Conversations Matter when discussing suicide in Aboriginal communities

Conversations Matter when discussing suicide in Aboriginal communities

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  Conversations Matter whendiscussing suicide in Aboriginal communities Jaelea Skehan & Alexandra Culloden conversationsmatter.com.au
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  A leading nationalorganisation dedicated to reducing mental illness and suicide and improving wellbeing for all Australians
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  Acknowledgements • HIMH staffthat lead the work – Todd Heard, Jennifer Robinson • Project working group and three local working groups • Recruiting partners – Biripi AMS, Awabakal AMS, Aboriginal health and mental health workers from HNELHD • Service providers and community members that participated in the consultation and continue to work with HIMH • NSW Ministry of Health & NSW Mental Health Commission.
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  Project Overview • Fundedunder the NSW Suicide Prevention Strategy 2010-2015 • Developed by the Hunter Institute of Mental Health • AIM: to develop resources to guide safe and effective conversations about suicide • FOR: Aboriginal and Torres Strait Islander people; people from culturally and linguistically diverse backgrounds; gay, lesbian, bisexual, and transgender people; young people; older people; males.
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  Generate evidence through analysisof current approaches, consultation with experts and communities, and using a measurable approach to finalise resources It has never been developed or evaluated before and the research evidence is limited and conflicting with many variables to be tested The problem The approach
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  Talking about suicide •Suicide is an important issue of community concern • It is important that as a community we are engaged with the issue • Often confusion about what is meant by “discussing” or “talking about” suicide, and confusion about the evidence • Need to ensure we are not “too afraid” to talk about suicide, while respecting and understanding the risks.
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  The risk associatedwith the “discussion” seems to be related to:  The focus of the information (about death, about how to cope with a death, about the broader issue)  The status of the individual receiving the information (little interest, vulnerable, bereaved by suicide)  The format they receive the information (face-to-face, media)  The place they receive the information.
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  Lenses considered • Why?= Focus of discussion – Prevention, Intervention or Postvention • How? = Format of discussion – One-on-one, small group, wide-scale (e.g. media) • Where? = Setting – School, Workplace, Families, Community, Online, Media • Who? = Target groups to be considered – Carers, GLBTI, Young People, Older People, Aboriginal and Torres Strait Islander People, CALD Communities, People with a mental illness, People Living in Rural and Remote Areas, Men, People Bereaved by Suicide.
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  Approach Literature Review • Reviewof research evidence • Review and analysis of existing resources and approaches Consultations • Service providers and key informants across four settings • Consultations with community Core Principles Three review panels (experts, target groups, settings) reviewed a series of ‘principles’ to guide conversations focussed on: prevention, intervention and postvention Online resources • Community resources for discussing suicide (tailored resources for Aboriginal communities) • Professional resources to support community discussion of suicide
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  Aboriginal consultations Aim: toengage with Aboriginal stakeholders and community members to collect information about their professional and personal views on discussing suicide. Strategy 1: Stakeholder forums Strategy 2: Community focus groups. * Both had ethics approval through HNEHREC & AH&MRC
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  Strategy 1: stakeholderforums • Attended by 38 participants across the three locations: Awabakal community in Newcastle; Gomeroi community in Tamworth; Biripi community in Taree • Participants: 70% female; 90% heterosexual; 60% personally affected; 60% Aboriginal • Forum facilitated by an Aboriginal psychologist with support from two other Aboriginal health workers • Group activities included: – Identification of key issues, priority target groups & key influencers – Identification of opportunities, risks and barriers – Key considerations for format and dissemination.
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  Forum outcomes • Youngpeople identified as a priority, but groups believed whole of community was important • Prevention conversation (general awareness) and support for intervention conversations seen as most important • Need to identify and support ‘natural gatekeepers’ • Communities would need to feel a sense of ownership over the resources • The resources should complement and support existing programs and services • Focussing on protective factors and hope was important
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  Forum outcomes (cont.) •Stigma and shame were major barriers across communities • Trauma, grief and loss has major impacts on communities • Shortage of Aboriginal staff and services was seen as a barrier to dissemination and uptake • Building capacity of services and communities was integral to success • Aboriginal people to be involved in developing the resources.
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  Strategy 2: Communityfocus groups • To engage with Aboriginal community members to collect information about their personal views on discussing suicide • Aboriginal people from the Biripi and Gomeroi communities (n=14) • Facilitated by an Aboriginal psychologist • Focus groups were asked to discuss: – whether or not they think it is important to talk about suicide; the types of conversations that they think are already occurring; the types of conversations they think might be the most important to have; the reasons why people might not be able to talk about suicide; and the things that they think would assist people to have conversations.
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  Focus group outcomes •People in Aboriginal communities need to be encouraged to talk about suicide as they rarely occurred “I think it is important…because we never talk about it. We need to understand.” • Supporting families and communities after a suicide was seen as important “After the funeral, everyone goes their separate ways, and then everyone tries to go on…” “they say it’s a part of life and ‘get on with it’…but it’s truly not part of life in Aboriginal culture”
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  Focus group outcomes(cont) • Shame, stigma and reluctance to seek help were identified as major barriers “…they get shamed because of the stigma…they go, I’m not ‘naragah’, I’m not ‘womba’…” • Services are not culturally aware enough to be helpful or engaging “…the services…the helplines…you may as well sit down and talk to yourself” • There is a strong fear of making things worse “…they are frightened to talk to them in case they push them over the edge”
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  Focus group outcomes(cont.) • Building trust and relationships is important “we need to have someone they trust, someone they can form a relationship with…” • Resources need to address the fear of talking “help us overcome the fear, help us to sit down and have the conversations…it’s gotta be all right to talk” • People need skills and confidence “we need to put it out in a workshop that can educate and put it out there”
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  Reports available onlineat: www.conversationsmatter.com.au
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  conversationsmatter.com.au The resources willassist communities when: • They want to know how to talk about suicide more generally • They are worried about someone and want to know what to say and do • There has been a death and they want to know how best to handle individual and community level conversations. These resources have been designed for community level conversations and not for clinical or health related conversations. Prevention-focused conversations Intervention-focused conversations Postvention-focused conversations Resource development
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  Next steps 1. Identifygate-keepers and identify pilot organisations for more comprehensive support (and evaluation) 2. Develop Capacity building plan 3. Implement Plan with targeted organisations, including professional develop and support for engaging communities 4. Support ongoing communities of practice around the Conversations Matter resources. conversationsmatter.com.au
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  www.himh.org.au Follow us onTwitter and Facebook @HInstMH www.conversationsmatter.com.au