Dr Nicole Coupe - Preventing Māori suicide: Improving care and intervention


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Dr Nicole Coupe discusses suicide prevention for Māori in the third of three online seminars.

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Dr Nicole Coupe - Preventing Māori suicide: Improving care and intervention

  1. 1. Cultural Assessment for Suicide Prevention with Māori Dr Nicole Coupe Kāi Tahu
  2. 2. Whakapapa Rangahau Past ResearchMaori Suicide – ~80-100 /year – Males – 15-35 years – Hanging 67%Maori Attempted Suicide – ~700 / year – Females – Median age 30 years – Overdose
  3. 3. Roopu Te Ira Tangata TeamInvestigation Team– Simon Hatcher, Nicole Coupe, Mason Durie, Rees Tapsell, Hinemoa ElderAdvisory Group (past and present)– Maria Baker, Sharon Baillie, Tuwhakairiori Williams, Phyllis Tangitu, Materoa Mar, Mel Robson, Ministry of Health, Counties Manukau, Northland and Waitemata (DHB reps)Project Team (past and present)– Nicole Coupe, Ruth Herd, Karen Wikiriwhi, Alice Walker, Moana Pene-Prokopis, Te Ami Henare- Toka, Mihiteria King, Waiora Pene-HareEvaluation– Tania Wolfgramm
  4. 4. Huarahi – MethodologyRecruitment– Counties Manukau, Northland and Waitemata DHBsEligibility– >17, not at school and cognitively able to consent, MaoriRandomisation– Treatment as Usual (controls) and Powhiri: Model of Engagement (intervention)
  5. 5. Person Identified Presenting To Emergency Department with an Episode of Deliberate Self Harm Project Staff determine eligibility and ethnicity from psychosocial assessment and discharge summary Eligible Non Maori INELIGIBLE Eligible Maori Project staff gathers information required Unable To Give Informed Consent or Still At School Collect (Age, Gender, Ethnicity, DSH details) Person randomised information from DHB and NZHIS Person randomised Control Group Experimental Group Consent Form Control Group Intervention GroupConsent Form Rating ScalesRating Scales Patient SupportTreatment as Usual Problem Solving Therapy Vouchers GP visit •Consent Form • Consent Form Cultural Assessment Risk Assessment •Rating Scales • Rating Scales •Treatment as Usual • Patient support 3 and 12 months post index presentation • Problem Solving Therapyrating scales telephone interview • Vouchers GP visit DHB Records interrogated NZHIS information collected • Cultural Assessment • Risk Assessment 3 and 12 months post index Postcards 3 and 12 months post index presentation Postcards presentation 1, 2, 3, 4, 6, 8, 10 & 12 months • Rating scales 1, 2, 3, 4, 6, 8, 10 &rating scales post index telephone interview • Telephone interview 12 months post presentation DHB Records interrogated NZHIS information collected • DHB Records interrogated index presentation • NZHIS information collected
  6. 6. Tukunga Iho Outcome measuresThe primary outcome is:1. Beck Hopelessness Scale.Secondary outcomes are:1. Repetition self harm (3 months and one year).2. Anxiety and depression (HADS)3. Cultural Identity Profile & Sense of Belonging (SOBI)4. Quality of life measures (EQ-5D; SF36)5. Overall mortality at 3 months, one year, five years and ten years6. Health service use at three months, one year, five years and ten years
  7. 7. Powhiri – Process of Engagement– Taki/Wero Consent– Karanga Patient support– Karakia Prayer (coming together)– Whaikorero Problem solving therapy– Waiata PST homework– Koha Reciprocity– Hongi End of Patient support– Hakari Food & drink closure– Poroporoaki Dissemination
  8. 8. Taki / Wero (challenge - consent)• Consent
  9. 9. Karanga (Call –Patient support)
  10. 10. Karakia (Prayer)
  11. 11. Whaikorero(Speech – Problem Solving Therapy)
  12. 12. Waiata (Song - Workbook)
  13. 13. Koha (Gift)
  14. 14. Hongi(coming together)
  15. 15. Hakari (Feast)
  16. 16. Poroporoaki(Farewell – Dissemination)
  17. 17. Nā Reira So farTe Ira Tangata has:• Recruitment 3 November 2009 – N=167, 5 withdraws, – 582 Māori presented to ED for self harm, – 365 meet inclusion criteria & randomised • intervention, 95 consented • control group, 72 consented• Three month follow ups: 97 of the 166 All Forms (58%)• Twelve month follow ups: 116 of the 162 All forms (71%)
  18. 18. Nā Reira Findings!• Significantly decreased hopelessness• Significantly increased time before re-presentation
  19. 19. Whoatu What you can do!Keep• Improving Māori cultural identity through problem solving therapy that addresses access to • te reo Māori • Whakapapa • Whanau • Whenua • Marae • Those things Māori