He Koha Aroha - Preventing Māori Suicide

• 1.He Koha ArohaPreventing Mori Suicide

2. Our Client... 3. Research Question A comparative analysis of social marketing and community development approaches for Mori suicide prevention. 4. Aims and Objectives Define the terms: social marketing and community development with respect to Mori suicide prevention. Identify forms of social marketing and community developmentcurrently in practice. Identify and analyse suicide trends within indigenous populations, with particular emphasis on Mori. Perform a comparative analysis of social marketing and communitybased intervention through discussion with experts in the field of mental health with particular emphasis on Mori suicide. 5. Aims and Objectives Investigate the cost-effectiveness of social marketing and community development in Mori suicide prevention and the economic, social, cultural, and political costs of Mori suicide. Discuss the logistics of community development and social marketing as forms of intervention. Produce a set of recommendations for the Mental Health Foundation based on the findings of the study. 6. Methods 1. Extensive literature review. 2. Key informant interviews. 3. Cost-Benefit Analysis. 7. DEFINITIONS 8. Application of commercial marketing technologies to the analysis, planning, execution and evaluation of programmes designed to influence the voluntary or involuntary behaviour of target audiences in order to improve the welfare of individuals and society Donovan and Henley (2003) Benefit lies with society rather than the marketer or contractor. 9. Start the Conversation Todayhttp://www.lifeline.org.nz/ 10. Community Development The concept of community development involves a group of people with a shared identity interacting in order to come up with ideas, ways to improve and also solutions to problems (Cavaye, 2006). 11. The Kia Piki te Ora o te Taitamariki Strategy Keri Lawson-Te Aho authored and developed Version One. MoH implemented programme (2000). Mori-tailored approach aimed at reducing taitamariki (youth) suicide. Achieved strengthening of whnau, hap and iwi by focussing on community development. In 2010 the programme evolved into an all ages strategy (Kia Piki) - mainstreaming. 12. LITERATURE REVIEW 13. Mori Suicide Statistics 82 Mori suicide deaths in 2008. 2008 Mori suicide rate was 13.3/100,000 population, while non- Mori rate was 10.6/100,000 population. 2008 Mori youth (15-24y) suicide rate was 27.6/100,000 compared to non-Mori youth 16.4/100,000. Greatest disparity between Mori and Non-Mori exists in theyounger population (15-24 y). Mori suicide rates show no downward trend over time unlike non-Mori. 14. Mori Suicide Statistics II Mori male suicide rates were 2.25 times higher than female Mori suicide rates in 2008. When comparing Mori with non-Mori male suicide rates, Mori were higher. Similar in Females. Globally, suicide rates among indigenous populations is a noted problem. In all these countries indigenous suicide rates are higher than non-indigenous groups. 15. Age-standardised Suicide Rate, by Ethnicity and Gender 1996-2008 35.0Maori Male30.0Maori Female Rate per 100,000 population25.0Non-Maori Male Non-Maori Female20.015.010.05.00.0 1996199719981999200020012002 Year200320042005200620072008 16. Youth Suicide Rate, by Ethnicity 1996-2008 45.0 40.0 MaoriRater per 100,000 population35.0Non-Maori 30.0 25.0 20.0 15.0 10.05.0 0.0 1996199719981999200020012002 Year200320042005200620072008 17. Mori Suicide Risk Factors Inequalities Historical Trauma Colonisation Cultural Identity Individualistic Society Population Age Structure Welfare Services Unemployment Incarceration Reduced Contact with Healthcare Services 18. Social Marketing Social marketing initiatives in New Zealand: SunSmart Land Transport Authority campaign Its About Whnau anti-smoking Like Minds Like Mine Social marketing targeting suicide: Start the Conversation Today Mori TV Campaign. Reachout Internet-based campaign targeting Australian Youth. 19. Community Development In NZ, should work within Mori communities, at the whnau, hap and iwi levels. Cultural development as a protective factor against suicide. International studies Increase in awareness (Allen et al 2010 Utilize local knowledge, skills, resources (Smith et al 2003) Can be self sustaining (Lucke et al 2003) Difficult to assess results quantitatively Funding difficulties 20. KEY INFORMANT INTERVIEWS 21. Key Informants List RANGATIRA Professor Sir Mason Durie, Pro Vice Chancellor, Massey University Dr Huirangi Waikerepuru, Taranaki Kaumatua THE CLIENT - MENTAL HEALTH FOUNDATION Materoa Mar, Chair, Mental Health Foundation Judi Clements, CE, Mental Health Foundation Witi Ashby, Manager, Mori Resource Development, Suicide Prevention and Information MORI SUICIDE PREVENTION CLINICIANS Eliza Snelgar, Clinician, CASA 22. Key Informants List MORI SUICIDE PREVENTION RESEARCHERS Professor Sunny Collings, Dean, University of Otago, Wellington School of Medicine Associate Professor Jo Baxter, Director Ngi Tahu Mori Health Research Unit, University of Otago Dr Nicole Coupe, Director, Te Ira Tangata, Mori Suicide Prevention Programme, CEO Hapai te Hauora Tapui Limited Keri Lawson-Te Aho, Lecturer, Hauora Mori, University of Otago, Mori suicide prevention policy writer, PhD candidate Keri Newman, Masters graduate, Victoria University of Wellington Paea Paki, Clinician, Multi-level Intervention Suicide Prevention Study Dr Denise Steers, Clinician , Multilevel Intervention Suicide Prevention Study 23. Key Informants List MORI COMMUNITY DEVELOPMENT EXPERTS (WHNAU, HAP, IWI DEVELOPMENT) Pahia Turia, Director, Taipak Development Aotearoa Emma Kutia, Project Manager, Te Ao Hou, Kia Piki Te Ora, Eastern Bay of Plenty Michael Naera, Project Manager, Kia Piki te Ora, Ngti Pikiao Irene Walker, Te Ao Hou, Kia Piki Te Ora, Eastern Bay of Plenty INDEPENDENT MORI EXPERTS Mike King, TV personality and mental health commentator Gordon Matenga, Coroner 24. Social Marketing: The BenefitsIncreases population awarenessReaches a large and widespread populationEncourages conversation and reduces stigmaSocial MarketingProvokes thought and discussionOnline support forumsEducationPromotion leading to intervention 25. Social Marketing: The Disadvantages $$ May burden downstream services if illpreparedContagion riskSocial Marketing Ineffective if no access to mediaMost effective if culturallytargetedLack of supporting evidence as suicide interventionOrganisations involved inexperienced with media 26. (there is) a concern that suicide can be contagious - Professor Sir Mason DurieThose dont work for Mori (cigarette packet graphic pictures) but if you put a picture of mokopuna on them, that would work. - Michael Naera 27. Community Development: The Benefits Addresses proximal and distal determinantsSelf-sustainingConnection with family and communityUses the intrinsic resources of the communityCommunity DevelopmentDesigned by the community for the communityShifts power to the peopleBuilds resilience and selfdeterminationSpecifically targeted interventions 28. Community development is revolutionary; it is about change, it is about relocating the locus and power of control into the hands of those most affected by the issue Keri Lawson-Te Aho 29. Community Development: The Disadvantages Time consuming Requires good communicationLittle evidence of effectiveness$$ & Resource demandingCommunity DevelopmentDifficult to monitorSlow to changeGeographically confined Problematic for rurally isolated families 30. Other Important Themes Every case is different Causes of suicideTe Ao MoriOther Themes Positive healthcare interactionsNormalisation of risky behaviourEmotional suppression in Mori men 31. Te Pae Mahutonga Health model based on the Southern Cross. Four central stars used to represent the four key tasks of health promotion: Mauriora cultural identity Waiora physical environment Taiora healthy lifestyles Te Oranga participation in society Two pointers: Ng manakura community leadership Te Mana Whakahaere Autonomy 32. INTENDED COST-BENEFIT ANALYSIS 33. Cost-Benefit Analysis Potential value: Concrete quantitative evidence Informing policy makers Better design of interventions for the future Challenges: Lack of quantifiable data Future research needed 34. Economic Costs of Suicide Economic Cost: $448,250 (Des ODea 2005) Mori likely to be more due to younger age of suicide. Life-years Lost: 39.68 DALY for non-Mori vs. 44.02 DALY for Mori. 35. Political, Social and Cultural Costs of Suicide Costs PoliticalLow priority issue for political parties. Political hot potato.SocialGrief for whnau and friends. Potential conflict among dealing with suicide. Devalues life.CulturalLoss of cultural identity. Some Mori believe that those who commit suicide should be condemned. 36. DISCUSSION 37. Research Strengths Culturally respectful kaupapa. Key informants interviewed were selected across a variety of fields providing insight into both sides of the argument; community development and social marketing. 38. Research Limitations Lack of objective comparison due to insufficient objective data. Exclusion of logistics modelling. 39. Discussion Community development vs. Social Marketing. Combined Approach? Culturally appropriate interventions are essential. 40. Recommendations I Due to deficits identified within the published literature, we recommend that further research needs to be done into the effectiveness of social marketing and community developmentinterventions as Mori suicide prevention strategies. Future suicide prevention initiatives need to utilize both social marketing and community development strategies in order to have the most successful outcomes in preventing Mori suicide. 41. Recommendations II When designing suicide prevention strategies it is important todesign them around a Mori health framework to ensure they are culturally relevant to Mori people. When designing suicide prevention strategies at the community level, involve community leaders and harness the strengths already present within the community. This aids to ensure wide dissemination and utilization of these services by the members of the community. 42. Acknowledgements E ng iwi, e ng reo, tn koutou ng rau rangatira ma. E ng tini aitua kua wheturangitia ki te kupenga wairua, haere, haere, haere atu ra. N rtou i whakatakoto tnei kaupapa, ko te hauora, hei huarahi m ng tamariki mokopuna e whai ake nei. Tnei te mihi ki ng pukenga kua tautoko i tnei kaupapa. Tn koutou m t whakapau kaha ki te hapai i tnei kaupapa oranga whnau. He taonga katoa te whnau. He mihi kau atu ki te Mental Health Foundation, Te Tari Hauora Tmatanui, me Te Rp Rangahau Hauora a Eru Pomare. Tn koe Kerry Hurley m t tautoko i a mtou. He mihi hoki ki a mtou kaiako, ko Keri Lawson Te Aho rtou ko Sarah Mckenzie ko Pania Lee, m t mahi tautoko kia oti pai. Ka nui te aroha ki a koutou. Ko te pae tawhiti, whia kia tata. Ko te pae tata, whakamaua kia tina. 43. Hutia Te Rito Htia te rito Htia te rito o te harakeke Kei hea te kmako e k K mai ki ahau, ahau He aha te mea nui He aha te mea nui, o te ao Maku e k atu He tangata, he tangata, he tangata Hi!