Thursday, 29 March 2012

Programs to assist Aborigines to Overcome Aboriginal Suicide

I discuss below ten programs which have the potential to alleviate suicide. All require input from non-Aboriginal sources. Two may require that Aboriginal community members visit New Zealand, or that New Zealand personnel tour Aboriginal communities.


(a) Aboriginal suicide ‘AA’
In the United States, there are growing numbers of groups formed by relatives and friends of suicides. The ‘survivors of suicide’ hold promise for the possibility of some alleviation. Suicide avoidance can be modelled on Alcoholics Anonymous and Gambling Anonymous programs. Our limited observation (perhaps a dozen large group meetings) was that, within a group, individuals were keen to talk about their suicide attempts: it was a kind of revelation time. Regular ‘suicide AA’ meetings, in their own domains, may draw youth. The capacity for such a strategy is already there. In the initial period, external assistance may be needed for establishing protocols of do’s and don’ts, handling such matters as anonymity and confidentiality.

(b) Smoke free/suicide free?
The Health Sponsorship Council in Wellington, New Zealand, has been quite successful in seeking sponsorships for sport, youth and Maori programs from other than tobacco companies. The Council provides, or raises, funds to replace tobacco sponsorship. One of many programs is SMOKEFREE, with a Maori subset called ‘Smoke free Maori’—aiming at abandoning the habit. It is not the usual ‘quit smoking ’campaign, accompanied by terrifying pictures of damaged lungs. Rather, a reverse psychology is used: that it is ‘cool’ and ‘with it’ not to smoke. ‘Cool’ activities include dances, with large attendances. The non-smokers gather en masse; smokers are asked to smoke away from the group, at a distant, segregated space. The peer group pressure of the ‘cool’ ones seems to be prevailing.

Throughout, the accent is on positive change to a healthy lifestyle. Youth are asked to consider taking this experience to their homes and workplaces and, above all, to the marae, ‘the last bastion of Maoritanga and lifestyle’. And the slogan is to stop smoking for the benefit of all Maori: to do it for your people.

In a sense, this is replacement rather than displacement innovation: learning to do something new, and is the germ of an important idea: that ‘cool’ kids don’t commit suicide.

(c) ‘Going-for-Goal’ (GOAL)
Ken Hodge at the University of Otago and Steve Danish at Virginia Commonwealth University in the United States have established both pilot and ongoing life-skills programs: ‘basic skills needed to achieve across [different] environments’. The project authors ‘believe that sport provides an excellent metaphor for this message’. Adolescents aged 10 to 14 are taught to:
•identify positive life goals;
•focus on the process (not the outcome) of goal attainment;
•use a general problem-solving model;
•identify health-compromising behaviours which can facilitate goal attainment;
•seek and create social support; and
•transfer these skills from one life context to another, for example, sport to classroom, school to career.

The pilot study in Dunedin has been promising, especially given that New Zealand youth are so sports-conscious. GOAL has been established in 25 places in the United States.

There is every reason to believe that GOAL can not only be taught in Aboriginal societies, but that its premises, aims and methods are appropriate to suicide prevention, or rather, life-positive outlooks.

Dr Ken Hodge should be brought to Australia to teach us the GOAL system.

(d) Parenting and conflict resolution skills
Duclos et al examined suicidal behaviour among Indian adolescents in detention. Factors involved were alcohol abuse and dependency, frequent run-ins with police, frequent interpersonal conflicts, chronic family instability and, above all, ‘prolonged, unresolved grieving’ and ‘continued deprivation of parental caring’, resulting in ‘difficulties with the law’. The authors could as well have been writing about Aboriginal youth.

Parenting styles vary across cultures. There are many who deplore what they see as a laxity in Aboriginal child-rearing practices, at least in non-traditional domains. Certainly there is a difference in the degree of anxiety about life’s dangers. Aboriginal parents often allow their children to see and experience risks, believing that ‘once-burned-twice shy’ will teach the young. The virtues of cultural systems are not in question in this context. What is problematic is why Aborigines are today failing as parents.

In all cultures, there is, at bottom, a ‘being there’ for one’s children: loving and nurturing, guiding them through emotional and intellectual difficulties, setting boundaries for behaviour, disciplining when appropriate, assisting in decision-making, and the all-embracing obligation to provide food, shelter and clothing. There are many reasons why these skills can be missing, including child removal, parental absorption in grief, and family breakdown—all leading to the absence of role models. However, even where these skills are lacking, they can be taught—and learned.

If we are serious about reducing suicide, then we have to travel to the problem, not wait for the problem to come to the consulting room, by appointment. This applies to all the strategies suggested in this chapter. In the main, Aboriginal parents will not leave home to attend classes or workshops in a city, or in the next large town. They will not travel to environments in which they feel ill at ease, as in a university or TAFE(unless for pleasure, or escape from the kitchen, as is now common with painting classes). They avoid ‘mental health units’ at hospitals. Internets or websites are inappropriate tools, and Aborigines are unlikely to watch instructional video material.

In sum, classes will have to be facilitated by invitation, at Aboriginal places, and essentially on their terms.

Teaching parenting skills and grief counselling are, I believe, the most important skills in providing any alleviation.

Conflict resolution is another invaluable tool for defusing explosive situations. It also gives an insight into the individual’s pain, frustration, needs and how to learn to express them without self-harm. It can be learned in a few sessions, and courses can be tailored to the needs of special interest groups.

(e) Grief counseling
No other cultural group in Australia is so exposed to death so frequently, especially early death. For many, grief is prolonged, constant and unresolved.

Grief counselling is crucial. I am told that for Aboriginal men and women to become counsellors, they must have a degree in psychology, preferably an Honours year, and then specialised training. A BA Hons (Psych) does not necessarily guarantee a good counsellor: specific short-term training could. There is need to explore the idea of bringing professional counsellors to Aboriginal centres for introductory lessons on what to do, or not to do, in the immediacy of death, especially by suicide. Even if these ‘trainees’ learn only how to recognise and refer to specialised professionals, that would be a start. I have every confidence in suitable Aborigines’ fulfilling the role of grief counsellors. Those with a nursing background would be immediate candidates.

(f) Removed children
Grief counselling is usually conducted one-on-one or in a small group. A larger group could address whole communities in grief. Children and kin of the stolen generations need special therapy. Every family we met during this research had a strong or direct connection with the removal system, and its effects spill over across the entire Aboriginal population.

There is another kind of child removal: the large movement of Aboriginal youth to juvenile detention facilities. Most families have one or more children either in such a facility or who has recently been there. The removal is temporary and visits are possible. But the family member is absent and missed. It is a complex problem, but counselling could begin to address family structures.

(g) School programs
The United States and Canada consider school programs on suicide a virtue. For Canadian Indians, the issue is important because the discredited system of removing children to boarding schools still prevails—therefore special programs need to be included in the school syllabus.

There is American evidence that some programs were effective. Four high schools established programs for girls at high risk of suicide. The girls were paid an hourly wage for attending two group meetings for one-and-a-half hours each week. The curriculum included parenting skills, the psychology of sexuality, decision-making, drug and alcohol matters, unwed pregnancies and even suicide ‘presented by medicine men’. The program lasted two years, with dropouts and replacements. The outcome was: 10 per cent of girls became pregnant, as opposed to the earlier figure of 30 percent; grades improved slightly; there was no police trouble in the group; and 90 percent of the drinkers had cut down their intake. Only three of the girls attempted suicide. A similar program on a Zuni reservation also produced ‘lowered scores on a measure of suicide potential as compared to a control group who did not take the program’.

A contradictory North American report opposes these programs, suggesting that they ‘enhance’ the notion of suicide and give youth ideas they may not have entertained before.

Aboriginal youth at the suicide risk age—from 12 upwards—could not benefit from any school-based programs unless they were, indeed, still attending school: the programs would simply not reach them.

There is much more likelihood of success if classes were conducted by Aborigines, and by other respected helpers, outside of school hours, at Aboriginal medical services, legal services or on land council premises.

(h) Sport
The Australian Sports Commission and the NSW Departments of Sport and Recreation and of Health should initiate programs to bring rural and remote Aboriginal facilities closer to a ‘level playing field’. More pertinent, they should help Aborigines towards any kind of playing field.

The GOAL program could be integrated into these initiatives. This is not merely a recommendation about money for travel, equipment and improved facilities; rather, it is that these agencies develop and implement sports policies that focus on life skills, early starts, suicidal and risk-taking behaviours, aggression, leisure in its true sense, recreation, anti-boredom, and specific activities aimed at therapy for diabetics.

(i) Police and Community Youth Clubs (PCYCs)
The NSW Police Service should rethink its role in Aboriginal life. Community policing is, or was, for long the ideal of the Service. Even if ‘frontline policing’ has replaced that policy, the community aspect remains a much-needed aspect of good policing.
Policemen and women interact with Aboriginal youth more than do any other non-Aborigines. They see and hear more than anyone else. They are present when everyone else is off duty. PCYC officers are in an even more advantageous position to be assisting police rather than arresting police. They offer Aborigines what no one else can: sport, computers, computer games, pool, preparation for driving licences, space, an outlet for energy, a meeting place, food, possibly an enlightened witness, are spite from home life. In the great majority of towns, including the towns which want curfews, caged shop windows, alcohol-free zones, boot camps and the like, these officers are the youth workers. The potential for suicide monitoring, and suicide and life- skills education are nowhere better than in refurbished premises, with uplifted and better-trained PCYC personnel.

(j) Ann Morrice’s literacy program
Three to six hours of training is all that is required to train teachers to teach literacy to children. There is something of a ‘magic bullet’ available in Ann Morrice’s language/literacy program, one demonstrated as being highly effective in at least 300schools in Australia, including Aboriginal schools in South Australia and Western Australia. The technique is also effective with English-as-a-second-language students.

The philosophy is based on oral language development, linked to meaningful content and to the child’s visual world. Speaking, listening, reading and writing are linked in meaningful contexts. Skill-based learning is included, and the written product is the focal point towards which lessons are directed. The process includes all the conventions of writing: phonemic awareness, phonics, conventional spelling, grammar, punctuation, syntax, reading skills, and comprehension. The technique can be taught at any venue and is not based on school-attendance. A key to the program is that it builds on the positives which exist for the child in his or her own environment. Ernabella, a remote South Australian Aboriginal community, has shown remarkable results from an approach that places a positive value on their own environment.

Material is presented from children aged 5 through to secondary pupils. At the sixth national conference on Suicide Prevention Australia in Melbourne in March 1999, Ms Morrice demonstrated her technique to an audience.(Demonstration is more effective than trying to describe the method.) Subsequently, several Aboriginal community representatives have invited Ann Morrice to visit and train local people.

The cost of her programs is minimal. The efficacy is beyond any doubt. The responses of Aboriginal youth border on the miraculous, especially in light of the disposition of conventional teachers dispositions to dismiss Aboriginal educability in general, or to cease bothering with children once they reach a certain age.

The federal government pledge to implement a literacy program is to be applauded. But, for reasons discussed throughout this report, much of the ensuing activity will not reach Aboriginal children. We cannot wait for standard school procedures, including special literacy projects, to become attractive to Aboriginal children. We can, however, teach Aboriginal children literacy, in a remarkably short time, outside of school, with the hope, or belief, that literacy skills will give them both the confidence and the incentive to return to, or to stay at, school.

Key Messages:
Non-Aborigines can make significant contributions to suicide alleviation by:
• assisting Aborigines to establish suicide equivalents of Alcoholics Anonymous;
• sponsoring the equivalents of the New Zealand ‘Goal-for-Goal’ life-skills and the Maori Smoke-Free programs;
• sending trainers to Aboriginal communities to develop both training and operational parenting, grief counselling and conflict resolution skills;
• establishing programs modelled on the successful North American Indian school ‘prevention’ programs, outside of school hours and premises;
• offering counselling and advice to communities which have experienced the forcible removal of children;
• the NSW Department of Sport and Recreation, and the Australian Sports Commission, committing funds for increased sport, leisure and recreation programs in communities that have none;
• the NSW Education Department supporting the proliferation of Ann Morrice’s literacy programs within and without the school curriculum;
• the NSW Police Service uplifting the training and promotion opportunities of PCYC officers, and encouraging them, after appropriate training, to engage in suicide alleviation projects.

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