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SPINZ 2009




SUICIDE PREVENTION

      Mason Durie
    Massey University
How best to understand human
         behaviour?
Looking through the microscope
Psychological &
emotional conflicts
   Low self esteem
   lack of confidence
   loss of hope
   Loss of mana
                            Biochemical &
 Life-cycle crises          neurological disturbances
     • Identity diffusion        • Chemical imbalances
     • Alienation                • Synaptic failures
     • de-culturation            • Mental disorders
     • poor health
Looking through the Telescope
                                   Interpersonal
                                   relationships
                                    Disrupted
                                    Bereavement
                                    Dysfunctional

Relationships with family           Threatening

      & community
 • Unemployment              Relationships with society
  • School failure             • Lossof usefulness
  • Homelessness               • Loss of role
  • Risk-taking lifestyles     • Loss of purpose
  • Bankruptcy                 • Loss of engagement
SUICIDE
         FOUR PERSPECTIVES
   SOCIETAL
       suicide as a social phenomenon

   MEDICAL
       suicide as a medical condition

   CULTURAL
       suicide and cultural identity

   INTERPERSONAL
       suicide and relationships between people
SUICIDE
      SOCIETAL PERSPECTIVES
   Altruistic suicide
    ‘sacrifice for the greater good’
       e.g. suicide-bombers

   Anomic suicide
    ‘detachment & disengagement’
       e.g. nihilistic suicide,

   Coercive suicide
    ‘group pressures and expectations’
       e.g. cult suicide, text messaging
SUICIDE
       MEDICAL PERSPECTIVES

   Mental disorders
      e.g. depression

   Chronic ill health
      e.g. immobilisation

   Terminal illness
       e.g. cancer
SUICIDE
     CULTURAL PERSPECTIVES

   Cultural alienation
       insecure identity

   Cultural exclusion
       frustrated identity

   Unconditional cultural conformity
      culturally sanctioned suicide
SUICIDE
INTER-PERSONAL PERSPECTIVES

   Termination of a loving relationship
       loss

   Response to a threatening relationship
      fear

   Protection of survivor(s)
       sacrifice
PERSPECTIVES ON SUICIDE

Societal   Medical   Cultural   Inter-personal




   Greater understanding of suicide and
     a basis for preventive strategies
PREVENTION
   Primary prevention
       reduction in prevalence e.g. A & D

   Secondary prevention
       reduced incidence (early intervention)
              e.g. GPI
   Tertiary prevention
       reduced levels of disability
              e.g. Schiozohrenia
TERTIARY PREVENTION
             SUICIDE

   Reduction of impacts on survivors

   Coroners findings

   Community management of event
Tertiary Prevention
             Notified cases
   Ongoing support, monitoring for friends,
    relatives

   Access to health and social services

   Education and counselling
PRIMARY PREVENTION
              Whole populations
       (Reducing health risks for everyone)
   Reduced levels of estrangement
    e.g. cultural enrichment, employment, religious affinities,
    family cohesion, participation in sport, decision-making

   Regulatory Controls
    e.g. A&D, seat belts, cycle helmets, smoking laws,
    nutrition, folic acid, Vitamin B6, mobile phones

   Reduction of inequalities between groups
    e.g. Education, incomes, housing, imprisonment
PRIMARY PREVENTION & SUICIDE
    Regulations and legislation
        Suicide ‘a crime’
        Gun laws, access to heights, drug regulations
        Use of the web - Bebo, face book

    Health Care and Medical Practice
        Prescribing practices e.g. barbiturates
        Improved risk detection
        Mental health in Primary Health Care

    Societal institutions and values
        Endorsement of world views and beliefs
        Secure cultural identity
        Social coherence
SECONDARY PREVENTION
Interventions with ‘At risk’ Populations
   Early identification of ‘at risk’ individuals
    and/or groups

   Strengths based approach
             vs
    Problem-oriented approach

   Ready access to relevant services

   Individual and group interventions
SECONDARY PREVENTION
             SUICIDE
   Psychological focus
        Or
   Relational focus          Intervention
        Or                     milestones
   Societal focus
        Or                • Engagement
   Cultural focus
                          • Enlightenment
        Or
   Integrated focus      • Empowerment
Whakapiri - Engagement
Establishing rapport requires attention to:
 Space
 Time
 Boundaries
 Ways of thinking
Engagement
         Space, time, boundaries
‘The marae atea’              Physical distance

‘Time to ‘hear out’           Allocation of time


Distinctive roles             Observation of
   manuhiri, tangata whenua    boundaries
   men and women
Engagement
            WAYS OF THINKING
    Centrifugal                   Centripetal
   Outwards direction       Inwards direction

   Understanding            Understanding
    comes from larger         comes from analysis
    contexts e.g. wider       of component parts
    relationships               e.g. inner thoughts
                              and feelings

   Similarities convey      Differences help
    essence of meaning
                              gain understanding
Flows of mental energy
Centrifugal          Centripetal




     The Telescope   The Microscope
Whakamārama - Enlightenment
   ‘Switching on the light’

   Interventions should lead to a higher level
    of enlightenment

   Increased:
     awareness
     understanding
     maturity
Whakamārama - Enlightenment
   The ways in which interventions are
    received vary between individuals

   Multi-sensory perceptions

   Information, procedures, advice are not
    processed in the same ways
Whakamārama - Enlightenment
Taha hinengaro   Improved intellectual understanding,
                 an expanded knowledge base,

Taha wairua      Strengthened cultural and spiritual identity,
                 meaningful connections with time & place,
                 restored values and ethics

Taha tinana      Increased awareness of body and physique,
                 enjoyment of exercise & movement,


Taha whanau             Re-assessment of family & social
                        relationships,
                 renewed energy for positive relationships
                 less enthusiasm for negative relationships
Modes of Interaction to maximise
                 impact
   Kanohi ki te kanohi

   The web

   Individual or group

   Whānau
Cultural Pathways to enlightenment
   The spiritual domain
       Marae participation, tangihanga, waiata
   The intellectual domain
       Te reo, metaphor & symbolism, centrifugal energy
   The physical domain
       Mau rakau, touch rugby, waka ama
   The social domain
       Whānau occasions, networks, kapa haka
Whakamana - Empowerment
Interventions should ultimately lead to
  empowerment



Engagement + Enlightenment
              = Empowerment
Successful interventions lead to
              Empowerment
   Self control – capacity to communicate, to
    manage behaviour, emotions, adaptation,
    weight, relationships

   Human dignity – sense of integrity, self
    worth, secure identity, wider connections

   Knowledge – sufficiently well informed to
    understand risks and pathways to
    wellbeing
Whakamana - Empowerment
   Able to participate in te ao whanui – wider
    society

   Able to participate in te ao Maori – the Maori
    world

   Capacity to enjoy positive relationships and
    contribute to whānau

   Capacity for self determination
SUICIDE PREVENTION
Perspectives        Levels of
                                            Interventions
 on Suicide         Prevention
-

    Societal      Primary Prevention        Engagement
                     Population-wide
                        approaches
    Medical
                 Secondary Prevention        Enlightenment
    Cultural         A focus on ‘at risk’
                   individuals or groups

Interpersonal                                Empowerment
                  Tertiary Prevention
                  Alleviating the impacts

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Suicide prevention: whānau-centred approaches

  • 1. SPINZ 2009 SUICIDE PREVENTION Mason Durie Massey University
  • 2. How best to understand human behaviour?
  • 3. Looking through the microscope Psychological & emotional conflicts  Low self esteem  lack of confidence  loss of hope  Loss of mana Biochemical & Life-cycle crises neurological disturbances • Identity diffusion • Chemical imbalances • Alienation • Synaptic failures • de-culturation • Mental disorders • poor health
  • 4. Looking through the Telescope Interpersonal relationships  Disrupted  Bereavement  Dysfunctional Relationships with family  Threatening & community • Unemployment Relationships with society • School failure • Lossof usefulness • Homelessness • Loss of role • Risk-taking lifestyles • Loss of purpose • Bankruptcy • Loss of engagement
  • 5. SUICIDE FOUR PERSPECTIVES  SOCIETAL suicide as a social phenomenon  MEDICAL suicide as a medical condition  CULTURAL suicide and cultural identity  INTERPERSONAL suicide and relationships between people
  • 6. SUICIDE SOCIETAL PERSPECTIVES  Altruistic suicide ‘sacrifice for the greater good’ e.g. suicide-bombers  Anomic suicide ‘detachment & disengagement’ e.g. nihilistic suicide,  Coercive suicide ‘group pressures and expectations’ e.g. cult suicide, text messaging
  • 7. SUICIDE MEDICAL PERSPECTIVES  Mental disorders e.g. depression  Chronic ill health e.g. immobilisation  Terminal illness e.g. cancer
  • 8. SUICIDE CULTURAL PERSPECTIVES  Cultural alienation insecure identity  Cultural exclusion frustrated identity  Unconditional cultural conformity culturally sanctioned suicide
  • 9. SUICIDE INTER-PERSONAL PERSPECTIVES  Termination of a loving relationship loss  Response to a threatening relationship fear  Protection of survivor(s) sacrifice
  • 10. PERSPECTIVES ON SUICIDE Societal Medical Cultural Inter-personal Greater understanding of suicide and a basis for preventive strategies
  • 11. PREVENTION  Primary prevention reduction in prevalence e.g. A & D  Secondary prevention reduced incidence (early intervention) e.g. GPI  Tertiary prevention reduced levels of disability e.g. Schiozohrenia
  • 12. TERTIARY PREVENTION SUICIDE  Reduction of impacts on survivors  Coroners findings  Community management of event
  • 13. Tertiary Prevention Notified cases  Ongoing support, monitoring for friends, relatives  Access to health and social services  Education and counselling
  • 14. PRIMARY PREVENTION Whole populations (Reducing health risks for everyone)  Reduced levels of estrangement e.g. cultural enrichment, employment, religious affinities, family cohesion, participation in sport, decision-making  Regulatory Controls e.g. A&D, seat belts, cycle helmets, smoking laws, nutrition, folic acid, Vitamin B6, mobile phones  Reduction of inequalities between groups e.g. Education, incomes, housing, imprisonment
  • 15. PRIMARY PREVENTION & SUICIDE  Regulations and legislation Suicide ‘a crime’ Gun laws, access to heights, drug regulations Use of the web - Bebo, face book  Health Care and Medical Practice Prescribing practices e.g. barbiturates Improved risk detection Mental health in Primary Health Care  Societal institutions and values Endorsement of world views and beliefs Secure cultural identity Social coherence
  • 16. SECONDARY PREVENTION Interventions with ‘At risk’ Populations  Early identification of ‘at risk’ individuals and/or groups  Strengths based approach vs Problem-oriented approach  Ready access to relevant services  Individual and group interventions
  • 17. SECONDARY PREVENTION SUICIDE  Psychological focus Or  Relational focus Intervention Or milestones  Societal focus Or • Engagement  Cultural focus • Enlightenment Or  Integrated focus • Empowerment
  • 18. Whakapiri - Engagement Establishing rapport requires attention to:  Space  Time  Boundaries  Ways of thinking
  • 19. Engagement Space, time, boundaries ‘The marae atea’ Physical distance ‘Time to ‘hear out’ Allocation of time Distinctive roles Observation of manuhiri, tangata whenua boundaries men and women
  • 20. Engagement WAYS OF THINKING Centrifugal Centripetal  Outwards direction  Inwards direction  Understanding  Understanding comes from larger comes from analysis contexts e.g. wider of component parts relationships e.g. inner thoughts and feelings  Similarities convey  Differences help essence of meaning gain understanding
  • 21. Flows of mental energy Centrifugal Centripetal The Telescope The Microscope
  • 22. Whakamārama - Enlightenment  ‘Switching on the light’  Interventions should lead to a higher level of enlightenment  Increased:  awareness  understanding  maturity
  • 23. Whakamārama - Enlightenment  The ways in which interventions are received vary between individuals  Multi-sensory perceptions  Information, procedures, advice are not processed in the same ways
  • 24. Whakamārama - Enlightenment Taha hinengaro Improved intellectual understanding, an expanded knowledge base, Taha wairua Strengthened cultural and spiritual identity, meaningful connections with time & place, restored values and ethics Taha tinana Increased awareness of body and physique, enjoyment of exercise & movement, Taha whanau Re-assessment of family & social relationships, renewed energy for positive relationships less enthusiasm for negative relationships
  • 25. Modes of Interaction to maximise impact  Kanohi ki te kanohi  The web  Individual or group  Whānau
  • 26. Cultural Pathways to enlightenment  The spiritual domain  Marae participation, tangihanga, waiata  The intellectual domain  Te reo, metaphor & symbolism, centrifugal energy  The physical domain  Mau rakau, touch rugby, waka ama  The social domain  Whānau occasions, networks, kapa haka
  • 27. Whakamana - Empowerment Interventions should ultimately lead to empowerment Engagement + Enlightenment = Empowerment
  • 28. Successful interventions lead to Empowerment  Self control – capacity to communicate, to manage behaviour, emotions, adaptation, weight, relationships  Human dignity – sense of integrity, self worth, secure identity, wider connections  Knowledge – sufficiently well informed to understand risks and pathways to wellbeing
  • 29. Whakamana - Empowerment  Able to participate in te ao whanui – wider society  Able to participate in te ao Maori – the Maori world  Capacity to enjoy positive relationships and contribute to whānau  Capacity for self determination
  • 30. SUICIDE PREVENTION Perspectives Levels of Interventions on Suicide Prevention - Societal Primary Prevention Engagement Population-wide approaches Medical Secondary Prevention Enlightenment Cultural A focus on ‘at risk’ individuals or groups Interpersonal Empowerment Tertiary Prevention Alleviating the impacts