Whānau-centred approaches to counselling, community development and suicide prevention place greater emphasis on group relationships and functionality than on individual psychopathology. Positive whānau development is a preventative process insofar as it mediates between individuals, groups, and wider society. The focus is on building strengths and resilience and enabling the creation of an environment where empowerment can over-ride marginalisation, despair, and loss of hope.
Centering preventative strategies on whānau does not dismiss individual needs but recognises the importance of relational synergies as ways of understanding human situations. Expertise in whānau mediation, culturally relevant styles of communication, and building effective whānau leadership are key elements of a community based preventative programmes for Māori.
Presentation by Professor Mason Durie, Assistant Vice-Chancellor (Māori & Pasifika), Massey University at the 2009 SPINZ National Symposium: Culture and Suicide Prevention in Aotearoa: http://www.spinz.org.nz/page/108-events-archive+spinz-national-symposium-2009+symposium-coverage
A video showing parts of this presentation is at: http://www.youtube.com/watch?v=YvjnYoJAx3o
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
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
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