Through the Eyes of Men: Towards a more critical understanding of men’s mental health in New Zealand (2019-2022)
Dr Sarah McKenzie, Professor John Oliffe, Professor Sunny Collings
This multidisciplinary three year study will provide the first in-depth gender analysis of how dominant ideas about ‘how to be a man’ in NZ society impact on young men’s mental health, leaving some at far greater risk of taking their own lives. Informed by critical gender theory and mental health geography, this project uses visual methods to enable men to photograph their lived experiences of depression, anxiety and suicidality. The rich gender analysis of images and stories will provide original insights into how young men’s mental health-related beliefs and behaviours are influenced by dominant ideas of masculinity, as well as how particular gendered space and places may help or hinder the ways in which men cope when going through crisis.
‘Boys don’t cry’: Understanding masculinity and mental health-related stigma among men (2018-2020)
Dr Sarah McKenzie
Currently, 75% of suicides in New Zealand are among men. Despite this higher rate, there is a dearth of research examining the perspectives and experiences of men at risk of suicide, particularly in terms of understanding how the gendered aspects of men’s lives can put some men at greater risk of dying by suicide. To date, much of the research on men’s suicide has focused on risk factors with long-standing epidemiological evidence that suicide is a significant men’s health issue. Yet, this focus on risk factors limits our understanding of the social complexity of suicide. This research examines whether a gender perspective on men’s experiences of mental health-related stigma could expand our understanding of higher suicide rates among men. This research is funded by a Health Sciences Postdoctoral fellowship.
13 Reasons Why: Dangerous sensationalism or opening up the suicide conversation? Examining young people’s perspectives (2017-2018)
Dr Sarah McKenzie, Dr Gabrielle Jenkin, Professor Sunny Collings
Current public debate on youth suicide, in the context of the recently released Netflix suicide drama ‘13 Reasons Why’, suggests a need to document and understand young people’s perspectives on suicide. This study will involve interviewing teenagers about their views on the dramatisation of adolescent suicide in the Netflix series. This research will provide new insights to inform youth suicide prevention in NZ including guidance around the fictional media depiction of suicide. This research is funded by the University of Otago.
Major physical health conditions and risk of suicide among men (2017-2018)
Dr Sarah McKenzie, June Atkinson, Dalice Sim, Professor Sunny Collings
The latest coroner’s statistics show 75% of suicide deaths in the last year were males, with the rate three times that of females. Despite this, our knowledge about men who die by suicide in New Zealand and the contributing risk factors for suicidal behaviour remains limited. This lack of knowledge has significant implications for identifying key intervention points for suicide prevention in order to reduce suicides. This case-control study will investigate the links between major physical health conditions, health service use, receipt of health related benefits and suicide risk in adult men using data in the Integrated Data Infrastructure held by Statistics New Zealand.
Acute Mental Health Facility Design: the NZ experience (2017-2020)
Dr Gabrielle Jenkin, Dr Susanna Every-Palmer, Dr Debbie Peterson, Chris Watson, Dr Evangelia Chrysikou, Professor Sunny Collings
The acute mental health ward is the modern equivalent of the old mental asylum but little is known about factors informing its design and use or the underpinning philosophy of care upon which these facilities are based and if they could benefit from improvements.
This multidisciplinary three year study will draw on perspectives from social science, psychiatry, nursing and architecture to understand the architectural design, therapeutic philosophy and social regime of the modern acute mental health unit in New Zealand.
It will examine as case studies, three acute adult psychiatric wards in New Zealand. Using multiple existing sources of data, including architects plans, briefs and grey literature and collecting new data via in-depth interviews and small focus groups with mental health consumers resident in the wards, staff and other ward users and stakeholders, the findings from this research will inform a much needed evidence base for optimal acute psychiatric facility design in NZ. This research is funded by a Marsden Fast Start.
Understanding *diverse sex development/intersexuality in NZ
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Suicide inquests: interviews with NZ Coroners (2016)
Dr Gabrielle Jenkin, Professor Sunny Collings, Dr Justin Canty
Little is known about the perspectives, experiences and decision-making processes of New Zealand coroners as they go about their business of investigating deaths by suicide and making recommendations. This study, based on interviews with NZ coroners, aimed to uncover how suicide inquests are conducted in New Zealand. It examines how coroners go about their investigations, what factors influence their decision-making and recommendations and, coroners’ perspectives on these processes and suicide in general. This research was funded by a University of Otago Research Grant.
For further information email
The suicide and serious self-harm risk of ‘Mixed Presenters’ to emergency departments
Ms Silke Kuehl, Professor Sunny Collings, Dr James Stanley, Dr Katherine Nelson
Suicide is a major health and social concern in New Zealand. A small group of people who present to emergency departments (ED) with intentional self-harm (ISH) also present for other causes (‘Mixed Presenters’). These people experience significant psychological distress, poor physical health status and may have a suicide risk higher than the risk conferred by ISH alone.
This PhD research project was an extension of the existing MISP study. It used the unique opportunity to examine all ED presentations in detail in 4 District Health Boards (DHBs) from this study. This data was used to estimate the relative risk of suicide and serious ISH events between Mixed Presenters and the ‘ISH Only Presenters’; and to identify service gaps. Mixed Presenters were interviewed to explore how best to enhance their health outcomes when presenting to ED. This research is funded by the Health Research Council.
For further information email
Suicide Mortality Review Feasibility Study (2015)
Professor Sunny Collings, Dr Gabrielle Jenkin, Dr Sarah McKenzie, Dr Debbie Peterson, June Atkinson
The primary objective of the Suicide Mortality Review Feasibility Study was to evaluate the feasibility and potential benefits of a national suicide mortality review process. In particular, whether such a process is likely to provide additional information about factors contributing to suicide (for specific groups), and potential points of intervention for suicide prevention. These may be at individual, family, whānau, community, government agency or health systems levels. This research was funded by the Health Quality and Safety Commission.
On 26 July 2017 Health Minister Jonathan Coleman announced the Government would be extending funding for the Suicide Mortality Review Committee to continue its work beyond its trial period.
The effects of change in coronial attitude and practice on suicide news reporting in NZ (2014)
Dr Gabrielle Jenkin and Professor Sunny Collings
The portrayal of suicide in the media is known to have an influence on suicide rates. Because of this, there are best practice guidelines restricting aspects of suicide reporting by the media. However, in August of 2010, the Chief Coroner suggested that there was a need to ‘open up’ the issue of suicide. This comment led to a controversial debate over the reporting of suicide in the media. This research investigated this debate and assessed its impact on the reporting of suicide by the New Zealand news media. This research was funded by a University of Otago Research Grant.
MISP – Multi-level Interventions to reduce suicidal behaviour: a New Zealand controlled community intervention project (2012)
Professor Sunny Collings, Dr Nandika Currey, Dr Silke Kuehl, Ms June Atkinson, Dr James Stanley, Professor Diego De Leo, Dr Sarah Mckenzie, Dr Simon Hatcher
MISP was a 25 month Multi-level community Intervention for Suicide Prevention designed for and implemented in New Zealand (MISP-NZ) between 01 June 2010 and 30 June 2012 with the aim of reducing rates of suicidal behaviours. Its design was based on a cluster randomised controlled trial (cluster RCT) with eight District Health Boards (hospital) regions matched into four pairs (based on key socio-demographic factors) randomised to either the intervention or practice as usual (PAU) i.e. control arm of the study. Each intervention region received 25 months of interventions (01 June 2010 to 30 June 2012) which can be categorised broadly as: 1) training in the recognition of suicide risk factors; 2) workshops on various mental health issues; 3) community based interventions; 4) work with the media on the safe reporting of suicide; and 5) distribution of print based material and information on web based resources. The main outcome was the annual rate per 100,000 of suicidal behaviours (intentional self-harm (ISH) and self-inflicted deaths) evaluated over the study period. This trial is registered by the Australian New Zealand Clinical Trials Registry (ACTRN12613000399796). This trial was funded by the Ministry of Health.
Found in translation: implementing a toolkit for Primary Mental Health Care Development
Professor Sunny Collings, Dr Sarah Mckenzie, Professor Tony Dowell, Philip Gandar,David Rees, Dr Nandika Currey
In this HRC funded project we worked in an existing partnership with Valley Primary Health Organisation and Hutt Valley District Health Board to investigate the adoption and implementation of a newly developed New Zealand based Toolkit for primary mental health care development. Using an explanatory case study design we determined the structural and non-structural characteristics of the organisations that influenced adoption and implementation, and whether or not adoption of the Toolkit led to any measurable changes in service provision or use. We also assessed the sustainability of the Toolkit use and the transferability of our findings to other health contexts.
The Toolkit was developed by the University of Otago Wellington and Synergia Ltd. in partnership with providers in four DHB localities during an 18-month DHBRF/HRC funded project (2009-2010).
For further information about this research
Māori Adaption of an Ultra-brief Intervention for Common Mental Health Syndromes in Primary Care
Ms Fiona Mathieson,Professor Sunny Collings, Professor Tony Dowell, Dr Kara Mihaere
Many people who attend primary care have significant psychological symptoms and distress that cause problems in day-to-day life. These are often not defined as mental disorders, which means that often these people are not eligible for treatment. However, the people with this ‘subthreshold syndrome’ experience genuine suffering and impairment in functioning. Those with depressive symptoms may go on to develop a disorder. We have developed a very brief psychological treatment and have adapted it for use with Maori participants to determine whether it is acceptable to patients and to primary care nurses and other clinical staff based in General Practices. Funded by the Oakley Foundation and a University of Otago Research Grant.
For further information contact Fiona Mathieson
Experiences of Treatment Pressure in Community Mental Health Care in New Zealand
Professor Sunny Collings, Dr Richard Mullen, Professor John Dawson, Dr Gavin Cape, Dr James Stanley, Dr Ruth Cunningham, Ms Natasha Taylor, Ms Denise Steers, Ms Kim Dobchuk
The aim of this project was to investigate the ways in which mental health consumers are encouraged or pressured to participate in treatment, and to determine how common these experiences are in NZ community mental health services. Information was collected from mental health consumers/tangata whaiora and their case managers/clinicians.
Where agreement cannot be reached between clinicians and mental health consumers, there are a variety of ways in which clinicians might seek to persuade people to take treatment, which might sometimes include the use of pressure such as incentives or threats. Others such as family/whānau and those involved in the legal system may also exert pressure to encourage mental health consumers to do what they want in terms of taking treatment. This project does not take the position that pressure to take treatment is a good or a bad thing. This is a project that was driven by clinicians who are interested in finding out more about what happens and what those who apply and experience this pressure feel about it. Funded by the Health Research Council.
For further information contact Natasha Taylor
Understanding the mental health status of sole parents
Professor Sunny Collings, Dr Gabrielle Jenkin, Dr Kristie Carter
Sole parent families account for 30% of families with children in NZ. Sole parents are predominantly women (84%) and Maori and Pacific families are particularly overrepresented. Research has revealed that sole parents have considerably poorer socioeconomic resources and poorer mental health than couple parent families. The poorer mental health of sole parents is a significant health issue for sole parents and their children. Children of sole parents are more likely to have mental health problems and mental health problems amongst children are strongly correlated with poorer mental health in adulthood.
Recent and proposed welfare reforms are attempting to address the problems faced by sole parent families by encouraging sole parents into paid employment. However, the association between poorer mental health and sole parent status has not been investigated and little is known about the impacts of employment on this association. This research aims to untangle these associations using cross-sectional data from the Survey of Families, Income and Employment (SoFIE) conducted in NZ from 2002-2010 by Statistics New Zealand. Funded by a University of Otago Research Grant.
The specific research questions were:
- What social and economic factors explain the relationship between sole parent status and mental health?
- How is this relationship mediated by employment status?
- Does the relationship differ by gender and ethnicity?
For further information contact Gabrielle Jenkin
Health outcomes for mental health service users – exploring the case of cancer
Dr Ruth Cunningham, Professor Sunny Collings, Dr Debbie Peterson, Dr Diana Sarfati, Dr James Stanley
The overall aim of this PhD study was to investigate the role of general health services in mortality and morbidity differences in those with severe mental illness compared to the general population, using cancer care as an example. The hypothesis was that differences in the quantity and quality of general health service care contribute to worse outcomes for people with severe mental illness. The specific objectives of this study will be:
- To review the literature on the physical health and health care of people with severe mental illness, with a particular focus on cancer.
- To determine the incidence, mortality and survival from three major cancers (lung, breast, and colorectal) and all cancer combined for those who have used mental health services in NZ prior to cancer diagnosis, for cancers diagnosed between 2000 and 2009 and to compare these rates with general population rates.
- To investigate how aspects of cancer treatment quality and quantity contribute to differences in outcomes from cancer for mental health service users compared to the general population, using the major cancers identified above.
- To investigate the reasons for any differences in service receipt identified in the quantitative research, through interviews with users of mental health services who have experience of cancer, and also with clinicians (including cancer clinicians and general practitioners).
- To develop recommendations about the ways in which cancer treatment service quality can be improved for those with mental illness.
This study was funded by the Health Research Council.
For further information please contact Ruth Cunningham email
Mental health services in Aotearoa/New Zealand: Delivering sustainable services to meet the needs of Pacific populations
Professor Sunny Collings, Dr Nandika Currey, Professor Tony Dowell
Pacific peoples have been found to experience mental disorders at higher levels than the general population. This disproportionate mental health burden is met with service trends of: low utilisation, late presentation, high rates of emergency referral, longer stays and the highest average cost of adult inpatient and community episodes. Current evidence points to the limits of existing services to respond effectively to the Pacific mental health context.
It has been recognised that building responsive services for Pacific peoples who are affected by mental illness is of high priority. Also of high importance is the need for services to be resilient, flexible and sustainable in light of resource constraints.
This PhD research project seeks to investigate the sustainability of mental health services in meeting the needs of Pacific peoples. Funded by the Ministry of Health
Community reintegration of male Pacific prisoners with mental illness: A Public Health perspective
Mr Sione Feki, Professor Sunny Collings, Dr Nandika Currey
Prisoner reintegration is a widely used term for defining ex-prisoners re-entry, transition and resettlement from prison to the community. It is centred on social and personal disadvantages that create obstacles to successful participation to the community. The reintegration framework suggests that the risk of re-offending is high if social and personal barriers are not reduced and removed. Reintegration promotes social inclusion and the adoption of positive lifestyle that leads to successful return from prison and becoming a productive member of the society.
The Masters research project will examine the obstacles to the community reintegration of Pacific prisoners (males) with mental illness, when they are released from Rimutaka prison to the Wellington region.
The two settings to be examined are the Corrections and District Health Boards, the research focuses on
- Mental health policies & procedures
- Mental health service delivery.
The research question to be explored is: "What are obstacles to community reintegration of male Pacific prisoners with mental illness?"
Key issues to be explored are the interfacing issues between of Corrections and District Health Boards mental health systems.
This Research was funded by the University of Otago.
For further information contact Sione Feki
Improving Pacific peoples’ access to mental health services
Professor Sunny Collings, Dr Nandika Currey, Miss Malsha Kularatna
Pacific peoples experience mental disorders at higher levels than the general population. Even if their disorder is serious, Pacific peoples have been found to be much less likely to access mental health services compared to the general population.
Improving Pacific peoples’ access to mental health services has been identified as a high priority. Currently, however, there is a paucity of data and literature on Pacific mental health.
This Pacific Summer Studentship project seeks to identify ways of improving Pacific peoples’ access to mental health services. In doing so, this project adds to the small body of knowledge so that Pacific peoples affected by mental health can receive the highest quality care and support in a timely manner. Funded by the University of Otago Summer Studentship Funds.
For further information contact Nandika Currey
Suicidality and mental illness: From self-stigma to self-management
Media influences on suicidal behaviour: An interview study of young people in New Zealand
Professor Sunny Collings, Professor Keith Hawton, Dr Sarah Fortune, Ms Denise Steers, Ms Nandika Currey
This study aimed to provide a detailed understanding of the mechanisms by which the media may have influenced episodes of self-harm by adolescents who have harmed themselves and attend child and adolescent mental health services. While there exists a body of literature about media effects at a population level we understand very little about the mechanisms underlying these effects at the individual level. This was a qualitative survey study using in-depth interviews to generate the data, followed by systematic coding for categories of media and associated themes. The interview and method have been piloted in Oxford, England with 12 people aged 17-23 years who had self-harmed. This research was funded by Te Pou.
Influences of the virtual social environment on suicide and self-harm: a qualitative investigation of the perspectives of young male adult website users
Ms Susan Knox, Professor Sunny Collings, Dr Sarah Fortune
This Masters research was an extension of an existing study ‘Media influences on suicidal behaviour: an interview study of young people’. The primary aim of this study was to investigate how young men interact and engage with electronic media to increase our understanding of how media influences behaviour. This study provided an opportunity increase understanding of media influences on self-harm and suicide. This research was funded by Te Pou.