Live chat transcripts
This webpage contains transcripts of all live chat sessions that have been held on the LIFE website. They are:
LIFE live chat with Professor Ian Webster AO.
Topic: Men and suicide prevention.
Date: December 2009
Read here.
Professor Ian Webster AO - December 2009
|
|
Above: Professor Ian Webster AO participates in a LIFE live chat session held in December 2009.
|
|
Below is a transcript of a live chat session held on the LIFE website in December 2009 with Professor Ian Webster AO, one of Australia's leading voices in suicide prevention. The topic was 'men and suicide prevention.'
This transcript is abridged; the complete version is available on the LIFE discussion forums. To access the forums you must be a registered member of the LIFE Professional Development Network.
Q: What are your recommendations for working with men to reduce psychological and emotional pain?
A: When people have physical pain it is a very hard thing to describe and understand clearly. It is commonly associated with suffering, feelings of discomfort and, in many cases, wondering whether life is worthwhile. So physical pain has many mental health ramifications. Indeed in studies in Melbourne in general practice, of people with chronic physical illnesses, 50% have depression and amongst those with physical pain the figure goes up to 90%. It's very difficult to distinguish physical pain from psychological pain, and many people who have mental illnesses and are mentally distressed experience a range of pains - sometimes simple headaches, but many other bodily symptoms. For me separating out these two ideas is very difficult and when we speak of co-morbidity, these are real examples of complex, interacting problems and unfortunately in relation to physical pain our health care systems do very badly. I was pleased to learn that next year there is to be a national forum on chronic pain and hopefully our healthcare systems may be better at managing these problems.
Q: I work in Alice Springs in the area of suicide prevention. One of the projects that I have some connection to here is the involvement of men from Santa Teresa (80 kilometres south of Alice) in meaningful activities and potential employment such as the revival of a cultural dance that was performed for the local communities and at special events and the sharing of horse handling and cattlemen skills with young Aboriginal people from NSW. My question is: how can we ensure that these projects get further support to measure their success in reducing high risk behaviour?
A: That sounds like a terrific project and one of the important approaches in my opinion to helping with reducing suicides in communities is to have this frontline community-based approach which engages with the community and its members. Unfortunately, it is often hard to explain to funding bodies how well these projects work, as funding bodies tend to have very specific criteria and outcomes rather than the more universal and community approach that you describe. It seems to me that the sort of project you're describing has a lot to do with how we generally support Indigenous communities and the whole idea that is now developing around social inclusion. Social inclusion is a very important idea, being the opposite of excluding people, and I certainly hope that more government, non-government and industry funding will go in that direction.
Q: I am a researcher at the Brain and Mind Research Institute (BMRI) currently working on an ARC project in collaboration with the Inspire Foundation. We are looking into how the internet could be used to promote mental health awareness and help-seeking among young men aged 14-16. I’d love to ask you a couple of questions about this issue. Firstly: why do you think young men are far less likely to seek help than young women? Sub-question: in what ways do you think this problem could be addressed?
A: I don't know that I've got clear answers to that question any more than you have, but like many people I've thought about them a lot and I suppose it goes to the nature of our culture and the ways boys grow up to be adolescents and then adults to be tough. Being un-emotional is regarded as a strength. I could go on as I'm sure you could and discuss other aspects of this but I think your idea of engaging with at-risk young men and boys using the internet and other media (which I don't understand very well) is an excellent idea and should be one way of engaging with young men and boys.
Q: Are young Aboriginal males still in one of the highest risk areas? It was here in the Goldfields of WA...I’m just wondering what your thoughts are with contributing factors such as AOD use, trans-generational trauma etc?
A: You obviously have thought about this a lot already and I know that many Aboriginal communities link high consumption of alcohol with high suicide rates. I know that was the outcome of a workshop recently conducted in the Kimberly area. Alcohol has a very potent association with suicide and suicide risk – stronger, in my opinion, than many aspects of mental health. For example, it is said that a person who is intoxicated from alcohol has a 90 times higher risk than a non-intoxicated person. In the Emergency Department of a public hospital, of those who present with attempted suicide, 60% or thereabouts have consumed high levels of alcohol in the previous 12 hours and I could go on with much more evidence. For example, Russia and similar countries have massive rates of alcohol consumption and extremely high rates of suicide. The other thing you mentioned was intergenerational, and of course this must have an effect, but that relates to intergenerational marginalisation and disadvantage and impoverished lives in which younger people feel they have no future. Unfortunately, this is what's happening to young Aboriginal males in many marginalised and remote communities.
Q: What can we do to assist in suicide prevention out in rural communities for farmers and other agricultural workers? We cannot realistically expect to 'reach' everybody with therapeutic help, so in what ways can you suggest that we can prevent suicides in rural communities?
A: One thing I've touched upon already is the consumption of alcohol. I'm not saying this is the main risk factor, but it is an important contributor to risk-taking behaviour in men in rural communities and I agree with you that this is not a question of providing services on their own - though of course that's important - but looking at those broader social and environmental factors that impact upon life in rural areas. The Australian Suicide Prevention Advisory Council (ASPAC) sees this as an important issue and we are commissioning work to look at the factors which constitute particular risks in rural communities because they're not all the same, and there are different segments of the rural population at higher risk than others. For example, agricultural workers have much higher rates than, say, business people working in rural areas. The risks are likely to be higher in impoverished townships and so on. I work as a doctor visiting a regional centre in NSW, where I see patients with drug and alcohol problems and mental health problems referred in from surrounding small townships and hamlets. My impression is that you can almost predict that some communities are going to have higher rates of problems than others. I don't want to labour the point too much, but it often seems to me it's a mix between nothing for young people to do mixed up with high availability of alcohol in those areas.
Q: As most participants in this chat would realise men are particularly vulnerable to taking their own life. It would seem to me that one of the most vulnerable times for men is when they experience (perhaps for the first time) the loss or grief from a failed relationship. This I believe is particularly a problem for young males, both Indigenous and non Indigenous. I would appreciate your comments on this and ask what strategies or resources there are in place that assist young men experiencing extreme grief and depression resulting from relationship breakdown?
A: The evidence is that severing of relationships is a critical trigger factor for mental distress in men and for suicide. I used the word trigger because it can be the end point of problems evolving over a long period of time in relationships. So clearly men do need support and help during these critical periods, as they are often perplexed and don't understand what has happened or why it has happened and it is an incredible loss, not only of a partner but often of children. One of the things that has been done in the last few years in Australia has been influencing the Family Court to be more understanding and responsive to the stresses and suicide risks at the time of separation. The evidence we have is that this has improved greatly as the Court has referred people on to other agencies and sought help for people in these circumstances.
Q: According to research undertaken in NSW by Kiriminia and colleagues (2007), the suicide risk for men is significantly higher in the first two weeks post release from prison than at any other time post release. What could be done better to reduce this risk for men in the first few weeks post prison release?
A: It is absolutely true that the risk of suicide immediately after leaving prison is extremely high and this has been shown by studies in NSW quite recently. However this question goes beyond the issue of the prison service and is also applicable to other facilities and services, especially mental health facilities. In the case of discharge from a mental facility, the risk of suicide is multiplied many times during that first two week period, so this is about transitions from institutional type settings, or care settings, back into the community. It's a risk period also for hospital discharge and discharge from a rehabilitation centre. What we need to do is establish 'a chain of care' which means that while the job at one link in the chain may be done and done quite well. For example in an emergency department the service and the staff have not done their job properly if they have not established a strong connection between the link they are involved with and the next link. The chain of care is only as strong as the connections it makes.
Q: What about child protection and early prevention from abuse? I have heard that children who have suffered traumatic experiences and/or have disorganised attachments to their primary caregivers are at an increased risk of developing mental health problems such as PTSD and depression, all of which can increase the risk of suicide. Do you think that the Australian CPS (Child Protection Service), as Dorothy Scott I think says, should seek out at-risk children and have a fences at the cliff rather than a net at the bottom?
A: You've got the answers to your question, in your question. There is no doubt that the trajectory to suicide risk and to many other problems in adolescence and adult life start in childhood, and inadequate care and of course more seriously child abuse is one of the strongest predictors of these adverse outcomes in youth and early adult life. It does mean, as you say, that our interventions should be much more anticipatory than reactive as so often happens now. If you look at the National Drug Strategy, the National Mental Health Plan, the National Crime Prevention Strategy, the National Indigenous Health Strategy and many other national approaches to problems of living in our society, they all start speaking about early childhood development, the role of the family, the need for supportive communities and so on, all with the aim of trying to create resilient young people and to build protective factors into their lives. In my opinion this is the greatest challenge to our society, and it is at this level that suicide prevention and the prevention of many other harmful things later in life can be most effective, but it is the most difficult to implement because it demands a much more generous, caring and thoughtful approach of society and communities towards young people and evolving families.