title: First Australian Holistic Health: Development of a Multi-Dimensional Model of Suicidal Ideation and Suicide-Related Behaviour
Creators: name: Barnett, Leda R
Publisher: name: Griffith University
Year: 2020
Subjects: subject: Aboriginal Australian
subject: Ecological Systems
subject: Emotional Health
subject: First Australian
subject: Health domain
subject: Holistic health
subject: Indigenous
subject: Suicidality

description: Despite the prevalence of First Australian deaths by suicide there is a lack of services developed and delivered by First Australians and limited evidence for the effectiveness of mainstream programs. This dissertation is focused on developing a better understanding of First Australian suicidal ideation and suicide-related behaviours in order to inform effective responses to suicide in our communities. As a First Australian researcher I subscribed to a research model based on an Indigenist paradigm. The Indigenist paradigm entails a cultural alliance with the First Australian community and participants in this research. My enculturation as a First Australian obliges me to work with the First Australian community to pursue emancipation by challenging structures and societal issues that oppress First Australians. My established professional, family and personal relationships within the First Australian community in the regional city of Mackay (Queensland, Australia) facilitated my engagement with the community in this research. My engagement with this research began at the time of a cluster of deaths by suicide of First Australian youth within Mackay’s First Australian community. I participated in an initial investigation of this suicide cluster to strengthen the community’s knowledge about deaths by suicide. My work has been overseen by an Indigenous Critical Reference Group consisting of highly respected community representatives. Given deaths by suicide continued to affect Mackay’s First Australian community, the Indigenous Critical Reference Group requested a deeper understanding of the issues that needed to be addressed and proposed my involvement in continued research. Their request led to this thesis, ensuring that this dissertation represents true community-driven research. To respond to the request of the Indigenous Critical Reference Group, I revisited the initial investigation. During the initial interviews, some participants shared their own personal experiences of suicide-related behaviours and suicidal ideation. It was envisaged further investigation of these interviews would provide valuable insight into antecedents and precursors beyond what was available in coroners’ reports. The 14 interviews included in this research are comprised of three (M=0, F=3) participants who shared their own experiences of suicide-related behaviour and eleven (M=3, F=8) participants who shared their own experiences of suicidal ideation. These participants’ interview transcripts were reviewed and the portions of the transcripts directly relating to their suicide-related behaviour and suicidal ideation were re-analysed. The findings of this analysis were discussed with key informants and Critical Reference Group members to build an explanatory model, which is described in this thesis. In subscribing to an Indigenist research paradigm, my cultural identity and experiences as a First Australian informed the entire research project, making me a participant-observer. My partnership with Mackay’s First Australian community, especially in my relationships with the Indigenous Critical Reference Group members and the research participants, featured collective ownership of the research process to produce research outcomes that initiate change. I conducted qualitative interviews with research participants who had engaged in suicide-related behaviours or experienced suicidal ideation. To deepen the analysis of the qualitative data, I developed a data analysis matrix defined by the intersection between five health domains (drawn from a First Australian perspective on holistic health) and the three dimensions of experience (time, space and distance). The latter dimensions allowed me to establish a broader context of participants’ life experiences. The data analysis matrix enabled analysis from multiple perspectives to provide a more comprehensive understanding of participants suicide-related behaviours and suicidal ideation. To broaden my understanding even further, I approached the interviews and analysis from the perspective of a multi-layered Ecological Theory incorporating the micro, meso, exo, macro and chrono-systems (see Chapter 1). This Ecological Theory ensured that I examined the data and my interpretation from a complex rather than simplistic perspective. Data analysis was conducted in three phases. The first phase involved analysing participants’ experiences to develop an understanding of the Social, Intellectual, Physical, Emotional and Spiritual (SIPES) domains of health. In the second phase, participants’ SIPES experiences were analysed across the dimensions of time, space and distance. The third and final phase comprised meetings with Indigenous Critical Reference Group members, alongside ongoing engagement with the data, to develop an explanatory model, namely the Empowerment to Prevent Suicidality (EPS) Model, that depicts First Australian experiences of suicidal ideation and suicide-related behaviours. The EPS Model emphasises the social and spatial nature of suicidality, located in the interpersonal environment and the places that have most meaning to people. Rather than being a personal and emotional experience, suicidal ideation and suicide-related behaviour begins in a social spatial context of powerlessness where it escalates until it reaches an emotional threshold. Once the emotional threshold has been breached, the energy created is driven by a sense of urgency that is steeped in history, judgements about the future, physical and emotional distancing and spatial/social influences or reactions. This distress-filled period often continues until such time as there is an intellectual realisation, usually triggered and supported by a social ally. The role of the ally is as a social guide who can prompt a shift into an empowerment cycle where people can again take control over their time, space and connections in a more positive way. Allies, unlike many other social connections that dominated the chaotic environment, refused to be complicit in defining a space that trapped participants and instead created a space that allowed participants to move to safety. Many traditional medical responses to deaths by suicide rely on interventions delivered by authorities. These authorities are steeped in the historical, social/spatial and interpersonal challenges that contributed to cycles of chaos and powerlessness in the first place. Consequently, these interventions often contribute to further powerlessness. Rather than contributing to powerlessness, interventions for First Australians must focus on strategies for facilitating empowerment at crucial points in time, addressing the powerlessness cycle and preventing threshold breaches. Interventions for First Australians must focus on development and mobilising social allies and building safe empowering spaces, but also allowing the time to support people back to a place of empowerment. Most importantly, interventions must recognise and respect the social/spatial nature of First Australian suicidality rather than focusing on individual mental health conditions. The First Australian experience of suicidality identified in my research has been investigated through a culturally informed method of acquiring and interpreting information that has revealed a new way of thinking about suicidality. This research highlights features of First Australian experiences of suicidality that can be integrated into interventions, particularly in the case of clusters of youth deaths by suicide. Findings suggest a more effective approach to address First Australian suicidality can be developed using a social/spatial orientation, that is mindful of history and the impact of time on First Australian people. Additionally, it is important to examine the connections and disconnections that have occurred in First Australian people’s lives to understand ways in which the social environment facilitates suicide-related behaviours and triggers shifts into both powerlessness and empowerment.