SUICIDE PREVENTIONSUICIDE PREVENTION

Mason DurieMason Durie

Massey UniversityMassey University

How best to understand human How best to understand human behaviour?behaviour?

Looking inwards through the Looking inwards through the microscopemicroscope

Psychological & Psychological & emotional conflictsemotional conflicts Low self esteemLow self esteem lack of confidencelack of confidence loss of hopeloss of hope Loss of manaLoss of mana

Biochemical & neurological disturbances

• Chemical imbalances• Synaptic failures• Mental disorders

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

Looking outwards through the Looking outwards through the TelescopeTelescope

Interpersonal Interpersonal relationshipsrelationships

DisruptedDisruptedBereavementBereavementDysfunctionalDysfunctionalThreateningThreateningRelationships 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

SUICIDESUICIDEFOUR PERSPECTIVESFOUR PERSPECTIVES

SOCIETALSOCIETALsuicide as a social phenomenonsuicide as a social phenomenon

MEDICALMEDICALsuicide as a medical conditionsuicide as a medical condition

CULTURALCULTURALsuicide and cultural identitysuicide and cultural identity

INTERPERSONALINTERPERSONALsuicide and relationships between peoplesuicide and relationships between people

SUICIDE SUICIDE SOCIETAL PERSPECTIVESSOCIETAL PERSPECTIVES

Altruistic suicideAltruistic suicide‘‘sacrifice for the greater good’ sacrifice for the greater good’

e.g. suicide-bomberse.g. suicide-bombers

Anomic suicideAnomic suicide‘‘detachment & disengagement’detachment & disengagement’

e.g. nihilistic suicide, e.g. nihilistic suicide,

Coercive suicideCoercive suicide‘‘group pressures and expectations’group pressures and expectations’

e.g. cult suicide, text messaginge.g. cult suicide, text messaging

SUICIDESUICIDEMEDICAL PERSPECTIVESMEDICAL PERSPECTIVES

Mental disordersMental disorderse.g. depressione.g. depression

Chronic ill healthChronic ill healthe.g. immobilisatione.g. immobilisation

Terminal illnessTerminal illnesse.g. cancere.g. cancer

SUICIDESUICIDECULTURAL PERSPECTIVESCULTURAL PERSPECTIVES

Cultural alienationCultural alienationinsecure identityinsecure identity

Cultural exclusionCultural exclusionfrustrated identityfrustrated identity

Unconditional cultural conformityUnconditional cultural conformityculturally sanctioned suicideculturally sanctioned suicide

SUICIDESUICIDEINTER-PERSONAL PERSPECTIVESINTER-PERSONAL PERSPECTIVES

Termination of a loving relationshipTermination of a loving relationshiplossloss

Response to a threatening relationshipResponse to a threatening relationshipfearfear

Protection of survivor(s)Protection of survivor(s)sacrificesacrifice

PERSPECTIVES ON SUICIDEPERSPECTIVES ON SUICIDE

Societal Medical Cultural Inter-personal

Greater understanding of suicide and a basis for preventive strategies

PREVENTIONPREVENTION

Primary preventionPrimary preventionreduction in prevalence e.g. A & Dreduction in prevalence e.g. A & D

Secondary preventionSecondary preventionreduced incidence (early intervention)reduced incidence (early intervention)

e.g. GPIe.g. GPI Tertiary preventionTertiary prevention

reduced levels of disabilityreduced levels of disabilitye.g. Schiozohreniae.g. Schiozohrenia

TERTIARY PREVENTIONTERTIARY PREVENTIONSUICIDESUICIDE

Reduction of impacts on survivors Reduction of impacts on survivors

Coroners findingsCoroners findings

Community management of eventCommunity management of event

Tertiary PreventionTertiary PreventionNotified casesNotified cases

Ongoing support, monitoring for friends, Ongoing support, monitoring for friends, relativesrelatives

Access to health and social servicesAccess to health and social services

Education and counsellingEducation and counselling

PRIMARY PREVENTIONPRIMARY PREVENTIONWhole populations Whole populations

((Reducing health risks for everyoneReducing health risks for everyone))

Reduced levels of estrangement Reduced levels of estrangement e.g. cultural enrichment, employment, religious affinities, e.g. cultural enrichment, employment, religious affinities, family cohesion, participation in sport, decision-makingfamily cohesion, participation in sport, decision-making

Regulatory Controls Regulatory Controls e.g. A&D, seat belts, cycle helmets, smoking laws, e.g. A&D, seat belts, cycle helmets, smoking laws, nutrition, folic acid, Vitamin B6, mobile phonesnutrition, folic acid, Vitamin B6, mobile phones

Reduction of inequalities between groupsReduction of inequalities between groupse.g. Education, incomes, housing, imprisonmente.g. Education, incomes, housing, imprisonment

PRIMARY PREVENTION & SUICIDE PRIMARY PREVENTION & SUICIDE Regulations and legislationRegulations and legislation

Suicide ‘a crime’Suicide ‘a crime’Gun laws, access to heights, drug regulationsGun laws, access to heights, drug regulationsUse of the web - Bebo, face book Use of the web - Bebo, face book

Health Care and Medical Practice Health Care and Medical Practice Prescribing practices e.g. barbituratesPrescribing practices e.g. barbiturates

Improved risk detectionImproved risk detectionMental health in Primary Health CareMental health in Primary Health Care

Societal institutions and valuesSocietal institutions and valuesEndorsement of world views and beliefsEndorsement of world views and beliefsSecure cultural identitySecure cultural identitySocial inclusionSocial inclusion

SECONDARY PREVENTIONSECONDARY PREVENTIONInterventions with ‘At risk’ PopulationsInterventions with ‘At risk’ Populations

Early identification of ‘at risk’ individuals Early identification of ‘at risk’ individuals and/or groupsand/or groups

Strengths based approachStrengths based approach

vsvs

Problem-oriented approachProblem-oriented approach

Ready access to relevant servicesReady access to relevant services

Individual and group interventionsIndividual and group interventions

SECONDARY PREVENTIONSECONDARY PREVENTIONSUICIDESUICIDE

Psychological focusPsychological focusOrOr

Relational focusRelational focusOr Or

Societal focusSocietal focusOrOr

Cultural focusCultural focusOrOr

Integrated focus Integrated focus

Intervention milestones

• Engagement

• Enlightenment

• Empowerment

Whakapiri - EngagementWhakapiri - Engagement

Establishing rapport requires attention to:Establishing rapport requires attention to:SpaceSpaceTimeTimeBoundariesBoundariesWays of thinkingWays of thinking

EngagementEngagementSpace, time, boundariesSpace, time, boundaries

Physical distancePhysical distance

Allocation of timeAllocation of time

Observation of Observation of boundariesboundaries

‘The marae atea’

‘Time to ‘hear out’

Distinctive roles manuhiri, tangata whenuamen and women

EngagementEngagementWAYS OF THINKINGWAYS OF THINKING

CentrifugalCentrifugal CentripetalCentripetal Outwards directionOutwards direction

Understanding comes Understanding comes from larger contexts from larger contexts e.g. wider e.g. wider relationshipsrelationships

Similarities convey Similarities convey essence of meaningessence of meaning

Inwards directionInwards direction

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

Differences help Differences help gain understandinggain understanding

Flows of mental energyFlows of mental energyCentrifugal Centrifugal CentripetalCentripetal

The Telescope The Microscope

Whakamārama - EnlightenmentWhakamārama - Enlightenment

‘‘Switching on the light’Switching on the light’

Interventions should lead to a higher level Interventions should lead to a higher level of enlightenmentof enlightenment

Increased: Increased: awarenessawarenessunderstandingunderstandingmaturitymaturity

Whakamārama - EnlightenmentWhakamārama - Enlightenment

The ways in which interventions are The ways in which interventions are received vary between individualsreceived vary between individuals

Multi-sensory perceptionsMulti-sensory perceptions

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

Whakamārama - EnlightenmentWhakamārama - 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 relationshipsless enthusiasm for negative relationships

Modes of Interaction to maximise Modes of Interaction to maximise impactimpact

Kanohi ki te kanohiKanohi ki te kanohi

The webThe web

Individual or groupIndividual or group

WhānauWhānau

Cultural Pathways to enlightenmentCultural Pathways to enlightenment

The spiritual domainThe spiritual domainMarae participation, tangihanga, waiata Marae participation, tangihanga, waiata

The intellectual domainThe intellectual domainTe reo, metaphor & symbolism, centrifugal energyTe reo, metaphor & symbolism, centrifugal energy

The physical domainThe physical domainMau rakau, touch rugby, waka amaMau rakau, touch rugby, waka ama

The social domainThe social domainWhānau occasions, networks, kapa hakaWhānau occasions, networks, kapa haka

Whakamana - EmpowermentWhakamana - Empowerment

Interventions should ultimately lead to Interventions should ultimately lead to empowermentempowerment

Engagement + EnlightenmentEngagement + Enlightenment

= Empowerment= Empowerment

Successful interventions lead toSuccessful interventions lead toEmpowermentEmpowerment

Self control – capacity to communicate, to Self control – capacity to communicate, to manage behaviour, emotions, adaptation, manage behaviour, emotions, adaptation, weight, relationshipsweight, relationships

Human dignity – sense of integrity, self Human dignity – sense of integrity, self worth, secure identity, wider connectionsworth, secure identity, wider connections

Knowledge – sufficiently well informed to Knowledge – sufficiently well informed to understand risks and pathways to wellbeingunderstand risks and pathways to wellbeing

Whakamana - EmpowermentWhakamana - Empowerment

Able to participate in te ao whanui – wider Able to participate in te ao whanui – wider societysociety

Able to participate in te ao Maori – the Maori Able to participate in te ao Maori – the Maori worldworld

Capacity to enjoy positive relationships and Capacity to enjoy positive relationships and contribute to whānaucontribute to whānau

Capacity for self determinationCapacity for self determination

SUICIDE PREVENTIONSUICIDE PREVENTION

Primary PreventionPrimary PreventionPopulation-wide Population-wide

approachesapproaches

Secondary PreventionA focus on ‘at risk’

individuals or groups

Tertiary PreventionAlleviating the impacts

Engagement

Enlightenment

Empowerment

Societal

Medical

Cultural

Interpersonal

Perspectiveson Suicide

Levels of Prevention

Interventions

-