This cultural assessment summarizes a study on preventing suicide among Māori in New Zealand. The study investigated over 700 cases of Māori suicide and self-harm annually. It formed an investigation team and advisory group to design a randomized controlled trial comparing a culturally-informed intervention ("Powhiri") to treatment as usual for Māori presenting with self-harm. Powhiri incorporated elements of Māori culture and problem-solving therapy. Preliminary findings showed Powhiri significantly decreased hopelessness and increased time before re-presentation with self-harm compared to the control group. The assessment calls for continuing to improve Māori cultural identity through culturally-informed problem solving interventions.

1. Cultural Assessment for Suicide
Prevention with Māori
Dr Nicole Coupe
Kāi Tahu

2. Whakapapa Rangahau
Past Research
Maori Suicide
– ~80-100 /year
– Males
– 15-35 years
– Hanging 67%
Maori Attempted Suicide
– ~700 / year
– Females
– Median age 30 years
– Overdose

3. Roopu
Te Ira Tangata Team
Investigation Team
– Simon Hatcher, Nicole Coupe, Mason Durie, Rees
Tapsell, Hinemoa Elder
Advisory 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-Hare
Evaluation
– Tania Wolfgramm

4. Huarahi –
Methodology
Recruitment
– Counties Manukau, Northland and Waitemata
DHBs
Eligibility
– >17, not at school and cognitively able to
consent, Maori
Randomisation
– Treatment as Usual (controls) and Powhiri: Model
of Engagement (intervention)

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 Group
Consent Form Rating Scales
Rating Scales Patient Support
Treatment 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 Therapy
rating 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. Tukunga Iho
Outcome measures
The 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 years
6. Health service use at three months, one year, five years and ten years

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. Taki / Wero
(challenge - consent)
• Consent

9. Karanga (Call –
Patient support)

10. Karakia (Prayer)

11. Whaikorero
(Speech – Problem Solving
Therapy)

12. Waiata (Song -
Workbook)

13. Koha (Gift)

14. Hongi
(coming together)

15. Hakari (Feast)

16. Poroporoaki
(Farewell – Dissemination)

17. Nā Reira
So far
Te 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. Nā Reira
Findings!
• Significantly decreased hopelessness
• Significantly increased time before re-presentation

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