and screaming at kids, little kids left alone to look after their brothers and sisters, party culture, kids having kids," he said.
"Intergenerational dysfunction is getting passed on, a sickness in the culture, people are part of a community of dysfunction. It's an illness in the western way of living. The culture is where the disease process lies.
"It's really hard because medicine is built on the disease being in the person, but this is a disease in society.
"People need to be loved by parents to develop or you are at risk of not growing and at risk of making poor decisions. It's a society illness and the problem with that is no one is to blame but everybody is pointing.
"Inflammation breeds inflammation. We need to deal with it painstakingly cell by cell, person by person. You get cotton wool around families and love them back - it's painstaking.
"I don't think it's really rocket science but to [heal the issue] requires lots of manpower and connections between people, within the community and within our health services," he said.
Therein lies the problem, as Glen believes that as a nation we don't have the man power, the capacity and health care services are run off their feet, which Glen talks about in Friday's Horowhenua Chronicle.
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