Cultural Assessment for Suicide Prevention with Mori Dr Nicole
Coupe
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Hine Titama Hine nui te Po 1848 Tiramorehu wrote of his
partners whakamomori and mate 1995 Kia Piki Te Ora o Te Taitamariki
2000 Needs assessments for sites 2005 Whakamomori: Mori Suicide
Prevention 2009 Te Ira Tangata: Cultural Assessment for suicide
prevention Whakapapa Rangahau Past Research
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Maori Attempted Suicide ~700 / year Females Median age 30 years
Overdose Maori Suicide ~80-100 /year Males 15-35 years Hanging
67%
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Whakapapa Rangahau Maori Medical Record Review (CMDHD, ADHB,
WDHB) n = 252 Mori n = 310 Mori DSH presentations n = 93 repeat
presentations Females accounted for 61% Sole Mori identity 86%
CMDHB 43% Occupational Status 25% employed 21% unemployed 17%
receiving government benefit 70% sickness or invalids Methods 70%
Poisoning by solid or liquids 53% took prescription medications 20%
Analgesics Circumstances Home, 1800-2400 hours injury period and
presentation, Alcohol 37% Living arrangements 10% alone 56% with
family/whnau Previous ED contact 71% first timers Repeaters (74%
twice before, 17% 3x, 9% >5x) ED Service Provision 53 %
Medications, 88% Psychiatric interventions 16% cultural informed
13% absconded or refused services Discharge Summary 87% with post
discharge plans 67% went home Follow up Community Mental Health
Services Hospital Psychiatric / Psychological Services General
Practitioners Cultural Services minimal 4% Summary 1 Mori every
2days presents ED for DSH 1/5 presented following OD analgesics
previously been to ED and 1/3 more than twice Overnight admissions
allow culturally appropriate treatment and follow up
arrangements
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Whakapapa Rangahau Maori Attempted Suicide Case Control Study
214 (85.5%) cases & 203 (81.2%) controls Cultural Indicators
Demographic & Socio-economic Factors General Health
Questionnaire (GHQ28) Health Service Accessibility Social Supports
Environmental Factors Hospital Anxiety & Depression Scale
(HADS) & Mental Health Factors Substance Use (CAGE) Suicidality
(CIDI) Becks Scale of Suicide Intent (SIS14) & Event
Characteristics
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Whakapapa Rangahau Maori Attempted Suicide Case Control Study
214 (85.5%) cases & 203 (81.2%) controls
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Whakapapa Rangahau Maori Attempted Suicide Case Control
Study
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Whakapapa Rangahau Past Research
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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 Roopu Te Ira Tangata Team
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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) Huarahi Methodology
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Project Staff determine eligibility and ethnicity from
psychosocial assessment and discharge summary INELIGIBLE Unable To
Give Informed Consent or Still At School Collect information from
DHB and NZHIS Eligible Non Maori Project staff gathers information
required Person randomised Experimental Group Control Group Consent
Form Rating Scales Treatment as Usual Consent Form Rating Scales
Patient Support Problem Solving Therapy Vouchers GP visit Cultural
Assessment Risk Assessment Postcards 1, 2, 3, 4, 6, 8, 10 & 12
months post index presentation 3 and 12 months post index
presentation rating scales telephone interview DHB Records
interrogated NZHIS information collected 3 and 12 months post index
presentation rating scales telephone interview DHB Records
interrogated NZHIS information collected Eligible Maori (Age,
Gender, Ethnicity, DSH details) Person randomised Control
GroupExperimental Group Consent Form Rating Scales Treatment as
Usual Consent Form Rating Scales Patient support Problem Solving
Therapy Vouchers GP visit Cultural Assessment Risk Assessment
Postcards 1, 2, 3, 4, 6, 8, 10 & 12 months post index
presentation 3 and 12 months post index presentation Rating scales
Telephone interview DHB Records interrogated NZHIS information
collected Person Identified Presenting To Emergency Department with
an Episode of Deliberate Self Harm
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Taki/Wero Consent KarangaPatient support KarakiaPrayer (coming
together) WhaikoreroProblem solving therapy WaiataPST homework
KohaReciprocity HongiEnd of Patient support HakariFood & drink
closure PoroporoakiDissemination Powhiri Process of Engagement
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Taki / Wero (challenge) Consent
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Karanga (Call)
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Karakia (Prayer)
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Whaikorero (Speech)
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Waiata (Song)
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Koha (Gift)
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Hongi (coming together)
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Hakari (Feast)
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Poroporoaki (Farewell)
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The primary outcome is: 1.Beck Hopelessness Scale. Secondary
outcomes are: 1.The proportion of Mori who repeat self harm (3
months and one year). 2.Anxiety and depression measured by the
Hospital Anxiety and Depression Scale (HADS) 3.Cultural Identity
Profile (Durie et al, 1995) & Sense of Belonging (SOBI)
4.Quality of life as measured by the (EQ-5D) and the (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 Tukunga Iho Outcome measures
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As at 21 June 2012 Te Ira Tangata has: Recruitment statistics
for Te Ira Tangata since November 2009 582 participants completed
form A, 217 ineligible 365 participants eligible for the study 182
participants randomised into the intervention group, 95 consented
183 participants randomised into the control group, 72 consented
N=167 (19 months), 5 withdraws, Twelve month follow ups: 116 of the
162 All forms (71%) Three month follow ups: 97 of the 166 All Forms
(58%) N Reira So far
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Process evaluation will help determine whether Powhiri: model
of engagement improves outcomes for Mori who self harm Te Ira
Tangata finished 15 June 2012 all 12 month follow ups Te Ira
Tangata finishes 15 June 2016 all 5 year follow ups Role out
training in Powhiri: Model of Engagement into DHBs, Primary care,
and community services Tr Next
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Keep Improving Mori cultural identity by Improving te reo Mori
Increasing access to Whakapapa Whanau Whenua Marae Those things
Mori Whoatu What you can do!
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1.Promote mental health and wellbeing, and prevent mental
health problems 2.Improve the care of people who are experiencing
mental disorders 3.Improve the care of people who make non-fatal
suicide attempts 4.Reduce access to means of suicide 5.Promote safe
reporting and portrayal of suicidal behaviour by media 6.Support
whanau, friends and others affected by suicide or suicide attempt
7.Expand the evidence about rates, causes and effective
intervention Huarahi hou New Plan!
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1.Secure cultural Identity a)Childhood abuse and neglect
b)Alcohol and drug c)Life stress (relationships, employment,
finance, health) d)Socio-economic inequalities e)Social cohesion
and support (whakapapa, collective vs individual) f)Discrimination
2.Policy to Prevention 1.Strengthen linkages - intersectoral
collaboration 2.Address needs of Maori 3.Reduce inequalities
Huarahi hou Promote Maori mental health and wellbeing, and prevent
mental health problems
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1.Population based initiative a)Improved access for Maori,
increased help seeking behaviour b)Improved public awareness,
destigmatisation c)Depression awareness campaigns,
destigmatisation, telephone counselling eg NDI, LMLM, Lifelines
2.Community Approaches a)Programmes support CHW to improve
understanding recognition mental health problems & suicidal
behaviour to improve help seeking b)Living Works ASIST Prog, Mental
Health Literacy, Gatekeeper Initiatives 3.Health Services
approaches (Primary, Secondary, Mental Health, Youth) a)Service
need to be effective, appropriate, accessible and user friendly
4.Institutional Settings (Criminal, Correctional, educational,
CYFS) Huarahi hou Improve the care of people who are experiencing
mental disorders assoc with suicidal behaiour
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1.Improving acute management of Maori a)Whakawhanaungatanga:
Self harm & Suicide Prevention Collaborative b)Te Ira Tangata:
Powhiri: Model of Engagement c)Problem Solving Therapy addressing
non-secure identity 2.Improving long-term management for Maori
a)PST addressing non-secure identity b)Innovation approaches
3.Improving management in institutional settings (CYFS, Schools,
Police, Prisons) best practice guidelines Huarahi hou Improve the
care of people who make non-fatal suicide attempts
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1.Hanging a)Control physical environment I.Whanau informed
about reducing access 2.Overdose a)Control and restricting access
to prescription drugs b)Paracetamol, blister packets with
restricted points of sale 3.Firearms a)Fire arms regulations
focused on licensing and safe storage 4.Jumping a)Barriers
installed popular jumping sites Huarahi hou Reduce access to means
of suicide
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1.Rationale imitation, contagion, normalisation 2.Legislative
response in Coroners Act 2006 limiting publication of details of
deaths of individual suicides 3.Media guidelines and protocols
supported by education Huarahi hou Promote safe reporting and
portrayal of suicidal behaviour by media
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Postvention 1.Support whanau bereaved by suicide a)Recognise
variation in cultural attitudes to death, dying and suicide
2.Support whanau after suicide attempt a)Family psycho-education
programmes to reduce stress b)Written information c)Liaison between
carers and providers 3.Minimise contagion a)Unified community
response utilising community resources b)Defuse tension c)Accurate
timely information d)Media management e)Identify susceptible
individuals Huarahi hou Support whanau, friends and others affected
by suicide or suicide attempt
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1.Improving the quality and timeliness of suicide data
a)Coroners investigations systematic and accessible b)Improved
intentional self harm data collection c)Improved ethnicity
recording 2.Expanding the research base a)Kaupapa Maori research
required 3.Improve the dissemination of research and information
Huarahi hou Expand the evidence about rates, causes and effective
intervention
