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FLO: Pasifika for Life

Pasifika community perspectives on suicide prevention in New Zealand

ISBN 978-1-877537-18-9

Le Va. (2014). FLO: Pasifika for Life – Pasifika

community perspectives on suicide prevention in

New Zealand. Auckland, New Zealand: Le Va.

This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from Pacific Inc. Ltd.

© Pacific Inc. Ltd. (2014)


Pasifika community perspectives on suicide prevention in New Zealand

Contents

Acknowledging the ef forts of many .....................................................................................5

At a glance..............................................................................................................................6

Outcomes at a glance ............................................................................................................8

1. Purpose ........................................................................................9Background ..................................................................................................................... 9

Context ............................................................................................................................ 12

FLO: Pasifika for Life ....................................................................................................... 13

Engaging communities .................................................................................................. 14

2. Method .......................................................................................15Pasifika theoretical frameworks .................................................................................. 15

Community fono approach ............................................................................................ 16

Process ............................................................................................................................. 18

Analysis ........................................................................................................................... 19

3. Findings .......................................................................................20Fono locations ................................................................................................................ 20

Fono attendees ............................................................................................................... 22

What people said ............................................................................................................ 23

4. Outcomes ....................................................................................32It’s time to talk ................................................................................................................ 32

Appropriate resources are required ............................................................................. 33

Appropriate community education is required ........................................................... 33

5. Conclusion ...................................................................................34

Endnotes ................................................................................................................................35

4

O le fogava’a e tasi:

we are on the same deck of the ship.”

“

5

Acknowledging the efforts of many

So many of us have experienced the shock and sadness of losing someone who has taken their own life and we want to acknowledge the Pasifika families and communities that have lost a loved one. Our thoughts and prayers are with you. The reality facing many of our communities is a failure to provide an environment where the most vulnerable people feel safe, valued and connected.

We are grateful for the opportunity to explore what humble contribution we may of fer to the issue of suicide and its prevention within Pasifika communities. We must acknowledge that tackling this issue is not just beginning – many courageous volunteers, workers and organisations have walked alongside Pasifika communities to address suicide and its impact, support those who have lost friends and family, and further prevent suicide. We are thankful for your ef forts, and hope to build upon your experiences and endeavors.

We would like to sincerely thank all the people, families and communities that have given generously of their time to attend the Pasifika suicide prevention fono throughout New Zealand.

In particular, thank you to the members of the FLO suicide prevention ambassadors network (Rev. Veitomoni Siufaga, Phylesha Brown-Acton, Albert Fale, Josiah Teokotai, Memea Eleitino Ma’aelopa Siania, Lani Alo, Liku’one Latu, Epenesa Ana Elisara, ‘Alisi Tatafu, Te Hiwi Preston and Mere Ratuva), and the following community groups that facilitated, organised and ran many of our community fono meetings – your contributions and support are so valuable.

• Toko Collaboration.

• Langimalie Health Clinic.

• The Pacific Island Safety and Prevention Project Inc (The Project).

• Genetics Gym Manukau.

• Strive Community Trust (Youth Health Provider Network).

• Pacific services, Hawke’s Bay District Health Board region.

• South Waikato Pacific Islands Community Services.

• Kaute Pasifika Trust.

• Pacific Trust Canterbury.

• The Family Centre.

Thank you to Le Va’s cultural and spiritual protectors and advisors, the Northern Region Matua Advisory Group. We are privileged to have your guidance and support.

• Matua Levaopolo Seupule Tiava’asu’e – Samoa (advisory group chair and Le Va matua)

• Matua Bill Teariki – Cook Islands

• Matua Rev Elder Suamalie – Tuvalu/Tokelau

• Matua Neville Luisi – Niue

• Matua Kupu Kaulaga – Tonga

• Matua Qoriniasi Tuifagalele – Fiji

• Matua Maiava Koroseta – Samoa

• Matua Papali’i Seiuli Johnny Siaosi – Samoa (consumer advisor).

Le Va acknowledges report contributors Dr Gerhard Sundborn, Dr Monique Faleafa, Denise Kingi-‘Ulu’ave and Abba Fidow, as well as community facilitation undertaken by Jay Williams, Pauline Taufa and Saveatama Eroni Clarke, and research by Dr Jemaima Tiatia-Seath.

And finally we would like to acknowledge the Waka Hourua leadership group and support from Te Rau Matatini and the Ministry of Health. We appreciate your well-considered direction and willingness to support innovation and culturally relevant approaches and solutions to suicide prevention.

As the Samoan proverb “o le fogava’a e tasi” implies, there is strength in unity of purpose. When it comes to preventing suicide in our Pasifika communities we are all on the same deck of the same ship – working together to save lives, foster resilience, and hope for a better future.

6

At a glance

Every suicide is a tragedy that has long lasting ef fects on families and communities.

There is concern that suicidal behaviour is increasing in Pasifika communities in New Zealand. Pasifika peoples have higher rates of suicidal ideation, suicide plans and suicide attempts than all other ethnic groups in New Zealand.

Te Rau Matatini and Le Va deliver Waka Hourua: National Suicide Prevention Programme for Māori and Pasifika Communities on behalf of the Ministry of Health and contributing to the Suicide Prevention Action Plan 2013-16; to support Māori whānau, hapū, iwi, Pasifika families and communities to develop solutions to suicide prevention.

Le Va’s programme FLO: Pasifika for Life is New Zealand’s first national Pasifika suicide prevention programme. It aims to build strong, resilient Pasifika families and communities, address at-risk groups within Pasifika communities and assist Pasifika families who have been impacted by suicide.

Community engagement is key to suicide prevention and is one of four workstreams within the FLO programme, which aims to enhance understanding of Pasifika suicide and suicide prevention, empower communities to lead initiatives, and prioritise ethnic specific, youth specific and rainbow Pasifika groups so that they are enabled to seek their own solutions.

Overall, 15 community fono were facilitated across New Zealand between May and October 2014, with approximately 400 attendees. The process for facilitating these conversations around suicide and suicide prevention is as important as the outcomes. There is limited evidence investigating utility, impact and risks surrounding community level conversations about suicide and suicide prevention – with next to no published evidence specified for Pasifika communities. Robust protocols and processes were developed and considered good practice.

This report describes themes and results from the FLO programme community fono, but should not be considered representative of all Pasifika communities nor limit the wide range of perspectives on suicide prevention for Pasifika.

In summary, the findings from 15 community fono with approximately 400 Pasifika participants indicated that Pasifika communities are ready to talk about suicide, with the right resources and appropriate education.

7

15 Fono across New Zealand

Male

64%Female

36%< 25 years

36%26-44 years

38%+ 44 years

26%

394 people

1 Tokoroa

1 Hawke’s Bay

2 Wellington

1 Christchurch

1 Dunedin

8 Auckland

1 Hamilton

28% - Samoan

15% - Cook Islands

20% - Tongan

5% - Niue

7% - Fijian

4% - Tokelau

9% - Maori

10% - NZ European2% - Other

8

Outcomes at a glance

It’s time to talk – suicide and suicide prevention are important to talk about within our families and communities. Approaches on how to talk about it were based on ef fective communications skills and building trusting relationships, particularly strengthening family relationships. From a community perspective church, sport, culture and the arts were referred to as vehicles to open conversations about suicide prevention. However, rainbow Pasifika young people may be disempowered to have a voice to talk about suicide.

Appropriate resources are required – overall, the top three preferred resource types for Pasifika suicide prevention are face to face workshops, large scale campaigns and social media. Young people however preferred social media. The content of resources should emphasise a resiliency and strengths based approach and at the same time be realistic and factual.

Performing arts, church, family, school settings, TV and radio were identified as useful settings to target suicide prevention resources.

Appropriate community education is required – face to face workshops were the most preferred medium by far for suicide prevention training and/or education, followed by online and combined face to face and online. Education should be carried out by community people empowered with knowledge to share with others within their communities.

In addition to the above findings, there were emerging focal points that communities identified required attention in relation to suicide prevention programmes for Pasifika.

1. Pasifika churches and clergy can play a significant role in communicating safe and appropriate suicide prevention messages and ultimately influence how those conversations may be accepted by many of our Pasifika communities. A coordinated approach, co-created and co-led by church leaders is required to communicate the right messages to Pasifika communities.

2. Avenues should be explored to improve the current approach to suicide prevention and postvention in secondary schools (concerns were raised on numerous occasions regarding dissatisfaction with current responses which appeared as ad-hoc and inconsistent).

3. Better understanding of all services involved in suicide prevention and postvention, and how these services coordinate in responding to Pasifika communities is essential.

4. Pasifika communities should be regularly engaged and informed about resources, information and progress in addressing Pasifika suicide prevention. Pasifika communities feel that suicide prevention needs to be led and driven by and with Pasifika communities.

9

Background

Every year approximately 500 New Zealanders take their own lives by suicide. In 2011 there were 2,647 admissions to hospital (that lasted more than 48 hours) for suicide attempts in New Zealand, which equated to 61.1 hospitalisations per 100,000 population (age standardised).1 Every life is a life lost, and suicide in New Zealand is an ethnically disproportionate issue. One in five people who die by suicide are Māori, and suicide death rates for Māori youth are two and a half times higher than those for non-Māori youth. There is growing concern that suicidal behaviour is increasing in Pasifika communities in New Zealand. Pasifika peoples have higher rates of suicidal ideation, suicide plans and suicide attempts than all other ethnic groups in New Zealand. In fact, Pasifika peoples have a 12-month prevalence of suicide attempts that is three times the rate of the general population.2

Pasifika people living in

New ZealandFrom 1945 to 2013 the Pasifika population in New Zealand grew from 2,200 to 295,941, representing 7.4 per cent of the total New Zealand population.3 This growth is largely concentrated in Auckland, with two thirds of all Pasifika people living in the Auckland region. A similar number of Pasifika people are New Zealand-born (62.3 per cent or 181,791 people), while half of all Pasifika people are under the age of 20, and just over a third (35 per cent) are aged 0-14 (a higher proportion than all other New Zealand ethnic groups).

Importantly, the Pasifika population in New Zealand is highly diverse and made up of many dif ferent ethnic groups. The largest Pasifika ethnic group in New Zealand is Samoan, followed by Cook Islands, Tongan and then Niuean. Although these ethnic groups have similarities, each group is unique with its own cultural beliefs, values, traditions, language, social structure and history. It is therefore important to acknowledge that there is no generic ‘Pasifika community’, but rather Pasifika peoples who align themselves variously depending on social and cultural circumstances.

1. Purpose

10

In 2011 there were 24 suicides of Pasifika people (15 male and 9 female) in New Zealand, while 92 intentional self-harm hospitalisations of Pasifika people (lasting more than 48 hours) were recorded.

A 2011 report on health and Pacific peoples in New Zealand noted that in 2006, a greater proportion of Pasifika peoples had considered (16.9 per cent compared to 15.7 per cent) or attempted (4.8 per cent compared to 4.5 per cent) suicide compared to the overall population.4 The report also noted that more Pasifika females compared to males had considered suicide, and had made suicide attempts, while those aged 16–24 had considered suicide and attempted suicide the most, which is consistent with the total population.5

Pasifika suicide prevention approach

The United States, England, Scotland, Australia, New Zealand, Finland and Norway have comprehensive national suicide prevention strategies with a public health approach. They have a number of commonalities which include:

• using educational settings as sites of intervention

• promotion of research on suicide and suicide prevention

• attempts to change the portrayal of suicidal behaviours and mental illness in the media

• ef forts to increase and improve the detection and treatment of depression and other mental health disorders

• emphasis on reducing the stigma associated with help-seeking behaviours

• strategies designed to improve access to services

• promotion of ef fective preventative ef forts with rigorous evaluation

• ef forts to reduce access to suicide means.5

In light of these strategies, it is important to establish what the priorities are for Pasifika suicide prevention. Traditional Pasifika values and beliefs incorporate key principles of love, respect, humility, caring, reciprocity, spirituality, humour, unity and belief in the importance of family.

The fundamental beliefs are that Pasifika peoples traditionally view health holistically (that is, inclusive of spiritual, physical, emotional and mental dimensions) and that health is a family concern rather than an individual matter. These fundamental beliefs exude a relationship focus (including acknowledgement of communities), and the use of Pasifika languages and cultural practices.6

Samoan Cook Islands Maori Tongan

Niuean Fijian Tokelauan Tuvaluan

New Zealand Pacific

Population

Source: Statistics New Zealand

11

Approaches to consider for

Pasifika postventionReducing suicide requires dedication to intervention at all levels of the mental health system. Postvention activities seeking to inhibit suicide contagion are a vital component.7

For one suicide death, at least six others are severely impacted by grief.8 For traditionally collective communities such as Pasifika, the numbers impacted may be higher. These people impacted have an increased risk for suicide, between 2 and 10 times higher than the general population.9 Heightened stress augments vulnerability.10 Grief, stigma, isolation, shame and self-blame result in a state of increased stress and are some of the major factors impacting those bereaved by suicide.

A structured and feasible method for provision of postvention services and referrals is required to support those bereaved by suicide to cope with loss, and decrease risk factors associated with further distress. The issue of access to appropriate resources for those bereaved by suicide has been implicated by inadequate referral systems that fail for many who have lost a loved one.11 As there appear to be no Pasifika focused postvention initiatives, the following suicide prevention approaches may also be helpful towards the development of Pasifika focused postvention strategies.

Preventing suicide for Pasifika The reasons people attempt to take their own life are complex and there can be many contributing factors. We can all play our part in preventing suicide by learning how to identify when people need support, and speaking up when we need help.

To understand how to prevent suicide, we need to know what puts people at risk (risk factors), what we can do to protect people from these risks (protective factors) and how to recognise and respond to warning signs. Risk and protective factors can be influenced by many things, including people’s individual characteristics, friendships, mental health, family relationships, employment situation, or their home, school or work environment. Based on research and clinical and technical expertise, some examples of risk and protective factors for Pasifika are noted below.

Examples of risk factors for Pasifika communities

Examples of protective factors that improve our ability to cope

Poor mental and/or physical health. Social connectedness.

Exposure to violence, trauma or abuse. Secure cultural identity.

Failure to meet unrealistic expectations. Spirituality.

Conflict about sexual identity. Church participation.

Unemployment. Supportive family.

Alcohol and drug misuse. Problem solving skills.

Intergenerational misunderstandings. Access to support and help.

Sense of shame. Self-esteem and a sense of belonging.

Relationship problems. Meaningful contribution.

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Context

The Ministry of Health’s New Zealand Suicide Prevention Strategy 2006-2016 guides cross-government suicide prevention ef forts, and recognises that suicide deaths and instances of intentional self-harm are preventable.

In January 2014, Le Va joined with Māori workforce development organisation Te Rau Matatini to deliver the National Suicide Prevention Programme for Māori and Pasifika Communities (known as Waka Hourua). Le Va leads implementation of the Pasifika community programme within Waka Hourua, while Te Rau Matatini is responsible for the Māori community programme, as well as the overall programme.

Waka Hourua activities align with Action Item 1.1 of the Suicide Prevention Action Plan 2013-16; to support Māori whānau, hapū, iwi, Pasifika families and communities to develop solutions to suicide prevention through:

• building the capacity and capability of Māori whānau, hapū, iwi, Pasifika families and communities, to prevent suicide and to respond safely and ef fectively when and if suicide occurs

• ensuring that culturally relevant education and training is available to Māori whānau, hapū, iwi, Pasifika families and communities that focus on building resilience and leadership

• building the evidence base of what works for Māori whānau, hapū, iwi, Pasifika families and communities to prevent suicide, through research carried out by, with and for these groups

• building the leadership for suicide prevention.

Te Rau Matatini and Le Va are approaching this through four workstreams:

• national coordination centre• leadership group• Māori community programme• Pasifika community programme.

The Pasifika community programme is named FLO: Pasifika for Life.

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Engage

Equip

Lead

Inform

Pasifika families and communities know how to prevent suicide and

respond in the right way if it occurs.

Pasifika families and communities, and people who work with them, have access to effective tools, resources and training.

Quality research and information

is available to support Pasifika

suicide prevention initiatives.

Pasifika communities

know where to go for support and

have inspirational leaders promoting suicide prevention

and resiliency.

1. 2.

3.4.


As a national Pasifika non-government organisation, Le Va’s purpose is to create opportunities for Pasifika families and communities to flourish through embracing Pasifika solutions. Le Va takes a holistic perspective to health and wellbeing, encompassing the physical, mental, social, cultural and spiritual dimensions of wellbeing. FLO is New Zealand’s first ever national Pasifika suicide prevention programme. It aims to build strong, resilient Pasifika families and communities, address at-risk groups within Pasifika communities and assist Pasifika families who have been impacted by suicide.

FLO refers to ‘for life’ and the O symbolises our ‘flow’. Flow is the reciprocal interaction that we have in our relationships with friends, family, community and environment. Flow happens in the va - the relational space between people. Smooth flow happens when we communicate well, have strong cultural identity,

connect with others, strengthen family, and find hope and courage through spirituality. These are our top 5 tactics12 for life that help our Pasifika families and communities to flourish.

The FLO programme consists of four streams that are interconnected and interdependent.

14

Engaging communities

It is well recognised that community engagement is key to suicide prevention. The aim of the ’engage’ stream of work is that Pasifika families and communities know how to prevent suicide and respond in the right way if it occurs. In order to achieve this aim, the objectives are to:

• enhance understanding of Pasifika suicide and suicide prevention

• empower communities to lead initiatives

• prioritise ethnic specific, youth specific and rainbow Pasifika groups, so that they are empowered to seek their own solutions.

In tandem with facilitating ethnic specific, youth specific and rainbow Pasifika community fono, Le Va has been:

• engaging communities by developing a suite of useful and relevant Pasifika suicide prevention resources

• assessing, selecting, managing and funding 17 Pasifika suicide prevention initiatives that are addressing suicide from within their communities

• developing and funding quality research to inform communities about FLO and its implementation

• supporting and developing the national FLO suicide prevention ambassadors network to champion Pasifika suicide prevention.

Community fono aimsThe series of Pasifika community fono held through New Zealand were developed as part of the ’engage’ stream of the FLO programme. The community fono aimed to:

• support safe consultation with specific Pasifika community groups on the FLO programme, and how it might be implemented

• raise awareness of current evidence and information about suicide and suicide prevention relevant to Pasifika communities, including where to find help

• gather feedback and guidance from communities on training and education needs

• highlight champions for ongoing consultation, training, community leadership and community development.

15

2. Method Le Va is aware of Pasifika frameworks in existence, and endeavours to include these in its work. We have selected two specific research frameworks that reflect our process in this particular project.

Pasifika theoretical frameworks

Two Pasifika theoretical frameworks were used during this process to guide the design, methodology, information collection and dissemination of results. A combination of Teremoana Maua-Hodge’s Tivaevae Model and Konai Helu Thaman’s metaphor of ‘Kakala’ were woven together to develop this appropriate cultural theoretical approach.

The Kakala Model13 is based on Tongan values and principles of reciprocity, sharing, respect, collectivism and context-specific skills and knowledge whereby the processes involved in research are likened to the processes involved in the making of kakala (garland). These processes include the following.

• Toli refers to gathering of material to make the kakala. This involved the Le Va team,

FLO ambassadors and community leaders engaging with our communities, gathering and reviewing their knowledge and preparing it for analysis.

• Tui is the actual making or weaving of the kakala and requires special knowledge and skills of dif ferent types of kakala depending on the occasion and who will wear it. It is the actual process of putting together the information collected, discussing results and presenting them in the form of a final report.

• Luva is the final process and involves the giving away or presentation of the kakala. It is based on sacred values of fa (respect) and ofa (compassion) for whom the kakala is made. In this Tongan perspective, the kakala

16

is never made for the weaver (the researcher or clinician) to wear, rather, it is always made to be given away. This is an important stage in the process where the information is returned to participants, communities and key stakeholders to say thank you, and so that it can be useful.

Teremoana Maua-Hodges’ Tivaevae Model14 has also been incorporated into our approach and provides a useful framework for the work of the diverse team. It uses processes followed by Cook Island women to make a tivaevae or quilt. One person has the design and allocates dif ferent roles and responsibilities to other women in the group. Each has specific tasks to accomplish. Working together as a team ensured that all patterns and parts of the tivaevae will be sewn together in the appropriate way to produce a final, high quality report.

Community fono approach

There is limited evidence investigating utility, impact and risks surrounding community level conversations about suicide and suicide prevention – with next to no published evidence specified for Pasifika communities.15 New Zealand reviews have found that although no research evidence exists, there is strong support from professional guidelines that no risk exists when asking about suicidality.16

There is however international guidance identifying that the way the issue of suicide is discussed is vital, and should therefore be well planned and monitored with clear intended outcomes and experienced and skilled facilitators. While conversations can inform and educate audiences, if not handled well they may also upset, alienate or increase risk for some individuals in the audience.17 Although there are no guidelines for Pasifika communities, the Le Va FLO team referred to the Hunter Institute of Mental Health Australian-based ‘Conversations Matter’18 guidelines, in combination with local Pasifika clinical and cultural expertise to develop its own robust protocols and processes.

Prior to any community fono taking place, planning and preparation was extensive. The Le Va FLO team ensured the following responsibilities were carried out.

• FLO ambassadors and Le Va staf f completed the ASIST 2-day suicide intervention training programme in early May 2014, prior to the first community fono.

• Pasifika clinical psychologists and clinicians were available at all times to advise on safety and risk regarding fono programme content and process.

• Facilitators’ guidelines and fono protocol were developed by FLO staf f, clinical psychologists and FLO ambassadors (including cultural expertise). For example, at least two facilitators were allocated to each fono with one clinical psychologist. Facilitators who could speak the language lead ethnic specific fono. Guidelines were based on Australian best practice guides and adapted to the local and cultural contexts.19

• Facilitators were trained to lead the workshops and provided with a standardised presentation package to ensure consistency. Weekly feedback meetings were held by the FLO team.

• Resources tailored for Pasifika communities were developed and promoted to ensure appropriate information about suicide, suicide prevention and where to find help.

• Lifeline New Zealand was notified that the fono were taking place and Pasifika language speaking helpline counsellors were available if required.

• Fono programme and questions were developed by FLO staf f, clinical psychologists and FLO ambassadors (including cultural expertise). They were based on Australian best practice group discussion factsheet and ensured the following ‘things to remember’ were considered.20

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Things to remember

✓ ensure there is a clear purpose for the discussion

✓ think about the format of the discussion

✓give advance notice and be clear about expectations

✓plan how personal stories are used

✓use an experienced facilitator who is appropriate for the audience

✓ focus on increasing knowledge and skills

✓ avoid simplistic explanations about why suicide occurs and be accurate

✓ choose words carefully

✓ limit discussion about methods of harm

✓handle the discussion sensitively

✓ encourage people to seek help

✓ learn about other services and resources.

Source - Factsheet: Conversations Matter when running group discussions about suicide prevention

conversationsmatter.com.au

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Process

Fif teen fono were facilitated across New Zealand between 27 May 2014 and 16 October 2014. Approximately 400 people attended the community fono, reflecting the diversity of the Pasifika population in New Zealand, as well as those working with Pasifika communities in the area of suicide prevention. Targeted fono focused on the larger Pasifika populations (Samoan, Cook Islands, Tongan, Niuean, Fijian and Tokelauan), Pasifika rainbow community (LGBTIQ ) and Pasifika young people. Geographic locations with higher Pasifika populations were prioritised (Auckland, Hamilton, Wellington and Christchurch), as well as apparent higher need locations such as Otago and Hawke’s Bay regions.

Where possible, FLO ambassadors or community-based organisations led and facilitated the meetings, and were supported by the FLO team and Le Va staf f. For most fono, attendee numbers were kept under 30, so that any sensitive issues arising could be addressed individually or in small groups, and the ratio of facilitators and support people was manageable. For this reason, the community fono were not actively advertised or promoted widely, and FLO ambassadors and community leaders purposively sampled, inviting networks.

Each fono was carried out as close to the planned programme as possible (where practicable) for consistency and with appropriate food provided. Fono were scheduled for evenings and weekends for accessibility, had a Pasifika clinical psychologist present (and available post-fono), and were conducted mostly in English with intermittent Pasifika languages used at the ethnic-specific fono.

The aim of the fono was to consult with specific community groups to identify:

• how we can talk safely about suicide and suicide prevention

• ef fective resources that would assist Pasifika communities to enhance their understanding of suicide and suicide prevention and also increase help seeking behaviour

• guidance on training and education needs

• champions for ongoing consultation, training, community leadership and community development.

Open-ended qualitative questions for group break-out sessions were developed based on the above aims. General overarching questions were asked, with prompting questions to take a deeper focus where necessary. In addition, a 10 minute quantitative questionnaire based on the fono aims was also distributed prior to the start of the fono, to gather attendees’ thoughts prior to the fono start. These questionnaires outlined that information was confidential and anonymous, with permission slips for use of any information gathered.

As per international guidelines, appropriate resources were developed and promoted to:

• inform fono attendees of the current evidence and information about suicide and suicide prevention relevant to Pasifika communities

• increase knowledge and skills and ensure an accurate snapshot of information was provided

• provide useful information about suicide prevention and where to find appropriate help.

19

Analysis

Af ter completion of registration, and prior the of ficial start of the fono, a short questionnaire (with explanation) was given to participants to voluntarily complete. Quantitative information and demographic data were collected via the questionnaire, which included a seven-point Likert scale for most questions related to talking about suicide, suicide prevention, resources and training. Data was categorised, analysed via descriptive statistics and presented in tables and graphs.

During fono, break-out groups were formed to discuss open-ended questions related to the aims of the fono and presented back to the wider group. Break-out groups were largely organised into ethnicity, gender and age. Young people were largely allocated to the same group to encourage feedback amongst peers in a safe format. Group notes were recorded as qualitative data as well as verbatim quotes recorded by note-takers (some fono were audio recorded, while notes were taken at others). Data was examined and common emerging themes were loosely categorised via thematic analysis. Results are provided via provision of relevant quotes to complement and enhance quantitative results.

About fono findingsThis report compiles results and describes themes from the FLO suicide prevention programme community fono. It is not representative of all Pasifika community perspectives – it is intended only as a starting point, and should not limit the range of issues that may be raised around suicide and suicide prevention for Pasifika communities.

The intended audiences for this report are primarily those who attended and contributed at each fono, and for people and organisations wishing to be informed of Pasifika perspectives for suicide prevention. We acknowledge and are attempting to act consistently with the Kakala Model (particularly the Luva process), ensuring that information received from communities is given back through meaningful, face-to-face engagement. This engagement will disseminate results, as well as explain how information will be used.

20

Fono locations

In total 15 community fono were held, with 394 attendees. A total of 331 questionnaires were completed by attendees, giving an 84 per cent response rate. Two other fono were held but not recorded in results due to deviation from methodology.

3. Findings

15 fono

394 people

331 responses

84%response rate

21

Pasifika

Host: Epi Elisara, Lani Alo (FLO ambassadors)

36 attendees / 32 responses

Tongan

Host: Toko Collaboration and Langimalie Health Clinic


Rainbow

Host: The Project (NGO)


Cook Islands

Host: FLO team and Cook Islands community representative


Pasifika

Host: Genetics Gym


Fijian

Host: Mere Ratuva (FLO ambassador)


Pasifika youth

Host: Youth Health Provider Network


Pasifika

Host: Reverend Veitomoni Siufaga (FLO ambassador) and Kaute Pasifika Trust


Pasifika

Host: Pacific Trust Canterbury


Pasifika

Host: Pacific service, Hawke’s Bay DHB


Pasifika

Host: Nathaniel Lees and FLO team

9 attendees

Pasifika

Host: Josiah Teokotai (FLO ambassador) and South Waikato Pacific Islands Community Services


Tokelau, Cook Island, Samoan, Tongan and Fijian

Host: The Family Centre


Pasifika

Host: FLO team

5 responses

Niue youth

Host: Niuean Teachers Association/Niuean community representative


22

Fono attendees

At least 394 people attended the fono overall with 331 people responding to the questionnaire (others attended the fono but did not wish to formally record their attendance). Of people who completed the questionnaire, there was stronger representation

from women (63 per cent) at all community fono – comprising nearly two-thirds of all responses. There was also high representation from people in the older age groups.

114: male

207: female

99 Samoan: 28%52 Cook Islands: 15%68 Tongan: 20%17 Niue: 5%26 Fijian: 7.5%12 Tokelau: 3.5%31 Maori: 9%34 NZ European: 10%7 Other: 2%

64%

7: other

2%

3: unanswered

1%

35%82: 16 - 25 year olds

49: 26 - 35 year olds

15%

63: 36 - 45 year olds

119: 46+ year olds

18: not specified

5%

25%

19%

36%

*Ethnicity has been recorded using Total Response output method which allows an individual to be counted for each ethnic group they have identified with. This means that the sum of the ethnic groups will be greater than the number of people.21

23

What people said

Eight questions were asked via the questionnaire and during the fono to determine the attendees’ thoughts and perspectives on suicide and suicide prevention, as well as their perceptions of their wider communities. This information (along with notes from each fono) has been summarised below.

The importance of talking about

suicide and suicide preventionIn Pasifika communities fear, stigma related to culture or religion, and sometimes lack of knowledge can make it dif ficult for some people to talk openly about the issue of suicide. Yet many Pasifika people and communities want the opportunity to talk about suicide and suicide prevention.

Figure 1 below summarises the findings from questions regarding talking about suicide, which is presented for the Pasifika rainbow community, younger adults (16-25 years), older adults (25+ years) and for the total sample.

The overall pattern of results showed that participants strongly agreed that suicide and suicide prevention is important to talk about. To a lesser degree they agreed they can talk safely about suicide and suicide prevention – particularly for rainbow Pasifika and young people.

Figure 1: Agreement on statements on importance to talk and community acknowledgment of suicide and suicide prevention.

Participants strongly agreed that suicide and suicide prevention is important to talk about.”

“

Rainbow

It is important to talk about suicide

My community think it is important to talk

about suicide

My community has acknowledged that

suicide is an issue

6.7

5.3 5.5

Stro

ngly

disa

gree

Stro

ngly

agre

e

Young adults

Older adults

Total

24

Rainbow

I can talk about suicide prevention in an informed

and safe manner

My community can talk about suicide prevention in an

informed and safe manner

5.7

4.9

Stro

ngly

disa

gree

Stro

ngly

agre

eYoung adults

Older adults

Total

Figure 2: Agreement on statements on confidence to talk in an informed and safe manner.

Participants were also asked to rate the level to which they agreed with the following statements.

• Pasifika families and communities need more training and education on suicide prevention.

• There is a need for Pasifika suicide prevention resources.

There was strong agreement to both of these statements, with a total average of 6.6 and 6.7 respectively (7 = strongly disagree, 1 = strongly disagree). There was little dif ference in the level of agreement for rainbow or age stratified groups.

It was acknowledged at all community fono that suicide was an important issue in Pasifika communities that needs to be addressed:

“…no matter what your background is, no matter how loved your children are, no matter how much information is shared, sometimes our children just become so sad that they consider this option.” - Fiji community fono

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All comments regarding talking about suicide were positive – that it’s time to talk:

“It is important that the community is made to feel that it is OK to talk about suicide.” - clergy, Hamilton fono

“It is important to be explicit when speaking of suicide, because the subject was once tapu [sacred ; implied prohibition; spiritual restriction] but it is now apparent it needs to become noa [a blessing to lift tapu]. This is because where once life was tapu it is evident, particularly with young people, that they consider their lives noa.” - Cook Islands community fono

“Keeping someone safe is more important than fears of getting involved.” - Hamilton fono

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How to talk about itWhen prompted on how we should talk about suicide and suicide prevention, specific characteristics were outlined (in order of most common responses).

“…build trusting relationships with family and friends.”

“…communicate with people and just listen.”

“…ensuring a safe environment for children.”

Be “open minded”, “non-judgmental”, “sensitive” and “open-hearted”.

“…employ the correct language.” It was noted in some ethnic specific fono that “there is no word for suicide” in their Pasifika language, “only words that explain the specific act”. It was also noted that language should be adapted when talking to young people.

Family relationships (in particular, trusting relationships) was by far the most reported attribute to focus on in order to enhance communication and lead to openly talking about suicide and suicide prevention.

“…every child has the right to be loved and home is where this starts, so we need to strengthen family.”

“…the bottom line is that everything our young people need to succeed in life is already built in to them. So we must provide an environment where this beauty inside them can be released, and this mana [spiritual essence] recognised.”

“Men need to step up. Our men need to live their role as head of the family, build relationships between father and daughter and between father and son.” - Fijian community fono

Spirituality and the church featured a lot in the discussion on how to talk, to be utilised as a vehicle to open the conversation.

“There is a need to start open discussions from churches and the pulpit, so that congregations feel sanctioned to talk more openly about suicide without fear of criticism.” - Auckland community fono

“We need to approach church groups. There are existing church groups like mine that want to support our congregations, and we need help with talking about suicide in our churches, and talking to our youth leaders.”

“We want to be able to talk to our youth about suicide but we are not sure how. We want to know how. Our church is in a similar position where we don’t know what to do, we don’t even know where to start and need support.”

Not all agreed with church as a vehicle. Sport, culture and the arts were other vehicles and modes of talking about suicide and suicide prevention identified uniquely for Pasifika communities.

“As much as I respect church and our culture we know a lot of our young people don’t quite engage with our culture and don’t even go to church. So how do we engage them?”

“Polyfest is an amazing cultural experience and we need to engage and promote cultural identity through these events so our young people know who they are.”

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“Music, celebrities and sport… If we are not engaging all young people through culture and church, these are good vehicles… rugby league and other sports clubs are a place to support our young people to be part of communities and families.”

“Using the arts and music as a way of sending messages around this issue.”

When the questions about talking about suicide are stratified by gender and age there are noticeable dif ferences seen between the younger and older Rainbow community in particular, when compared to other groups (Table 1). There were no significant dif ferences when stratified by ethnicity.

When we look at the responses of our rainbow community by age there are noticeable dif ferences to a number of questions that are not found for the male and female groups. In particular older rainbow members were most agreeable that it is important to talk about suicide (which may reflect their knowledge of the issue within their community). Rainbow youth were notably the least agreeable with the statement ‘My community thinks it is important to talk about suicide’. Similarly, rainbow youth were least agreeable that their community have acknowledged suicide as an issue. The statement ‘I can talk safely about suicide’ scored the lowest for rainbow youth (4) however the older rainbow participants were most confident of all groups. This question in particular shows how these groups are quite dif ferent and these dif ferences will need to be understood and acknowledged when

planning any rainbow-specific engagement, resources and possibly training. Finally, rainbow youth were also least agreeable with the statement ‘My community can talk safely about suicide’.

Conversations in the rainbow Pasifika fono highlighted how these communities may be our most disempowered or at risk Pasifika communities.

“How do we address an issue when our community is invisible? How do we champion our own voice around reinforcing positive messages?”

“There is a real need to identify what our community looks like and target our Pacific communities where suicide is not a topic of discussion, to empower and encourage these conversations to take place.”

7 = Strongly agree, 1 = Strongly disagree Rainbow Male Female

Youth Adults Youth Adults Youth Adults

Important to talk about suicide 6.5 7 6.5 6.7 6.5 6.8

My community thinks it is important to talk about suicide 4.5 5.1 5.4 5.5 5 5.3

My community acknowledged suicide is an issue 4.5 5.3 5.5 5.6 5.5 5.4

I can talk safely about suicide 4 6.2 5.2 5.7 5.3 5.9

My community can talk safely about suicide 3.9 5 4.5 5.1 4.7 4.9

Table 1: Talking about suicide by gender and age.

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Useful types of suicide

prevention resourcesThe total sample strongly agreed (6.7 out of 7) that Pasifika suicide prevention resources are needed for Pasifika communities. Overall, total responses show that the top three preferred resource types for Pasifika suicide prevention are face to face workshops, television based campaigns and social media, as illustrated in Figure 3.

When considering age, there was no change in the top three priorities, however, there was in their order. The younger (≤25 years) age group preferred social media initiatives as the leading priority (22.2 per cent) followed by television based campaigns (20 per cent) and then face to face workshops (19.8 per cent).

In the qualitative information gathered at the fono, social media was the most reported preferred type of resource.

Approximately 15 per cent (15.3 per cent) indicated a combination of internet-based resources as the next highest preference (a dedicated website 9.5 per cent and other online resources 5.8 per cent) followed by a radio based campaign (8.5 per cent).

The majority of responses that described the ‘other’ category in more detail included performing arts type resources as useful. Church, family and school settings were also identified in this category as useful settings to target suicide prevention resources.

Rainbow Young adults Older adults Total

Pamphlet Website Booklet Helpcards

Print media

Radiocampaign

TV campaign

Face toface

workshop

Online Socialmedia

Other

5.5

4 3.9

8.5

17.9

20.9

5.8

17.5

5.1

9.5

2.4

Figure 3: Proportion (%) of total responses that identify most useful type of suicide prevention resources needed.

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When prompted on the content of the Le Va FLO resources (booklets, wallet card, posters and healing stories videos) provided at the fonos, participants generally approved. An overarching emerging theme was the need to further emphasise resiliency and a strengths based approach.

“Information should have a focus on protective factors. Creating forums to teach or educate the community about the signs to watch out for and the steps to take to prevent suicide from happening.”

“We need to celebrate the good stuf f, foster confidence, encourage citizenship – a feeling of belonging – we need to build on our strengths rather than messages filled with statistics.”

“We want to see more survival stories of faith, hope and love.”

“Information should build identity, encouraging the young to engage in their culture to add strength.”

Some participants however reported the need for a fine balance of being realistic and stating the facts.

“There is a need to hear more stories about [survivors of ] suicide, and approach it from a holistic point of view – not just talking about the act of suicide, but also the situations leading up to it, and subsequent fall outs.”

TV and radio were reinforced as ef fective methods of engagement.

“We can promote messages through Pasifika television such as Tagata Pasifika, who have a community noticeboard at the end of their screened episodes. This is an ef fective way of alerting Pacific communities.”

Don’t sugar coat the subject (of suicide), just say it straight.”

- Dunedin fono, Year 13 student

“

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Suicide prevention education

and training preferences

The total sample strongly agreed (6.6 out of 7) that Pasifika suicide prevention training and/or education is needed for Pasifika communities.

Face to face workshops were the most preferred medium by far for suicide prevention training and/or education (37.2 per cent), followed by online (14.6 per cent) and combined face to face and online (12.8 per cent).

Participants were also asked whether they thought young people should be separated from adults or trained together (Figure 5). Interestingly, the same proportion of young people felt that training should be delivered together with adults (49 per cent) as opposed to being separate from adults (49 per cent). For older adults there was a clear preference for preference for training to be delivered separately, however, 18 per cent of respondents indicated that they thought was value in a combined approach where groups were together separated for dif ferent aspects of the training.

On-line course Face to faceworkshop

Combined faceto face and

on-line

14.6

37.2

12.8

Young adults

Older adults

Total

Figure 4: Preference for suicide prevention training (%) of total responses.

Figure 5: Should training be delivered to specific age categories (%) of total responses.

Separated Together Both

48

39

13

Young adults

Older adults

Total

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When prompted about what might be included in Pasifika suicide prevention education and/or training, participants reported a range of topics with the most common being:

• early warning signs

• risk and protective factors

• communication skills

• cultural awareness and identity

• creating trust

• the importance of appropriate language (that does not promote stigma)

• parenting skills

• age appropriateness.

There was still a focus on a strengths based approach.

“Information should be positive and encourage a strong sense of cultural identity.”

When prompted to identify who might be the best people to educate or train, the responses were overwhelmingly in favour of community people to be empowered with knowledge to share with others.

“We all have a big role when it comes to [suicide prevention] training and education – parents, neighbours, clinicians and politicians.”

“…[suicide prevention training] should be facilitated by local community people… people who hold mana in their particular communities leading the way.”

“We need specific training for church leaders…The churches should be linked to the whole process, because not only does the minister preach suicide prevention before the fact, but af ter the fact when he or she presides over a suicide funeral. The minister must find a way of comforting the family, but also discouraging young people to follow the path of suicide.”

‘…[it’s about] the power of the spoken word and what gets spoken into the lives of our young people at a young age…”

A review of resource types undertaken by Dr Jemaima Tiatia-Seath22 noted that it must be recognised that while posters, brochures, advertisements or videos are ef fective communication tools, these alone cannot replace a support network, mental health services, training or interventions. It takes people to support each other and reinforce messages of strength and hope. And it takes a community-based and culturally responsive strategy to engage in comprehensive suicide prevention.23

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4. OutcomesIn summary, the findings from 15 community fono with approximately 400 Pasifika participants indicated that Pasifika communities are ready to talk about suicide, with the right resources and appropriate education.

It’s time to talk

• Suicide is an issue for Pasifika communities and needs to be addressed with a sense of urgency.

• Suicide and suicide prevention are important to talk about within our families and communities.

• Approaches on how to talk about it were based on ef fective communications skills and building trusting relationships, particularly strengthening family

relationships to enhance open communication.

• From a community perspective church, sport, culture and the arts were referred to as vehicles to open conversations about suicide prevention.

• In terms of talking about suicide and suicide prevention, rainbow Pasifika young people may be the most disempowered and at risk within Pasifika communities.

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Appropriate resources

are required

• Appropriate and relevant Pasifika suicide prevention resources are needed for Pasifika communities.

• Overall, the top three preferred resource types for Pasifika suicide prevention are face to face workshops, large scale campaigns, and social media. Young people however preferred social media.

• The content of resources should emphasise a resiliency and strengths based approach and at the same time be realistic and factual.

• Performing arts, church, family, school settings, TV and radio were identified as useful settings to target suicide prevention resources.

Appropriate community

education is required

• There was strong agreement that Pasifika suicide prevention training and/or education is needed for Pasifika communities.

• Face to face workshops were the most preferred medium by far for suicide prevention training and/or education, followed by online and combined face to face and online.

• Suicide prevention education and/or training should be carried out by community people empowered with knowledge to share with others within their communities.

• Content could include: early warning signs, risk and protective factors, communication skills, cultural awareness and identity, creating trusting relationships, the importance of using appropriate language (that does not promote stigma), parenting skills, being age appropriate.

In addition to the above findings, there were emerging focal points that communities identified required attention in relation to suicide prevention programmes for Pasifika.

1. Pasifika churches and clergy can play a significant role in communicating safe and appropriate suicide prevention messages and ultimately influence how those conversations may be accepted by many of our Pasifika communities. A coordinated approach, co-created and co-led by church leaders is required to communicate the right messages to Pasifika communities.

2. Avenues should be explored to improve the current approach to suicide prevention and postvention in secondary schools (concerns were raised on numerous occasions regarding dissatisfaction with current responses which appeared as ad-hoc and inconsistent).

3. Better understanding of all services involved in suicide prevention and postvention, and how these services coordinate in responding to Pasifika communities is essential.

4. Pasifika communities should be regularly engaged and informed about resources, information and progress in addressing Pasifika suicide prevention. Pasifika communities feel that suicide prevention needs to be led and driven by and with Pasifika communities.

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5. Conclusion

Le Va acknowledges and draws strength from the wise words and passionate work of our Pasifika people, families, organisations and communities. Suicide and suicide prevention are not new topics for our communities, and much has occurred prior to this report - much more will happen as a result of this report, and beyond its release.

The urgency in which Pasifika communities want to reduce suicide, talk about suicide prevention, and drive this work, shows a determination by our communities to support and protect people, families and communities. There is an acknowledgment within our communities that there is no one solution – Pasifika training and education approaches must be safe, appropriate and tailored for and by our communities. This is particularly important for Pasifika youth, elders, ethnic groups and rainbow Pasifika communities.

While there is no single solution, our communities have reinforced the view that our answers lie within Pasifika culture, values, traditions and leadership.

The importance of those in traditional Pasifika leadership roles, such as churches and clergy, has been emphasised; as have contemporary approaches through sport, music and performing arts. Better coordination, between those in the sector, and structures outside of it (such as schools) are another avenue.

Understanding Pasifika suicide and suicide prevention means empowering Pasifika communities to seek and use solutions that work for them. The Ministry of Health and Waka Hourua support this approach through the establishment of the FLO: Pasifika for Life programme. Le Va recognises this through engaging ethnic specific, youth specific and rainbow Pasifika communities, enhancing understanding of Pasifika suicide and suicide prevention, funding 17 Pasifika community initiatives, funding quality research to inform initiatives, supporting FLO suicide prevention ambassadors that champion the issues of our community, and of course, acting on the outcomes of this report.

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Endnotes

1- Ministry of Health. (2014). Suicide Facts: Deaths and Intentional Self-Harm Hospitalisations 2011. Wellington: Ministry of Health.

2- Oakley Browne, M.A., Wells, J.E. and Scott, K.M. (eds). (2006). Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health.

3- Statistics New Zealand. (2014). 2013 Census QuickStats about Culture and Identity. http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-culture-identity/pacific-peoples.aspx Wellington: Statistics New Zealand.

4- Statistics New Zealand and Ministry of Pacific Island Af fairs. (2011). Health and Pacific peoples in New Zealand. Wellington: Statistics New Zealand and Ministry of Pacific Island Af fairs.

5- ibid

6- World Health Organization. (2010). Public health action for the prevention of suicide: A framework. Geneva: World Health Organization.

7- Northern DHB Support Agency. (2010). The Regional Pacific Model of Care and Mental Health and Addictions Service Framework. Auckland: Northern District Support Agency.

8- Goodwin-Smith, I., Hicks. N., Hawke, M., Alver, G., & Raf tery, P. (2013). Living beyond Aboriginal suicide: Developing a culturally appropriate and accessible suicide postvention service for Aboriginal communities, South Australia Advances in Mental Health. 11(3): 238-245.

9- Shneidman, E.S. (1972) Forward. In: Cain, A.C(ed.) Survivors of Suicide. Springfield, IL: Charles C Thomas.

10- Runeson, B., Asberg, M. (2003). Family history of suicide among suicide victims, American Journal of Psychiatry. 160: 1525-1526.

11- Aguire, T.P., Slater, H. (2010). Suicide postvention as suicide prevention: Improvement and expansion in the United States. Death Studies. 34: 529-540.

12- Campbell, F. (1997). Changing the legacy of suicide, Suicide and Life-Threatening Behavior. 7: 40-44.

13- http://www.leva.co.nz/library/leva/preventing-suicide-for-pasifika-top-5-tactics

14- Helu-Thaman, K. (1992). Looking Towards the Source: A Consideration of (cultural) context in Teacher Education, ACCESS Critical Perspectives on Education Policy. 11, (2): 44-50.

15- Maua- Hodges, T. (2000). Ako Pai Ki Aitutaki: Transporting or Weaving Cultures. Research Report of Field Experiences to the Cook Islands. Wellington: Wellington College of Education.

16- Hunter Institute of Mental Health. (2012). Outcomes Report: Summary of Literature for Discussing Suicide. Australia: Hunter Institute of Mental Health.

17- Hall, K. (2002). Suicide prevention topic 7: Does asking about suicidal ideation increase the likelihood of suicide attempts? New Zealand Health Technology Assessment (NZHTA) Report. Christchurch: University of Otago.

18- Hunter Institute of Mental Health, 2014. Conversations Matter - Core Principles: Prevention Focussed Conversations. Australia: Hunter Institute of Mental Health.

19- www.conversationsmatter.com.au

20- Hunter Institute of Mental Health. (2014). Conversations Matter - when holding group discussion about suicide prevention. Australia: Hunter Institute of Mental Health.

21- ibid.

22- Statistics New Zealand. (April 2005). Understanding and working with ethnicity data. http://www.stats.govt.nz/~/media/Statistics/browse-categories/population/census-counts/review-measurement-ethnicity/understanding-working-ethnicity-data.pdf

23- Tiatia-Seath, J. (2014). Background analysis report and scope to inform design of ef fective resources for Pasifika suicide prevention. Auckland: Le Va, unpublished report.

24- California Mental Health Services Authority. (2014). Know the Signs Suicide Prevention Campaign. Culture and community: Suicide prevention resources for Native Americans in California. USA: California Mental Health Services Authority.

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