Warning: This article is about youth suicide and may be distressing for some readers.
For the past five weeks, the New Zealand Herald has run a special series called Break the Silence. The series has analysed why we have the highest teen suicide rate in the developed world and the second highest youth (25 and under) rate.
It has also explored the history of why silence on suicide has been orthodox in New Zealand since the mid-1990s, the different ways the issue has been handled in classrooms and how thousands of distressed children are turned down by specialist mental health services each year.
During our coverage - and while we were researching this series - we have been approached by dozens of advocates, experts, academics, grieving family members and people who have suffered from suicidal ideation who have raised more than 50 potential solutions to reduce our youth suicide rate. We have chosen 10 to highlight, five today and five tomorrow.
• A national target:
An expert panel established to advise the Ministry of Health on ways to reduce our overall suicide rate suggested adopting a national target to lower suicide by 20 per cent over 10 years.
The target was dropped by the ministry in late February over fears of the government being held accountable if the target was not met. That resulted in prominent campaigner Mike King stepping down from the panel.
Since then, a dozen parents who lost children to suicide have made a united call for the target to be implemented.
Late last month, Auckland hosted a zero suicide prevention forum where international experts told 100 mental health advocates how an ambitious national target could change the culture of a society and galvanise the public.
In an interview with the Herald, Health Minister Dr Jonathan Coleman said he had asked his officials to reconsider the possibility of a national target and noted the option was not off the table.
But he said it would need to be a whole-of-society target not just a Government target. "We are all responsible for getting the rate down," Coleman said.
• Mental health screening for kids:
Before a child leaves pre-school they should be screened for their mental health and emotional well-being, says Sir Peter Gluckman, chief science adviser to the Prime Minister.
Every child should be screened to see how they interact with other children and how they respond to adults so concerns can be addressed as early as possible.
Gluckman wants a child's emotional competence to be considered as important as their cognitive competence in early childhood education programmes.
Emma Harford, who lost her 15-year-old son Cole to suicide a year ago and has shared her grief via an online blog, is also urging health leaders to introduce health screening surveys for teens - similar to a Plunket check.
The potential to screen New Zealand youth for mental health issues is being investigated by Gluckman and the chief science adviser for the Ministry of Education, Stuart McNaughton.
"We are working on a report to the incoming government on these particular issues," Gluckman said.
• Develop e-therapy
Many experts believe the best way to connect with the youth of today is online. This means the role of 24/7 helplines for those in crisis needs to change and adapt in order to keep up with the digital revolution.
The National Telehealth Service, which runs various helplines on behalf of the Ministry of Health, is working towards delivering care and support to youth through Facebook, Instagram and other social media platforms.
"For me, it's about moving beyond the helplines," said Andrew Slater, chief executive of the National Telehealth Service. "The thing that keeps me awake at night is wondering how we are communicating with our youth on Facebook and online chat."
Young people are more likely to connect online or send a text message than call if they are in crisis, he said.
"At the moment we have about 20,000 young people engaged in our e-therapy talks. This is a critical toolkit to change mental health outcomes, particularly for young people," Slater said.
• Reduce access to alcohol
Half of the young people who die by suicide in New Zealand have alcohol in their bloodstream.
The alcohol likely disinhibited them and made them make more rash decisions than they otherwise would have, said Gluckman.
Making it harder for youth to access alcohol by raising the drinking age could result in a significant reduction in youth suicide and self-harm issues, according to advocates from the mental health and education sectors across New Zealand.
More than a quarter of Kiwi drinkers aged 15-17 say they downed eight or more drinks the last time they touched alcohol, according to data released by the Health Promotion Agency in 2016.
The Crown entity analysed the consumption habits of 4005 youths "during their last drinking occasion" and found more than half were classed as consuming alcohol at a "risky level" - with 28 per cent reporting 5-7 drinks and 27 per cent saying they drank eight or more.
Gluckman suggested introducing a national target on reducing youth access to alcohol could in turn help to reduce our suicide rates.
• Build resilience in children
Gluckman, Coleman and Education Minister Nikki Kaye have all told the Herald we need to work towards building resilience in younger Kiwi kids.
Gluckman suggested the way to do this would be embedding well-structured behaviour exercises into the ordinary classroom environment of primary schools to focus on social skills development and improve children's self-control and emotional control.
These exercises, or games, should be started in pre-school or from the age of 5 and rolled out in all primary schools across the country, he said.
"All the evidence from overseas is that these early childhood programmes are really important. We've seen data from overseas that these can impact into teen years and are said to reduce the rates of teenage suicide."
The structured exercises, often called good behaviour games, can be run by effectively trained teachers.
This relatively simple solution would need buy-in from the education sector, but could be implemented within a few months, Gluckman said.
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