Understanding Families and Suicide Risk Dr John Fitzgerald, Dr Karma Galyer, Mr Gavin Whiu, & Ms Philippa Thomas The Psychology Centre, Hamilton

Suicide Prevention Strategy Suicide continues to be one of the leading causes of youth mortality. New Zealand Suicide Prevention Strategy aims to reduce the rate of suicide and suicidal behaviour. The specific goals of this Prevention Strategy all highlight family involvement and/or family support.

Why Focus on Family? Data from New Zealand and international studies shows family adversity is related to increased suicide risk for young people - Christchurch Health and Development Study (Fergusson et al. 2000) The impact appears cumulative, with more adversity over time increasing suicide risk.

Why Focus on Dynamic Family Factors? Dynamic factors in current family life have also been shown to be relevant. For example:  Family cohesion and bonding (Greene Bush & Pargament, 1995; Compton et al., 2005)  Current conflict between family and a young person (Randell et al. 2006; Kaslow et al., 2000; Krupinski et al., 1998)  A sense that family did not understand or value the young person, lack of listening, trust and support (Sun & Hui, 2007)  The sense that a difficult family situation could not change (Sun & Hui, 2007; Carris et al. 1998).

Dynamic Family Factors that Mitigate Suicide Risk Most young people who experience suicide risk factors do not go on to develop suicidal behaviour (Beautrais, 2006). Resilience research asks this question, “What accounts for why some stay healthy and do well in the face of risk and adversity, and others do not?” (Patterson, 2002).

Family Resilience Frameworks Current models locate resilience factors in systems such as families (e.g., Walsh, 2003; Patterson, 2002; McCubbin, 1997). Investigations of family stress and coping have found that dynamic family factors facilitate good outcomes in times of crisis (Patterson 2002). The clinical utility of these models includes the development of family interventions that identify and amplify existing and potential competences, thus empowering families at times of adversity (Walsh, 2003).

Current Project Two general questions provided a context for this project. –What dynamic, day-to-day family life factors are important in suicide risk? –What can families do when a young person is at risk that leads to positive outcomes? Mixed methods design. Small number of standard questions about family, strengths and coping. 11 families (25 participants, 18 family interviews), 8 practitioner interviews.

Family: What does being a family mean to you? a)Family Bond, Connectedness, Valuing Independence b)The Family is Bigger Than Us c)Sharing Our Lives d)How We Relate Non-judgmental Negotiated settlements Unconditional acceptance and forgiveness e)Taking Care of Each Other

Family: What are the Strengths of this Family? a)Strengths of the Individuals b)Commitment to Each Other Caring For Each Other Roles and Rules c)Communications Skills d)Forgiveness e)Sharing Interests and Activities

Family: How does this Family React to Challenges? a)Individual Differences Within the Family Unit b)Reliance of Individuals c)Communicating About Challenges d)Collaboration Looking outside for help The art of compromise

Family: How were the Strengths/Coping Strategies Identified Relevant at the Time of the Attempted/Completed Suicide? a)Central Role of Good Communication b)Balance Between Individual and Shared Coping c)Using Your Strengths, But Acknowledging Your Limits d)Influence of a Young Person’s Peers e)Skills to Identify When a Young Family Member Was at Risk f)Acknowledging the Reality of Depression and Suicide.

Recommendations (1) 1.Proactive stance to supporting families 2.Supporting development of family communication skills 3.Programmes to enhance intra-familial engagement 4.Enhancement of general family problem- solving skills 5.Identification and support of at-risk families 6.Open and informed discussion about trauma and adversity

Recommendations (2) 7.Easily accessible support/advice on ‘raising young people’ 8.Easier access to general information about mental health (especially depression, trauma, and suicide) 9.Easier access to reliable information about suicide risk 10.Further research on development and enhancement of family resilience