Chapter 6Plann<strong>in</strong>g and Coord<strong>in</strong>ationA comprehensive suicide prevention program requires a central coord<strong>in</strong>at<strong>in</strong>g group to ensure that there areno gaps <strong>in</strong> the system and there is no duplication. This group should <strong>in</strong>volve representatives from majorsectors of the community: youth, respected Elders, caregivers, professionals (from health, social services,and education), local government, and others. Inter-agency collaboration should be encouraged <strong>in</strong> order tofully utilize the strengths of all concerned, result<strong>in</strong>g <strong>in</strong> a comprehensive strategy responsive to the chang<strong>in</strong>gneeds of <strong>in</strong>dividuals and the community. Together they may create or adapt programs that reflect the truenature of the community. The immediate effect of such collaboration will be a coord<strong>in</strong>ated response tosuicide prevention. The long-term effects will be the strengthen<strong>in</strong>g of the community and cultural identity,as well as the emergence of local control that will improve the health of both <strong>in</strong>dividuals and communities.This coord<strong>in</strong>at<strong>in</strong>g group should also l<strong>in</strong>k with and supervise a research team who can help design andcarry out evaluations on the prevention activities and programs.PreventionPrimary suicide prevention strategies for <strong>Aborig<strong>in</strong>al</strong> communities should <strong>in</strong>clude the activities listed below:1) Peer counsell<strong>in</strong>g <strong>in</strong> which a group of youth are tra<strong>in</strong>ed <strong>in</strong> basic listen<strong>in</strong>g skills and are identified as resourcepeople for other youth <strong>in</strong> crisis.2) A school curriculum that <strong>in</strong>corporates learn<strong>in</strong>g about positive mental health, the recognition of suicide,substance use, and other problems as serious mental health issues, as well as cultural heritage as a sourceof ways of healthy cop<strong>in</strong>g.3) Recreational and sports programs for children and young people to combat boredom and alienation,and to foster peer support and a sense of belong<strong>in</strong>g.4) Workshops on life skills, problem solv<strong>in</strong>g, and communication for children and young people; much ofthis can be given by youth counsellors who could provide positive role models.5) Family life education and parent<strong>in</strong>g skills workshops for new parents and adults.6) Support groups for <strong>in</strong>dividuals and families at risk (e.g. young mothers, recover<strong>in</strong>g substance abusers,ex-offenders who have returned to the community after serv<strong>in</strong>g time).7) Cultural programs and activities for the community at large (e.g. record<strong>in</strong>g and transmitt<strong>in</strong>g thetraditions of elders, camp<strong>in</strong>g on the land, ceremonial feasts, <strong>Aborig<strong>in</strong>al</strong> language courses).8) Collaboration between community workers <strong>in</strong> health, social services, and education to promote <strong>in</strong>tegrationof services.9) Tra<strong>in</strong><strong>in</strong>g <strong>in</strong> mental health promotion and suicide risk factor awareness for lay and professional helpers.10) Open<strong>in</strong>g l<strong>in</strong>es of communication by creat<strong>in</strong>g opportunities for community members to express theirconcerns and <strong>in</strong>terests (e.g. town council or community meet<strong>in</strong>gs and gather<strong>in</strong>gs).107
Chapter 6While many of these activities and programs can be implemented through the school or cl<strong>in</strong>ic, this wouldbe greatly facilitated by the development of a community drop-<strong>in</strong> centre where these activities could takeplace.InterventionThe follow<strong>in</strong>g types of programs and services address the needs for <strong>in</strong>tervention with <strong>in</strong>dividuals at highrisk for suicide and should form part of a comprehensive prevention strategy:1) Tra<strong>in</strong><strong>in</strong>g of primary care providers (e.g. nurses, physicians, social workers, etc.) <strong>in</strong> suicide detectionand crisis <strong>in</strong>tervention, as well as <strong>in</strong> treatment of depression, anxiety disorders, substance use, andother psychiatric disorders.2) Development of a regional crisis hotl<strong>in</strong>e based outside the community to provide some confidentiality;but workers should have knowledge of the community <strong>in</strong> order to respond appropriately and havecommunity contacts who are available to <strong>in</strong>tervene quickly when necessary.3) Development of a crisis centre based <strong>in</strong> the community or <strong>in</strong> an adjo<strong>in</strong><strong>in</strong>g community to provide asafe place, “time out,” and an opportunity for <strong>in</strong>tensive <strong>in</strong>tervention. It can be staffed by lay helpersand “big brothers” or “big sisters,” along with available professional assistance.4) Immediate availability of crisis <strong>in</strong>tervention for those at acute risk. This must address not justthe affected youth themselves but their family and social networks as well (Stewart, Manion, andDavidson, 2002). Family therapy and social network <strong>in</strong>terventions fit the family- and communitycentredvalues of many <strong>Aborig<strong>in</strong>al</strong> people (Thompson, Walker, and Silk-Walker, 1993).5) Development of assessment and <strong>in</strong>tervention services for parents of youth at risk (e.g. <strong>in</strong>dividual,couple, or family <strong>in</strong>terventions for substance use, family violence, effects of residential schoolexperiences, relocations, etc.).Some of these services may be difficult to provide <strong>in</strong> an ongo<strong>in</strong>g way <strong>in</strong> remote communities. Limitationsof local resources may be offset by the use of telehealth ( Jong, 2004; Muttit, Vigneault, and Loewen,2004) and the development of regional crisis <strong>in</strong>tervention teams able to support and work collaborativelywith people with<strong>in</strong> the community (Debruyn et al., 1988).PostventionThere is a need for rout<strong>in</strong>e follow-up of family and friends who have experienced a loss through suicide toidentify and help those at risk for suicide themselves. S<strong>in</strong>ce <strong>Aborig<strong>in</strong>al</strong> communities are closely-knit andmany youth f<strong>in</strong>d themselves <strong>in</strong> similar predicaments, suicides often occur <strong>in</strong> clusters. Therefore, there isa need to develop a crisis team to respond to suicide clusters. This can be done locally and complementedby a regional team with additional resources (Debruyn, Hymbaugh, and Valdez, 1988). The U.S. Centersfor Disease Control and Prevention has developed guidel<strong>in</strong>es for the community response to suicideclusters (O’Carroll et al., 1988). In brief, these guidel<strong>in</strong>es suggest:1) A community should review these recommendations and develop their own plan before the onset ofa suicide cluster.108
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Suicide Among Aboriginal Peoplein C
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Aboriginal Healing Foundation75 Alb
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Table of ContentsPreface...........
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Table of ContentsCultural and Lingu
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PrefaceThis report was prepared und
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GlossaryAmbivalence - Ambivalence r
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GlossaryParasuicide - Any acute, in
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Chapter 1IntroductionWhen I was 14
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Chapter 1Definitions of Suicide and
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Chapter 1Methods of Studying Suicid
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Chapter 1suicide attempts (Marttune
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Chapter 1A central problem for cros
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Chapter 2The Epidemiology of Suicid
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Chapter 2the economic status of Abo
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Chapter 2No study to date has syste
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Chapter 2Despite the overall patter
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Chapter 2Figure 2-6) Average Annual
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Chapter 2are only a portion of thos
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Chapter 2Figure 2-9) Suicide Rates
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Chapter 2Indeed, the rising rate of
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Chapter 2Figure 2-11) Number of Dea
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Chapter 2Rate per 100,000 populatio
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Chapter 2There are only a handful o
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Chapter 3Origins of Suicide: Indivi
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Chapter 3Anxiety disorders also car
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Chapter 3Many of the factors associ
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Chapter 3American Indians compared
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Chapter 3genetic and constitutional
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Chapter 3Single-parent families are
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Chapter 3Hopelessness, Problem Solv
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Chapter 3higher rates of suicidal b
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Chapter 3Physical EnvironmentSuicid
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Chapter 31990; Chandler, 1994). Thi
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Chapter 3Risk FactorsDepressionSubs
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Chapter 4Origins of Suicide: Social
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- Page 114 and 115: Chapter 6Conclusion: Understanding
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- Page 131 and 132: Appendix AASIST participants receiv
- Page 133 and 134: Appendix AThe Training for Youth Ed
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- Page 142 and 143: Appendix BAdditional Resources: Man
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- Page 147 and 148: Appendix CNational Aboriginal Healt
- Page 149 and 150: References——— (1987). Unravel
- Page 151 and 152: ReferencesBeck, A.T., R.A. Steer, M
- Page 153 and 154: ReferencesBrent, D.A., J.A. Perper,
- Page 155 and 156: References——— (1995). The Pro
- Page 157 and 158: ReferencesDevereux, G. (1961). Moha
- Page 159 and 160: References——— (2005b). In wha
- Page 161 and 162: ReferencesGardiner, H. and B. Gaida
- Page 163 and 164: ReferencesGuo, B. and C. Harstall (
- Page 165 and 166: ReferencesHoberman, H.M. and B.D. G
- Page 167 and 168: ReferencesJong, M. (2004). Managing
- Page 169 and 170: ReferencesKouri, R. (2003). Persona
- Page 171 and 172: References——— (1997). Suicide
- Page 173 and 174: ReferencesMatheson, L. (1996). The
- Page 175 and 176:
ReferencesNeimeyer, R.A., B. Fortne
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ReferencesPirkis, J.E., C.E. Irwin,
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ReferencesRutz, W. (2001). Preventi
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References——— (1992). Marriag
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ReferencesTrimble, J. and B. Medici
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ReferencesWebb, J.P. and W. Willard