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SUICIDE PREVENTION. Mason Durie Massey University. How best to understand human behaviour?. Looking inwards through the microscope. Psychological & emotional conflicts Low self esteem lack of confidence loss of hope Loss of mana. Biochemical & neurological disturbances - PowerPoint PPT Presentation


  • SUICIDE PREVENTIONMason DurieMassey University

  • How best to understand human behaviour?

  • Looking inwards through the microscopePsychological & emotional conflictsLow self esteemlack of confidenceloss of hopeLoss of manaBiochemical & neurological disturbances Chemical imbalances Synaptic failures Mental disorders

    Life-cycle crises Identity diffusion Alienation de-culturation poor health

  • Looking outwards through the TelescopeInterpersonal relationshipsDisruptedBereavementDysfunctionalThreateningRelationships with family & community Unemployment School failure Homelessness Risk-taking lifestyles BankruptcyRelationships with society Loss of usefulness Loss of role Loss of purpose Loss of engagement

  • SUICIDEFOUR PERSPECTIVESSOCIETALsuicide as a social phenomenon

    MEDICALsuicide as a medical condition

    CULTURALsuicide and cultural identity

    INTERPERSONALsuicide and relationships between people

  • SUICIDE SOCIETAL PERSPECTIVESAltruistic suicidesacrifice for the greater good e.g. suicide-bombers

    Anomic suicidedetachment & disengagemente.g. nihilistic suicide,

    Coercive suicidegroup pressures and expectationse.g. cult suicide, text messaging

  • SUICIDEMEDICAL PERSPECTIVESMental disorderse.g. depression

    Chronic ill healthe.g. immobilisation

    Terminal illnesse.g. cancer

  • SUICIDECULTURAL PERSPECTIVESCultural alienationinsecure identity

    Cultural exclusionfrustrated identity

    Unconditional cultural conformityculturally sanctioned suicide

  • SUICIDEINTER-PERSONAL PERSPECTIVESTermination of a loving relationshiploss

    Response to a threatening relationshipfear

    Protection of survivor(s)sacrifice

  • PERSPECTIVES ON SUICIDESocietalMedicalCulturalInter-personalGreater understanding of suicide and a basis for preventive strategies

  • PREVENTIONPrimary preventionreduction in prevalence e.g. A & D

    Secondary preventionreduced incidence (early intervention)e.g. GPITertiary preventionreduced levels of disabilitye.g. Schiozohrenia

  • TERTIARY PREVENTIONSUICIDEReduction of impacts on survivors

    Coroners findings

    Community management of event

  • Tertiary PreventionNotified casesOngoing support, monitoring for friends, relatives

    Access to health and social services

    Education and counselling

  • 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 groupse.g. Education, incomes, housing, imprisonment

  • PRIMARY PREVENTION & SUICIDE Regulations and legislationSuicide a crimeGun laws, access to heights, drug regulationsUse of the web - Bebo, face book

    Health Care and Medical Practice Prescribing practices e.g. barbituratesImproved risk detectionMental health in Primary Health Care

    Societal institutions and valuesEndorsement of world views and beliefsSecure cultural identitySocial inclusion

  • SECONDARY PREVENTIONInterventions with At risk PopulationsEarly identification of at risk individuals and/or groups

    Strengths based approachvsProblem-oriented approach

    Ready access to relevant services

    Individual and group interventions

  • SECONDARY PREVENTIONSUICIDEPsychological focusOrRelational focusOr Societal focusOrCultural focusOrIntegrated focus

    Intervention milestones




  • Whakapiri - EngagementEstablishing rapport requires attention to:SpaceTimeBoundariesWays of thinking

  • EngagementSpace, time, boundariesPhysical distance

    Allocation of time

    Observation of boundaries

    The marae atea

    Time to hear out

    Distinctive roles manuhiri, tangata whenuamen and women

  • EngagementWAYS OF THINKINGCentrifugalCentripetalOutwards direction

    Understanding comes from larger contexts e.g. wider relationships

    Similarities convey essence of meaningInwards direction

    Understanding comes from analysis of component parts e.g. inner thoughts and feelings

    Differences help gain understanding

  • Flows of mental energyCentrifugal CentripetalThe TelescopeThe Microscope

  • Whakamrama - EnlightenmentSwitching on the light

    Interventions should lead to a higher level of enlightenment

    Increased: awarenessunderstandingmaturity

  • Whakamrama - EnlightenmentThe ways in which interventions are received vary between individuals

    Multi-sensory perceptions

    Information, procedures, advice are not processed in the same ways

  • Whakamrama - EnlightenmentTaha hinengaroImproved intellectual understanding, an expanded knowledge base, Taha wairuaStrengthened cultural and spiritual identity, meaningful connections with time & place, restored values and ethicsTaha tinanaIncreased awareness of body and physique, enjoyment of exercise & movement, Taha whanauRe-assessment of family & social relationships,renewed energy for positive relationshipsless enthusiasm for negative relationships

  • Modes of Interaction to maximise impactKanohi ki te kanohi

    The web

    Individual or group


  • Cultural Pathways to enlightenmentThe spiritual domainMarae participation, tangihanga, waiata The intellectual domainTe reo, metaphor & symbolism, centrifugal energyThe physical domainMau rakau, touch rugby, waka amaThe social domainWhnau occasions, networks, kapa haka

  • Whakamana - EmpowermentInterventions should ultimately lead to empowerment

    Engagement + Enlightenment= Empowerment

  • 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

  • Whakamana - EmpowermentAble 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 whnau

    Capacity for self determination

  • SUICIDE PREVENTIONPrimary PreventionPopulation-wide approachesSecondary PreventionA focus on at risk individuals or groupsTertiary PreventionAlleviating the impactsEngagementEnlightenmentEmpowermentSocietalMedical

    CulturalInterpersonalPerspectiveson SuicideLevels of PreventionInterventions-