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Preventing Māori suicide: what can we do?


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Keri Lawson-Te Aho discusses suicide prevention for Māori in the first of three online seminars. She shares a story from her own whānau, looks at how the issue is different for Māori including culturally-specific risk and protective factors, and suggests a paradigm shift is needed to respond to Māori suicide more effectively. For more information about this seminar series, see:

Published in: Health & Medicine
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Preventing Māori suicide: what can we do?

  1. 1. Preventing Māori suicide: what can we do? Keri Lawson-Te Aho 29 January 2013
  2. 2. OverviewWords of wisdom and encouragementTea-Kay’s story – heeding the lessonsThe evidence - experiential/research basedJoining the dotsSo what?
  3. 3. A paradigm shift is required to deal with theissue of Māori suicide. That paradigm shiftmust be based on the privileging ofMāori worldviews, Māori epistemology,Māori values and processes (Irwin, 2012 )thereby changing the way interventions arecurrently conceptualised and strategies areframed.
  4. 4. A Māori-centered approach to Māorisuicide prevention is critical and alignswith indigenous thinking about theprevention of suicide in indigenouscommunities (Duran 2006; Elliot-Farrelly, 2004; Evans-Campbell,2008; Durie, 2004; Duran, Firehammer & Gonzalez, 2008).
  5. 5. “young people need to be able to talk toadults sometimes but often we can’t. Nodisrespect mum, but sometimes adults don’tknow how to listen. It’s up to us to help eachother but sometimes we need help with that.After dad died, the only people I could talk towere my friends”“I can’t imagine talking to a mental healthexpert or a counsellor. They don’t know meand it takes trust to open up. You know me” Huriana Kopeke-Te Aho aged 17
  6. 6. “It’s not an easy thing to teach. I trustedmy mum and my dad, and my aunties anduncles when I was young but as you growup, it sort of leaves you, bit by bit. Thingshappen that sometimes strip that trustaway. How can we teach it and give it toour kids so it becomes their āhua andnever let it be stripped away?” parent,2012
  7. 7. "I can put my money on whānau. [...] to allpeople that work with families is to be able tohelp sort a problem. Go beyond that, and helpa whānau build capability, leadership [...]unwittingly, we put the whānau into a passive,dependant position and overlook the potentialthey might have for strength and for leadership."Professor Sir Mason Durie, 2012
  8. 8. “We admit that we are insular; we don’t wantpeople to know what’s going on in ourwhānau and we don’t want to know what’sgoing on over the back fence, let alone in thehapū next door, and the iwi and the waka. Wehave to, as Māori, rise above our own issuesto communicate with each other about themamae that we hold. How do we deal withthat? We have ideas that we can share andimplement and take practical steps. I am hereto listen to the kōrero.” (practitioner, 2012)
  9. 9. "No strategy should be dependent upon agovernment contract that provides aservice to a community to fix up thoseproblems that is affecting thosecommunities. Once that contract is gone ifthose communities are no better off anymore resilient or able to sustain thosestrategies or approaches or responses thathave been injected into those communities,those communities are going to end up wherethey are.“ Pahia Turia, 2012
  10. 10. “The greatest resource is whānau. If you canlift their sights, value them, give them dignity,watch them go. We need to take stock ofourselves. I’ve been in positions where I haveto fix families. What a waste of time. At theend of the day, we were de-dignifying people.Taking away their dignity and sense of theirfuture and responsibility. Are we trying toassume responsibility for families or are wegetting there just to tell them how wonderfulthey are.” Dame Iritana Tawhiwhirangi, 2012
  11. 11. Tea-Kay1992-2012
  12. 12. Tea-Kay’s story• Background of severe bullying (Klomek et al., 2008, 2009).• Father took his own life when Tea-Kay was 4 (Brent & Melhem, 2008).• Close knit whānau (Clarke et al, 2010; Kirmayer, 2007)• Historical abuse (Joiner et al., 2007)• Gang affiliations on father‟s side (Paikea, 2011; Ashby, 2011; Cuestas, 2013)• Diagnosed with depression and anorexia/bulimia at 17 (Albizu-Garcia et al., 2001) (Rohde, Seeley, Kaufman, Clarke, & Stice, 2006)• Client of mental health services (Rohde et al, 2006; Te Rau Matatini, 2008)• Sexuality (Coupe, 2005)• Raised in Christian church (Garroute et al, 2008)• Dreamed of being a fashion designer but no chance to realise dreams/unemployment (Platt & Hawton, 2000)/heavy alcohol use (Baxter, 2008), self harming – seeing the cries for help and reading the signs
  13. 13. Tea-Kays strengths/protective factors• Strong and loving whānau, connected to whānau (Clarke et al, 2010; Wannan & Fombonne, 1998; Coggan et al., 1997)• Dreams and goals/visions/moemoea/hope (Kruger et al, 2004)• Close knit network of friends/gothic gay community/peer support (Smalley, 2005;Lawson-Te Aho, 2012).• Faith – raised in the Christian church (Garoutte, et al., 2003)• Access to cultural identity and values (Durie, 2012; Tahupārae)• Giftings on his life/intelligent, creative, caring, courageous• Loving and lovable/aroha
  14. 14. Tea-Kay’s risk factors• Father‟s suicide (Brent & Melhem, 2008).• History of violence, gang membership/abuse in father‟s side (Dube et al., 2005; Brodsky et al., 2008; Lawson-Te Aho, 1997)• His sexuality was invisible• Low self esteem/bulimia/anorexia (Lawson-Te Aho, 2012)• Alcohol abuse• Bullying/physical threats to his safety (Klomek et al., 2008, 2009)• Unfulfilled dreams• Confusion about his cultural identity• Accumulation of stressors – sexual identity; history of abuse; death of dad; lack of continuity between services and community
  15. 15. What did we do?• Supported him into training as a fashion designer• Mum opened home to his friends• Youth looked out for him• Friends supported him via Facebook• Church supported him and involved him in leading church youth events• Searched for help for self harming
  16. 16. After his suicide - what did we do?• Took him onto his marae, had a tangi for him, friends spoke at service/performed haka/Toia mai• Drew his friends together and kept an eye on them/opened homes/Provided a safety net for his friends• Sought grief counselling (not easy to find help)• Talked about his suicide (as whānau but not openly with friends/friends talked about his suicide amongst themselves)• Used Facebook as a form of social support• Tried to rally the community• Information and training (assessing need)• Networked amongst suicide prevention networks/social support/counselling networks/professional responses• Identified „at risk‟ youth in his networks (safety)• Sought understanding/started telling his story
  17. 17. What could we have done differently?• Supported him to be who he was/out of school (Durie, 1997)• Counselling and support to deal with loss of father (Lawson-Te Aho, 2012)• Address bullying/protection and safety (Lawson-Te Aho, 2012)• Address historical trauma and abuse (Duran, 2006; Walters et al, 2012) – long term agenda (Chandler and Lalonde, 2008)• Supported his whānau/mum raising children as a widow• Tried behavioural activation as suicide prevention (Bennett, 2010)• Attended to wairua issues more closely (Valentine, 2010)• Cultural development? Strategies for self determination?• Sustained activism (Durie, 2005)• Strengthened the whānau/capacity building of the whānau (Turia, 2012)• Specific interventions – problem solving/improving flow between psychiatric care and home (Coupe, 2012)• Kept him in the community/treated him in his own community instead of sending him away into psychiatric care• Got down off our professional high horses/overcoming fear
  18. 18. Looking at the big picture – Indigenous suicideprevention what we know
  19. 19. whakapapa hHistorical traum creates a determinants blockages in the life flow risk factors whānau as a protective factor/solution cClinical services/external agenciescCom unity support m cCultural options
  20. 20. The depiction of the whānau as the waka/vehicle for suicideprevention recognises at the most pragmatic levels, that it isthe whānau who buries their loved one after suicide. It is thewhānau who supports their loved one after a significantsuicide attempt. It is the whānau who breaks the news to thewider whānau when a loved one has ended their life. It is thewhānau who dresses their loved one after suicide. It is thewhānau that carries the burden of guilt and shame aftersuicide. The whānau is the primary point of responsibility,the socialisation site (Tomlins-Jahnke & Durie, 2008) andthe potential guarantor of Māori cultural continuity. It is thewhānau that is the engine room of iwi development (Kruger,2010). It is the whānau that is committed for life (bywhakapapa) to vulnerable and suffering whānau members.To reiterate, whānau offer the most untapped potentialfor Māori suicide prevention (Turia, 2012; Lawson-Te Aho,2012).
  21. 21. What is historical trauma? mamae• Trauma, cumulative, occurred over a lifespan and generations, from cataclysmic events in history• HT creates prolonged stress and distress• Trauma events produce outcomes HTR• Pathways by which trauma transfers through generations• HT factors (unresolved grief) interact with current experiences (proximal stressors) create a vulnerability to stress and disease (Walters et al, 2012)
  22. 22. Historical ContextAboriginal/indigenous/Māori suicide isdifferent – additional risk and protectivefactors (Durie, 2005; Lawson-Te Aho, 2012)Historical and contextual issues and inter-generational transfer; unresolved griefpoverty through land alienationcultural loss through sustained colonisation(Duran, 2006; Wesley et al, 2008; Walterset al, 2012; Lawson-Te Aho & Liu, 2010)
  23. 23. Common Themes in Indigenous Suicide Prevention• Requires a paradigm shift – power within not power without/impacts of history• Cultural development (Te Pataka Uara)• Gaining consciousness of who we are and where we come from (whakapapa consciousness)• Self determination enables privileging of indigenous/Māori responses (mana motuhake/Rangatiratanga)• Cultural continuity a hedge against suicide• Long term healing not short term treatment (wairua healing)
  24. 24. Whanganui kaumātua, Rangitihi Tahupāraesaid:“Let us return to our origins. Since the timewe as Māori were immersed in theknowledge streams of Tauiwi we havebecome like a branch grafted to a foreigntree, producing fruit of a different qualityand somewhat unpalatable. It is time thatwe returned to the rootstock of ourancestors”
  25. 25. Ancestral rootstock1.Kotahitanga – whānau are collective and concerted in theirapproach2.Ūpōkaitanga – whānau are well connected to their home,land and people3.Whanaungatanga - whānau live with reciprocal obligationsto each other consistent with being part of and affirming thevalues of the wider collective4.Wairuatanga – whānau are experiencing the fulfillment oflife; wairuatanga connects all of the principles and is central tothe interconnectedness of all of the principles of whānau ora5.Manaakitanga – through the expression of aroha, hospitality,generosity and mutual respect as whānau practice6.Kaitakitanga – whānau are working in empowering andenabling ways that foster and encourage self determination7.Te Reo – is strong and vibrant in the everyday lives ofwhānau
  26. 26. Te Whānau e tū kaha anaTe Taiao - A secure identity - Taiohi, a voice, participation - Leadership, succession, generations coming together, whānau engagement - Whānau connectedness - Absence of abuse - Kaimahi development - Ahi kaaWhanaungatanga Manaakitanga Rangatiratanga/Mana Wairuatanga Whakapapa
  27. 27. “The revolution begins at home. So oftenwe look outside ourselves for the answersand they are there staring us in the facebut we don’t always have the confidenceor the courage to see what is there in frontof us and so we look for answers wherethere aren’t any”Keri Lawson-Te Aho, 2012
  28. 28. Hapu Transformation
  29. 29. Gaining consciousnessUnderstanding our history and its outcomestoday has to be part of a healing process –painful. The rongoa is in the mamae“In one sense all we have to offer to futuregenerations is the past containing as it does thehopes, the spirit, the determination of thepeople, their constant example of both virtue andof error. But what a treasure chest that really is.That is brightness enough to light the way”Professor Robert Te Kotahi Mahuta (2001)
  30. 30. Whakapapa analysisWhakapapa consciousness• The homies/te ahi kaaroa• The lost generations/diaspora• Repatriation and reconnection• Internalised oppression
  31. 31. Healing processesThe pathways back to ourselves:Whakapapa reconnection andhealingKōreroManaakitangaWe have some choices
  32. 32. WhakawaateaGrief ritualsSpiritual healingFaith in our own traditions, our owncultural values and practices
  33. 33. Cultural developmentRestoration of cultural values foundational forthe promotion of positive health for Māori • Whanaungatanga • Manaakitanga
  34. 34. LeadershipGiving voice to the kaupapaPassion, drive, commitment, longevityNo one owns this kaupapaThe summary from the first hui withHon Tariana Turia on 16 December2012
  35. 35. Kaimahi of „Whānau Ora‟ servicesneed to facilitate whānau telling theirown stories. It may be that the peoplebest placed to support thetransformation of whānau are alreadyplaced within the whānau, or broadernetwork of the whānau. It is importantthat whānau are able to identify theresources for support they have withinthemselves, their histories, and theirnetworks.
  36. 36. The role of kōrero in suicide prevention,intervention, and postvention is important.Trust is essential. Peer support groups, aswell as inter-generational supportmechanisms, have proven effectiveamongst hui participants.Rather than „fixing‟ whānau, supportservices must help to equip whānau withthe tools to navigate their own wellness.Whakapapa is a tool which can be used inunderstanding social responsibilities for thepurpose of suicide prevention, intervention,and postvention.
  37. 37. There is a wealth of untapped potential inour traditional knowledge bases, includinglessons to be drawn from characters suchas Hine-nui-te-pō, which needs to bedrawn on in the approach to Māori suicideprevention. Authoritative research ontraditional methods for dealing with mamaeis called for, as is a more thoroughunderstanding of the positive implicationsof political activism on an individual.Te Taha Wairua is a critical componentwhich must be addressed in Māori suicideprevention strategies e.g. karakia, and afuller understanding of the application ofmātauranga Māori.Māori suicide prevention must not solelyrely on an individual‟s ability to access, orconnect with, their taha Māori.
  38. 38. Whānau must be engaged at every level ofprevention, intervention, and postvention;from governance to delivery of care. Whānaumust also be willing and able to receive care.Whanaungatanga is a tool which can be usedto celebrate the positive, and connectindividuals with a wide fabric of people.‘Whānau ora’ will mean different things todifferent whānau. It is important that whānauhave the mana to determine their ownwellness. There is a distinction to be madebetween whānau-ā-whakapapa and whānau-ā-kaupapa.For whānau to be well, in every sense, anunbundling and accounting of the histories andtrauma they have suffered across generationsneeds to occur.
  39. 39. So what? That is for you to determine Whakapapa preservation and protection to ensure continuity Healing is our kaupapaThose of us who can should impact and influence what we can when we can Many hands make light work
  40. 40. the revolution begins at home Me kotahitanga tatou!