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: http://www.spinz.org.nz/page/108-events-archive+spinz-national-symposium-2009+symposium-coverage A video showing parts of this presentation is at: http://www.youtube.com/watch?v=YvjnYoJAx3o

1. SPINZ 2009
SUICIDE PREVENTION
Mason Durie
Massey University

2. How best to understand human
behaviour?

3. Looking through the microscope
Psychological &
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. Looking through the Telescope
Interpersonal
relationships
 Disrupted
 Bereavement
 Dysfunctional
Relationships 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. 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. 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. SUICIDE
MEDICAL PERSPECTIVES
 Mental disorders
e.g. depression
 Chronic ill health
e.g. immobilisation
 Terminal illness
e.g. cancer

8. SUICIDE
CULTURAL PERSPECTIVES
 Cultural alienation
insecure identity
 Cultural exclusion
frustrated identity
 Unconditional cultural conformity
culturally sanctioned suicide

9. SUICIDE
INTER-PERSONAL PERSPECTIVES
 Termination of a loving relationship
loss
 Response to a threatening relationship
fear
 Protection of survivor(s)
sacrifice

10. PERSPECTIVES ON SUICIDE
Societal Medical Cultural Inter-personal
Greater understanding of suicide and
a basis for preventive strategies

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. TERTIARY PREVENTION
SUICIDE
 Reduction of impacts on survivors
 Coroners findings
 Community management of event

13. Tertiary Prevention
Notified cases
 Ongoing support, monitoring for friends,
relatives
 Access to health and social services
 Education and counselling

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. 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. SECONDARY PREVENTION
Interventions 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. SECONDARY PREVENTION
SUICIDE
 Psychological focus
Or
 Relational focus Intervention
Or milestones
 Societal focus
Or • Engagement
 Cultural focus
• Enlightenment
Or
 Integrated focus • Empowerment

18. Whakapiri - Engagement
Establishing rapport requires attention to:
 Space
 Time
 Boundaries
 Ways of thinking

19. Engagement
Space, time, boundaries
‘The marae atea’ Physical distance
‘Time to ‘hear out’ Allocation of time
Distinctive roles Observation of
manuhiri, tangata whenua boundaries
men and women

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. Flows of mental energy
Centrifugal Centripetal
The Telescope The Microscope

22. Whakamārama - Enlightenment
 ‘Switching on the light’
 Interventions should lead to a higher level
of enlightenment
 Increased:
 awareness
 understanding
 maturity

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. Whakamārama - Enlightenment
Taha hinengaro Improved intellectual understanding,
an expanded knowledge base,
Taha wairua Strengthened cultural and spiritual identity,
meaningful connections with time & place,
restored values and ethics
Taha 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. Modes of Interaction to maximise
impact
 Kanohi ki te kanohi
 The web
 Individual or group
 Whānau

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. Whakamana - Empowerment
Interventions should ultimately lead to
empowerment
Engagement + Enlightenment
= Empowerment

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. 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. SUICIDE PREVENTION
Perspectives 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 groups
Interpersonal Empowerment
Tertiary Prevention
Alleviating the impacts