SPINZ 2009
SUICIDE PREVENTION
Mason Durie
Massey University
How best to understand human
behaviour?
Looking through the microscope
Psychological &
emotional conflicts



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Low self esteem
lack of confidence
loss of hope
Loss of mana
Life-cycle crises
• Identity diffusion
• Alienation
• de-culturation
• poor health
Biochemical &
neurological disturbances
• Chemical imbalances
• Synaptic failures
• Mental disorders
Looking through the Telescope
Interpersonal
relationships
 Disrupted
 Bereavement
 Dysfunctional
Relationships with family
& community
• Unemployment
• School failure
• Homelessness
• Risk-taking lifestyles
• Bankruptcy
 Threatening
Relationships with society
• Loss
of usefulness
• Loss of role
• Loss of purpose
• Loss of engagement
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
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
SUICIDE
MEDICAL PERSPECTIVES

Mental disorders
e.g. depression

Chronic ill health
e.g. immobilisation

Terminal illness
e.g. cancer
SUICIDE
CULTURAL PERSPECTIVES

Cultural alienation
insecure identity

Cultural exclusion
frustrated identity

Unconditional cultural conformity
culturally sanctioned suicide
SUICIDE
INTER-PERSONAL PERSPECTIVES

Termination of a loving relationship
loss

Response to a threatening relationship
fear

Protection of survivor(s)
sacrifice
PERSPECTIVES ON SUICIDE
Societal
Medical
Cultural
Inter-personal
Greater understanding of suicide and
a basis for preventive strategies
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

TERTIARY PREVENTION
SUICIDE

Reduction of impacts on survivors

Coroners findings

Community management of event
Tertiary Prevention
Notified cases

Ongoing support, monitoring for friends,
relatives

Access to health and social services

Education and counselling
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
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
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
SECONDARY PREVENTION
SUICIDE




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Psychological focus
Or
Relational focus
Or
Societal focus
Or
Cultural focus
Or
Integrated focus
Intervention
milestones
• Engagement
• Enlightenment
• Empowerment
Whakapiri - Engagement
Establishing rapport requires attention to:
 Space
 Time
 Boundaries
 Ways of thinking
Engagement
Space, time, boundaries
‘The marae atea’
Physical distance
‘Time to ‘hear out’
Allocation of time
Distinctive roles
Observation of
boundaries
manuhiri, tangata whenua
men and women
Engagement
WAYS OF THINKING
Centrifugal
Centripetal

Outwards direction

Inwards direction

Understanding
comes from larger
contexts e.g. wider
relationships

Understanding
comes from analysis
of component parts
e.g. inner thoughts
and feelings

Similarities convey
essence of meaning

Differences help
gain understanding
Flows of mental energy
Centrifugal
Centripetal
The Telescope
The Microscope
Whakamārama - Enlightenment

‘Switching on the light’

Interventions should lead to a higher level
of enlightenment

Increased:
awareness
 understanding
 maturity

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
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
Modes of Interaction to maximise
impact

Kanohi ki te kanohi

The web

Individual or group

Whānau
Cultural Pathways to enlightenment

The spiritual domain


The intellectual domain


Te reo, metaphor & symbolism, centrifugal energy
The physical domain


Marae participation, tangihanga, waiata
Mau rakau, touch rugby, waka ama
The social domain

Whānau occasions, networks, kapa haka
Whakamana - Empowerment
Interventions should ultimately lead to
empowerment
Engagement + Enlightenment
= Empowerment
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
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
SUICIDE PREVENTION
Perspectives
on Suicide
Levels of
Prevention
Interventions
-
Societal
Primary Prevention
Engagement
Population-wide
approaches
Medical
Enlightenment
Secondary Prevention
Cultural
Interpersonal
A focus on ‘at risk’
individuals or groups
Tertiary Prevention
Alleviating the impacts
Empowerment