Thursday, 29 March 2012

Organising Capacity-Based Workshops aimed at curbing Aboriginal Suicide

The easiest path to new knowledge is to listen to attractively delivered material, preferably at times and places which suit the listener’s professional or personal lifestyle. Reading and studying tend to be dismissed once one has graduated, trained or is on the job. Short, sharp workshops in situ have educational advantages: they can
be styled as in-service training, advanced studies, professional training, and even certificated training. They also build on the capacities of the people attending: Aborigines, police, coroners, lawyers, mental health workers, and so on. The materials can be framed as new, supplementary or complementary, rather than suggesting ‘a whole new ball game’. Several such workshops can be arranged, with minimal difficulty, and within reasonable costs, by the organisations concerned. Almost every agency has a component of in-service training and hence funding is not required. In most instances, the costs will be in terms of weekend rostering, travel to an equidistant, suitable venue, and the travel and/or fee costs of the presenters.

(a) Pharmacists
The medical and pharmaceutical professions are rightly concerned about ‘non-compliance’, that is, patients who are not taking what is prescribed for them. A NSW pharmacist who specialises in ‘compliant packaging systems’, informs me that non-compliance is not merely a problem with the aged and the confused, but with ‘normal’ people.

Throughout this study, we observed the standard dispensing of pharmaceutical drugs to people who cannot read the labels, the instructions and the manufacturer’s micro-printed side-effects or contra-indications. During the research, I approached the NSW Pharmaceutical Association about seminars for regional pharmacists, with a view to their dispensing medication to illiterate people in blister packs for daily or weekly collection, or introducing medication-under-observation—as is the practice with methadone here or programs for the treatment of tuberculosis in several countries. Several lectures and seminars were given to country town pharmacists: the responses are very positive in that Aborigines are now taking to the use of blister and directive packs.

There needs to be a regular series of regional workshops by staff from the NSW Pharmaceutical Association, Manrex Pty Ltd–Webstercare, and Medifrax (who specialise in medical awareness education), to pharmacists, doctors, nurses and Aboriginal parents.

Such instruction is as much about Aborigines taking medication for their diabetes, heart and kidney disease as it is about minimising the availability of lethal means of suicide, or attempted suicide. Blister-packing, or better still, ‘daily-dosage’ packing, could well mean that the young girl from Brewarrina, would not have had 50 Digesic tablets on which she fatally overdosed.

(b) Police
Regional workshops can be conducted with little effort. Several police officers, who had attended an in-service course on Aboriginal history and culture, were enamoured of the materials given to them. All claimed a better appreciation of their clients. The only caveat is that history and culture needs to be directed to the present rather than the past. There is a danger in many of these ‘Aboriginal Studies’ courses of the painting of an historic, romanticised and idealised picture of a people who, in the listener’s experience, have no relationship whatever to the people they deal with in their daily lives. Often, these ‘traditional’ courses produce an antithetical effect: they make the contemporary population appear altogether removed from, or even ‘deviant’ from, their ‘attractive’ ancestors.

There is no shortage of Aboriginal and non-Aboriginal personnel to conduct such workshops. The focus, however, must be on suicidal behaviour, the possible causes, the warning signs (if any), the movements toward suicide, was of deflecting what look like destructive path choices, and so on.

(c) Coroners
We interviewed 31 New South Wales coroners in this study. Some are extremely competent and confident. Others are unsure in matters of suicide, and many are not au fait with Aboriginal societies. Several feel isolated, even though there is regular, helpful advice and service from the State Coroner and his staff.

Most were positive about wanting to attend a regional workshop on all coronial matters, including the suicide issue, at least once, if not twice a year. They see the coroners’ association meetings as being for the ‘real coroners’ in Sydney and Melbourne. A few felt that they could not take off any time to attend training, as there was no locum and because they acted also as clerks of the court. I have no doubt that most would be willing to attend a workshop on the contents of this report.

(d) Custody officers
I have not inquired into the training of those officers who now form custodial units in rural police stations; nor do I know what training is given to corrective service officers in prisons in New South Wales. However, it would be surprising if the situation were markedly different from Canada and the United States, where the general conclusion is that such personnel are under-trained regarding prisoners at suicide risk. The NSW Corrective Services system does have psychologists who prepare screening tests for suicidal tendencies. However, screening on admission is not the same as knowledge on the part of the custodian as to what to look for, how to look for it, and what to do about it if something untoward manifests. Immediate referral to a prison hospital is neither the sole nor the whole answer.

Workshops should be conducted, in police stations and jails, to familiarise officers with the dimensions and possible causal ingredients of the problem.

(e) Mental health workers, local doctors and nurses
Health personnel in every region would benefit from annual workshops. My experience is that they are always interested in how they are faring, new inputs, how other jurisdictions function, what makes Aborigines ‘tick’, what are the latest ideas on suicide. The most commonly expressed ‘complaint’ is that they ‘don’t know how to get through to Aborigines’. That, at the least, is true. The fault is not personal: research in North America has shown that mental health jargon is a barrier to communication and understanding, and therefore to therapy of any kind.

Such workshops would need to tackle the history of an Aboriginal experience that has resulted in antipathy to government institutions of the ‘welfare’ type. We all need to face this kind of history, and in facing it, there might be a breakthrough to a less hostile future.

(f) Psychiatrists and psychiatrists-in-training
A small group of psychiatrists in training at a major Sydney hospital, perhaps 20,has asked Ernest Hunter and me to address them. They claim that they lack confidence in how to handle youth suicide and ask whether there are any especial tools for handling Aboriginal youth. The Otago Medical School curriculum, discussed earlier, ensures that every graduate is taught whatever knowledge, however limited or speculative, is available. The National University Curriculum Project, established by the Hunter Institute of Mental Health in Newcastle, is currently preparing what can be called a ‘suicide syllabus’ for use in university curricula for doctors and nurses, among others.

Informal or formal university and/or hospital workshops for psychiatry residents would provide an ideal opportunity for the emergent practitioner to correlate, and possibly to integrate, the various approaches to youth suicide. It is not a matter of persuading them about choosing one or other of only two alternative approaches. Rather, it is to overcome what appears to be a fear of intervening, or trespassing, into an ‘Aboriginal territory’ for which they have no training, no invitations and no culturally appropriate licence.

Key Messages:
A series of joint or separate capacity-based workshops should be established forthwith. They should be the forums for discussion and action by those involved, directly or indirectly, with Aboriginal youth suicide, including:
• Aborigines who have lost children to suicide and who could form ‘suicide AA’ programs;
• police in training at police academies and universities;
• remote and rural police officers in towns of known high suicide risk;
• pharmacists who need to appreciate the need for a different form of dispensing drugs to those who are illiterate;
• coroners who feel isolated, or who believe they need an understanding of Aboriginal issues generally;
• custody officers who, generally, have no training in either the causes or the signs of suicidal behaviour in youth;
• mental health and related professional workers who need to find ways of communicating with Aboriginal communities and whose language of training and operating currently cause antagonism to those who might need their services;
• psychiatrists and psychiatrists-in-training who want, and need, to know whether there are especial tools for dealing with Aboriginal suicide.

The agenda for these workshops need to be discussed with the professions and people listed here. However, a starting point could be their analysis of the Hunter-Reser study of suicide in North Queensland communities, the Maori Suicide Review Group report, and this report.

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