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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

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Suicide prevention l.jpg

SPINZ 2009

SUICIDE PREVENTION

Mason Durie

Massey University


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How best to understand human behaviour?


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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


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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


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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


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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


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SUICIDEMEDICAL PERSPECTIVES

  • Mental disorders

    e.g. depression

  • Chronic ill health

    e.g. immobilisation

  • Terminal illness

    e.g. cancer


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SUICIDECULTURAL PERSPECTIVES

  • Cultural alienation

    insecure identity

  • Cultural exclusion

    frustrated identity

  • Unconditional cultural conformity

    culturally sanctioned suicide


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SUICIDEINTER-PERSONAL PERSPECTIVES

  • Termination of a loving relationship

    loss

  • Response to a threatening relationship

    fear

  • Protection of survivor(s)

    sacrifice


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PERSPECTIVES ON SUICIDE

Societal

Medical

Cultural

Inter-personal

Greater understanding of suicide and

a basis for preventive strategies


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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


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TERTIARY PREVENTIONSUICIDE

  • Reduction of impacts on survivors

  • Coroners findings

  • Community management of event


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Tertiary PreventionNotified cases

  • Ongoing support, monitoring for friends, relatives

  • Access to health and social services

  • Education and counselling


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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


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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


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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


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SECONDARY PREVENTIONSUICIDE

  • Psychological focus

    Or

  • Relational focus

    Or

  • Societal focus

    Or

  • Cultural focus

    Or

  • Integrated focus

  • Intervention milestones

  • Engagement

  • Enlightenment

  • Empowerment


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Whakapiri - Engagement

Establishing rapport requires attention to:

  • Space

  • Time

  • Boundaries

  • Ways of thinking


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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


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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 THINKINGCentrifugalCentripetal


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Flows of mental energyCentrifugal Centripetal

The Microscope

The Telescope


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Whakamārama - Enlightenment

  • ‘Switching on the light’

  • Interventions should lead to a higher level of enlightenment

  • Increased:

    • awareness

    • understanding

    • maturity


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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


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Whakamārama - Enlightenment

Taha hinengaroImproved intellectual understanding, an expanded knowledge base,

Taha wairuaStrengthened cultural and spiritual identity, meaningful connections with time & place, restored values and ethics

Taha tinanaIncreased awareness of body and physique,

enjoyment of exercise & movement,

Taha whanauRe-assessment of family & social relationships,

renewed energy for positive relationships

less enthusiasm for negative relationships


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Modes of Interaction to maximise impact

  • Kanohi ki te kanohi

  • The web

  • Individual or group

  • Whānau


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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


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Whakamana - Empowerment

Interventions should ultimately lead to empowerment

Engagement + Enlightenment

= Empowerment


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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


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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


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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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