SUICIDE PREVENTION

1. SUICIDE PREVENTION Mason Durie Massey University

2. How best to understand human behaviour?

3. Looking inwards through the microscope Psychological & emotional conflicts • Low self esteem • lack of confidence • loss of hope • Loss of mana • Biochemical & • neurological disturbances • Chemical imbalances • Synaptic failures • Mental disorders • Life-cycle crises • Identity diffusion • Alienation • de-culturation • poor health

4. Looking outwards through the Telescope Interpersonal relationships • Disrupted • Bereavement • Dysfunctional • Threatening • Relationships with family & community • Unemployment • School failure • Homelessness • Risk-taking lifestyles • Bankruptcy • Relationships with society • Loss of usefulness • Loss of role • Loss of purpose • Loss of engagement

5. SUICIDEFOUR 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. SUICIDEMEDICAL PERSPECTIVES • Mental disorders e.g. depression • Chronic ill health e.g. immobilisation • Terminal illness e.g. cancer

8. SUICIDECULTURAL PERSPECTIVES • Cultural alienation insecure identity • Cultural exclusion frustrated identity • Unconditional cultural conformity culturally sanctioned suicide

9. SUICIDEINTER-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 PREVENTIONSUICIDE • Reduction of impacts on survivors • Coroners findings • Community management of event

13. Tertiary PreventionNotified cases • Ongoing support, monitoring for friends, relatives • Access to health and social services • Education and counselling

14. PRIMARY PREVENTIONWhole 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 inclusion

16. SECONDARY PREVENTIONInterventions 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 PREVENTIONSUICIDE • Psychological focus Or • Relational focus Or • Societal focus Or • Cultural focus Or • Integrated focus • Intervention milestones • Engagement • Enlightenment • Empowerment

18. Whakapiri - Engagement Establishing rapport requires attention to: • Space • Time • Boundaries • Ways of thinking

19. EngagementSpace, time, boundaries Physical distance Allocation of time Observation of boundaries • ‘The marae atea’ • ‘Time to ‘hear out’ • Distinctive roles • manuhiri, tangata whenua • men and women

20. EngagementWAYS OF THINKINGCentrifugal Centripetal • Outwards direction • Understanding comes from larger contexts e.g. wider relationships • Similarities convey essence of meaning • Inwards direction • Understanding comes from analysis of component parts e.g. inner thoughts and feelings • Differences help gain understanding

21. Flows of mental energyCentrifugal Centripetal The Microscope The Telescope

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 toEmpowerment • 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 Levels of Prevention Perspectives on Suicide Interventions Primary Prevention Population-wide approaches - Societal Engagement Medical Enlightenment Secondary Prevention A focus on ‘at risk’ individuals or groups Cultural Empowerment Interpersonal Tertiary Prevention Alleviating the impacts