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SPINZ 2009. SUICIDE PREVENTION. Mason Durie Massey University. How best to understand human behaviour?. Looking through the microscope. Psychological & emotional conflicts Low self esteem lack of confidence loss of hope Loss of mana. Biochemical & neurological disturbances

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suicide prevention

SPINZ 2009

SUICIDE PREVENTION

Mason Durie

Massey University

looking through the microscope
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
looking through the telescope
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
suicide four perspectives
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

suicide societal perspectives
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

suicide medical perspectives
SUICIDEMEDICAL PERSPECTIVES
  • Mental disorders

e.g. depression

  • Chronic ill health

e.g. immobilisation

  • Terminal illness

e.g. cancer

suicide cultural perspectives
SUICIDECULTURAL PERSPECTIVES
  • Cultural alienation

insecure identity

  • Cultural exclusion

frustrated identity

  • Unconditional cultural conformity

culturally sanctioned suicide

suicide inter personal perspectives
SUICIDEINTER-PERSONAL PERSPECTIVES
  • Termination of a loving relationship

loss

  • Response to a threatening relationship

fear

  • Protection of survivor(s)

sacrifice

perspectives on suicide
PERSPECTIVES ON SUICIDE

Societal

Medical

Cultural

Inter-personal

Greater understanding of suicide and

a basis for preventive strategies

prevention
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

tertiary prevention suicide
TERTIARY PREVENTIONSUICIDE
  • Reduction of impacts on survivors
  • Coroners findings
  • Community management of event
tertiary prevention notified cases
Tertiary PreventionNotified cases
  • Ongoing support, monitoring for friends, relatives
  • Access to health and social services
  • Education and counselling
primary prevention whole populations reducing health risks for everyone
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

primary prevention suicide
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

secondary prevention interventions with at risk populations
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
secondary prevention suicide
SECONDARY PREVENTIONSUICIDE
  • Psychological focus

Or

  • Relational focus

Or

  • Societal focus

Or

  • Cultural focus

Or

  • Integrated focus
  • Intervention milestones
  • Engagement
  • Enlightenment
  • Empowerment
whakapiri engagement
Whakapiri - Engagement

Establishing rapport requires attention to:

  • Space
  • Time
  • Boundaries
  • Ways of thinking
engagement space time boundaries
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
engagement ways of thinking centrifugal centripetal
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
whakam rama enlightenment
Whakamārama - Enlightenment
  • ‘Switching on the light’
  • Interventions should lead to a higher level of enlightenment
  • Increased:
    • awareness
    • understanding
    • maturity
whakam rama enlightenment23
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
whakam rama enlightenment24
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

modes of interaction to maximise impact
Modes of Interaction to maximise impact
  • Kanohi ki te kanohi
  • The web
  • Individual or group
  • Whānau
cultural pathways to enlightenment
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
whakamana empowerment
Whakamana - Empowerment

Interventions should ultimately lead to empowerment

Engagement + Enlightenment

= Empowerment

successful interventions lead to 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 empowerment29
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
suicide prevention30
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

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