Wednesday, 28 March 2012

Movement Towards Alleviation from Suicide

There are always simple solutions to complex problems. And they’re always wrong.           —H. L. Mencken

Existential therapy focuses on death, isolation, meaninglessness and freedom issues, which are easy for American Indians to understand. Death crises occur more often for American Indians at an earlier age and,
furthermore, the deaths of their ancestors (which came close to genocide) remains a powerful tribal memory. American Indians are aware of their isolation from mainstream culture. They are both isolated geographically and suffer from racism ... Suicide by the American Indian, for example, may be seen as seeking freedom in death.                                                                                                                                —David Lester

Suicide ‘prevention’, especially in North America, is undertaken by doctors, who are mainly psychiatrists, psychologists, and mental health workers who are generally social workers or nurses. In the case of Indians and Alaskan Natives, tribal ‘gatekeepers’ are also involved in some programs.

Only three grades of strategy are delineated. Primary ‘prevention’ focuses on psychiatric disorder, education of the physician doctors (and then of the children and parents), the provision of ‘good general mental health services’, psychotherapy for traumatised and sexually abused children, attempts to predict suicide, and a toning down of media hysteria about the subject of suicide. Secondary strategies include establishing suicide prevention centres, medical emergency services and hotline telephone services, and restricting access to lethal weapons. Tertiary strategies can only apply to those who have tried suicide but failed: essentially this involves counseling for those who make ‘suicidal gestures’.

I prefer the words ‘alleviation’ or ‘mitigation’ to the conventional ‘prevention’. One can only prevent what one knows is likely to happen, and then only of one can clearly identify a cause which can be ameliorated or mitigated. We do not know the causes of youth suicide. ‘Prevention’ has not diminished youth suicide in Australia, New Zealand, North America, the Scandinavian countries, Scotland, Sri Lanka or the Pacific Islands, in each of which the rates of youth suicide have escalated markedly. All we can do is try to slow, or deflect, the development of trends towards attempts at suicide.

More diverse people and professionals than those listed above are needed for successful alleviation. Who they should be will emerge from the following analysis.
Key Messages:
• We do not know the causes of youth suicide. The best we can do is alleviate or mitigate what look like trends, or movements, towards suicide. We can’t prevent it.
• Alleviation is not the sole domain of ‘mental health’ personnel. A wide range of people and skills is needed.

I have assembled my conclusions and recommendations under nine headings:(1) philosophies and theories of suicide; (2) research directions; (3) ‘prevention’ projects; (4) treatment practices; (5) Aboriginal initiatives; (6) Aboriginal and non-Aboriginal co-operative programs; (7) coronial matters; (8) suicide and the role of the police; and (9) practical ‘capacity-based’ workshops.

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