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Suicide Prevention: Exploring Aboriginal Understandings of Suicides from a Social and Emotional Wellbeing Framework

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Suicide Prevention: Exploring Aboriginal understandings of suicides from a Social and Emotional Wellbeing Framework Thesis submitted by Raelene Marie Ward BNur, MH USQ For the award of Doctor of Philosophy Faculty of Health, Engineering & Sciences Australia 2019 ABSTRACT The purpose of this research (PhD) was to explore Aboriginal understandings of suicide from a Social and Emotional Wellbeing (holistic) Framework through the establishment of traditional yarning style approaches to interviews and focus groups. Culturally this framework fits well with an Indigenous holistic view of health, connection to land, culture, spirituality, family, and community. These are important to Aboriginal people and can impact on their wellbeing. This research was undertaken in consultation with up to 55 Aboriginal residents across Toowoomba Darling Downs and South West regions of Queensland classified as rural, remote, semi-urban and urban Aboriginal communities. There is a need for additional research into understandings and definitions of suicidal behaviour for Aboriginal and Torres Strait Islander people and their communities (Suicide Prevention Australia, 2009a; 2014b). The loss of a life from suicide impacts considerably on the family and the wider community, which in turn disrupts social and emotional wellbeing - mental health (De Leo et al., 2011) of Aboriginal people. As the social and emotional well-being (SEWB) and mental health problems are not completely recognised or understood from an Aboriginal perspective within the broader health care system. It is evident that suicides among Aboriginal and Torres Strait Islanders are much more frequent in comparison to other Queenslanders, for Aboriginal and Torres Strait Islanders suicide rates are 50 percent higher (Kõlves, Potts & De Leo, 2015). Not only are these high rates characteristic of the interplay of both risk and protective factors but broader social, economic and historic factors affecting social and emotional wellbeing and mental health of Aboriginal and Torres Strait Islanders are also important. Evidence suggests improving social and emotional wellbeing of people results in a reduction in suicides for Aboriginal and Torres Strait Islanders (Queensland Mental Health Commission, 2015). 2 | P a g e This research set out to attain a comprehensive understanding of suicides from an Aboriginal perspective. This incorporated undertaking a historical and contemporary analysis of the literature on suicide across the broader population – internationally and nationally to determine when suicides primarily occurred in Australian Aboriginal populations. In addition further historical understanding of suicides in each Aboriginal community was also important in appreciating the historical and cultural context of communities where Aboriginal people currently resided. Aboriginal participants including females and males, young people (18 years and over), middle-aged people and elders residing within each of the communities participated in pre-arranged face to face semi- structured interviews and focus groups. Thematic analysis of the data achieved a number of themes (Italics) and subthemes: Suicide, Community – underlying issues and substance misuse, Young people – relationships and help-seeking, mental health – services and awareness and Culture – cultural perspectives, social, lifestyle and leadership. In conclusion suicide in Aboriginal communities is on the rise accompanied by intergenerational trauma, substance misuse, poverty, disempowerment, disengagement and disadvantage within the larger social and health context. Historically suicide and self- harm did not appear to exist prior to the 1960s; and there is a difference in understandings and shifts in attitudes towards suicides today. The negative effects from emotional distress, violence, self-harm, substance abuse, anti-social behaviour, behavioural and disciplinary problems are all compounded by the ongoing experiences of social and economic disadvantages further impacting on the risk of social and emotional wellbeing of Aboriginal people and their communities. 3 | P a g e Certification Page This thesis is entirely the work of Raelene Ward except where otherwise acknowledged. The work is original and has not previously been submitted for any other award, except where acknowledged. Student and supervisors signatures of endorsement are held at USQ. Principal Supervisor: Professor Don Gorman Associate Supervisor: Dr John Williams-Mozley 4 | P a g e ACKNOWLEDGMENTS I would like to take this opportunity to thank everyone who has encouraged, embraced and supported me immensely physically, emotionally, mentally, academically and technically throughout my journey in completing my PhD. To my loving, caring and patient immediate family (my husband Scott and our children Hannah, Callum and Trinity) foremost who have witnessed and been along my journey the entire time, and I promise to spend more time with you all. To my extended family including my close friends for their ongoing moral support and for accepting my absence at times and for helping me get through the many challenges that I have faced over the last few years. Thank you for being there in the struggle and giving me the strength to go forward. The following individuals and organisations who I would like to acknowledge personally are: Professor Don Gorman my confidant and fellow colleague a very special thank you to you for encouraging me back into studies at University of Southern Queensland and has been a huge mentor as my direct supervisor and lastly thank you for believing in me. My associate supervisor, Dr John Williams-Mozley a colleague and good friend has also given me a lot of support and guidance. Thank you to my colleagues who currently work alongside me within the School of Nursing and Midwifery, who have assisted me in taking on a lecturing role with both technical and administrative requirements while continuing my PhD. To the Aboriginal people within the communities of Cunnamulla, Charleville, Oakey and Toowoomba with whom good relationships have become stronger through Murri style yarning sessions and thank you for accepting me into your community and places with open arms and sharing their stories honestly but most of all for participating in my research, as I would not have achieved this without each of you. I would also like to 5 | P a g e acknowledge the Aboriginal and Torres Strait Islander health services across the region and within the communities, mainstream and other organisations for collaborating and hosting research interviews and focus groups. Lastly, I would also like to pay acknowledgment to Karin Hosking who provided professional copyediting assistance of my Thesis. Raelene Ward 6 | P a g e Table of Contents ABSTRACT ..................................................................................................................................................... 2 ACKNOWLEDGMENTS .................................................................................................................................. 5 STRUCTURE OF CHAPTERS ..........................................................................................................................11 CHAPTER 1 INTRODUCTION TO THE RESEARCH .........................................................................................16 1.1 Positioning the Aboriginal researcher within the research ..............................................................16 1.2 Contributions to suicide prevention .................................................................................................17 1.3 Focus of the study ............................................................................................................................19 1.4 Goal of the research .........................................................................................................................20 1.5 Objectives for the research ..............................................................................................................20 1.6 Research questions ...........................................................................................................................21 1.7 Keeping Research on Track ...............................................................................................................22 1.8 Community engagement processes .................................................................................................24 1.9 Cultural and Ethical considerations ..................................................................................................25 CHAPTER 2 SOCIAL AND EMOTIONAL WELLBEING (MENTAL HEALTH) .....................................................29 Introduction ............................................................................................................................................29 2.1 Social and Emotional Wellbeing .......................................................................................................30 2.2 Aboriginal multi-dimensional model of health and wellbeing .........................................................33 CHAPTER 3 - BACKGROUND .......................................................................................................................37 Introduction ............................................................................................................................................37 3.1 Context and significance of the research .........................................................................................37
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