He Koha Aroha - Preventing Māori Suicide


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A study comparing social marketing and community development approaches to preventing Māori suicide.

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He Koha Aroha - Preventing Māori Suicide

  1. 1. He Koha Aroha Preventing Māori Suicide
  2. 2. Our Client...
  3. 3. Research Question “A comparative analysis of social marketing and community development approaches for Māori suicide prevention.”
  4. 4. Aims and Objectives • Define the terms: social marketing and community development with respect to Māori suicide prevention. • Identify forms of social marketing and community development currently in practice. • Identify and analyse suicide trends within indigenous populations, with particular emphasis on Māori. • Perform a comparative analysis of social marketing and communitybased intervention through discussion with experts in the field of mental health with particular emphasis on Māori suicide.
  5. 5. Aims and Objectives • Investigate the cost-effectiveness of social marketing and community development in Māori suicide prevention and the economic, social, cultural, and political costs of Māori suicide. • Discuss the logistics of community development and social marketing as forms of intervention. • Produce a set of recommendations for the Mental Health Foundation based on the findings of the study.
  6. 6. Methods 1. Extensive literature review. 2. Key informant interviews. 3. Cost-Benefit Analysis.
  8. 8. • “Application of commercial marketing technologies to the analysis, planning, execution and evaluation of programmes designed to influence the voluntary or involuntary behaviour of target audiences in order to improve the welfare of individuals and society” – Donovan and Henley (2003) • Benefit lies with society rather than the marketer or contractor.
  9. 9. “Start the Conversation Today” http://www.lifeline.org.nz/
  10. 10. Community Development • “The concept of community development involves a group of people with a shared identity interacting in order to come up with ideas, ways to improve and also solutions to problems” (Cavaye, 2006).
  11. 11. The Kia Piki te Ora o te Taitamariki Strategy • Keri Lawson-Te Aho authored and developed ‘Version One’. • MoH implemented programme (2000). • Māori-tailored approach aimed at reducing taitamariki (youth) suicide. • Achieved strengthening of whānau, hapū and iwi by focussing on community development. • In 2010 the programme evolved into an all ages strategy (Kia Piki) - mainstreaming.
  13. 13. Māori Suicide Statistics • 82 Māori suicide deaths in 2008. • 2008 Māori suicide rate was 13.3/100,000 population, while non- Māori rate was 10.6/100,000 population. • 2008 Māori youth (15-24y) suicide rate was 27.6/100,000 compared to non-Māori youth – 16.4/100,000. • Greatest disparity between Māori and Non-Māori exists in the younger population (15-24 y). • Māori suicide rates show no downward trend over time unlike non-Māori.
  14. 14. Māori Suicide Statistics II • Māori male suicide rates were 2.25 times higher than female Māori suicide rates in 2008. • When comparing Māori with non-Māori male suicide rates, Māori were higher. Similar in Females. • Globally, suicide rates among indigenous populations is a noted problem. • In all these countries indigenous suicide rates are higher than non-indigenous groups.
  15. 15. Age-standardised Suicide Rate, by Ethnicity and Gender 1996-2008 35.0 Maori Male 30.0 Maori Female Rate per 100,000 population 25.0 Non-Maori Male Non-Maori Female 20.0 15.0 10.0 5.0 0.0 1996 1997 1998 1999 2000 2001 2002 Year 2003 2004 2005 2006 2007 2008
  16. 16. Youth Suicide Rate, by Ethnicity 1996-2008 45.0 40.0 Maori Rater per 100,000 population 35.0 Non-Maori 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1996 1997 1998 1999 2000 2001 2002 Year 2003 2004 2005 2006 2007 2008
  17. 17. Māori Suicide Risk Factors • Inequalities • Historical Trauma  Colonisation  Cultural Identity  Individualistic Society • Population Age Structure • Welfare Services • Unemployment • Incarceration • Reduced Contact with Healthcare Services
  18. 18. Social Marketing • Social marketing initiatives in New Zealand: SunSmart Land Transport Authority campaign “It’s About Whānau” anti-smoking Like Minds Like Mine • Social marketing targeting suicide: “Start the Conversation Today” – Māori TV Campaign. “Reachout” – Internet-based campaign targeting Australian Youth.
  19. 19. Community Development • In NZ, should work within Māori communities, at the whānau, hapū and iwi levels. • Cultural development as a protective factor against suicide. • International studies  Increase in awareness (Allen et al 2010  Utilize local knowledge, skills, resources (Smith et al 2003)  Can be self sustaining (Lucke et al 2003)  Difficult to assess results quantitatively  Funding difficulties
  21. 21. Key Informants List RANGATIRA • Professor Sir Mason Durie, Pro Vice Chancellor, Massey University • Dr Huirangi Waikerepuru, Taranaki Kaumatua THE CLIENT - MENTAL HEALTH FOUNDATION • Materoa Mar, Chair, Mental Health Foundation • Judi Clements, CE, Mental Health Foundation • Witi Ashby, Manager, Māori Resource Development, Suicide Prevention and Information MĀORI SUICIDE PREVENTION CLINICIANS • Eliza Snelgar, Clinician, CASA
  22. 22. Key Informants List MĀORI SUICIDE PREVENTION RESEARCHERS • Professor Sunny Collings, Dean, University of Otago, Wellington School of Medicine • Associate Professor Jo Baxter, Director Ngāi Tahu Māori Health Research Unit, University of Otago • Dr Nicole Coupe, Director, Te Ira Tangata, Māori Suicide Prevention Programme, CEO Hapai te Hauora Tapui Limited • Keri Lawson-Te Aho, Lecturer, Hauora Māori, University of Otago, Māori suicide prevention policy writer, PhD candidate • Keri Newman, Master’s graduate, Victoria University of Wellington • Paea Paki, Clinician, Multi-level Intervention Suicide Prevention Study • Dr Denise Steers, Clinician , Multilevel Intervention Suicide Prevention Study
  23. 23. Key Informants List MĀORI COMMUNITY DEVELOPMENT EXPERTS (WHĀNAU, HAPŪ, IWI DEVELOPMENT) • Pahia Turia, Director, Taipak Development Aotearoa • Emma Kutia, Project Manager, Te Ao Hou, Kia Piki Te Ora, Eastern Bay of Plenty • Michael Naera, Project Manager, Kia Piki te Ora, Ngāti Pikiao • Irene Walker, Te Ao Hou, Kia Piki Te Ora, Eastern Bay of Plenty INDEPENDENT MĀORI EXPERTS • Mike King, TV personality and mental health commentator • Gordon Matenga, Coroner
  24. 24. Social Marketing: The Benefits Increases population awareness Reaches a large and widespread population Encourages conversation and reduces stigma Social Marketing Provokes thought and discussion Online support forums Education Promotion leading to intervention
  25. 25. Social Marketing: The Disadvantages $$ May burden downstream services if illprepared Contagion risk Social Marketing Ineffective if no access to media Most effective if culturallytargeted Lack of supporting evidence as suicide intervention Organisations involved inexperienced with media
  26. 26. “(there is) a concern that suicide can be contagious” - Professor Sir Mason Durie “Those don’t work for Māori (cigarette packet graphic pictures) but if you put a picture of mokopuna on them, that would work.” - Michael Naera
  27. 27. Community Development: The Benefits Addresses proximal and distal determinants Self-sustaining Connection with family and community Uses the intrinsic resources of the community Community Development Designed by the community for the community Shifts power to the people Builds resilience and selfdetermination Specifically targeted interventions
  28. 28. ‘”Community development is revolutionary; it is about change, it is about relocating the locus and power of control into the hands of those most affected by the issue” Keri Lawson-Te Aho
  29. 29. Community Development: The Disadvantages Time consuming Requires good communication Little evidence of effectiveness $$ & Resource demanding Community Development Difficult to monitor Slow to change Geographically confined Problematic for rurally isolated families
  30. 30. Other Important Themes Every case is different Causes of suicide Te Ao Māori Other Themes Positive healthcare interactions Normalisation of risky behaviour Emotional suppression in Māori men
  31. 31. Te Pae Mahutonga • Health model based on the Southern Cross. • Four central stars used to represent the four key tasks of health promotion:  Mauriora – cultural identity  Waiora – physical environment  Taiora – healthy lifestyles  Te Oranga – participation in society • Two pointers:  Ngā manakura – community leadership  Te Mana Whakahaere – Autonomy
  33. 33. Cost-Benefit Analysis • Potential value: Concrete quantitative evidence Informing policy makers Better design of interventions for the future • Challenges: Lack of quantifiable data Future research needed
  34. 34. Economic Costs of Suicide • Economic Cost: $448,250 (Des O’Dea 2005) Māori likely to be more due to younger age of suicide. • Life-years Lost: 39.68 DALY for non-Māori vs. 44.02 DALY for Māori.
  35. 35. Political, Social and Cultural Costs of Suicide Costs Political Low priority issue for political parties. “Political hot potato”. Social Grief for whānau and friends. Potential conflict among dealing with suicide. Devalues life. Cultural Loss of cultural identity. Some Māori believe that those who commit suicide should be condemned.
  36. 36. DISCUSSION
  37. 37. Research Strengths • Culturally respectful kaupapa. • Key informants interviewed were selected across a variety of fields – providing insight into both sides of the argument; community development and social marketing.
  38. 38. Research Limitations • Lack of objective comparison – due to insufficient objective data. • Exclusion of logistics modelling.
  39. 39. Discussion • Community development vs. Social Marketing. • Combined Approach? • Culturally appropriate interventions are essential.
  40. 40. Recommendations I • Due to deficits identified within the published literature, we recommend that further research needs to be done into the effectiveness of social marketing and community development interventions as Māori suicide prevention strategies. • Future suicide prevention initiatives need to utilize both social marketing and community development strategies in order to have the most successful outcomes in preventing Māori suicide.
  41. 41. Recommendations II • When designing suicide prevention strategies it is important to design them around a Māori health framework to ensure they are culturally relevant to Māori people. • When designing suicide prevention strategies at the community level, involve community leaders and harness the strengths already present within the community. This aids to ensure wide dissemination and utilization of these services by the members of the community.
  42. 42. Acknowledgements E ngā iwi, e ngā reo, tēnā koutou ngā rau rangatira ma. E ngā tini aitua kua wheturangitia ki te kupenga wairua, haere, haere, haere atu ra. Nā rātou i whakatakoto tēnei kaupapa, ko te hauora, hei huarahi mō ngā tamariki mokopuna e whai ake nei. Tēnei te mihi ki ngā pukenga kua tautoko i tēnei kaupapa. Tēnā koutou mō tō whakapau kaha ki te hapai i tēnei kaupapa oranga whānau. He taonga katoa te whānau. He mihi kau atu ki te Mental Health Foundation, Te Tari Hauora Tūmatanui, me Te Rōpū Rangahau Hauora a Eru Pomare. Tēnā koe Kerry Hurley mō tō tautoko i a mātou. He mihi hoki ki a mātou kaiako, ko Keri Lawson Te Aho rātou ko Sarah Mckenzie ko Pania Lee, mō tō mahi tautoko kia oti pai. Ka nui te aroha ki a koutou. Ko te pae tawhiti, whāia kia tata. Ko te pae tata, whakamaua kia tina.
  43. 43. Hutia Te Rito Hūtia te rito Hūtia te rito o te harakeke Kei hea te kōmako e kō Kī mai ki ahau, ahau He aha te mea nui He aha te mea nui, o te ao Maku e kī atu He tangata, he tangata, he tangata Hi!