Suicide prevention: whānau-centred approaches


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Whānau-centred approaches to counselling, community development and suicide prevention place greater emphasis on group relationships and functionality than on individual psychopathology. Positive whānau development is a preventative process insofar as it mediates between individuals, groups, and wider society. The focus is on building strengths and resilience and enabling the creation of an environment where empowerment can over-ride marginalisation, despair, and loss of hope.

Centering preventative strategies on whānau does not dismiss individual needs but recognises the importance of relational synergies as ways of understanding human situations. Expertise in whānau mediation, culturally relevant styles of communication, and building effective whānau leadership are key elements of a community based preventative programmes for Māori.

Presentation by Professor Mason Durie, Assistant Vice-Chancellor (Māori & Pasifika), Massey University at the 2009 SPINZ National Symposium: Culture and Suicide Prevention in Aotearoa:

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Suicide prevention: whānau-centred approaches

  1. 1. SPINZ 2009SUICIDE PREVENTION Mason Durie Massey University
  2. 2. How best to understand human behaviour?
  3. 3. Looking through the microscopePsychological &emotional conflicts Low self esteem lack of confidence loss of hope Loss of mana Biochemical & Life-cycle crises neurological disturbances • Identity diffusion • Chemical imbalances • Alienation • Synaptic failures • de-culturation • Mental disorders • poor health
  4. 4. Looking through the Telescope Interpersonal relationships  Disrupted  Bereavement  DysfunctionalRelationships with family  Threatening & community • Unemployment Relationships with society • School failure • Lossof usefulness • Homelessness • Loss of role • Risk-taking lifestyles • Loss of purpose • Bankruptcy • Loss of engagement
  5. 5. SUICIDE FOUR PERSPECTIVES SOCIETAL suicide as a social phenomenon MEDICAL suicide as a medical condition CULTURAL suicide and cultural identity INTERPERSONAL suicide and relationships between people
  6. 6. 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
  7. 7. SUICIDE MEDICAL PERSPECTIVES Mental disorders e.g. depression Chronic ill health e.g. immobilisation Terminal illness e.g. cancer
  8. 8. SUICIDE CULTURAL PERSPECTIVES Cultural alienation insecure identity Cultural exclusion frustrated identity Unconditional cultural conformity culturally sanctioned suicide
  9. 9. SUICIDEINTER-PERSONAL PERSPECTIVES Termination of a loving relationship loss Response to a threatening relationship fear Protection of survivor(s) sacrifice
  10. 10. PERSPECTIVES ON SUICIDESocietal Medical Cultural Inter-personal Greater understanding of suicide and a basis for preventive strategies
  11. 11. 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
  12. 12. TERTIARY PREVENTION SUICIDE Reduction of impacts on survivors Coroners findings Community management of event
  13. 13. Tertiary Prevention Notified cases Ongoing support, monitoring for friends, relatives Access to health and social services Education and counselling
  14. 14. PRIMARY PREVENTION Whole 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
  15. 15. 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
  16. 16. 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
  17. 17. SECONDARY PREVENTION SUICIDE Psychological focus Or Relational focus Intervention Or milestones Societal focus Or • Engagement Cultural focus • Enlightenment Or Integrated focus • Empowerment
  18. 18. Whakapiri - EngagementEstablishing rapport requires attention to: Space Time Boundaries Ways of thinking
  19. 19. Engagement Space, time, boundaries‘The marae atea’ Physical distance‘Time to ‘hear out’ Allocation of timeDistinctive roles Observation of manuhiri, tangata whenua boundaries men and women
  20. 20. Engagement WAYS OF THINKING Centrifugal Centripetal Outwards direction  Inwards direction Understanding  Understanding comes from larger comes from analysis contexts e.g. wider of component parts relationships e.g. inner thoughts and feelings Similarities convey  Differences help essence of meaning gain understanding
  21. 21. Flows of mental energyCentrifugal Centripetal The Telescope The Microscope
  22. 22. Whakamārama - Enlightenment ‘Switching on the light’ Interventions should lead to a higher level of enlightenment Increased:  awareness  understanding  maturity
  23. 23. 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
  24. 24. Whakamārama - EnlightenmentTaha hinengaro Improved intellectual understanding, an expanded knowledge base,Taha wairua Strengthened cultural and spiritual identity, meaningful connections with time & place, restored values and ethicsTaha 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
  25. 25. Modes of Interaction to maximise impact Kanohi ki te kanohi The web Individual or group Whānau
  26. 26. 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
  27. 27. Whakamana - EmpowermentInterventions should ultimately lead to empowermentEngagement + Enlightenment = Empowerment
  28. 28. Successful interventions lead to Empowerment 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
  29. 29. 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
  30. 30. SUICIDE PREVENTIONPerspectives Levels of Interventions on Suicide Prevention- Societal Primary Prevention Engagement Population-wide approaches Medical Secondary Prevention Enlightenment Cultural A focus on ‘at risk’ individuals or groupsInterpersonal Empowerment Tertiary Prevention Alleviating the impacts
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