It takes a village

It takes a village to raise a child is a proverb which means that it takes an entire community to raise a child: A child has the best ability to become a healthy adult if the entire community takes an active role in contributing to the rearing of the child.

Of recent concern in New Zealand has been some reports from UNICEF and the OECD showing how kiwi youth are struggling to cope. In particular, New Zealand youth are killing themselves at a world leading rate (see the blue line on the right of the below graph).

OECD Teenage Suicide report

What makes this statistic worse is that unlike many other countries, New Zealand’s youth suicide rate is showing no sign of reducing.

This is of concern to me for several reasons. I am the father to two kiwi pre-teenage boys and I hope that they and their peers get the best start in life. I work in mental health and see the consequences of poor mental wellbeing. Finally, my private-time interest is advocating for affordable housing -something which I will explain has a connection to New Zealand’s poor youth well-being.

So given this concern I have done some research. It is not exhaustive and although I have some professional knowledge in this area I would not claim expertise status.

This article will look at what doesn’t work, what has worked overseas, what might work in New Zealand and how much it would cost.

What does not work

What doesn’t work to improve youth wellbeing is victimisation.

Centuries ago when misfortune fell on a community -in some places a woman was singled out and punished for witchcraft. In the modern day -victimisation processes are more subtle -but they still occur.

Victimisation is about making excuses and not honestly looking for the root causes or finding genuine solutions. Unfortunately in New Zealand, victimisation is a common practise, even at the highest levels of society.

At a Federated Farmers meeting last year, Bill English (now the Prime Minister) said there was a “cohort of Kiwis” who “were pretty damn hopeless”. His comments were directed at “young males” who he claimed didn’t turn up to work or didn’t stay on when offered a job. Bill English repeated these claims in February this year -making unsubstantiated claims that young kiwis cannot fill job vacancies due to drug use.

Bill English’s government has been in power for nearly a decade and youth wellbeing has not improved in that time. So calling young men -“pretty damn hopeless” and making unsubstantiated claims that young kiwis cannot fill job vacancies due to drug use is an indictment on Bill English and his government.

New Zealand needs a fresh approach. Many people in New Zealand are asking for an independent inquiry into mental health. The last major inquiry were the Mason Reports of the 1980s and 1990s.

New Zealand has longed suffered from high rates of ‘insanity’. In an 1870 inquiry into mental health, Dr M. S. Grace attributed the higher rate of insanity in New Zealand compared to Britain as being related to a lack of sympathy for the loneliness and isolation of New Zealand. Implying it was the loss of a supportive social networks that many immigrants experienced which put New Zealanders at greater risk of suffering from mental illness.

Hopefully New Zealand will look overseas to get a broad view of what works and what doesn’t.

What has worked overseas

In the above graph on youth suicide you can see that Iceland had the worst youth suicide rates in 1990 and 2000, but by 2013 it had one of the lowest. The OECD cautions that “due to small populations, suicide rates in Iceland and Luxembourg are likely to show high variability and outliers across the time series”.

What is helpful is that UNICEF have an index for child and youth health, averaging five indicators -neonatal mortality, suicide rates, mental health symptoms, drunkenness and teenage fertility rates. This indicates Iceland is a very good performer for ensuring health on these measures and New Zealand is performing very badly in comparison.

So given Iceland’s across the board good results for youth we can have some confidence that it’s low youth suicide statistic is not a statistical aberration.

Yet Iceland did have a problem with youth drug use twenty years ago -so the past bad figures are also likely to be accurate. In Iceland, the rate of teenage smoking, drinking and drug use have been radically cut in the past 20 years. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.

In Iceland clinicians worked with the theory that drug use was an inappropriate coping strategy -that drug users were seeking artificially altered mental states -numbness or highs in response to stress. The solution found to counter this was to encourage more appropriate coping strategies -natural highs -such as sport, drama and community activities. The breakthrough came when this theory was applied generally to the whole youth population of Iceland.

There is a full description in the below linked article of how Iceland made this beneficial social change.

To me the key initiatives were;

  • Using an evidence based approach to ascertain/monitor the protective and risk factors -undertaken by professional clinical researchers.
  • Actively engaging with the community -youth, parents and community organisations to create social networks which enhance the protective factors and reduce the risk factors. Leadership was demonstrated -a sensible mix of rights and responsibilities was used.
  • The State providing institutional and financial support. For instance, creating a 250-euro leisure card which families with youth could access to pay for club activities.
Iceland in the last 20 years systematically, replaced artificial highs -such as drugs and alcohol, with natural highs -such as sports, drama, arts and community activities. The results have been unexpectedly good!

As a registered nurse with many years working in psychiatry this seems like common sense approach to me. I am not at all surprised that when Iceland systematically applied this approach that it worked. This approach is also consistent with some newer studies on social networks.

Social networks have been shown to influence a range of factors from obesity to depression. They are a fascinating way of looking at humanity. The theory of social network fits somewhere between individualism -economic man type analysis and the whole of society works of Marx etc.

What might work in New Zealand?

I think the Icelandic model could work in New Zealand if it was applied in a systematic way. It is really about using an evidence based approach to strengthen communities.

New Zealand has some small scale strengthening community initiatives already. Christchurch City Council, for instance, has a $7.2 m strengthening communities fund that distributes grants. But these community initiatives are not as evidence based, systematic or as large scaled as what Iceland uses.

For the Iceland approach to improving youth wellbeing to be successfully applied in New Zealand, the first step would be undertaking an evidence based approach to ascertain/monitor the protective and risk factors.

Although the protective factors of increased social activities for youth are likely to be the same. Some of the risk factors might be different and therefore require adjustments to the model.

For instance, New Zealand might have a bigger problem with bullying and trauma (Christchurch and Kaikoura earthquakes, high physical and sexual abuse statistics).

Another risk factor which may be more present in New Zealand is the increasing numbers of renters and the difficulty renters have in settling into a community due to the shortness of New Zealand’s average tenancy. New Zealand’s home ownership rate has been falling since 1990, and by 2013 only 49.8 percent of people aged 15 years and over owned or partly owned the home they lived in.

On average, owner-occupiers live in each house for 5 years, compared to the average residential tenancy which lasts only 15 months. In Europe -Germany, for instance, due to more security of tenancy laws, the average tenancy period is more than double this amount, at 3 years.

John A Lee was responsible for housing in New Zealand first Labour Party -in the 1930’s famously saying -“it is well to remember that good housing is essential for a good community.” John A Lee started a big State house building programme as a practical expression of his government’s desire to create safe and secure communities for New Zealanders.

Note some of the recent increase in State House building will be rebuilding State houses destroyed in the Canterbury earthquakes.

Unfortunately this practical support to community building has faded out. State house numbers are static to falling, especially per capita. Social housing in New Zealand has not kept pace with the country's fast growing population. Given the declining numbers who own their own home, this means more and more kiwis are reliant on private rentals, which only provides transient accommodation and little ability to integrate into community life.

How much would it cost to implement Iceland’s model in New Zealand?

If families in New Zealand with youths (13 -18 year olds) could access a $250 activity card per child to pay for community activities, perhaps after attending a networking meeting where they agreed to the goals and responsibilities that went with this benefit, this would cost approx $80 million (65,000x5x250).

It is possible to extend this benefit down a few years -to 11 year olds -to engage youth in the habits and routines of activities before the challenging teenage years -this would increase the cost to around $110 million.

$80 -$110 million is not an small amount of money, but if New Zealand could reduce youth suicide, youth cigarette consumption and drug and alcohol use, like Iceland achieve then this would be money well spent.