1. Preventing Mori suicide:what can we do? Keri Lawson-Te Aho29 January 2013

2. OverviewWords of wisdom and encouragementTea-Kays story heeding the lessonsThe evidence - experiential/research basedJoining the dotsSo what? 3. A paradigm shift is required to deal with theissue of Mori suicide. That paradigm shiftmust be based on the privileging ofMori worldviews, Mori epistemology,Mori values and processes (Irwin, 2012 )thereby changing the way interventions arecurrently conceptualised and strategies areframed. 4. A Mori-centered approach to Morisuicide prevention is critical and alignswith indigenous thinking about theprevention of suicide in indigenouscommunities (Duran 2006; Elliot-Farrelly, 2004; Evans-Campbell,2008; Durie, 2004; Duran, Firehammer & Gonzalez, 2008). 5. young people need to be able to talk toadults sometimes but often we cant. Nodisrespect mum, but sometimes adults dontknow how to listen. Its up to us to help eachother but sometimes we need help with that.After dad died, the only people I could talk towere my friendsI cant imagine talking to a mental healthexpert or a counsellor. They dont know meand it takes trust to open up. You know meHuriana Kopeke-Te Aho aged 17 6. Its not an easy thing to teach. I trustedmy mum and my dad, and my aunties anduncles when I was young but as you growup, it sort of leaves you, bit by bit. Thingshappen that sometimes strip that trustaway. How can we teach it and give it toour kids so it becomes their hua andnever let it be stripped away? parent,2012 7. "I can put my money on whnau. [...] to allpeople that work with families is to be able tohelp sort a problem. Go beyond that, and helpa whnau build capability, leadership [...]unwittingly, we put the whnau into a passive,dependant position and overlook the potentialthey might have for strength and for leadership."Professor Sir Mason Durie, 2012 8. We admit that we are insular; we dont wantpeople to know whats going on in ourwhnau and we dont want to know whatsgoing on over the back fence, let alone in thehap next door, and the iwi and the waka. Wehave to, as Mori, rise above our own issuesto communicate with each other about themamae that we hold. How do we deal withthat? We have ideas that we can share andimplement and take practical steps. I am hereto listen to the krero. (practitioner, 2012) 9. "No strategy should be dependent upon agovernment contract that provides aservice to a community to fix up thoseproblems that is affecting thosecommunities. Once that contract is gone ifthose communities are no better off anymore resilient or able to sustain thosestrategies or approaches or responses thathave been injected into those communities,those communities are going to end up wherethey are. Pahia Turia, 2012 10. The greatest resource is whnau. If you canlift their sights, value them, give them dignity,watch them go. We need to take stock ofourselves. Ive been in positions where I haveto fix families. What a waste of time. At theend of the day, we were de-dignifying people.Taking away their dignity and sense of theirfuture and responsibility. Are we trying toassume responsibility for families or are wegetting there just to tell them how wonderfulthey are. Dame Iritana Tawhiwhirangi, 2012 11. Tea-Kay1992-2012 12. Tea-Kays story Background of severe bullying (Klomek et al., 2008, 2009). Father took his own life when Tea-Kay was 4 (Brent & Melhem, 2008). Close knit whnau (Clarke et al, 2010; Kirmayer, 2007) Historical abuse (Joiner et al., 2007) Gang affiliations on fathers side (Paikea, 2011; Ashby, 2011; Cuestas, 2013) Diagnosed with depression and anorexia/bulimia at 17 (Albizu-Garcia etal., 2001) (Rohde, Seeley, Kaufman, Clarke, & Stice, 2006) Client of mental health services (Rohde et al, 2006; Te Rau Matatini, 2008) Sexuality (Coupe, 2005) Raised in Christian church (Garroute et al, 2008) Dreamed of being a fashion designer but no chance to realisedreams/unemployment (Platt & Hawton, 2000)/heavy alcohol use (Baxter,2008), self harming seeing the cries for help and reading the signs 13. Tea-Kays strengths/protective factors Strong and loving whnau, connected to whnau (Clarke etal, 2010; Wannan & Fombonne, 1998; Coggan et al., 1997) Dreams and goals/visions/moemoea/hope (Kruger et al,2004) Close knit network of friends/gothic gay community/peersupport (Smalley, 2005;Lawson-Te Aho, 2012). Faith raised in the Christian church (Garoutte, et al., 2003) Access to cultural identity and values (Durie, 2012;Tahuprae) Giftings on his life/intelligent, creative, caring, courageous Loving and lovable/aroha 14. Tea-Kays risk factors Fathers suicide (Brent & Melhem, 2008). History of violence, gang membership/abuse in fathers side(Dube et al., 2005; Brodsky et al., 2008; Lawson-Te Aho,1997) His sexuality was invisible Low self esteem/bulimia/anorexia (Lawson-Te Aho, 2012) Alcohol abuse Bullying/physical threats to his safety (Klomek et al., 2008,2009) Unfulfilled dreams Confusion about his cultural identity Accumulation of stressors sexual identity; history of abuse;death of dad; lack of continuity between services andcommunity 15. What did we do? Supported him into training as a fashiondesigner Mum opened home to his friends Youth looked out for him Friends supported him via Facebook Church supported him and involved him inleading church youth events Searched for help for self harming 16. After his suicide - what did we do? Took him onto his marae, had a tangi for him, friends spoke atservice/performed haka/Toia mai Drew his friends together and kept an eye on them/openedhomes/Provided a safety net for his friends Sought grief counselling (not easy to find help) Talked about his suicide (as whnau but not openly withfriends/friends talked about his suicide amongst themselves) Used Facebook as a form of social support Tried to rally the community Information and training (assessing need) Networked amongst suicide prevention networks/socialsupport/counselling networks/professional responses Identified at risk youth in his networks (safety) Sought understanding/started telling his story 17. What could we have donedifferently? Supported him to be who he was/out of school (Durie, 1997) Counselling and support to deal with loss of father (Lawson-Te Aho, 2012) Address bullying/protection and safety (Lawson-Te Aho, 2012) Address historical trauma and abuse (Duran, 2006; Walters et al, 2012) long term agenda (Chandler and Lalonde, 2008) Supported his whnau/mum raising children as a widow Tried behavioural activation as suicide prevention (Bennett, 2010) Attended to wairua issues more closely (Valentine, 2010) Cultural development? Strategies for self determination? Sustained activism (Durie, 2005) Strengthened the whnau/capacity building of the whnau (Turia, 2012) Specific interventions problem solving/improving flow between psychiatriccare and home (Coupe, 2012) Kept him in the community/treated him in his own community instead ofsending him away into psychiatric care Got down off our professional high horses/overcoming fear 18. Looking at the big picture Indigenous suicideprevention what we know 19. whakapapa hHistorical traum createsa determinantsblockages in the life flow risk factorswhnau as aprotective factor/solutioncClinical services/externalagenciescCom unity supportmcCultural options 20. The depiction of the whnau as the waka/vehicle for suicideprevention recognises at the most pragmatic levels, that it isthe whnau who buries their loved one after suicide. It is thewhnau who supports their loved one after a significantsuicide attempt. It is the whnau who breaks the news to thewider whnau when a loved one has ended their life. It is thewhnau who dresses their loved one after suicide. It is thewhnau that carries the burden of guilt and shame aftersuicide. The whnau is the primary point of responsibility,the socialisation site (Tomlins-Jahnke & Durie, 2008) andthe potential guarantor of Mori cultural continuity. It is thewhnau that is the engine room of iwi development (Kruger,2010). It is the whnau that is committed for life (bywhakapapa) to vulnerable and suffering whnau members.To reiterate, whnau offer the most untapped potentialfor Mori suicide prevention (Turia, 2012; Lawson-Te Aho,2012). 21. What is historical trauma? mamae Trauma, cumulative, occurred over alifespan and generations, fromcataclysmic events in history HT creates prolonged stress and distress Trauma events produce outcomes HTR Pathways by which trauma transfersthrough generations HT factors (unresolved grief) interact withcurrent experiences (proximal stressors)create a vulnerability to stress anddisease (Walters et al, 2012) 22. Historical ContextAboriginal/indigenous/Mori suicide isdifferent additional risk and protectivefactors (Durie, 2005; Lawson-Te Aho, 2012)Historical and contextual issues and inter-generational transfer; unresolved griefpoverty through land alienationcultural loss through sustained colonisation(Duran, 2006; Wesley et al, 2008; Walterset al, 2012; Lawson-Te Aho & Liu, 2010) 23. Common Themes in IndigenousSuicide Prevention Requires a paradigm shift power within not powerwithout/impacts of history Cultural development (Te Pataka Uara) Gaining consciousness of who we are and where we comefrom (whakapapa consciousness) Self determination enables privileging of indigenous/Moriresponses (mana motuhake/Rangatiratanga) Cultural continuity a hedge against suicide Long term healing not short term treatment (wairua healing) 24. Whanganui kaumtua, Rangitihi Tahupraesaid:Let us return to our origins. Since the timewe as Mori were immersed in theknowledge streams of Tauiwi we havebecome like a branch grafted to a foreigntree, producing fruit of a different qualityand somewhat unpalatable. It is time thatwe returned to the rootstock of ourancestors 25. Ancestral rootstock1.Kotahitanga whnau are collective and concerted in theirapproach2.pkaitanga whnau are well connected to their home,land and people3.Whanaungatanga - whnau live with reciprocal obligationsto each other consistent with being part of and affirming thevalues of the wider collective4.Wairuatanga whnau are experiencing the fulfillment oflife; wairuatanga connects all of the principles and is central tothe interconnectedness of all of the principles of whnau ora5.Manaakitanga through the expression of aroha, hospitality,generosity and mutual respect as whnau practice6.Kaitakitanga whnau are working in empowering andenabling ways that foster and encourage self determination7.Te Reo is strong and vibrant in the everyday lives ofwhnau 26. Te Whnau e t kaha anaTe Taiao - A secure identity - Taiohi, a voice, participation - Leadership, succession, generations coming together, whnau engagement - Whnau connectedness - Absence of abuse - Kaimahi development - Ahi kaaWhanaungatanga Manaakitanga Rangatiratanga/Mana Wairuatanga Whakapapa 27. The revolution begins at home. So oftenwe look outside ourselves for the answersand they are there staring us in the facebut we dont always have the confidenceor the courage to see what is there in frontof us and so we look for answers wherethere arent anyKeri Lawson-Te Aho, 2012 28. Hapu Transformation 29. Gaining consciousnessUnderstanding our history and its outcomestoday has to be part of a healing process painful. The rongoa is in the mamaeIn one sense all we have to offer to futuregenerations is the past containing as it does thehopes, the spirit, the determination of thepeople, their constant example of both virtue andof error. But what a treasure chest that really is.That is brightness enough to light the wayProfessor Robert Te Kotahi Mahuta (2001) 30. Whakapapa analysisWhakapapa consciousness The homies/te ahi kaaroa The lost generations/diaspora Repatriation and reconnection Internalised oppression 31. Healing processesThe pathways back to ourselves:Whakapapa reconnection andhealingKreroManaakitangaWe have some choices 32. WhakawaateaGrief ritualsSpiritual healingFaith in our own traditions, our owncultural values and practices 33. Cultural developmentRestoration of cultural values foundational forthe promotion of positive health for Mori Whanaungatanga Manaakitanga 34. LeadershipGiving voice to the kaupapaPassion, drive, commitment, longevityNo one owns this kaupapaThe summary from the first hui withHon Tariana Turia on 16 December2012 35. Kaimahi of Whnau Ora servicesneed to facilitate whnau telling theirown stories. It may be that the peoplebest placed to support thetransformation of whnau are alreadyplaced within the whnau, or broadernetwork of the whnau. It is importantthat whnau are able to identify theresources for support they have withinthemselves, their histories, and theirnetworks. 36. The role of krero in suicide prevention,intervention, and postvention is important.Trust is essential. Peer support groups, aswell as inter-generational supportmechanisms, have proven effectiveamongst hui participants.Rather than fixing whnau, supportservices must help to equip whnau withthe tools to navigate their own wellness.Whakapapa is a tool which can be used inunderstanding social responsibilities for thepurpose of suicide prevention, intervention,and postvention. 37. There is a wealth of untapped potential inour traditional knowledge bases, includinglessons to be drawn from characters suchas Hine-nui-te-p, which needs to bedrawn on in the approach to Mori suicideprevention. Authoritative research ontraditional methods for dealing with mamaeis called for, as is a more thoroughunderstanding of the positive implicationsof political activism on an individual.Te Taha Wairua is a critical componentwhich must be addressed in Mori suicideprevention strategies e.g. karakia, and afuller understanding of the application ofmtauranga Mori.Mori suicide prevention must not solelyrely on an individuals ability to access, orconnect with, their taha Mori. 38. Whnau must be engaged at every level ofprevention, intervention, and postvention;from governance to delivery of care. Whnaumust also be willing and able to receive care.Whanaungatanga is a tool which can be usedto celebrate the positive, and connectindividuals with a wide fabric of people.Whnau ora will mean different things todifferent whnau. It is important that whnauhave the mana to determine their ownwellness. There is a distinction to be madebetween whnau--whakapapa and whnau--kaupapa.For whnau to be well, in every sense, anunbundling and accounting of the histories andtrauma they have suffered across generationsneeds to occur. 39. So what? That is for you to determineWhakapapa preservation andprotection to ensure continuity Healing is our kaupapaThose of us who can should impact and influence what we can when we canMany hands make light work 40. the revolution begins at home Me kotahitanga tatou!