Chris Bowden, Lecturer, School of Education Studies, Victoria University of Wellington. SPINZ Symposium, Wellington, 2007. http://www.spinz.org.nz
- 1. Collaboration,ConnectionandA StrengthsbasedApproachtoSuicide
Goal3oftheTheNewZealandSuicidePreventionStrategyPrevention(AssociateMinisterofHealth,2006)focusesonimprovingthecare
ofpeoplewhomakenonfatalsuicideattempts.
Itsuggestsdevelopingpolicies,strategiesandservicesthatleadto
bettertreatment,managementandaftercaresupportforthose
makingnonfatalsuicideattempts. Itoutlinesareasofactionincluding:
Improvingmethodsoftreatment,management,aftercareandsupport
ChrisBowden Improvingquality,continuityandaccessibilityofcare
Lecturer,SchoolofEducationStudies,Victoria
Supportingfamilies/whnautocareforsomeonewhohasmadeUniversityofWellington.asuicideattempt
[email protected]
DevelopingbetteraftercareandsupportsystemsforMoriwhohavemadeasuicideattempt.
21Nov2007SPINZ2007Symposium:BuildingtheJigsaw
CollaboratingforSuicidePreventionTheNeedtoImproveServices,Connect
WithandEngageYouthImprovingServices
Buston(2002)echoesthesegoalsinherstudyofadolescentusers
Hickie,Fogarty,Davenport,Luscomb&Burns(2007)ofmentalhealthservices.
identifysomeofthekeychallengesinvolvedin
Sheclaimsthatfurtherattentionneedstobegiventothedevelopingnewyouthappropriateprimarycaredevelopmentofempathiccommunicationskillsbyhealthservices:professionalsworkingwithyoungpeoplewhoareexperiencingmentalhealthproblems.
Increasingyoungpeoplesaccesstosuchservices.Theimportanceofsupport,empathyandaccessibilitywere
Providingthestyleofservicesthatyoungpeoplemostseek.repeatedlystressedbyrespondents(Buston,2002,p.240).
Focusingworkforcetraininganddevelopmentlargelyonearly
interventionmodels.
Shealsohighlightstheneedforhealthprofessionalstoworkon
Providingevidencebasedpsychologicalandmedicalservices.connectingwithyoungpeopleinawaythatencouragesthemtoremainengagedwithservices:
Hickieetal(2007)recognisetheimportanceofFurtherdevelopmentbycliniciansofamannerwhichencourages
developingintegratedcollaborativecaremodelsamongthepatienttoopenupandwhichgivestheimpressionofcaring,empathyandbeinglistenedto,shouldnotbeunderestimated
someofthesolutions.(Ongetal.,1995Meryn,1998).(Buston,2002,p.241).ListeningtoYouth&CollaboratingDifferentandDiverseAcrossDisciplines
McGorry(2007)reflectingonthepublicmentalhealth
Ourhealthsystemneedstotakethenextstepforwardin
systeminAustraliastates:
removingthebarriersbetweenhealthprofessionalsandyoungpeople.Itneedstostartlisteningtowhatweare
Anewyouthmentalhealthapproachisrequiredthatsayingandwhatweareaskingfor.Toknowwhatworksbestforus,thesystemhastobecomeyouthfriendlyand
buildson,butisqualitativelydifferentfrom,existingchildyouthoriented.(VictoriaTonin,Platformyouth
andadolescentandadultapproaches,whichhavebothparticipationprograme,ORYGENYouthHealth,2007)
struggledtoaddressthementalhealthneedsof (McGorry,2007,p.S53).
teenagersandyoungadults(McGorry,2007,p.S54).
Inordertounderstandwhatsupportsthehealthy
Youthmentalhealthservicesneedtoprovideanintensive,
developmentofyoungpeopleandthebestapproaches
comprehensiveandintegratedserviceresponsetoyoung
forpromotingwellbeingweneedtosynthesiseand
peopleandtheirfamilies,focusedonsymptomremission,
integrateknowledge,notjustfromawiderangeof
researchfields,orevendisciplines,butfromacrossthe
socialandvocationalrecovery,andrelapseprevention
naturalandsocialsciencesandhumanities(Eckersley (McGorry,2007).
2004,p.41).1
2. InterdisciplinaryApproach
Muchcanbelearntfromthestudyofhumandevelopment,youthStrengthsBasedSuicidePrevention
developmentandyouthwork,nursingandtherapy.
Improvingcare,protectionandtreatment
Thesedisciplinescontainconcepts,researchandknowledgethat
caninformthedevelopmentofastrengthsbasedapproachtoCollaboratingwithyouthtobuildcompetenceandconfidence
suicideprevention.
Fosteringdevelopmentandwellbeingandaddressingrisk
Muchoftheworkinthesedisciplinesisstrengthsbased.Reconnectingyouthwiththeirsocialworldandlife
Somekeythemeswithinthesedisciplinesare: YouthLife Nursing
Therapeutic Startingwiththeindividualsstrengths.Development
HistoriesCare Alliance
Participativeprovidingyouthwithopportunitiestotakepart,influence
decisionsthataffectthem.Theory
Empoweringprovidingyouthwithcompetenceandconfidence.
Educativeteachingyouth21stCenturyskillsandknowledgebut
acknowledgingtheflowofteachingandlearningbetweenyouthandNursingYouth
Human Therapy thosewhosupportthem.WorkDevelopment
RelationshipsWhatCanbeLearnedfromYouthDevelopment?
Focusingonyoungpeoplesstrengthsrather
thantheirfailingsistheunderlyingprincipleof
youthdevelopment(MYD,2002).
Reducingandpreventingdevelopmentaldeficits
andpromotingdevelopmentalstrengthsare
parallel,uniqueandcomplimentarytracks.
Figure1illustratestherelationshipbetween
deficitandstrengthsbasedpolicyorientations.
(Benson,Mannes,Pittman&Ferber,2004,p.785)SuicideandSelfharmasSymptomsofCollapsedSocialWorlds
ConnectingwithLifeHistories Traditionallyyoungpeoplehave
DenovandMaclure(2007)state:beenlabelledasatriskonthe
Lifehistoriescanprovidelistenersandreaderswithinsightsintothecourseofbasisofthesymptomsratherhumandevelopmentandtheworkingsofthehumanmind(McAdams2001,thanthecausesoftheirp.307)situation(Martin,2002,p.20).
Theuseofalifehistoriesapproachwithyoungpeoplewhohaveengaged
Weneedtolookatworlds
innonfatalsuicidalbehaviourmayshedlightontheindividuals
behaviouroccursin.experiences,choicesmade,actionstaken,andconsequencesfeltaswellasrevealimprtantinformationaboutlocalcontexts,socialstructuresand
Interventionsbasedonsymptoms
culturalmoresthatinfluenceyoungpeoplesbehaviour.areusuallyonlygoingtoaddressasinglefactor(notgettingthe
Lifehistoriesmayalsobeusedtoilluminateturnings(fundamentalshiftsinbiggerinterconnectedpicture).rolesandidentity)andadaptations(alterationsofbehaviourandidentityovertime)(Denov&Maclure,2007)thatmayhelpsuicidalyouth
Interventionsbasedonsymptoms
understandtheirbehaviour,livesandfindnewwaysofcopingandadapting.leadustolookatwhatiswrongwiththeindividualdeficits
Healthprofessionalsmightusealifehistoriesapproachtobothconnectbasedapproach(Martin,2002).
withyouth,provideyoungpeoplewithavoiceandfinditausefultoolforbeginningtocollaboratewithsuicidalyouthtofindmeaningandwaysforwardfortheirrecovery.
(Martin,2002,p.21) 2 3. LifeTrajectoriesandHumanDevelopment
GettingtoKnowYouth
Thestudyofsuicidalprofilesacrossthelifetrajectorycanhelpus
AsEtherington(2007)states:
mapdistinctivepathwaysandbetterunderstandthecumulativeLifestoryresearchcanhelpuscoconstructcomplex,multilayered
effectsofriskandprotectivefactors,includingchildhoodadversity
narrativeknowledgethatwecanholdalongsidetheparadigmatic
andmorerecentevents(Sguin,Lesage,Turecki,Bouchard,knowledgegainedbyusingtraditionalresearchmethods(Bruner,
Chawky,Tremblay,Daigle&Guy,2007).1986Mishler,1999Polkinghorne,1988)(p.456).
TheuseofLifechartscanhelpintheexaminationoftheduration,
Itisnotaboutfindingthecausalexplanationbutabout
developmentandcharacteristicsofthesuicidalprocessinyoung
howyoungpeoplemakeconnectionsbetweenlife
people,particularlywhenbasedonpsychologicalautopsy
experiences,healthissues,theirsenseofselfand
information(Fortune,Stewart,Yadav&Hawton,2006).identity.
Examiningthedevelopmentalinfluencesandtheuniquetrajectories
ofyoungpeopleisalsoakeyareawithinthestudyofHuman
Ifyouwanttoknowme,thenyoumustknowmystory,formy
DevelopmentandtheareaofeducationforHumanServicestorydefineswhoIam.AndifIwanttoknowmyself,togain
Professionals(Harms,2005).
insightintothemeaningofmyownlife,thenI,too,mustcome
toknowmyownstory(McAdams,1993,p.11)(quotedin
Etherington,2007,p.456). ReconnectingwithHumanitytoAidRecovery
DefiningaTherapeuticAlliance
Recentnotionsofrecoveryseemtoencompassa
Thetherapeuticrelationship,whetheritexistswithinthecontextoftherapy,
processwherebytheindividualcanreclaimhis/herselftreatment,careorsupportcallsforaperspectiveofcollaborationthatenablestheindividualtodefinetheirownneeds,usealanguagethatmakes
esteem,pride,choice,dignity,andmeaning(Wright,Haighsensetothemandtheirsignificantotherandempowersthemtotakecontroloftheirlife.
&McKeown,2007).
Thetherapeuticallianceisimportantforalleviatingasuicidalindividualssenseofpowerlessnesstochangehimselforherselfortheenvironment,
Healthprofessionalsneedtoembracepeopleshumanityandfacilitatetheexperienceofsuccessandmasteryindealingwithhis/hersituation.
tofacilitatethisprocess.
Itallowsthepersontotakeanewperspectiveorstandpoint(Sderberg,2004).
Recoveryisaboutthewholeperson,identifyingtheirstrengths,
instillinghope,andhelpingtofunctionatanoptimallevelby
Itrequiresthepresenceofsignificantotherswhocanreinforcethe
allowingthemtotakeresponsibilityfortheirlife(Townsend&individualsnewapproachtotheworld.
Glasser,2003,p.83,quotedinWright,Haigh&McKeown,
Theserelationshipscarrythepotentialforadevelopmentofselfesteem
2007,p.243)andselfworthandbuildonanactivedecisionandpersonalcommitmentforchange(Sderberg,2004).ConnectingwiththeExpertsYoung
WhatCanBeLearnedfromTherapy?People
Summer&Barber(2003)notethatthestrengthofthe
Suicidalyoungpeoplearevaluablesourcesof
collaborativerelationshipbetweenpatientandtherapistexpertiseandknowledgeandthatifpractitionershave
hasbeenrecognisedascrucialbytherapistsfrom
welldevelopedcommunicationskills,andarewillingto
differenttheoreticalbackgrounds.seepastthesuicidalbehaviourtomeettheexpertwithintheindividualtheyaremorelikelytofindthe
Establishingthisrelationshipisoftenseenasthefirst
answerstowhatthepersonneedstostoptheirsuicidal
stepintreatment.behaviourandrecoverandthrive(Crockwell&Burford,
Referredtovariouslyastherapeutic,workingorhelping1995). alliance.
Bordin(1979)definedithashavingthreecomponents:
Theimportanceofestablishingatherapeuticalliance1.
GoalsSharedgoals.withthesuicidalpersonisalsosomethingrecognised2.
TaskAcceptedrecognitionofthetaskseachpersonisto
withinNewZealandguidelines(NZGG,2003)asperfomintherelationship.somethingthatcanfacilitatethedisclosureofinformation3.
Bondanattachment.andasenseofhopefulnessandconnectedness.3 4.
CollaboratingwithYouthtofind WhatCanBeLearnedfromNursing? Strengths
Healthprofessionalsprovidingaftercaresupport,treatmentandcarealso
Samuelsson,Wiklander,sberg&Saveman(2000)identifiedthefollowingaspectsof
careintheirstudyofpyschiatricinpatientswhohadmadesuicideattempts:
needtoseebeyondthesuicidalbehaviourandhelpyoungpeoplediscover
Receivingunderstanding,confirmation(sympathy,allowingaction,thosewho
orrediscovertheirstrengthsandpotential.
mediatedhopeandorientationtowardsthefuture).
Understandingthepatientsworldfromtheirpointofviewinordertobeableto
WarelowandEdward(2007,p.134)state:rehabilitatehope.
Warmthandsupportduringinitialtreatmentstage.Recoveryorimprovementinmentalhealthwasoftenachievedwhen
peoplewith Beinginanursescaregivingasenseofsecurity.
mentalhealthissuesdiscoverorrediscoverstrengthsandabilitiesforpursuing
Confidenceandtrust.
theirownpersonalgoalsanddevelopingasenseofselfthatallowsthemtogrow
Aeccessibilityknowingtheywerewelcometocontactthewardatanytime.
ormovebeyondthesymptomatologythatdeemsthemtohaveamentalillnessin
Sensitivitytoneedstheneedtotalkortheneedtobeleftalone.
thefirstplace(Edward&Warelow2005p.101)
Verbalcontactswithstaff(essentialforhealingandfordesiretogoonliving).
WarelowandEdwardarguethatcaringasapracticemayassistpeopleto
Whatwasnthelpful: becomemoreresilient.
Nurseswhoweremoreinterestedinresearchthanintheperson.
Nurseswhotookroleoftheneutralspectatorratherthanthecloseinvolved
Psychiatricnurseshaveopportunitiestointerruptanongoingsuicidal
fellowcreature.
processbyinterveninginsuicideattemptsandprovidingcaretoreducethe
Lackofunderstandingofthepatientsperspectiveandnotacceptingthepatients
incidenceofsuicide(Samuelssonetal.1997citedinSun,Long,Boore&
suicidality. Tsao,2005,p.275).
Beingtreatedlikechildren,beingguardedandcontrolled.
Notbeingconfirmedledtofeelingsofbeingburdensome,desiretogohome,
andfurthersuicideattempts. NursingCareTheory
Nursesinthestudyindicatedthey
Nursingcaretheorycanguidethenursingcare
usededicatednursestoinitiate
forpatientsathighriskofsuicide.andmaintainatrusting
relationshipwithsuicidalpatients. Dedicatednursesassessed
patientssuicidalthoughts,used
Sunetals(2005)studyhighlightedtheneedforsuicideindexscalestoassess
nursestohavethefollowingskills: thoughtsandfeelings.
Advancedcommunicationqualitiesandskillsto:Basiccareincludedbeingthere
forpatientsintheirhumanity,
Effectivelyandcontinuallyassesssuicidalpatients
physicallyandemotionally,in Protecttheirsafety presenceandtime.
BethereforpatientstoprovidebasiccareCompassionateartofnursing
includedsixconcepts:
Usethecompassionateartofnursingtoprovideadvancedcare
Empathy,beingnonjudgemental, acceptanceofpatientasperson
Facilitatepatientstohealandregaintheirdesiretolive.
first,sincerity,kindnessand Figure2 respectfordignity.
Action/interactionstrategiesinthenursingcareofpatientswhoaresuicidal(Sunetal.2005,p.278)
KeyFindings:Roles,CommunicationSkills&InstillingHope
CaringforSuicidalPeople KeyFindingsfromSunetals(2005)study:
Nursestakeonmanyroleswhentakingcareofsuicidalpeople:
Cutcliffe&Stevensons(2007)bookargues Personcentredcare Educator
Counsellor
thatnursesneedtomovebeyondobservationalcarebecausethismayonly
NurturerConsultant Advocate deferandnotprevent,suicide.
Crisismanagement
Akeyconceptinthebookisreconnectingthesuicidalperson/patientwithhumanity
Effectiveuseofsevencommunicationskillshelpednursesacknowledge
andarguesthatnursesneedtoprovide
patientsthoughtsandfeelings:suicidalpeoplewith:
ListeningandhearingEngagingPerceptiveofmoods
Intense,warmhumancontactbecause Opencommunication
Facilitatingdisclosure
suicidalpeopleareoftendisconnectedfromfamilyandfriendsandlack
TouchUseofsilencesupport.Thisstageisaboutbeingwiththeperson.
Instillinghopewasrelatedtofourconcepts:
Theyneedtomovebeyondthistoalso
Encouragingorteachingpositivethinking
Promotingselfconfidencechallengingthepatientsideasand
ValuingpatientsaspeopleTeachingproblemsolving
thoughtsaboutsuicideandguidethepersonbacktolifeaffirmation.Thisstageisaboutdoingand
Inordertoachieveallthesenursingcarestrategies,nursesneededto
reconnectingthepersonwithpre
initiateandmaintaintherapeuticrelationshipswithpatients.suicidalideas,feelingsandhope.
Athirdstageinvolvesthesuicidalpersonembracingthehardworkofreinvestinginlife.
4 5. Issues:MicrofacismandtheEvidence Discourse
RonaldMaris,intheforewordtoCutcliffeandStevensons
Smith(2007)notesthatthereisaneedtobreakdownmicrofacismwhichisatplay
inthecontemporaryscientificarena.(2007)book,notesthefollowingpracticeimplicationsoftheauthorsresearch:
Microfacismoccurswhenadominantideologyexcludesotherforms
ofknowledge.It
seekstoprotectaprivilegedstatusbypromotingaregimeoftruth.
1.Nursesneedtobecomfortablewithdeathanddeathtalk.
Heclaimsthattheevidencebasedmovementinhealthsciencesisoutrageously
exclusionaryanddangerouslynormative.
2.Nursesneedtotalkinordertolisten.
3.Nursestrainingneedstobemorecarefocusedandless
Healsonotesthatscholarsnotonlyhaveascientificdutybutanethicalobligationtoassessmentfocused.
deconstructregimesofpower.
4.Nursesneedtoengagetheirpatientsandnotmerely
Collaborationacrossdisciplinesthatcancontributetosuicidepreventionwillobservethem.
bedifficultifsomedisciplinescontinuetoactasfaciststructuresandexclude
otherformsofknowledgeincludingthatwhichcomesfromyoungpeople.
5.Thereisaneedtomoveawayfrommedicationbasedtreatment.
Communitiesofpractice:whereknowledgeemerges,isexchangedandisco
constructedthroughmutualdiscussionandwhereyoungpeoplecanhaveavoice
6.Thereisaneedtomovebeyondsuicideriskassessmentshouldbeencouraged.tosuicidalpatientcare(Marisnotesthatriskassessmentneversavedanyoneslife).
Communitiesofpracticearewheresocialandintellectualcapitalarebuiltthrough
researchandpracticecommunitiesworkingtogether.Theyarecharacterisedby
7.Arecoverynotacuremodelneedstobeadopted(p.ix).
processesofmutualnegotiation,reciprocity,trustandcohesion
exist(Smith,2007).Implications
Thoseworkingtogethertopreventsuicideandinparticularinthoseyoung
Itisimportantforhealthcareprofessionalstobemorethanjust
peoplewhohavealreadyengagedinsuicidalbehaviourneedtolookatareasknowledgeabledoers
preventionactivitiesneedtobecarriedoutwithin
ofcommonalityacrosstheirservicesanddisciplinesandfocusonaspectsof
anethicalframeworkofcarewithcompassionandsensitivity
care,protectionandtreatmentthatseektoreduceriskandpromotewellbeingotherwiseyoungpeoplewillfeeltheyaretheretobecontrolledrather
anddevelopment. thancaredfor.
Inclusiveratherthanexclusivecommunitiesoflearningandpractice
Thereisaneedtogobeyondofferingbasiccarewhichisimportant,
shouldbeencouragedthatdrawuponawiderangeofknowledgeand
expertisetoadvancebestpractice,andresearchinformedpracticeand
toalsoofferingadvancedandcompassionatecarewhichcoulddraw
evidencebasedpractice.
onthelearningfromthecompassionateartofnursing.
Thereneedstobeamoveawayfromtheunhelpfuldebateaboutprevention
Healthandhumanservicesprofessionals(andinparticulartertiary
ORpromotion.students)mayneedspecificeducationinsuicideprevention.Thisis
somethingthathasbeennotedinsocialworkeducation(Feldman&
Researchneedstobeconductedonthebestwaystodevelopanddeliver
Freedenthal,2006).
integratedcommunityandaftercareservices(particularlyforthoseyoung
peoplewithseriousmentalhealthproblems)bymultidisciplinaryteamsthat
includenurses,GPs,psychiatrists,counsellors,youthworkers,socialworkers
Humanservicesandhealthprofessionalsmayalsobenefitfromsome
andeducators.
educationfocusingonadolescentandyouthdevelopmentsotheybetter
understandtheneedsandworldsofyoungpeopleandtraininginbasic
Thereneedstobeagreaterrecognitionthatyoungpeopleoccupymany
relationshipskills(Binder,Bongar&Messer,1993citedinSummers&
socialworldsandcontextsthatinfluencetheirdevelopment,wellbeingand
Barber,2003)andhowtobuildtherapeuticorworkingallianceswith
behaviour. youngpeople.SomeConclusions References
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