SUICIDE PREVENTION

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 & • neurological disturbances • Chemical imbalances • Synaptic failures • Mental disorders • Life-cycle crises • Identity diffusion • Alienation • de-culturation • poor health

4. Looking 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 coherence

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, tangatawhenua • men and women

20. 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 EngagementWAYS OF THINKINGCentrifugal Centripetal

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