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

Engagement

Enlightenment

Empowerment

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

Whnau

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-

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