Chris Bowden and Caroline Cole. SPINZ Symposium, Dunedin, 29 November 2006. http://www.spinz.org.nz
- 1. ImpactofSuicideonOthers n
SuicidalBehaviourdoesnotjusthaveanimpactonthesuicidalbuthassignificantimpactonothers.
Diversity,Communityand n
TheNewZealandSuicidePreventionStrategystates:OpportunityAmongstthoseNewZealanderswhomakeaserioussuicideattempt,almosthalfwillmakeatleastonefurtherattemptandMeetingtheNeedsofThose
onein12willdieasaresultofsuicidewithinfiveyears(Beautrais,20032004bGibbetal2005)(AssociateMinister
BereavedbySuicide ofHealth,2006,p.17). ChrisBowden n
ThosewhohavebeenbereavedbysuicidehaveoftenlivedwiththeLecturer,SchoolofEducationStudies,VictoriaUniversityofWellington.suicidalbehaviourofothers.
[email protected] n
Peoplebereavedbysuicideareatgreaterriskfor:&
Developingcomplicatedmourningresponsesandotherpsychiatric
CarolineCole andmedicalcomplications(Jordan&McMenamy,2004).
Counsellor,Skylight,WellingtonSouth,Wellington.
Heightenedlevelsofguilt,angerfamilydysfunction,social
[email protected]
stigmatisationanddisorderssuchastraumaticgriefandPostTraumaticStressDisorder(Jordan,2001).
Increasedriskofengaginginsuicidalbehaviouranddyingby29Nov20062006SPINZSymposium:Understand
ingSuic
idalBehaviour:UpdateYourKnowledgeandPracticesuicide(Jordan&McMenamy,2004).TheRoleofPostventionPreventiveInterventionsTheNeedforCollaborationnPostventionispreventionandanefficientwaytoprevent
n
Designing,implementingandevaluatingpreventivefuturedistress,psychiatricdisorderandmentalhealth
interventionsandsupportprogrammesisbestdonerelatedproblems,andevensuicidalbehaviourandsuicidethroughdevelopingpartnershipsbetweenresearchersanditself(Shneidman,1981).practitioners.nMaukandSharpnack(1999)definepostventionas:n
Throughcollaborationresearcherslearnmoreaboutwhat (i)
aprocessduringwhichpeopleworktowardsemotionalworksandwhatispracticalandpractitionerslearnmore
andpsychologicalrecoveryandreadjustment,andaboutresearch,theoryandeffectivewaysofsupportingthoseaffectedbysuicidalbehaviourandsuicide.
(ii) astheprovisionofinterventionsthatcombineeducation
andcounsellingthataimtopreventbereavementn
Collaborationandpartnershipsprovidesgreater
complicationsforindividualsaffectedbysuicide
opportunitiestoupdateknowledge,learnmoreabout
(includingfurthersuicidalbehaviour).
effectivepractice,developmorecomprehensiveandcriticalsharedunderstandings.nTheBereavedBySuicideSupportGrouprecentlysetup
n
ThismeansthatpracticeismorelikelytobefocusedonandrunbySkylightinconjunctionwithVictoriaUniversitysimilargoalsandbeeffective.ofWellingtonwasaneducationalpreventiveinterventiondesignedtoprovidepostventionandmeetaneedidentifiedbyindividuals,clientsandtheWellingtoncommunity.
LessonsfromtheResearchLessonsfromtheResearch
Meetingtheneedsofthosebereavedbysuicide
BereavedbySuicideSupportGroupsshouldaimto: n
Beautrais(2004)inherreviewandsynthesisoftheresearchevidencearoundthesupportneedsofthoseaffectedbysuiciden
Reducethelengthofthegrievingprocessforindividuals,identifiedthatsupportprogrammesneedtomeetthefollowingneeds
n
Reducethelikelihoodofmorbidity,subjectivestressandotherofthebereaved:
negativeoutcomesthatresultfrombereavement, n
Meettheneedsofbothindividualsandthegroup, Theneedforinformation, n
Identifyspecialpopulationsandthoseatrisk(e.g.,thoseindividuals
Theneedforassistancewithpracticalmatters,whomaybesufferingfromsevereandchronicgriefcharacterisedbyenduringsymptomsfittingwithearlydiagnosticcategoriesof
Theneedforcontactwithotherswhohavebeenbereavedby
depression,anxietyandPTSD), suicide, n
Buildsocialcapitalandpersonalcapital(resourcesthatinfluence
TheneedforsupportwithCoronersInquestandofficial
coping,adjustmentandadaptation)bylinkingpeopleto: procedures.
immediateservicesandgenericbereavementservices,
shorttermservices(e.g.,thatprovideinformationonsuicidean n
Twomaindifferencesbetweenbereavementbysuicideandotheropportunitytotalkabouthowithasaffectedthem,anprovideformsofbereavement:opportunitiesforindividualstofindpersonalunderstanding/putdeathin
bereavementprocesstendstobelongeraftersuicide,andperspectiveandcontinueonwiththeirlives)andby
longertermservices(e.g.,therapyandtreatmentgroups,selfhelpand
recoverytendstobeslowerinthosebereavedbysuicide
supportgroupsthatwillvaryintermsofleadership,duration,(Beautrais,2004).
membership,format,structure)(Beautrais,2004).1
2. LessonsfromtheResearch TheProgramme
Beautrais(2004)suggeststhatthosedesigninganddeliveringBereavedbySuicideSupportGroupsshouldconsider:
n 6weekprogrammeEducationalpreventive n
Includingaapretestandposttestmeasureinordertoevaluate
intervention.interventionchanges(e.g.,ameasureofgriefexperience,distressetc),n
2hrspersession,79pm. n Considerthenumberofsessions, stndn 1
hrInformation/skillbasedand2 hrEmotional n
Considertiming(soonorlateronsomeevidenceearlierinterventionsaremoreeffectivebutdependsonreadinessofparticipants),supportfocusedcomponent(educationaland
n
Considerdifferenttypesofprogrammesfordifferentgroups(i.e.,counsellingapproach).malesandfemales,youthvsadults),
n Considerdifferenttypesofprogrammesandinterventionswithhighn
Facilitatedbyexperiencededucatorandriskandlowriskindividuals(importanttoscreen/assessparticipantsbeforeselectionforgroupformentalhealthissuesthatcouldberiskcounsellor.factorsforfuturesuicidalbehaviour)
n Supportthedevelopmentofnaturalhelpersfamily,friends,n
Closedgroup(commitmentto6weeks).neighbours,peers,employers.n
Participantsvolunteered.
AimTheStrategyTohelpthosebereavedbysuicidetodevelop:n
Understandingof:Providethosebereavedbysuicidewith: Griefprocessn
Factualinformationaboutsuicide,grief,copingstrategiesand
Suicideresources.n
Asafe,respectfulandnurturingenvironmenttotalkabouttheirn
Skillsandstrategiesfor: experienceswithothers. ManagingGrief. n
Opportunitiestolearnmoreaboutsuicideandwaystounderstandit
Maintainingpersonalwellbeing.andputitintoperspective.
Protectingselfandothersandimprovingfamilyfunctioning.n
Opportunitiestolearnandsharestrategiesforenhancingindividual
Developingpersonalandsocialresourcesandsupport.
andfamilyfunctioning,dynamics,communicationandwellbeing(to
reducerisk,assistwithearlyidentificationofatriskindividuals,and
promotepositivesocialandindividualcapitalandselfcare).n
Ultimatelytoreduceriskofnegativeoutcomes,bereavementtime,
shortenrecoveryandreduceriskoffuturesuicide.n
Addresssocialinequalitiesfreetobereaved,appropriatetimeand
accessiblelocation(doneinconsultationwithbereaved)n
LinkbereavedwithSkylightandotherservicesthatcanprovide
ongoingsupportandaccesstoresources.ApproachContentn
Responsiveandflexibleapproach.n
Respectfulofthediverseneedsandwaysthatpeoplerespondtosuicideand n
MeetingthechallengeofDESIGN learn.n
BasedonNewZealandreviewofresearch(Beautrais,2004).n
Safetyandeffectivenessdonoharm.n
Aspectsofprogrammebasedoninternationalresearchandpractice(Murphy,n
Strengthsbased. 1996Murphyetal.,1996,1998,1999)n
Informedbythefollowingconceptsandprinciples:
Communitybasedpreventiveintervention.
Griefisanactiveprocessoflearning,relearningandresocialisation.
2dimensionalsupportprogammesfollowingsuddenorviolentdeathsofRelearningprovidesunderstanding,allowsindividualstoaddresstheirchildren(includingsuicide).helplessnessthataccompaniesgrievingandprovidesaframeworkforsupporters/caregivers(Attig,1996).
Informationalskillbuildingsupportandemotionalsupportprovided(both
ratedhighlybyparticipants).
QualitysupportprogrammesprovidebotheducationandcareorEducare(Smith,2003).
12weekand10weekprogrammes(510parentspergroup).
ThefivestrandsoftheearlychildhoodcurriculumTeWhriki: (Ministryof
Offered4mthsafterbereavement.Education,1996):belonging,wellbeing,opportunitiestoexploreand
Goodmeasuresusedtoassessoutcomesonmentaldistress,Postlearn,communication,andresponsibility.
TraumaticStresssymptoms,lossaccommodation,physicalhealth,marital
Learningenvironmentsareculturalsiteswhereindividualssocially
rolestrain.negotiatethemeaningofexperiencesandlearnhowtoadapt,use
Pretreatmentvariablesassessed,controlgroupsused.strategiesandculturaltoolsthroughinteractionsandthroughtheuseof
LongitudinalstudiesFollowedupparticipantsat4,12and24mthspostscaffolding(Smith,2003,Santrock,2004).deathaftercompletingprogramme.
Akototeachandlearn(Williams,1992)aprocessofreciprocal
Mixofquantitativeandqualitativemethodsforevaluation.teachingandlearning(Glynn,1993).Facilitatorsandthebereavedwork
Promisingresults(particularlyhighlydistressedwomenbutalsoformen).togetherinanintegratedwaylearningandteachingeachother.AkoAkowhichimpliesamutualteaching/learningdiscussion(Williams,1992).
2 3. ContentofModulesSession 1Module Introduction ObjectivesIndiv
idual,groupandprogrammeInformationContent
Definingbereavement,grief,SkillEmphasis
IdentifyingfactorsthatinfluenceEmotionalComponentShar
ingexperiences,building Recruitment&Screeningobjectivesmourning
duration,extentandoutcomesoftrustSettinggoals&boundariesbereavement
Sourcesofsupport
nInitially,supportgroupadvertisedthroughnewspapers,funeralhomes
2TheGrieving Pr ocessUnderstandingdiversityingrief,w hatisnor
mal,cognitive,emotional, Griefreactions GriefMapping How
griefaffectsus Realisticexpectationsf
orgriefDiscussingcommonanduniqueaspectsofgrief
andemailnetwork(poorresponse).social,physicalreactions
gender,individualandfamilyLearnnew strategiesfor managing
AccommodatingGriefmodel DifferentGrievingstyles
accommodationandfunctioning Strategiesformanaginggrief differences
nBetterresponseusinglocalradio,friendsandcolleaguesinformedgrief
intuitive,instru mental,dissonantImpactonfamilydynamics
familymembersandparticipants.Participantsslowtoregister.
3Understanding Suic
ideUnderstandingcomplexcauses,developingapersonaltheory,putting
Theories,modelsand explanations,r iskandprotective
Developingpersonaltheory, PuttingsuicideintoperspectiveDealingw
ithWhy?Guilt,responsibilityandunfinis hed
nPotentialparticipantsnonclinicallyscreenedandaskedforsuicideintoperspectivefactorspracticalw
aysoftalkingaboutand
explainingsuicidetoothersbusinessManagingstrongemotions
backgroundinformation(didnotusescreeningquestionnaireasthis
wouldputoffindividuals). 4Respondingto Understandinghow
suicideaffectsEffectsonchildre n,yo uth,others Ex
plaining&talkingaboutsuicide Copingw ithchangeinfamily
Othersothersandoursocialnetw orks Ec
omapofimpactofsuicideonModellinggoodgrieving Helpfulandhurtf
ulresponsesnDecisionmadetoexcludethosebereavedforunder6mths,theywereHow
todealw ithunhelpfulresponsesbyothers relationsh ips Identifyingw
aystostrengthen socialsupportnetw orkbyothersWaystocommunicateneeds
offeredalternative1:1supportandfamilycounsellingofferedtothose
5Self Care&Learningmore aboutw hatsupports
TeWhareTapaWhamodelof Assessingandmeetingneeds Dosingfeelings,
managing wantingsupportforchildrenandyoungeradolescents. Supporting
Othersandcompromisesw ellbeingAdaptive&maladaptivestrat egies w
ellbeing Import anceofrituals Recognisingriskinself&others
Achievingbalanceandconnectionthoughts,behaviours
nIndividualsweremonitoredduringsessionsforsignsofsevereand How
tosupportfamilymembers Identifyingprotectivefactors
chronicgrief,symptomsofdepression,anxiety,PTSDandother
6LookingAhead Achievingafutureor ientedfocusRevisitingGriefMap
Recognisingw hen,w here,how toRenegotiatinganew
mentalhealthproblems(oneparticipantwassubsequentlyreferredtoIdentifyfactorsthatcontributetoresiliency
TheChallengeModel SourcesofInfo&Support gethelp Repositioning,r
edefiningselfrelationsh ipw ithdeceased,preservingmemories
GPandcounsellorafterdisclosingsymptomsofPTSD). Identifyingfuturetas
ks,skillsand Whathashelpedthem support bounceback,Hopesforfuture
7datacollection Closureforgroup,chancetofeedbac k evaluation
Participants
DeliverynClosedgroup.Firstnight,someparticipantswhohadregistereddidnotshowup,othersshowedupwhohadnotregistered.2leftafterfirstnight(citing
nMeetingthechallengeofDIVERSITYrdgroupdidnotmeettheirneeds),2othersjoined3
week(oneparticipantfeltthiscompromisedtrustofgroup).
nDemonstratedtheyhaddiversegriefexperiencesand
nGroupruninSkylightsWellingtonSouthOffice,groupseminarroom.
supportneeds.Accessibleparkingandpublictransport,resourcescentre(librarywithbooks,videos,DVDs)available.
n7groupmembers(2male,5female). nst1
hourdiscussinformationandskillbuilding(someskillsdiscussed,modelledandpracticedothersintroducedandcriticallyreflectedon).
nAgesrangedfrom2050yearsofage.nBreakteaandcoffee,informallearning&sharingopportunities.
nLengthoftimebereavedrangedfrom7mthsto8years10nnd2
houremotionalsupportfocusedonsharingexperiences,obtaining mths.
feedbacktofacilitatereframingaspectsofsuicide,sharingstrategies.nBothprogrammecomponents(information/skillbuildingandemotional
nPredominantlyPakeha/NewZealander.
support)implementedjointlybythe2facilitators(educatorandcounsellor).nEndofeachsessionparticipantsaskedtoidentifytheirsupportpeople,future
nManyhadchildrenandfamiliesoftheirownandwereactivities,taskstheywouldworkonandstrategiestheywouldpracticeforthe
managingtheirowngrief,familyrolesandwork.followingweek.nFinalmoduleparticipantswereprovidedwithfolderwithmodulesummaries,
nGroupranTuesdays79pmfor6weeks,timeandday
generalresources,factsheets,sourcesoffurtherinformation,andalistof
suitedgroup,childcarearrangementsandtravelling.contactsanddescriptionsforcrisisandsupportservices.nInitiallyitwasenvisionedthateachmodulewouldbeevaluatedweekly,butparticipantsindicatedtheywouldpreferminimalpaperworkanddecisionwasmadetoevaluatemodulesatendofprogramme.TheRippleEffect
Evaluation nMeetingtheneedsoftheCOMMUNITY
nBackgroundsandExperiences:Howsuicidehadaffectedthem.FocusedonperceptionsofParticipantsof:
MotherandDaughterson/brotherdiedbysuicide,fathernotcopingathome. n
Information/Skillbuildingcomponent Twobrothersbrotherdiedbysuicide.
Relevance(usefulness), Widowedmotheroftwochildrenhusbandsuicided.
timingand Youngwomangrandfathersuicided,hushedupbyfamilyandthen
understandingofcontentandskillspresented.mothersuicided.
Opportunitiesforlearning(whatwaslearnt).
Middleagewomansonsuicided.n Emotionalsupportcomponent
nMosthadlivedwithsuicidalandselfharmingbehaviourforsometime.
Whatthegroupexperienceandfacilitatorsprovided(basedonYaloms
nTheysawthemselvesasdifferenttootherfriendsandextendedfamilywho1985,therapeuticgroupfactors).
hadalsobeenbereavedbysuicide(didnotwantsupportpeople/natural n
Facilitation helperscomingtothegroup).
Leadershipandexpertiseoffacilitators.
nAllwereconcernedabouttheeffectsofsuicideonotherfamilymembers, n
UsefulnessofthePreventiveIntervention
familyfunctioning,futureriskparticularlyonchildren.
Mostandleastusefulaspects
nGainedeachotherstrustquickly(within2weeks).
nInitiallysomeparticipantswantedaneducationalapproach(learning),others
wantedamorecounsellingapproach(sharingexperiences),somewantedn5pointLikertScaleitems
both.nOpenEndedquestions
nStartedcurryclubmetsociallythehourbeforethegroupinlocalIndian
restaurantfordinner. 3 4. Information/SkillBuilding
Relevance&Timing n
Relevanceofcontentandinformation:Alltheparticipantseitheragreedorstronglyagreedwiththefollowingstatements:
Component themajorityofmaterialpresentedwaspersonallyuseful
themajorityofmaterialwouldbeofusetootherpeople n
Mostrelevantmodules:
theskillstaughtandmodelledinthemodulesareuseful
Module4Respondingtoothers(100%) n Timingofcontentandinformation:
Module5Selfcare&SupportingOthers(100%) Module6Lookingahead(83%)
early(n=1bereaved5years) Module3Understandingsuicide(67%)
attherighttime(50%,n=3,bereaved8years,bereaved9mths,bereaved
Module2TheGrievingProcess(50%)7mths) Module1Introduction(50%)
late(n=1,bereaved8years10mths) n
note2participantsmissedmodules1&2
muchtoolate(n=1,bereaved8yearsandsecondsuicide8+years) n
Whenaskedabouttheirperceptionsofthemostappropriatetimingof n
Whatwasmostrelevantandwhy?workshopsforotherpeoplebereavedbysuicide:
Understandingsuicide[module3]andtheGrievingProcess[module2].Thisprovided
mostusefulforthosebereaved46mths(33%,n=2)mewithinformationthatIknewIcouldtrustandinacontrolledandsafeenvironment.Withsomuchinformationavailableitisdifficulttofindconstructive,
mostusefulforthosebereaved79mths(50%,n=3)helpfulinfoetc.Thisgroupgavemeanopportunitytoaskquestionsandclarify
mostusefulforthosebereaved1013mths(50%,n=3)whichwasinvaluable(Participant6).
Thisisdifficult.UponreflectionIwishIhadthisinformationearlier.However,
n Whatwasleastrelevantandwhy?
IamunsurethatIcouldhavecopedearliertooraw.Ithinkhavingthese
Module3.[Understandingsuicideandputtingitintoperspective]probablytoosoonkindsofworkshopsoccurringregularlyallowspeopletocomewhenthey
sincetheloss(Participant2).areready.Theyneedtoknowitsalwaysgoingtobeavailablethough
Module2,theGrievingProcessIamfinishedwiththispart.(Participant4).
(Participant6).UnderstandingofContentLearningOpportunitiesnLearningOpportunities:Nearlyalltheparticipantseitheragreedorstronglyagreedwiththefollowingstatements:
Theworkshopsprovidedopportunitiestolearnskillsandstrategiesformanaging
grief. n Understandingofcontent:Alltheparticipantseither
Theworkshopshelpedmelearnmoreaboutwaysofmaintainingpersonal
wellbeing.agreedorstronglyagreedwiththefollowingstatements:
Theworkshopshavehelpedmedevelopstrongerpersonalandsocialresources.
ThemajorityofthematerialpresentedisofusetonCommentsaboutwhattheylearntandwhichlearningtoolswereuseful:TheGriefMap
inthewaythatitaidedintoworkingwhatwasimportantindealingwith me.
grieforsuicide(Participant1). Theobjectivesofthemoduleswereclear.Te
WhareTapa
Whaconceptwasuseful.MakingaconsciousdecisiontoensurethatIamnurturingmywholebeing.Suicideisincrediblytraumaticandneedsspecial
Theworkshopshelpedmeunderstanddifferent treatment(Participant,6).
aspectsofthegriefprocess. TheEcoMap
Throughhelpinginworkingouttherelationshipswhichareimportanttomeintermsofsocialresources.AndTeWhareTapa
Whainrelationtopersonal Theworkshopshelpedmeunderstandsuicideand
resourcestheworkshophelpedmeworkouttheimportanceof[having]timeto
putitintoperspectivewithinmyownlife.onesself(Participant1)
IhavereallyfeltlikeavictimoverthepastfewyearsandwiththatIhavefeltquite
depressed.IsleptALOTandstilldo.ByworkingandschedulingtimetohealIhave
givenmyselfpermissiontogrieveandstartaroadtorecovery(Participant6).
EmotionalSupportComponent EmotionalSupportComponentn
TheExtenttowhichthegroupprovidedemotionalsupport:Nearlyallthen
The9therapeuticfactoritems(Yalom,1985)weremeasuredbyparticipantstickingthe
participantseitherstronglyagreedoragreedwiththefollowingstatements:
followingthatappliedandstartedwithacommonstem:
Theworkshopsandsupportgroupprovidedasenseofcommunityand belonging.
Themembersofthegroup
Theworkshopsprovidedanonjudgementalenvironmentforsharing
Helpedmewanttoforgetmyselfandthinkofothers(Altruism)(50%,n=3).
experiencesandexpressinggrief.
Helpedmesaywhatisbotheringme(Catharsis)(50%,n=3).
Theworkshopsprovidedanopportunitytosharediverseexperiences,
AcceptedmeasIam(CohesionItem1)(100%,n=6). needsandperspectives.
HelpedmefeelIbelongevenwhenIrevealedembarrassingthingsaboutmyself
Theworkshopsprovidedasafeenvironmentfordiscussingfearsand
(CohesionItem2)(67%,n=4). concerns.
GaveadvicewhenIaskedforit(GuidanceItem1)(17%n=1).
Theworkshopsgavemehopeandhelpedmeseebeyondsurvival.
GaveadvicewhenIdidntaskforit(GuidanceItem2)(17%n=1).
Helpedmeseethatothershavesolvedproblemssimilartomine(Installationof
Fourofthesixparticipantsstronglyagreedoragreedthatthey
hadlearntahope)(50%n=3). lotfromtheothergroupmembers.
Recognisedwhensomethingwastroublingme(Interpersonallearning)(0%).
HelpedmefeelthatIamnotalone(Universality)(83%n=5).Whathaveyoulearnt?Other
BasicallythatsuicideisnotaneventthatjustIhaveexperienced,andalotof
Offeredusefulstrategiesandsuggestions(Interpersonallearning)(67%n=4).
peopleincludingthoseinthegrouphavehadthesameexperience
Helpedmefeelnormal(Destigmatisation)(83%n=5).
(Participant1).WeareatdifferentstagesofthejourneyandthisallowedbothunderstandingtooccurIhavelearntthatthereareveryuniquefeelingsassociatedwithbereavement
butatthesametimeallowedmemberstolearnfromeachotherin
ameaningfulbysuicide.Thatthereisenormousvalueinbeingabletoconnectwithothersway(Participant6)whohaveexperiencedsuicide(Participant6).4
5. WhatWasImportant Facilitation n
QualityofFacilitation:Nearlyalloftheparticipantseitherstronglyagreedoragreedwiththefollowingstatements:Belongingto
Thefacilitatorsareinterestedinandsupportiveofourgroup.acommunity
Thefacilitatorswereabletocommunicateinformationandideasclearly.Acknowledge
Addressing
Thefacilitatorsexpertiseaseducatorsandcounsellorswerevaluable.
needs stigmaperspectives
Thefacilitatorsencouragedparticipationindiscussions.
Thefacilitatorsencouragedexpressionofdifferencesinopinionsamongstparticipants.Sharing
Thefacilitatorsencouragedparticipantstothinkcriticallyaboutthetopicscovered.AcceptanceExperiencesofDiversityParticipation
Thefacilitatorsencouragedparticipantstothinkcreativelyaboutwaystoworkonpersonalissues.
ThefacilitatorsencouragedparticipantstoidentifystrategiesformanaginggriefandTheBereaveddealingwithissues.
Overall,howsatisfiedwereyouwiththefacilitatorsdeliveryofcontent?(67%veryGainingsatisfied,17%satisfied,17%neutral/notsure).FactualControlinformation
Autonomy n
Whatsuggestionsdoyouhaveforimprovingthefacilitationoftheworkshops?
Moreinteractiveactivitiesbetweenthegroup(Participant1)Seeing
LearningapossibleStrategies
None.Thismusthavebeenanexhaustingandchallengingcoursetorun.The
Ideasfuture
fromothersinformalityofitallwasgreat.Yougavepeopletimetoreflectandthinkaboutwhat
&thinking
Challengedwasimparted.Youallowedpeopletocryandallowedpeopletosetthepace.Ifeltagenuinedesirefromfacilitatorstobethere.Itdidntfeellikeyouconsideredthiswork.Thankyou!(Participant6)
UsefulnessoftheProgrammeOutcomes n
Foroneparticipantitwasaboutrecognisingthatshehadneeds,andneededn
Whichpartwasmostbeneficial?
toprioritiseherwellbeing(notjustfocusonmeetingtheneedsofherchildand
33%Information/skillbuildingcomponenthusband).
33%EmotionalSupportcomponentn
ThemoduleonselfcareledoneparticipanttoidentifythatshehadsomeofthesignsandsymptomsindicatedthatwerelinkedtoPTSD.Asaresultthe
33%bothpartsfacilitatorswereabletoencouragehertocontactherGPandalsodiscussherexperiencesandsymptomswithhercounsellor.n
Whatdidyoufindmostuseful? n
Oneofthemenwasabletoputsuicideintoperspectiveandlearnhowsomeaspectsofsuicidalityarenonobservable(relievinghimofguilt).Healso
TheTeWhareTapaWhamodellearningwaysinwhichtocreate
identifiedapracticalwayofmaintainingapositiverelationshipwithhis
abalanceinyourlife(Participant1).deceasedbrotherandincludinghiminhischildrenslifebymakingamemory
BeinginaroomwhereeveryonedidunderstandwhatIwas book.
feeling(Participant2).n
Foranotherparticipanttheworkshophadhelpedherrealisehercounselling
Hearinghowothersfeltandcoped(Participant5)
wasworkingandtherightchoice,andbytheendshehadstartedtomoveawayfromafocusonherselfandherneedstohavingsomeempathyand
BeinginanenvironmentwhereIcouldforthefirsttimepullback
beingabletofocusonotherswhichwashealthyforher.
thelayers,removethemaskandshowothershowIreallyfelt
Weallcameinwithourownneeds.ItwasallaboutmewhenIfirstcame.
(Participant6). Wearenowabletoempathisewithothers. n
Foroneparticipantthegrouphadprovidedherwiththeability
totalktoothersn
Whatdidyoufindleastuseful?aboutsuicideandherexperiencewithmoreconfidenceandobjectivity.
ImactuallyOKtotalktopeopleaboutitnow.W hichisamazing.Itgives
Peoplecomplainingaboutotherpeoplenotdoingenoughabout
youconfidencethatitsOKforyou.NowImpartofacommunity.Itallsuicide(Participant5)helpedmeIammoreobjective.Theemotionsdonttakeover.
TheirWords:TheFeedbackSessionTheirWords:TheFeedbackSession n
Usefullearningtoolsn Opportunitiestolearn,share,reflectandprocess
Thegriefmapwasreallyuseful.IrealisedIhadbecomeamorefearful
Ithasbeengreatbeingabletolistentootherpeoplesexperiences
anduntrustingpersonandthatIneededtoworkonthat.andtotalkaboutourexperiences
Ifoundthemodelreallyuseful(TeWhareTapaWha).Ihaveneverreallylookedatbalancewithinmylife.Younevergettoascertainwhatyouare
Yeah,alotofwhatwetalkedaboutdidntsinkinuntilwewere
doingthatcontributestoyourwellbeing.IthelpedmerealisethatwhatIdrivinghome.OrlaterintheweekIdbethinkingaboutwhatwe
waseatinganddrinkingwasnthelpingandnowItakebettercareofmyweretalkingaboutanditwouldmakesense.
physicalneeds.n Belongingtoanactivecommunity
IwashorrifiedwhenyousaidIwouldnevergetoverit.Themodelwiththecircles(griefaccommodationmodel)helpedmerealisethatitnever
Itisgoodtobepartofacommunityandbewithpeoplewhohave
goesaway.Lifejustgrowsaroundit.Itwasreallyimportant.Ihavedayshadsimilarexperiences
likethatnow.Thatisreallyhopeful.n
Theimportanceofscreening,monitoringanddeveloping n
Theimportanceofastructuredprogramme trust
Havingastructuredmoduleisgood.Thatiswherethehealingstartedforme.Itvalidatedmyfeelingsseeingthemupthereonthescreen.Thats
Thefirstsessionwasreallyintense.Iwasntgoingtocomeback.
whentherealworkstarted.HavingtheopportunitytogetinformationbutBecausesomeonegotverypersonal.Youneedtobeabletoalsotoshareexperienceswasreallyimportantmonitorthat.
ItwasreallygoodhavingthatfirstsessionandseeingwhereI couldgo.I
Youcoulddoaquickonetooneattheendofthefirstsessionto
neverthoughtthatIwouldevergettothepointwhereIwouldbereadyto
seehowpeoplefeel.Youcouldusethistoencouragepeopletomoveforwardwithlife,butitwashopefultoseeitthere.
comebackandchecktheirsafety.
Hearingthatitwasgoingtobeinlecturestylemadeitsafeforme.Iknew
YouneedthesixweekcoursetobuildthetrustIdidnthavetoparticipateifIdidntwantto.Itsaboutlearningaboutsuicideanditsaboutinformationgivingandformenthatmightbesafer.5
6. TheirWords:TheFeedbackSessionTheirWords:TheFeedbackSessionn
Accesstoinformationandsupportn Facilitatorsgender
Itsaboutcatchingtheinformationattherighttime.Therearepeaksand
Itsgoodthatyouareabloke.Yourepresent.
troughswhenyouneedthatinformationandcontact.W eneedtoknowits
Theresagoodbalancehavingamanandawoman.
thereandthatwecanaccessitwhenweneedit
Funeraldirectorsarepeoplewedtakeinformationfrom.Youdevelopa
Ifyouwereaguyandyoucameandyoufoundtheresaloadofspecialrelationshipwiththemandtheyarethereforyouatthetime.
womenhereyouwouldntwanttocomeback.Ifhe(talkingabout
Atthetimeyoudontwanttoreadit.Icouldnthavetakenitin.Butlater
herpartner)washereandheardyoutalkingabouthowpeople
onImighthavelookedatit.
drinktogivethemselvespermissiontocryandgrievealightwould
Everyoneisdifferentinrelationtothetimingofinformation.Itsabout
havegoneonforhim. repetition.Itsaboutavailabilityn
Ongoingneedsforcommunication,contactandsupport
Thereneedstobesomethingprovidedforthosewhohavechildren.W e
Anyfamilyaffectedbysuicideneedsregularcommunication.Atleasthavechildcareissuesandbabysitterstoarrangeandpay.
onceaquarterforthefirstthreeyears.Theyneedtoknowwhatresourcesn
Differentgroupsfordifferentpeopleandpurposes
areoutthereandwheretofindsupportwhentheyneedit.
Whynotsendanemailthatjustsayshello.Wehavebeenthinkingof
Iwouldsuggestaseparategroupforteens.Theyhavedifferent
you.Thatgivespermissionforthemtogetintouchormakecontactiftheyissuesandneedtobesupportedindifferentways
needsupport.Youknowlikethoseemailsyougetfromfriendsoutofthe
Aftereverysixweeksofworkshopsthecommunitygetsbigger.
blueeveryonceandawhile.Thenyoucouldhaveamonthlymeetingorgroupforthosethat
Thereisaneedforacasualsupportgroup.Peopleneedtoknowthathavecomethroughtheworkshops.Justleaveitopensopeople
theresaregularvenueandatimethattheycandropinwhentheyneedit.frompreviousgroupscancomeornot.Itstotallyuptothem
Theyneedtoknowtheressupportavailableforthem.Theyneedaplace
wheretheycanbearoundpeoplewhounderstand.KeyFactorsintheSuccessoftheDesign&Implementation:MessagesfromtheBereavedProgramme
Dontwantsupporterstocometogroupforbereaved,unlesstheyn
Informedbybutnotconstrainedbyresearchbalancebetweenwhatisarecomingtodealwiththeirowngrief.
suggestedinresearchandtheoryandwhatispossibleinpractice.
Trust(keepthegroupclosed)6weeksisgoodcommitmentton
Notlosingsightofprioritiesthedesireforresearch/evaluationversusmeeting
make. theneedsofthebereaved.
Screenparticipants(wedontwanttobeexposedtovulnerablen
Expertise,professionalismandexperienceoffacilitators.
people).Lettingpeopleknowthatitisgoingtoberunbypeoplewhohaveexperiencedsuicideis
Acceptance(itsOKtohaveadiversegroupaslongasthereis
important.Ithinkhavingfacilitatorswhocouldinputpersonal
expertisewasbeneficial (Participant6).
maturity,respectandacceptance).n
Collaborationandworkingpartnerships.
Moreinteractionandgrouptasks(aswellassomediscussionandn
SkylightandVictoriaUniversityofW
ellingtontakingtimetobuildrelationships,informationproviding).
understandeachothersstrengths,negotiatetimelines,reviewingmaterialProvideuswithOPPORTUNITIEStoregaincontrolandtolearn
togetherandallowingeachothertoworktotheirstrengths.
Needforinformallongtermgroupaswellasclosedshortterm
group.TheNewZealandSuicidePreventionStrategystatesthat:
Keepinregularcontactwithus:letusreconnectifweneedto.Serviceswillbemosteffectivewhentheyarecoordinated,integrated,andwhere
peopleclearlyunderstandeachothersrole.Thisrequirescollaborationacross
n Otherkeymessages
sectorsandcommunities,andbetweengovernmentandnongovernment
organisations(AssociateMinisterofHealth,2006,p.14).
SuicidebereavementISdifferentbecausesuicideisaformof
rejection.Illnessandotherunexpecteddeathsdontinvolve rejection.
DesignandImplementation:Messages fromUsMessagesfromUsn
Needflexibleapproach. Planning Considerwhat
Understandtheproblemandbestn
Advertisingwordofmouth,reputationisimportant. researchsuggests,
ResearchProblemtheory whatpeopleneed, Programme waystoaddressit n
Diversity desirablevsdoabletheoryn
RepresentAddressingmensparticipationneeds.n Communityn
Choosewhoandwherecarefully. CollaborateTraining Considerprinciples
Considerthe Evaluation&update ofpracticen Ako
flowoflearningandteachingbetweenall. purposeofProcessknowledge
evaluation andOutcomeConnectofbest Ako,Learning,n
OpportunitypracticeReducingrisk n CreateSpace
Allowthebereavedtogainsomecontrolif
youwantthemtohavemorecontrolintheirlives.n
InformalrelationshipsarewheresharingandlearningalsoConsiderAccess,
Delivery Design occurs. AimsFlexibility,Responsivity Monitor&
collectdata Content ConsiderQuality,n
Involveothers,selfcare(avoidingfacilitatorburnout)soParticipantANDEvaluation
Timing,Groupsandthatgroupwilllast.Programmedriven Sustainability 6
7. Conclusions PostventionisPreventionn
Importanceofintegratingresearchandpractice. n
Postventionispreventionbutthereisnosinglebestapproachthatwillworkwithallindividualsandgroupsandineverycommunity.n
Collaboratingandpartnershipsimportantfor n
Theresearchcanandshouldguidepracticebutpracticeshouldalso
effectiveness,responsivityandsustainability.
beresponsiveandbasedoncriticalassessmentoftheneedsofthebereaved.n
Educareprovidesagoodframeworkfor
reducingriskandimprovingwellbeing(protect,Tosummarize,itseemslikelytousthattheonesizefitsallapproachtounderstandingandinterveningwithsurvivorswhichhasbeendominant
educate,empower).sincetheinceptionofmodernsuicidology
needsconsiderablen
Bereavementbysuicidemayinvolvealossofrefinement(Ellenbogen&Gratton,2001)
controlandautonomyandindividualsneed(Jordan&McMenamy,2004,p.345).
compassion,assistanceandopportunitiesto
movebeyondsurvivaltorelearnhowtolive.Referencesn
AssociateMinisterofHealth.(2006).NewZealandSuicide
PreventionStrategy20062016. Wellington:NewZealand.Available
fromhttp://www.moh.govt.nz/moh.nsf/indexmh/nzsuicideprevention
strategy20062016 n
Mauk,G.W.&Sharpnack,J.D.(1999).Alightuntothedarkness:Then
Attig,T.(1996).Howwegrieve:Relearningtheworld.NewYork:psychoeducationalimperativeofschoolbasedsuicidepostvention.
OxfordUniversitypress.AdolescentPsychiatry,Vol2324:179205.n
Beautrais,A.L.(2004).Supportforfamilies,whnauandsignificant n
MinistryofEducation(1996).TeWhriki:EarlyChildhoodCurriculum.Wellington:LearningMedia.
othersafterasuicideattempt.Aliteraturereviewandsynthesisof
evidence.Availablefrom n
Murphy,S.A.(1996).Parentbereavementstressandpreventiveinterventionfollowingtheviolentdeathsofadolescentoryoungadultchildren.Deathhttp://www.moh.govt.nz/moh.nsf/0/8BB9192555C20FCCCC2570A800074AStudies,20(5):441452.
2E/$File/bereavedbysuicidelitreview.pdf n
Murphy,S.A.,Baugher,R.,Lohan,J.,Scheideman,J.,Heerwagen,J.,n
Glynn,E.(1993).Educationalpsychologycoursebook201.
Johnson,L.C.,Tillery,L.&Grover,M.C.(1996).Parentsevaluationofa
DepartmentofEducation:UniversityofOtago.
preventativeinterventionfollowingthesudden,violentdeathsoftheirchildren.DeathStudies,20(5):453468.n
Jordan,J.R.(2001).IssuicidebereavementdifferentA
reassessmentoftheliterature.Suicide&LifeThreateningBehavior, n
Murphy,S.A.,Johnson,C.,Cain,K.C.,DasGupta,A.,Dimond,M.,Lohan,J.,
31(9):91102.
&Baugher,R.(1998).Broadspectrumgrouptreatmentforparentsbereavedbytheviolentdeathsoftheir12to28yearoldchildren:Arandomisedn
Jordan,J.R.andMcMenamy,J.(2004).Interventionsforsuicide
controlledtrial.DeathStudies,22(3):209235.
survivors:Areviewoftheliterature.Suicide&LifeThreatening
Behavior,34(4):337349.n
Murphy,S.A.,DasGupta,A.,Cain,K.C.,Johnson,L.C.,Lohan,J.,W
u,L.,&
Mekwa,J.(1999).Changesinparentsmentaldistressaftertheviolentdeath
ofanadolescentoryoungadultchild:Alongitudinalprospectiveanalysis.
DeathStudies,23(2):129159.n
Shneidman,E.S.(1981).Postvention:Thecareofthebereaved.InE.S.
Shneidman.Suicide:Thoughtsandreflections,19601980.Pp.157167.New
York:HumanSciencesPress.n
Smith,A.B.(2003).TeWhriki:DiversityorStandardisation?Innovative
AspectsoftheNewZealandEarlyChildhoodCurriculum.Apaperpresented
atconference,EducationintheEarlyYears:InternationalDevelopmentsand
ImplicationsforGermany inMunich,GermanyonJuly16th,2003.Retrieved
(1Nov2006)from http://www.otago.ac.nz/CIC/publications/TeW
harikiSmith2003.pdfn
Williams,H.W.(1992).DictionaryoftheMorilanguage,(7thed).W
ellington: GPPublicationsLtdn
Yalom,I.(1985).Thetheoryandpracticeofgrouppsychotherapy.(3rded.).
NewYork:BasicBooks. 7
