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We believe it is through mutual connection that we will weather the storms of life,
crafting wisdom and beauty along the way, that will benefit not only ourselves and
each other, but also the broader community.
About Thriving Madly
Thriving Madly is a charitable trust that aims to journey as and alongside Mad,
Divergent and Neurodivergent people, families and communities to improve our
status as citizens of Aotearoa New Zealand. Our focus is community transformation
through connection. We share our unique worldviews, wisdom, skills and creativity,
to provide opportunities for the community to understand us and our experiences
better. We also aim to increase connections and participation opportunities within
the community by growing spaces that are comfortable, accessible, and welcoming
of our diversity.
There are many ways that people who have a lived experience of mental distress can
identify. Thriving Madly uses the identity of Mad as a way of honouring the people
who have been involved in the Mad Movement, both here in Aotearoa and
internationally. This movement brought about changes to how people who are
identified as experiencing ‘mental illness’ have been treated within our community
and also within the services contracted to ‘care’ for them, many of which we have
benefited from.
“People who want to die are the canaries in the coalmine, they
will tell us what is wrong with society - the events in our
communities and in our worlds - we need to be able to listen”
“It’s about lives worth living, determined by people, realised
together”
Consultation questions:
1. Do you agree with the proposed actions for health and cross-government
agencies? How could these actions be improved? Please include the reasons for
your answer.
A. We have given specific feedback on the proposed actions for health and
cross-government agencies below. Our feedback is based on our lived
experience including navigating suicidal distress, suicide attempts,
using/refusing/being unable to access crisis services, and of suicide
bereavement.
2. What other actions do you think could be included for government
agencies to consider? Please include the reasons for your suggestions
A. We consider the cross-government actions to be insufficient and missing an
important focus on addressing the social and economic determinants of
suicide.
While health and cross-government actions are important, community
actions are even more important and are also largely missing from the plan.
Adequate resourcing is needed for all actions and we consider $18m vote
health funding to be inadequate to truly achieve aims of zero suicide and
lives worth living for all people in Aotearoa.
We do not agree with the structure of the plan under four action areas,
particularly as it obfuscates the work undertaken voluntarily by communities
and formal supports and workforces.
We also advocate a specific action area to address the significant inequities
faced by mental health service users/psychiatric survivors/people who
experience enduring distress. As such, we want to see the plan amended into
the following structure:
- Improve access to suicide prevention and postvention supports
- Grow a capable and confident suicide prevention and postvention
workforce
- Grow community and whanau capacity for mutual support
- Strengthen the focus on prevention and early intervention
- Reduce suicide and attempted suicide rates of mental health service
users through lived experience-led partnerships
“We need a sense of people really belonging, we just don’t have that”
“In the original plan, they talked about empowering communities,
whānau, people with lived experience - the emphasis has shifted to
cross-government”
3. What do government agencies need to consider when implementing these
actions to ensure what is delivered meets the needs of communities? Please include
the reasons for your suggestions
A. “Nothing about us without us!” Government agencies need to create
accessible spaces for people with lived and living experiences of suicidal
distress to contribute to implementation and evaluation of the plan. Lived
experience leadership and designated roles should support this.
Something we heard from our community is the importance of support being
available when people need it and in ways that work for people:
“Your feelings don’t wait for 4pm on a Tuesday just because that’s
when you have counselling”
“The right time and place, is the right time and place for you - and I
think that isn’t understood anywhere in this document”
4. Is there anything else you want government agencies to know about what is
needed to prevent suicide?
In our feedback we have four overarching concerns: valuing all people, growing
community belonging and capacity for mutual support, sufficient resourcing is
needed, and achieving equitable outcomes for mental health service users/
psychiatric survivors /people with enduring distress
Across the actions for health and cross-government agency work, we believe there is
not adequate detail that acknowledges and addresses some of the most pertinent
issues from a lived experience perspective. Starting from a place of lived and living
experience, our suicidality has had its roots in experiences of devaluation,
disconnection and a lack of belonging:
“Productivity-based value - if you’re not working you’re not of
value, devaluing some groups, disconnection, loneliness,
trauma, transactional interactions, assessing triaging and
“treating” [suicidal distress] without listening, caring and
healing”
“On first glances [at the plan] I want to say how hopeless I felt
as a person living with suicidal distress. I didn’t feel like there
was anything in here that would help me... Who was this
document made for? It wasn’t made for me”
To address suicide, it is crucial to ensure people experience inherent value,
belonging, connection, as well as attachment, healing and relationality. Linking to the
He Ara Oranga Wellbeing Outcomes framework by Te Hiringa Mahara and Kia
Manawanui could be a useful way to ground the suicide prevention action plan
2025-2029 in a wellbeing focus. Practically, expanding the cross-government actions
in the plan, to focus on social and economic determinants of suicidality is also
essential.
“The cross-government actions are very limited, particularly
given our knowledge of social and economic drivers of suicide”
The proposed actions for cross-government mahi are a good start, but need to be
expanded to specifically address these issues. The plan should include actions to:
● Establish a cross-government taskforce for ongoing action and accountability
around suicide prevention and support, focussed on social and economic
determinants, and policy, systems and processes impacting people
experiencing suicidal distress
● Co-production processes should be resourced and undertaken in Housing,
MSD, ACC, OT, Corrections, Education, Justice (and other relevant government
agencies) involving providers, policy makers and clients with lived and living
experience of suicidal distress. The aim of these processes should be to
identify and address areas where the agency can make systemic changes to
make a difference to clients’ experiences of suicidal distress, address the social
and economic determinants of suicidality, and improve holistic wellbeing from
a client/lived experience perspective.
● All government agencies should be required to gather and transparently
publish data on experiences of support (not just outcomes data) - this data
should include whether people and whānau felt respected and valued in their
interactions with the agency, and treated as a worthwhile human being
● Government agencies should be directed to commission services through
processes that place a high value on user experience data, not just fiscal or
outcomes data
● While we applaud that health has started embedding valued lived experience
roles in mental health and addiction, other government agencies should be
directed to identify where roles for people with lived and living experiences of
suicidal distress can be implemented to make genuine change. These roles
should sit at both a policy leadership and service design/delivery/evaluation
level of the agencies. They should be valued and well utilised.
● Specific cross-government actions are needed for MSD to ensure that people
who are out of work continue to feel valued and a sense of belonging. This is
needed to off-set the devaluation people experience when out of work, and
sever some of the strong ties between productivity and value that are
common under neoliberal capitalism
“Government agencies have a responsibility to ensure people have
lives worth living”
The proposed actions for health are a good start, and:
● The plan should provide support for Manatū Hauora to undertake a 20-year
research update on the Social Explanations for Suicide in New Zealand
ealand/) with particular attention to the current economic situation and its
impact on suicidality
● Effectiveness of policy, services and support needs to be based on hearing
from people who experience wanting to die. Create mechanisms for people to
be heard on how effective our current approaches are.
Specific feedback - Proposed Health-led actions
1: Improve access to suicide prevention and postvention supports
Establish a suicide prevention community fund focused on populations with higher
needs (for example, maternal, youth and rural communities) to complement existing
Māori and Pacific funds.
“Ehara toku toa i te toa takitahi, engari he toa takitini - Resource
communities to grow capacity for mutual support”
● This is a really important action, because it’s community focussed rather than
government agency and service focussed - change will happen from within our
communities
● The community fund needs to be adequately resourced. Current government
funding towards suicide prevention and post-vention is completely insufficient
for a goal of no suicide. A significant portion of the national suicide prevention
and post-vention funding should be allocated to this community fund, to
recongise that change happens in our communities
● We agree that funding needs to be extended to groups experiencing additional
adversity and suicidality, including: disabled people, rainbow communities,
rainbow young people, takataapui, and others, while we also advocate that
supports should be able to work with people experiencing intersectional
disadvantage, marginalisation and oppression
● We also want to see funding extended, rather than just maintained, for maori
and pacific funds
● Specific, ear-marked funding within or separate to the suicide prevention
community fund needs to be set aside for lived experience communities
(psychiatric survivors, consumers, mental health (ex-) service users) so that our
communities can work to address the horrific inequities we face in suicide
statistics
● We need more spaces, places, communities and connections that say to us: “If
you’re suicidal please come” rather than “if you’re suicidal it’s too
hard/beyond our scope”. This could look like groups and spaces based on
approaches such as Alternatives to Suicide (as developed by Wildflower
Alliance) or the Suicide Narratives and Just Listening approaches as (as
developed by the Humane Clinic)
“Community is not a monolith - we need a lot of different things so
that people can try different things and find what works for them”
“There’s good stuff happening that isn’t being captured, people
supporting each other over extended periods of suicidal distress”
Roll out enhanced suicide bereavement supports
● Commissioning services needs to be done with sensitivity and with lived
experience input
● Roles need to be established for people with lived experience of suicide
bereavement to lead the process of developing enhanced suicide bereavement
supports
● These supports need to be accessible to people in the mental health system -
e.g. cognisant of the gaps between acc and mental health, how we are
prevented from accessing counselling and other complementary supports
when in inpatient services etc.
● All resources to support people bereaved by suicide should be available in a
range of languages and accessible formats
Establish and evaluate six crisis recovery cafés/hubs/services.
“How suicidal do you need to feel? There needs to be low/no threshold for
accessing help - Address the feeling of ‘I don’t want to be here’. How do we
make things at least tolerable for people to be here?”
“Open dialogue family approach - [I] would have appreciated coming
together, communication support and resources”
● Setting up new crisis cafes / hubs need to be co-developed collaboratively with
people who have used crisis services, AND with people who have experienced
suicidal distress and have not been able to access services
● Principles for crisis cafes/hubs need to include: non-carceral, non-coercive
care, and should provide space to talk about how you’re feeling, support
people there to sit with, have space to just be
● Advocacy to address to social and economic drivers of suicidality (on an
individual level) needs to be a core aspect of new crisis services
● Funding needs to be made available in the first instance for a co-produced
model / models of care for these services. People with lived and living
experience of suicidal distress and crisis must be involved in and lead these
processes. Some approaches that we recommend be considered in model of
care development include: Open Dialogue, Mahi a Atua, Sucide Narratives,
Alternatives to Suicide, Just Listening
● All crisis recovery cafes/hubs/services must be fully accessible for disabled
folks, all resources for whānau and communities needs to be available in
accessible formats
● There should be no triage or referral process for access, people should be able
to walk in, phone up or text in
● In addition to crisis cafes/ recovery hubs, there needs to be recognition and
support for existing services that provide safe drop in spaces e.g. women's
drop in spaces
● Services need to be well resourced - staffed 24/7, valued and based around a
workforce of well-remunerated peer support workers and peer advocates
● Staffing, governance and leadership needs to be lived experience led - but can
include clinical support
● A lived experience led evaluation approach should be utilised, and
consideration given to a process evaluation or developmental evaluation so
that learning can be gathered immediately for service strengthening and
embedding
“Being with, rather than doing to, people”
“A place to shelter out the storm”
“Relational safety, comfy, accessible spaces, processing and healing
together”
“Coproduction of commissioning for new peer led peer goverened
services with a particular focus on suicide prevention and
intervention, utilising peer models like open dialogue, alternatives
to suicide, suicide narratives, etc. to be available across aotearoa”
Improve the cultural appropriateness of initial supports after a suicide death and
Aoake te Rā, bereaved by suicide service.
● We agree that supports following suicide should be culturally appropriate
● Many of us question the evidence base for ‘brief intervention’ approaches
given our lived experiences. The appropriateness of ‘brief intervention’
approaches should be reviewed and taken into consideration in
implementing this action
“Roll out Enhanced suicide prevention and post-vention support based
on open dialogue approach”
2: Grow a capable and confident suicide prevention and postvention workforce
We believe that the focus on communities, and resourcing communities and
whānau, needs to be strengthened in this plan. Therefore we suggest dividing this
section into two:
a) Grow connected and confident communities capable of supporting each
other with suicidal distress
b) Grow a capable and confident suicide prevention and postvention
workforce
To acknowledge and highlight the underfunding of suicide prevention and
response services, we advocate that any services or supports that are delivered by
volunteers should be included in the “community” rather than the “workforce”
action heading.
“Services aren’t the healing space, communities are the healing space”
Increase access to suicide awareness training for communities, families and
whānau
● You can give people all the trainings that you want, but you need to give
people the time to put that into action
● Suicide Awareness Training should result in compassionate support for
people in suicidal distress. Awareness training that is funded should have
evidence of behavioural effectiveness - that people trained act in
compassionate and supportive ways towards people who are suicidal
“The barrier isn’t necessarily awareness - ‘Get professional help’ is the
focus, whereas people should be able to support each other - ‘The story of
you is in trouble - tell me about the story of you that’s in trouble’”
“What are the constraints? People don’t have time, resources and energy to
look after our family and friends at the moment. When struggle is rising,
people at the bottom are impacted first”
Develop induction materials and improve ongoing best-practice supports for
suicide prevention and postvention coordinators and Kia Piki te Ora workforces.
● Any induction materials, training and ongoing best-practise supports should
be co-produced by people with lived or living experience of suicidal distress
and suicide bereavement
Publish a national competency-based framework for workforces, communities,
and family and whānau members.
● Any national competency-based framework/s developed or reviewed should
be done so through a co-production process with people who have lived
and living experiences of suicidal distress
Develop and publish enhanced guidance for health professionals on assessing and
supporting people who might be suicidal or experiencing suicidal distress.
● We need a plan that recognises and addresses the limitations and lack of
evidence base for current risk assessment processes; as stated in the National
Institute of Care and Excellence guideline [NG225]
sessment-tools-and-scales):
1.6 Risk assessment tools and scales
1.6.1 Do not use risk assessment tools and scales to predict future suicide or
repetition of self-harm.
1.6.2 Do not use risk assessment tools and scales to determine who should
and should not be offered treatment or who should be discharged.
1.6.3 Do not use global risk stratification into low, medium or high risk to
predict future suicide or repetition of self-harm.
1.6.4 Do not use global risk stratification into low, medium or high risk to
determine who should be offered treatment or who should be discharged.
1.6.5 Focus the assessment (see the section on principles for assessment and
care by healthcare professionals and social care practitioners) on the person's
needs and how to support their immediate and long-term psychological and
physical safety.
1.6.6 Mental health professionals should undertake a risk formulation as part
of every psychosocial assessment.
● Some of our lived experiences of assessment processes highlight the need for
a different (support not assessment) approach, and we advocate that:
● Enhanced guidelines, and other guidelines/resources/secondary legislation
should be focussed primarily on support rather than assessment
● Enhanced guidelines and other resources for health professionals should align
with work to repeal and replace the Mental Health Act - in that, the focus on
‘risk’ should be minimised in favour of safety, connection, upholding rights,
restorative approaches and trauma-informed responses
● The plan should specify that these enhanced guidelines must be led by and
co-produced with people who have lived and living experience of suicidal
distress
● Given the social and economic determinants of suicidal distress, and the
importance of maintaining our human rights at times of crisis, we advocate
pivoting the approach to a human approach and suggest the development and
adoption of a “human rights assessment” rather than a risk assessment. This
would focus on both areas where a persons rights (e.g. to housing, livable
income, freedom from discrimination, etc) are being impacted and what could
address these and address suicidality, and, how a persons human rights can be
best protected when experiencing suicidal distress
“Something happens when the focus goes off the person and onto risk
instead - Risk assessment destroys connection”
“It very much puts you in the ‘us and them’ when you’re suicidal and the
system is assessing and intervening. But suicidality is a human thing”
“ [A risk assessment focus] encourages a deviousness, encourages
people to feel scared, risky and fragile”
“We get told “You’re not bad enough” or “you’re too much/too hard” -
The system has a narrow window of tolerance for us”
3: Strengthen the focus on prevention and early intervention
Invest in enhanced acute, respite or crisis recovery services for young people in at
least two regions
● These services must be co-produced with young people who have lived and
living experience of crisis
Launch a new wellbeing promotion campaign that includes targeted resources for
youth
● We agree with this action, and would like to see additional campaigns
launched that include a targeted wellbeing promotion approach for adults
and older adults, and that have a community and whānau focus - not just
an individual focus
“[As a young person experiencing suicidality] It comes from
unstable homes, broken and abusive family - I would have
appreciated resources”
“You can do all of these wellbeing promotion campaigns for
people, but usually they are all so focussed on individual things -
the individual doesn’t exist without their societal and community
context”
“Lots of people in the Thriving Madly community have mentioned
that Intentional Peer Support training helped create a shared
language/framework to talk about distress, and provide each other
mutual support and mutual advocacy”
Develop and implement a national alcohol screening and brief intervention
programme that includes suicide prevention aspects
● This is an important action, and should be expanded to include
intervention/support approaches that go beyond ‘brief intervention’ to be
more relational and trauma-informed
Develop and publish updated suicide media guidelines and supplementary
resources for different types of media.
● Specific work needs to be undertaken with young people to consider how
this will relate to social media
Create safer environments in inpatient mental health and addiction facilities by
progressing work to remediate and minimise ligature points.
“The focus on means takes away from the fact that it’s a person, a
persons experiences - people are missing in most of the actions listed
in this plan”
● Additional actions are needed to ensure that mental health and addiction
facilities are attending to cultural, spiritual and relational safety, as
determined by the person, not just environmental safety
● Providing more opportunities for people to talk about feeling suicidal and
make sense of our experiences is needed in mental health and addiction
facilities
● Co-production work should be undertaken with people who have
experienced mental health and addiction facilities. This should focus on
understanding what changes could be made to policy and practise to ensure
people's sense of trust, dignity and safety are upheld when we feel suicidal
“What safety is it creating? We need cultural safety, cultural
humility”
“Safer environments in inpatient units - what creates a safer
environment aren’t security guards, cameras, ligature points, it's
about addressing the want to die, safe relationships and
connections”
“There isn’t a feeling of trust or dignity in receiving support”
“It’s kind of like how the system likes to sedate people - its not
dealing with the reasons that someone is upset in the beginning”
“What helps me make a different choice, a choice not to die, it
wasn’t access to means being prevented... the thing that makes me
make a different choice is connection and belonging”
4: Improve the effectiveness of suicide prevention and our understanding of
suicide
Review the effectiveness of Vote Health suicide prevention services investment
and implement any changes.
● Reviewing effectiveness needs to be undertaken alongside and led by
people who have personally experienced Vote Health funded suicide
prevention services and people who have not been able to access or who
have chosen not to engage with these services
● Investment review must not be used as a basis to reduce overall resourcing
or service provision
Explore options for testing a real-time suicide data tool to provide timelier and
improved suicide data.
● These actions are completely insufficient to meet the aim of improving our
understanding of suicide.
● Hearing from people who want to die needs to be included alongside gaining
better understanding of suicide statistics - mechanisms for hearing peoples
experiences need to be intentionally developed
● Additional data needs to be gathered to better understand the circumstances
of people who die by suicide, particularly we should know more about
whether people:
- Were on antipsychotic medications
- Had adverse childhood experiences
- Experienced homelessness
- Experienced a lack of sufficient income or relative poverty
“It feels like it’s not honouring the humanness of people”
“The only person who understands their actions is the person
themselves”
Specific feedback - Proposed Cross-Government actions
1: Improve access to suicide prevention and postvention supports
Complete development of site-based, local postvention response processes at prison
sites (Ara Poutama Aotearoa | Department of Corrections).
● Need to add first and foremost: A whole of government approach where all
government agencies identify and address the social and economic
determinant for suicide that they can impact
● There need to be more actions for Ara Poutama in this plan including support
for staff working in prisons
● Specific wellbeing and suicide prevention support for people coming out of
prison needs to be included
● Additional actions are needed to address gaps in support provision -
particularly for people experiencing suicidal distress who are navigating the
current gaps between ACC, Specialist Mental Health, Needs Assessment
provided supports, and MSD provided supports - identifying these gaps should
be informed by peoples lived experiences of trying to navigate multiple
systems for support
“The culture of the prison is so extreme, the guys who come out - a
lot of them have had to adjust to that”
“The environment doesn’t lend itself to you feeling like you’re
treated as a human”
“ACC, Specialist Mental Health, NASC, WINZ to work on identifying
and eliminating gaps in support provision”
“Understand that people die in corrections and inpatient facilities,
but people die out there in the world in many different ways - and
this also needs to be addressed”
“[We need to be] talking about suicide, and many things, openly in
our communities”
2: Grow a capable and confident suicide prevention and postvention workforce
Enhance the Elder Abuse Response Services workforce suicide prevention knowledge
and practices (Ministry of Social Development).
● Additional actions for MSD are needed to address social and economic
determinants of suicide experienced by beneficiaries
Update practice guidance and supports for social workers and carers working with
children and young people who might be suicidal or experiencing suicidal distress
(Oranga Tamariki).
● Additional action is required to work with VOYCE whakarongo mai and care
experienced young people to coproduce new services that will meet the needs
of young people in care who are suicidal and experiencing suicidal distress
3: Strengthen the focus on prevention and early intervention
Promote wellbeing and strengthen supports provided by schools to students
experiencing distress or self-harm and after a suicide (Ministry of Education).
Create safer environments in correctional facilities through work to remediate and
minimise ligature points (Ara Poutama Aotearoa | Department of Corrections).
● Cross-government actions to address access to means needs to be expanded
to include:
- Maintaining and strengthening restrictions on access to firearms
(government, police)
- Addressing access to pesticides
“I feel deeply worried about the key policy of the ACT party to
repeal, replace and rewrite the Arms Act in order to create what
they believe is "fair and reasonable" firearms laws that will "make
all of us safer". I don’t believe this makes people experiencing
suicidal distress safer”
4: Improve the effectiveness of suicide prevention and our understanding of suicide
Support exploration of testing of a real-time suicide data tool to provide timelier and
improved suicide data (Ministry of Justice).
Improve the effectiveness of online coronial recommendations recaps (Ministry of
Justice)
● Broader coronial processes should also be improved based on the experiences
of whānau bereaved by suicide
Suggested additional action heading for health and cross-government actions -
addressing equity
In addition to a strengthened focus on early intervention and prevention, we also
need a separate focus on equity for people who experience enduring mental distress,
mental health service users, psychiatric survivors. Thriving Madly is made up of
people with lived and living experience of mental distress, we do not fit an ‘early
intervention’ framework and we matter
“This plan reinforces hopelessness for some people by not caring
about us”
- Invest in a lived experience led co-production process for identifying and
addressing the determinants leading to suicide inequities specific to our
communities with an aim of eliminating inequities in suicide rates for
psychiatric survivors and people who use mental health and addiction services
- Specific, ear-marked funding within or separate to the suicide prevention
community fund needs to be set aside for lived experience communities
(psychiatric survivors, consumers, mental health (ex-) service users) so that our
communities can work to address the horrific inequities we face in suicide
statistics
- Co-production work should be undertaken with people who have
experienced mental health and addiction facilities. This should focus on
understanding what changes could be made to policy and practise to ensure
people's sense of trust, dignity and safety are upheld when we feel suicidal
- People with lived experience of diagnosis, mental health service use, enduring
distress need to have engagements with health services and government
agencies that validate their human worth, potential, etc.
- Address stigma. The ongoing focus on economics impacts our sense of
self-worth, and we need to talk about the stigma experienced by people who
do not feel worthy, who feel like we are a burden
- Government agencies and services that we interact with need to have an
awareness of power and trauma, not just mental distress
“We need to treat people like people, and honour their humanness,
and their ability to choose”
“Finishing high school it was the time of the GFC, and we absorbed
a lot of messages about money, economics, worth, that feed in to
our experiences of suicidality”
“Changing the narrative - it’s not explicitly named that suicide is not
necessarily mental illness”
“So often suicidal distress is framed as a crisis, but for some of us it’s
due to the ongoing situation we live in... I have lived with this for a
very very long time, I’m not the only person who has been living
with these feelings for a very long time”
“The thing that would make the most difference, there would have
had to be a lot of unpacking, and talking about the wanting to die”
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