Whanau-centred approaches to counselling, community development and suicide prevention place greater emphasis on group relationships and functionality than on individual psychopathology. Positive whanau development is a preventative process insofar as it mediates between individuals, groups, and wider society. The focus is on building strengths and resilience and enabling the creation of an environment where empowerment can over-ride marginalisation, despair, and loss of hope.

Centering preventative strategies on whanau does not dismiss individual needs but recognises the importance of relational synergies as ways of understanding human situations. Expertise in whanau mediation, culturally relevant styles of communication, and building effective whanau leadership are key elements of a community based preventative programmes for Maori.

Is best practice really elusive when working with Indigenous populations?

by Dr Tracy Westerman, Managing Director, Indigenous Psychological Services, Western Australia

Indigenous Psychological Services (IPS) is a private company based in Perth, Western Australia that was established in 1999 by Dr Tracy Westerman, an Aboriginal psychologist. Dr Westerman established IPS for the purpose of addressing a disturbing inequity - that Indigenous Australians have amongst the highest rates of mental ill health worldwide, but continue to have the lowest levels of access to mental health services.

Dr Westerman will overview the philosophy around the development of an Indigenous specific psychological service and discuss the obvious value with an approach which is based on extensive community engagement, ongoing validation of models and services, and importantly ensuring that a rigorous research methodology is applied to all aspects of service provision.

The paper will explore the value of an organisation which sees culture as a primary focus of all aspects of service delivery and particularly how such an approach can improve on equity in access to mental health services for Aboriginal people including:

Adequacy of the existing Aboriginal mental health research including an overview of the research gaps that are evident and which continue to impact upon the development of targeted service delivery and best practice,
Practitioner and Workforce Development Issues. Discussion will centre on the role that cultural competence of practitioners have in the delivery of effective services. Dr Westerman will discuss the development of the Aboriginal Mental Health Cultural Competency Test (CCT: Westerman, 2003, 2009 in preparation) as a method of ensuring a consistent baseline of cultural skills against which individuals and organisations are able to measure service efficacy,
Examine the indigenous perspective on mental health in terms of causality, manifestation, including the validation of culture bound syndromes; the role of traditional treatments and interventions, and importantly, the value of clinical training within a cultural context,
Community Capacity Building and what this looks like at a practical level. Dr Westerman will review Aboriginal mental health preventative efforts and conclude by overviewing IPS' Whole of Community Intervention Programs delivered throughout Australia since 2002.

Emergency department re-presentations following intentional self-harm

by Silke Kuehl and Dr Kathy Nelson, New Zealand Guidelines Group

Discoveries, surprises and learnings from a research about people that presented to an emergency department with intentional self-harm and then re-presented within one week.

This presentation will provide an overview of thesis findings. The aim of the thesis was to describe what factors contribute to people re-presenting to a New Zealand emergency department (ED) within one week of a previous visit for intentional self-harm (ISH).

A retrospective observational design was selected for a period of one year and data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations.

This study made several discoveries: many re-presentations (55%) occurred within one day; the exact number of people who re-presented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 40% higher for second presentations.

Recommendations in regard to the use of a triage assessment tool, cultural input for Maori and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required.

A private and opportunistic event: trends in locations and methods of suicide

by Barry Taylor and Sunny Collings, Social Psychiatry & Population Mental Health Research Unit, University of Otago Wellington

An quantitative and qualitative analysis of NZHIS Mortality Data and Coroners File for emerging or new trends in the locations and methods of suicide.

Background: Restricting access to means of suicide has been shown to be a highly effective suicide prevention strategy. Goal 4 of the New Zealand Prevention Strategy 2006 - 2016, Reduce Access to the Means of Suicide, seeks to develop policies, strategies and regulations to reduce access to, and lethality of, the means of suicide. Commissioned by the Ministry of Health, this study is an analysis of the locations and methods of suicide using the NZ Mortality Database and the Coronial Inquiry Reports.

The purpose of the analysis is to:

gain greater understanding of emerging methods of suicide and determine the frequency of less common methods
identify any trends in the locations of suicides and favoured suicide sites.

The analysis will inform future policy and programme strategies to reduce access to means of suicide and also establish a "baseline" monitoring system to identify trends in the use of means and locations of suicide against which emergent trends can be considered.

Methodology: Quantitative analysis of the NZ Mortality Database and a qualitative review of 1006 Coronial Report files for all deaths by suicide in 2005 & 2006

Findings: This presentation will present on several key themes arising from the analysis:

Suicide is mostly a localised event occurring mostly in the deceased's home.
Proximity, impulsivity and opportunity are key factors influencing location
There are few ‘iconic' public sites for suicide.
There are gender differences in both the location and methods utilised.
Methods utilised are influenced mostly about what is accessible for the deceased and common household items are often used
Suicide is often a private act with no one else being present when the suicide occurs
There are no emerging new trends in either locations or methods of suicide.

To infinity and beyond... whanau ora across the lifespan

by Trina Markland, Kia Piki oe te He Oranga Pounamu

Providing an overview of the mahi and challenges we face in the Ngai Tahu Rohe, from Kaikoura to the north, the Waitaki River to the south and west to the Southern Alps.

When I took the role of Kia Piki Project Manager my brief was to implement a new strategic direction which focused on an All Age (Population based) Strategy.

But what questions did I have and what challenges was I facing? How do we create better and more effective partnerships between service providers? And what about those not typically identifying with the mental health and addiction sector? What about those that don't identify as Maori? How do we engage them? What about the links between Kaupapa Maori, welfare, education, housing, employment, youth, religious, physical health and other sectors that help those in need get the right support at the right time. How can we help Canterbury to create a stronger and healthier community and forecast into the next 10 years? 20 years? And Beyond? Are community attitudes to mental health changing? Or are we an enabling society or one still afraid of what we don't know?

What we do know is that we are here to make a difference. Our focus which is Whanau Ora as the driver; whanau wellbeing across health, education, social development and throughout the lifespan becomes the priority.

Tua o Te Arai: unveiling understandings

by Tokararangi Totoro, Tuti Katene, Miriama Te Karu, Aroha Dawson, Sonja Macfarlane, Ministry of Education: Special Education

This presentation will enable participants to explore some of the key principles and beliefs that underpin a MÄori worldview, and then see how these notions serve to inform perspectives about - and implications of - youth suicide, and are therefore necessary in guiding responsivity when a suicide occurs.

In this paper/workshop, principles from te ao MÄori (the MÄori worldview) are presented in order to understand how suicide was experienced from a traditional MÄori perspective. These principles can also provide us with a platform from which to determine effective solutions for MÄori youth today.

Current research suggests that the levels of cultural connectedness and cultural disaffection are key factors that influence suicide rates amongst MÄori. This clearly alerts us to the significance of culture when attempting to both understand the possible causal factors, and fashion proactive responses.

The Ministry of Education in partnership with schools and Early Childhood centres has a responsibility to ensure that learning environments are as safe as they can possibly be. The provision of Traumatic Incident (TI) management support is one way MOE contributes to schools and Early Childhood centres providing safe learning environments. Aue ... He Aitua (Alas ... a Trauma) is a preventative and responsive MÄori focused approach to Traumatic Incidents, and although it is directly relevant to MÄori immersion settings it has implications for MÄori students in mainstream schools.

The process of recovery from traumatic incidents involves easing the physical and psychological difficulties for individuals, families (whÄnau) and communities, as well as building and bolstering psychological and social and cultural wellbeing. The education setting and community setting in which we work provides an opportunity to communicate and ascribe meanings to the physical, spiritual, emotional experiences of those bereaved by suicide. Personal working experiences with schools, ECE centres and whÄnau who have faced the trauma of whakamomori (suicide) have shown us that being responsive requires us to better understand the implications for all those who remain.

The Ministry of Education supports the use of psychological first aid whose processes align with Maori concepts of health and wellbeing such as Te Whare Tapa WhÄ where taha tinana (physical well-being), taha hinengaro (psychological well-being), taha wairua (spiritual well-being) taha whanau (family relationships) are likened to the four walls of a house; all are necessary and interact to ensure the whare's strength and stability essential for health and well-being (Durie, 1994).

These processes allow the community experiencing bereavement to understand and be supported in culturally appropriate ways. The concept and process of fostering social support through whanaungatanga (building relationships), provides the space and place for the community, whÄnau and practitioners to broach the mamae (hurt) in a respectful, considered and healing way.

Mauri Tangata: the long-term health effects of unemployment

by Jordan Waiti, Bridget Robinson, Eru Pomare MÄori Health Research Centre

This is a large cohort factory study that compares the health of redundant freezing workers with nearby workers who remained in employment.

Maori health and socio-economic wellbeing suffered more than that of others during the neo-liberal years of the 1980's and 90's. New challenges arise now with the global economic recession. The health impacts of being laid off are important to understand so we can prevent or mitigate the effects on our whanau and communities.

"Mauri Tangata: The Long-Term Health Effects of Unemployment" follows freezing workers laid off from Whakatu works in the mid-1980s and workers laid off from Tomoana works in the mid-1990s when unemployment was higher, benefits lower, rents more costly and no redundancy payouts. Deaths, cancer registrations and hospital admissions of workers who lost their jobs when the two freezing works closed were compared with those of workers from four other Hawkes Bay freezing works that remained open. This cohort study, conducted in partnership with NgÄti Kahungunu Iwi Inc, is the largest, longest, most well-controlled factory closure study in the world.

A substantially higher risk of suicide was found among workers laid off in the closures. The effect appeared stronger in the mid-1990s cohort. No other findings were significant. The New Zealand Suicide Strategy should consider strengthening its structural and socioeconomic dimensions. Intensive efforts must be put into maintaining and creating meaningful work, protecting workers, and supporting the unemployed, especially in regions that have already suffered from the withdrawal of investment and infrastructure/service.

The right to meaningful work and a decent standard of living, must be protected, upheld, and restored in order to maintain the right to health for all.

Whanau Ora - a practical tool for developing health programmes

by Miria James-Hohaia, Ministry of Health

The Whanau Ora Tool is a practical guide to developing health programmes where whanau/hapu/iwi and Maori communities play a leading role in achieving whanau ora. It places Maori at the centre of programme planning, implementation and evaluation.

Whanau ora is a whole of organisation responsibility, not just that of Maori staff. For this to succeed, commitment from the most senior levels of management is critical.

Improving Maori health and reducing inequalities continues to be a priority outcome for the NZ health sector. It is essential that healthcare providers respond effectively to the health needs of Maori to ensure that health outcomes for Maori are improved.

To support the health sector address this, the Maori Public Health team have developed a this tool to develop health programmes where whänau, hapu and Maori communities play a leading role in planning, implementation, monitoring and shared decision making.

The tool recognises the validity of Mäori approaches to achieving whänau ora and is designed to assist healthcare organisations to implement the strategic pathways woven into He Korowai Oranga (NZ Maori Health Strategy 2002). It can be applied at national, regional and local programme or project levels to enhance the effectiveness of health programmes for Mäori.

Achieving whänau ora is a journey and many things that keep Maori healthy or increase the likelihood of them becoming unwell lie outside the influence of this Tool. However, it is a very good place to start in initiating a process whereby greater attention is paid to the needs and realities for Maori health during planning and decision-making within the health and disability sector.

Principles underpinning the Whänau Ora Tool

The following principles underpin this Tool and reflect factors that contribute to the development of successful public health programmes that achieve Mäori aspirations for whänau ora.

Whänau ora is a priority for reducing inequalities between the health outcomes of Mäori and other New Zealanders
Mäori will be fully involved in the design, delivery and evaluation of services
Mäori providers will be identified and resourced to work with the service to design, deliver and evaluate programmes.
Mäori will be supported to implement Mäori models of health
Building Mäori staff capacity and capability to improve the uptake of services is a long term commitment
There is a commitment to building the non-Mäori staff capacity and capability to improve the uptake of services
Proposed programmes increase whänau ora by fostering Mäori community development and utilising assets already present in the community
Proposed programmes improve access to mainstream services for Mäori
Proposed programmes utilise accurate ethnicity data to ensure effective service delivery for Mäori.

Suicide behaviours among MÄori adolescents; data from the Youth2000 series

by Sarah Fortune, consultant clinical psychologist, and The University of Auckland, Adolescent Health Research Group

Data from the Youth2000 series on suicidal behaviours and protective factors among MÄori adolescents will be presented.

Data from the Youth2000 series on suicidal behaviours and protective factors among MÄori adolescents will be presented. These data are based on two nationally representative samples of nearly 20,000 young people in Aoteroa/New Zealand.

The epidemiology of suicidal thoughts, plans and attempts will be outlined including the prevalence in 2000 and 2007, differences across time and associations with known risk factors for sucide such as emotional wellbeing, depression, coping, alcohol binge drinking and sexual abuse.

The role and importance of protective factors against suicidal phenomena will also be presented with a particular focus on relationships with parents, experiences of school and access to health care services.

Kia Piki o te Ora He Oranga Pounamu

by Terence Matthews, Tracey Hiroa, Nga Tai O Te Awa Trust

Maaori feature prominently in New Zealand suicide statistics, and the development of a prevention strategy that can acknowledge and meet the need of Maaori is essential. So, how do we ensure that good relationships with our Maaori communities are secured in a collaborative way?

This presentation will provide a view of the different Maori project activities that Tracey and Terence have coordinated in their respective areas ensuring collaboration, Maori participation, planning and direction.

The New Zealand Suicide Prevention Strategy 2006 - 2016 provides a framework to help us understand how all the various activities across the range of sectors fit together to prevent suicide, and will guide our efforts over the next 10 years. The strategy builds on and replaces the New Zealand Youth Suicide Prevention Strategy: "In our Hands" and "Kia Piki te Ora o te Taitamariki"

The Kia Piki o te Ora - All Ages Strategy is a new direction of which the inspiration is a vision of a society where all people feel they are valued, nurtured, supported, strengthened if they experience difficulties and do not want to take their lives or harm themselves.

The presentation aims to showcase a variety of activities and projects implemented by Terence and Tracey in their respective areas with particular reference to some of the goals in the NZ Suicide Prevention Strategy and the collaborative efforts of these projects on a local level in the Maori community.

Whanau Ora is the outcome - now where is the map?

by Kia Piki National Coordinators

Kia Piki o te Ora aims to prevent suicide rates amongst Maori and promote Whanau Ora throughout Aotearoa. Experience through wananga how the KPOTO teams work to achieve our 7 goals.

Maori have a long history of maintaining the health of its population through concepts and practices that recognise and affirm the traditional influences of te Ao Maori (Maori World)
Prior to June 2006, New Zealand's strategic response to suicide forcused on youth suicide. The Ministiries of Youth Affairs, Health and Te Puni Kokiri launched the New Zealand Youth Suicide Prevention Strategy (NZYSPS) in 1998.

The NZYSPS (In Our Hands and Kia Piki te Ora o te Taimtamariki) has been a valuable resource in the last eight years for focusing a range of cross government and community actions on reducing suicide among young people.

It is now recognised, however, that a broader strategic response to suicidal behaviour across the whole population is needed, particularly those most at risk such as Maori Youth, Maori under the age of 35 years, particularly Maori males, Maori females who are significantly over represented in rates of attempted suicide and to a lesser extent, Maori over 65 years of age.

In acknowledgement of the evidence that suicide is occuring across all ages, the New Zealand Suicide Prevention Strategy 2006 - 2016 (NZSPS) was launched on 29 June 2006. The NZSPS takes an across sector government approach and though it replaces the NZYSPS, of significant importance, it continues to build on the major achievements from the earlier Strategy by refining and extending its goals and objectives to provide and all ages approach to Suicide Prevention.

The NZSPS embraces a Whanau Ora approach within the context of the Maori Health Strategy: He Korowai Oranga.

Key note: We all have culture

by Dr Simon Hatcher and Dr Nicole Coupe, University of Auckland

This presentation forms a link between the importance of culture in tangata whenua and culture in other groups.

Dr Coupe will describe a randomised controlled trial Te Ira Tangata which aims to demonstrate that Maori who present to hospital after self-harm benefit from a complex package of measures which includes culturally informed problem solving therapy, postcards, improved access to GP's and cultural assessment delivered by Maori therapists and researchers.

Dr Hatcher will then link this to applying ideas about culture to non-Maori. The argument starts by noting that we all have culture but this is rarely formally assessed or taken into account in assessment and treatment outside 'cultural services'.

A core component of culture is identity especially a sense of belonging. The belonging may be to a place, a history, a race or a family story and is usually far more complex and dynamic than stereotyped ethnic descriptions. The presentation will end by describing how these ideas are being applied in a large randomised controlled trial of non-Maori who present to hospital after self harm.

This study, the ACCESS study, aims to demonstrate that non-Maori can learn from Maori that taking culture seriously is an important part of suicide prevention in a group of people who are at high risk of suicide.

Keynote: Cherish the Va and strengthen Pacific wellbeing

by Dr Monique Faleafa, National Manager, Le Va, Pasifika within Te Pou

Recent research reports that Pacific people experience higher rates of mental disorder than the general population, higher rates of suicidality, and very low rates of access to services.

Thrown in the mix is a complex profile of compounding risk and protective factors different from other ethnic groups, such as migration, acculturation and cultural change. In response to this situation there is very high demand for a culturally and clinically competent workforce at all levels of services. However, supply to meet this demand is limited, so we need to be innovative and creative.

The concept of "Va" refers to the space between. It is fundamentally different from western notions of space defined by open areas, expanses or distances that separate. Va refers to the space that relates. It refers to the context that is connected to the individual, and it refers to relationships that are collective.

Nurturing these relationships is key to strengthening Pacific well being and a protective factor yet to be explored for Pacific communities in a New Zealand context.

A Pasifika model to address suicide prevention in Porirua

By Susana Kilioni, Kupa Kupa and Slaevao Manase, Regional Public Health, Wellington

This presentation will explain a model used with a Pacific community in Porirua, Wellington, to address the issue of suicides among their youth population. Tumai Mo Te Iwi PHO were supported by Regional Public Health and others to develop and run these workshops.

Over the last three years, commencing in 2006, the PIC Church in Porirua hosted a unique workshop to address youth suicides in their area. In 2006 the minister at the church was approached by young parishoners concerned about why some of their friends were thinking about and/or taking their life. The minister talked with a local primary health organisation - Tumai Mo Te Iwi to - ask for help.

With the help of other health and mental health supports, the PHO health promoters developed and then held community workshops each year from 2006-2009. They have been very popular with the community, allowing safe discussion of a difficult topic, a chance to learn more about the subject and how to support yourself and others who may be at risk.
The presentation will cover who was involved in the development of the workshops, how decisions were made about safety and the content of the workshops, the format on the day and community feedback about the workshops.

Travellers:

A resilience building programme for 1st year secondary students

By Phil Smith, Travellers, and Jane Brook, Skylight

An interactive workshop that aims to give participants an understanding of the Travellers Programme

Travellers is a programme designed to help build resilience in young people in their first year of secondary school who may have be dealing with change and difficult life challenges. It is a small group programme run by trained school staff in school time.

The programme has two key elements - a short on - line survey of all first year secondary students that seeks information form them on their life experiences. This survey is then used by trained Travellers facilitators in school to select students for the Travellers Programme.

The programme runs over eigth weeks in 90 minute sessions. Travellers is for students who are below the radar in secondary schools - those students who appear on the surface to be coping but underneath have a number of issues they are attempting to deal with.

The programme is currently running in 80 New Zealand Secondary schools and runs in Denmark under licence to Skylight. It is funded by the MOH under the Suicide Prevention Strategy.

Positive & Proud

Building a community that supports tamariki & whÄnau in life crises

by Graham Cameron, John Fletcher, Merivale Commuity Centre

The Positive and Proud workshop will assist participants to build resilience and generosity towards others in at-risk communities using flaxroots engagement strategies developed by the Merivale Community Centre.

Positive and Proud is a piece of action research providing an evidence base and direction for community action. It provides a snapshot of how the residents of Merivale, Tauranga feel about their community and what they would like to change about living there.

Merivale faces serious socio-economic challenges. It is amongst the most deprived 10% of New Zealand communities, with low levels of income, employment and educational attainment and high health disparities including youth suicide. People from Merivale are keen to address the community's negative reputation by building support for one another.

The research strongly indicates that change has to be something that emanates from within the community. The Merivale Community Centre holds a key role in organising and enabling all whÄnau to work collectively to support residents in their life crises.
There is a strong focus on engaging our young people to build their resiliency to risk-taking behaviours through identity and belonging.

Working to re-engage with people and build community on a street by street basis the Merivale Community Centre is at the heart of a new model of proactive flaxroots intervention.

Key findings from Maori hui

To address suicide postvention for Maori communities in Wellington

by Jennie Jones, Regional Public Health

This presentation will report on the findings from a hui held in June this year to establish how best to support Maori communities following death by suicide in their community.

The Regional Public Health Suicide Postvention Service was established in 2006 to respond to death by suicide. The service provided is a western model which is not always appropriate for various communities.

Research is showing that more and more MÄori communities are being affected by suicide. We know that the downward trend in the NZ suicide statistics is slower for Maori.

In June this year RPH held a hui, facilitated by Lyn Pere, to allow for open discussion with local Maori health providers about how best to resond to death by suicide within a Maori community. The hui also brought together key people who will continue to meet and support this important work in our community.

The presentation will cover the result of discussions and outcomes from the hui, including key points for ways to assist Maori whanau and the wider community following a death by suicide.

Suicide prevention education programmes and the New Zealand context

by Tui O'Sullivan, AUT, George Hill, Chris Goj, Stephen Edwards, Lifeline Aotearoa

Lifeline Aotearoa is working with the New Zealand Ministry of Health to tailor an existing suicide prevention education programme titled ‘Applied Suicide Intervention Skills Training' (ASIST) for the New Zealand context.

The adaptation programme has particular reference to Maori, Pacific and Asian populations and alignment with the NZ concepts of mental well being and recovery. Maori, the indigenous people of New Zealand, have suffered social and economic deprivation as a result of colonisation.

Maori suffer worse health than Pakeha (non Maori). For many years, suicide rates for Maori have been significantly higher than any other cultural group in New Zealand, with suicide and it prevention presenting today as a clear issue for Maori. This paper examines some of the opportunities, challenges and processes involved in adapting this internationally recognised prevention education programme that is culturally appropriate when working with tangata whenua.

Suicidal and self-injurious behaviour in adolescents: the DBT feasibility study

by Emily Cooney, Kirsten Davis, Pania Thompson, Julie Wharewera-Mika, Joanna Campbell, Kari Centre

We will present the design and the pre-treatment sample characteristics of a study comparing outcomes for young people with self-harm who have been randomly assigned to therapy as usual, or dialectical behaviour therapy in the Waitemata region.

Evidence from field trials suggests that Dialectical Behaviour Therapy (DBT) may be effective for reducing self-harm (i.e. suicide attempts and/or self-injury) in adolescents. To date there have been no published randomised controlled trials evaluating the effectiveness of DBT with this population.

This small-scale pilot study seeks to evaluate the acceptability of DBT and of the research methodology to New Zealand families with adolescents experiencing self-harm who have been referred to Child & Adolescent Mental Health Services (CAMHS).

Participating families are randomly assigned to DBT or treatment as usual. Suicide attempts, self injury, treatment participation, emotion regulation skills, and substance abuse are measured before treatment and 3, 6, 9 and 12 months after treatment onset.

The researchers are also investigating the feasibility of conducting a multi-site study of DBT by measuring therapist fidelity to DBT, the acceptability of the treatment and measures, and assessing whether clinicians and families are willing to support a process that involves families undergoing random-assignment to DBT or treatment as usual.

This presentation will describe the pre-treatment characteristics of young people taking part in the study to date, and also discuss the application of the research measures to assessing risk and treatment need in young people with a history of self-harm presenting to CAMHS.

Ssssh! Support for staff dealing with students who self harm

by Kirsty Dempster-Rivett, clinical psychologist, Michelle Rhodeler, Pinnacle Group

This presentation explores the supports secondary schools need to care for students who deliberately harm themselves and/or have suicidal thoughts and behaviours.

This presentation explores the supports secondary schools need to care for students who deliberately harm themselves and/or have suicidal thoughts and behaviours. In conjunction with Waikato Primary Health, a pilot project was undertaken in 2007 to help develop supports for secondary school nurses, GPS and school guidance counsellors to manage this issue that they described as increasing in frequency and severity.

This project was evaluated as being effective and by the end of 2009 will have run in 9 schools. This presentation will provide the research findings and observations to date with an emphasis on working collaboratively with Maori staff and students.

A difference for Maori?

Self-harm and suicide prevention collaborative whakawhanaungatanga

by Silke Kuehl, New Zealand Guidelines Group, Helen Mitchell-Shand, Wairarapa DHB, Louise Windleborne, Hutt Valley Health

The aim is to share the achievements and challenges encountered by DHBs in the project. A focus will be on issues related to cultural assessment and the strategies some DHBs have used to address these.

New Zealand Guidelines Group (NZGG) has been contracted by the Ministry of Health to implement recommendations from the ‘Assessment and Management of People at Risk of Suicide' guideline (NZGG & MoH, 2003). The aim of this project is to provide timely and appropriate services for people at risk of self-harm and suicide. Fourteen of New Zealand's 21 DHBs are currently participating in Phase Two of the 18 month Collaborative.

Now 12 months into the second Phase of the project, all participating DHBs have made improvements in the care for people at risk of self-harm and suicide. This presentation will outline achievements, challenges and future plans. DHB project members have been invited to talk about their experiences of being part of the project.

Nga taonga tuku iho - panel debate

by Maraea Johns, with pakeke, kaumatua and rangatahi.

Ko nga whainga o tenei wananga, kia hangai ki te kaupapa o te SPINZ Symposium, ara, nga tikanga-a-iwi, e pa ana ki nga ahuatanga maha o tenei mea te "whakamomori". Tapirihia atu te titiro hoki ki etahi huarahi rongoa kia heke haere, kia kore ranei e pa tenei mate ki o tatau whanau, hapu, iwi. Ma nga taonga tukuiho o nga tipuna hei kawe, hei arahi, hei tautoko, hei kokiri hoki i nga whakahaere o tenei wahanga. Otira, nga korero, nga whakaaro, nga tautohe i waenganui etahi kaumatua, pakeke, rangatahi e matau ana ki te reo rangatira, e marama ana ki nga take, nga tikanga mai te ao kohatu, tae noa mai ki te ao hurihuri. Ma te reo rangatira e kawe i nga whakawhiti korero mai te timatanga ki te whakamutunga o tenei wahanga. Nga whitiwhiti korero, nga patapai ranei mai te hunga e haramai ana ki te tautoko i tenei wananga, me mau kaha ki te reo Rangatira i nga wa katoa ki te whakanui, kia whakamaua kia tina.. . i te reo tuturu o Tangatawhenua.

The goals of this session will align with the SPINZ theme of "Culture and Suicide Prevention in Aotearoa" . I propose this session will involve a panel comprised of kaumatua, pakeke and youth who will share and exchange their knowledge of both contemporary and traditional understandings through the opportunity to engage in lively debate.

The debate topics will highlight the uniqueness of our ancestral treasures and the celebration of our indigenous language . The entire session will be conducted and facilitated in the Maori language by all participants including all audience involvement.

Ka whakahuihuihia mai etahi taangata (kaumatua, pakeke, rangatahi) ki te korero, ki te tautohe i nga take kua whakaritea mo tenei hui. Ka haangai nga take korero ki te kaupapa, ina, nga tuahuatanga o nga rongoa hei whakatutuki i tenei mate mauiui - te "Whakamomori", te "taronga" ranei ki etahi iwi. Ko taku e manakohia, kia noho hei roopu tautohetohe nga manukorero tokoono ki te tokowaru ranei.

Tokotoru ki te tokowha ranei ia roopu. Ka whakataetaehia ratau i runga i te/nga kaupapa korero ka whakaritea mo te wa. Ka tukuna te/nga take korero ki nga kaikorero i mua o te hui kia pai to ratau rangahau i te kaupapa memehea ka hiahia ratau ki te rangahau. Ka whakaritea te kotahi haora ki te kotahi haora toru tekau meneti te roa o tenei wahanga ki te whakahaere i nga tautohetohe, nga patapatai o nga kai whakarongo, mutu noa ki te whakawa me te whakatau ko tehea te roopu toa.

Ko nga whainga teitei o tenei wananga kia; Whakaaro marikahia nga taonga tuku iho a kui ma a koro ma e pa ana ki te kaupapa o te hui
Whakanuihia te reo rangatira
Korerohia nga momo rangahau mai te titiro a te Maori me te titiro a te Pakeha

This session is designed to bring together selected Maori Key Stakeholders (kaumatua, pakeke, rangatahi) to discuss, exchange views and opinions as participants of the SPINZ symposium theme of Culture and suicide prevention in Aotearoa.

A debate format will be adopted with a panel of six - eight members in total, comprised of two groups of three - four speakers each. Panel members will be forwarded the topic/s in advance of the symposium to allow individual opportunity for preparation as required. The session is estimated to take approximately 1 - 1.5 hours in order to complete the debate/s, questions/ answers, comments from the audience and the audience to decide on the champion team.

The overarching goals of the session are to; highlight our ancestral treasures in relation to Culture and Suicide Prevention in Aotearoa Celebrate and highlight our indeginous language of Aotearoa Discuss the issues relating to Western evidence based research approaches and Maori time honoured knowledge approaches to suicide prevention in relation to Maori.

Maori response to National Depression Initiative campaign

by Allan Wyllie, Jo Howearth, Phoenix Research

Maori response to the 'John Kirwan' depression advertising is reported, drawing on both results from tracking surveys and qualitative pre-testing. The role of Maori researchers at Phoenix Research will also be addressed.

The National Depression Initiative is funded from within the Ministry of Health Suicide Prevention programme. The campaign seeks to encourage people to recognise and become more responsive to depression.

The TV campaign, which has featured former All Black John Kirwan, has had very high recall among Maori (97% compared with). This is associated with increased discussion of the advertising and increased awareness of things they could do to be supportive of someone with depression. This information has been obtained from before and after campaign tracking surveys, which have involved 1000 interviews with the primary audience, including 300 Maori.

The results of qualitative pre-testing of the campaign with Maori will be used to examine possible reasons underlying the very positive Maori response to the campaign, especially given no Maori feature in the advertising.

This presentation will also discuss the role of Maori researchers at Phoenix Research.

He kura te tangata; the human being is precious

Supporting whanau and indivduals bereaved by suicide or affected by suicide attempt

by Eliza Snelgar, Dr Louisa Walker, Clinical Advisory Services Aotearoa

A presentation on the challenges and development of a Postvention Support Service that aims to provide support to Maori whanau and individuals bereaved by suicide or affected by suicide attempt.

In 2007 the New Zealand Ministry of Health funded the Postvention Support Initiative, intended to develop best practice models for support services following suicide and suicide attempt. A suicide bereavement support service was one of a suite of services developed. This presentation discusses the current service model developed to provide specialist counselling for those bereaved by suicide or affected by suicide attempt.

Careful attention and effort has been invested in the development of a Maori service that is highly accessible and appropriate for Maori whanau. Current experiences with, including challenges involved in the development of this service, will be presented including discussion regarding the needs of those bereaved by suicide.

The aim of the service is to ensure Maori whanau and individuals of all age groups have access to a bereavement service specifically tailored to their needs. The service includes access to providers who are skilled and experienced at working effectivley with Maori whanau affected by suicide and Kaumatua and Kai Atawhai for awhi, tautoko and karakia if whanau wish.

To date, the SCS has a network of Maori Counsellors, Kaumatua and Kai Atawhai established in most areas covered by this programme (Canterbury, Nelson Marlborough, Hawkes Bay, Tai Rawhiti, Counties Manukau, Waitemata and Auckland DHBs). The engagment of Maori providers in its planning, design and development is crucial. As the service develops we are faced with more questions than answers as we strive to develop and deliver a culturally appropriate bereavement service for Maori.

Manawaora o nga Taiohi

by Freedom Preston-Clark, Mental Health Foundation of New Zealand

Manawa ora o ngÄ Taiohi wÄnanga are about rangatahi advancement and development. This presentation will cover background information, an overview of the methodology used, findings from the review, and an interpretation of the findings.Manawa ora o ngÄ Taiohi wÄnanga are about rangatahi advancement and development; essentially, supporting rangatahi to define their own priorities for the future and wellbeing.

In December 2008, the Mental Health Foundation commissioned Te Rau Matatini to conduct an independent review of the programme Manawaora o nga Taiohi. The aim for the review was to describe the model of service delivery and identify the benefits and areas needing additional development within the wider context of the programme.

For the past 5 years, the Mental Health Foundation delivered Manawaora o ngÄ Taiohi conducting a minimum of 10 wÄnanga each year in the Canterbury, South Canterbury and West Coast regions, annually reaching more than 250 taiohi and their whanau.

The programme was developed to support local level community needs. Implications of findings suggest that through providing opportunities for participation in well taught pro-social culturally based activities, rangatahi will have greater opportunities to succeed.

The researchers found that the outcomes for taiohi contributed positively to wellbeing, cultural identity, and self-esteem.

Key Strengths of Manawa ora o ngÄ Taiohi WÄnanga include:

kaupapa MÄori service delivery;
use of traditional MÄori knowledge that applies to the daily realities of rangatahi;
MÄori knowledge perceived as valid by rangatahi;
enhancement of cultural identity of rangatahi;
increased confidence and self-esteem of rangatahi;
strong links with the community, support services, and iwi networks;
increased social support networks;
improved relationships with whÄnau members through wÄnanga participation;
marae based learning environment;
improved behaviours for rangatahi who have continual involvement with Manawa
ora o ngÄ Taiohi; and
transferable skills learnt during wÄnanga were applicable in other settings such as
School

The findings from the review are indicative of how rangatahi responded to learning within a Manawa ora o ngÄ Taiohi wÄnanga environment. Both qualitative and quantitative data provided consistent evidence to suggest that wÄnanga engaged rangatahi.

As a result of participating in wÄnanga, rangatahi reported having learnt more about tikanga, te reo MÄori and having increased confidence in their cultural identity. In terms of measuring the effectiveness of Manawa ora o ngÄ Taiohi wÄnanga, these results are indicative of best outcomes for MÄori rangatahi.

Te Rau Matatini (P2009). Service Review of Manawa Ora O Nga Taiohi

The Lowdown: early intervention services for young people

by Dylan Norton, Lifeline Aotearoa, Candace Bagnall, Ministry of Health

This presentation discusses the Lowdown services, including the ethnic breakdown of service users, support pathways for young people indicating suicide, and the results of the evaluation from the perspective of the service provider and service users. Major depressive disorder is very common amongst young New Zealanders, with a 12-month

prevalence of 8.7%, compared with 5.7% for the whole population. The link between depression and suicide is well established, depression making the largest single contribution to suicidal behaviour. Youth suicide rates are also high. The age standardised suicide rate for NZ males is 18.2%, and for females it is 5.9%, compared with 27.6% amongst young males and 8.2% for young females (15-24 year olds) .

The economic recession is likely to increase prevalence of both depression and suicide. Furthermore, when money is tight, people most in need of mental health or primary care services may be less inclined to access them because of the costs involved.

The Lowdown website and services were developed through an understanding of ‘youth culture', with significant input from young people at various stages in the development of the project. The Lowdown Team provide online, text and webcam support services backing up the website itself, which have been recently evaluated.

The Lowdown was designed primarily to provide information and support for young people with mild depression, with a view to reduce the likelihood of more severe episodes. However the evaluation identifies that over one third of Lowdown service users report symptoms associated with severe depression, and in the first 12 months of operation, there were 26 emergency interventions for suicide risk undertaken.

This presentation discusses the Lowdown services, including an overview of support pathways for young people indicating suicide, an ethnic breakdown of the service users and the results of the evaluation from the perspective of the service provider and service users.

It is clear that these services can play an increasingly important role over the next few years in filling well-documented service gaps, as well as complementing and moderating demand on existing primary care and mental health services.

Suicide prevention coordination pilot - district action plans and cultural perspectives

by Helen Hunter, Barry Bublitz, Lorraine Coelho, David Hough, Mapihi Raharuhi, Barry Taylor

The publication of the New Zealand Suicide Prevention Strategy 2006-2016 and the New Zealand Suicide Prevention Action Plan 2008-2012, provided a high level frame work for reducing the rates of suicide and suicidal behaviours.

To facilitate the implementation of the national plan at a regional level, the Ministry of Health has funded five district health boards (DHBs) to pilot a Suicide Prevention Coordinator role over two years. Commencing July 2008 the pilot runs until June 2010 in the following five DHBs - Auckland, Counties Manukau, Lakes, Wairarapa, and Nelson Marlborough.

Charged with the development of district suicide prevention action plans the coordinators face the challenges of translating national strategy into achievable, sustainable and realistic action at the local level. To achieve this, the coordinators find themselves at the interface between divergent world views and expectations. While we are still on the journey we hope to share some of our ‘snapshots' - particularly regarding cultural diversity.

This presentation will provide an overview of the Pilot from the Ministry of Health, an outline of the process, together with experiences and learning's from the coordinators. The focus will be on the cultural opportunities that exist across our communities and the role and experience of the coordinators in addressing the needs of both Maori and other cultures.

The coordinators have identified many similar trends among their districts; however, there are also points of difference, many of which are particularly related to cultural diversity. We will explore some of these differences and our responses this far into the development of district action plans.

During this session we particularly want to explore how ‘Whanau ora' concepts connect with suicide prevention planning.

We anticipate that we will open up more questions than provide answers but hope that through inviting you into our ‘waka' during this presentation that all of our journeys may be enhanced. Our hope is that we inspire you to desire coordinated action for your district, particularly towards addressing cultural needs.

Top Page last updated: 3 November 2009

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