Suicide in small communities Gro Berntsen Anne Silviken - - PowerPoint PPT Presentation

Suicide in small communities

Anne Silviken

Psychologsit/Researcher Sámi National Advisory Unit on Mental Health and Substance Abuse, Finnmarkssykehuset / Centre for Sami Health Research the Arctic University of Norway

Implementation workshop,1Inari,12019 Gro Berntsen

Antrhopologist/Senior Advisor Northern Norway Violence, Traumatic Stress and Suicide Prevention Resouce Centre, University Hospital, North Norway.

Quoteby(Shneidman,(1973

“A(person´s(death(is(not(only(an(ending: it(is(also(a(beginning(– for(the(survivors”

Suddenand'unexpecteddeath in'smallcommunites

! «Everybody»'knows each other ! Traditional close ties'and'multiplex relations in'Sami'communities ! Contagion of suicide

Sudden&and& unexpecteddeath–

suicide,&accidents,&sudden childdeathand&homicide

! Sudden&and&unexpected&death&represents&a&severe&life&event& incorporating&multiple&stressors,&and&is&potentially&more&traumatizing& than&natural&deaths&&&&&&&(Li&et&al.,&2003;&Rostila et&al.,&2012;&Stroebe et&al.,&2007) ! From&a&public&health&perspective&sudden&death&represents&considerable& stress:&impaired&quality&of&life,&human&functioning&and&use&of&health& services

The$North$Norwegian$ Bereavement$Study

The main aim of the study: To secure appropriate follow-up for bereaved after traumatic death in multi ethnic areas in Northern Norway, with a special focus on the indigenous Sami bereaved

The$North$Norwegian$ Bereavement$Study

Municipality Study

Questionaire All$municipalities$in$Northern; Norway$was$invited$to$ participate$(n=88)$and$some$ selected$municipalities$in$the$ South$Sámi$area$(n=8).$ RR$68$%$$

Bereavement$Study

Questionaire 424$requests$were$distributed 244$got$a$questionaire RR:$75$%$$$(n=182)$ In,depth0interviews 204$consented$to$be$ interviewed 30$bereaved$from$different$ rural$Sámi$societies$were$ interviewed

The qualitative interview sample

! Thirty bereaved individuals (20 women and 10 men) ! The informants classified themselves as: Sámi (n=10), Norwegians (n=9), Sámi/Norwegian (n=8) and Kven/Norwegian (n=3) ! The majority had lost a child (20). Others a sibling (5), parents (2), nephew/niece (3) ! The deaths were caused by suicide (8), accidents (9), sudden infant/child deaths (2) and homicide (1)

Qualitative method

Hermeneutic phenomenological approach The$study$aims: ! Getting$specific$and$local$knowledge$of$the$bereaved’s psychosocial$situation$and$bereavement$process.$ ! Their$needs$for$help,$and$examine$whether$they$seek$ and$get$help$from$the$health$care$system$when$ needed.$

Published arcticles from The North Norwegian Bereavement Study

! Challenges)in)the)encounter)with)local)support)services)for) bereaved)after)sudden)and)unexpected)death)in)Sami)areas)in) northern)Norway)

(published)in)Norwegian) Silviken,)Berntsen)&)Dyregrov,)2014

! Needs and)barriers for)professional help – a)qualitative study

• f bereavement in)Sami)areas)

Dyregrov,)Berntsen)&)Silviken,)2014

! Sudden)and)unexpected death in)Sami)areas)of Norway)– A) qualitative study of the significance of religiosity in)the bereavement process

Silviken,)Slettli Gundersen,)Berntsen)&)Dyregrov,)2015

Challenges in the encounter with local support services for bereaved after sudden and unexpected death

Two major themes of challenges

• 1. Tight and multiplex relations
• 2. Lack of confidence in the local support services

A"siblingloosinga" sisterin"an"accident

“ I believe that living in a small community with just one psychiatric nurse makes a difference. She got such a hopeless role, she was bereaved herself and at the same time she was supposed to help us. In addition, she was my friend, and sometimes I felt that I was the

• ne helping out. I had to comfort her, and be the one who provided

strength to deal with the situation. "

Lack of confidence in the local support services ! Inadequate help system ! Lack of cultural competance ! Majority – minority issues ! Mismatch between needs and barriers

Lack of cultural competance

” It$must$be$absolutely$terrible,$being$misunderstood$because$of$your$ culture$and$upbringing,$and$get$the$wrong$help…”

Lack of confidence in the local support services ! Inadequate help system ! Lack of cultural competance ! Majority – minority issues ! Mismatch between needs and barriers

An uncle losing his niece by suicide

"...#I#think#this#is#due#to#the#Sámi#culture#I#grow#up#in,#if#you#could#call# it#Sámi#culture.#I#think#it`s#about#fending#for#ourselves.#We#are#not# supposed#to#ask#for#public#help#and#before#this#happened#we#would# by#all#means#try#to#solve#it#within#the#family.#But#this#time#the#whole# family#was#falling#apart,#and#then#we#really#needed#someone#else#to# help#us.#So#I#was#a#little#surprised#that#it#didn’t#work#as#I#supposed#it# should#do”

Clinical implications

! More knowledge about the situation of bereaved after traumatic death in general ! To be aware of and pay attention to their various roles in relation to the bereaved in different situations ! Cultural knowledge and to be able to reflect about their own cultural competence

Significance)ofreligiosityin) thebereavementprocessin) Sami)areas)ofNorway Sudden)and)unexpected death in)Sami)areas)of Norway)– A) qualitative study of the significance of religiosity in)the bereavement process

Why is it important to talk about religion and spirituality in the bereavement process?

! Religion and spirituality is often a non-topic within the health care system. ! After-death communication and healing traditions challenging to talk about: secret and/or taboo. ! It is important that the health care system has a culturally sensitive approach and local knowledge.

Religiosity and bereavement

! Religiosity is present in everyday life and is closely bound up with culture and way of living

(Myrvoll, 2010)

! Religiosity may be especially important during times of loss as a resource and coping strategy during the bereavement process ! A positive relation between religion, spirituality and adjustment to bereavement (Becker et al., 2007; Wortman & Park, 2008)

The significance of religiosity in the bereavement process

• Three major themes of importance for religious coping were found:
• 1. Rituals
• 2. Signs and warnings
• 3. After death communication

Rituals

• Public and private rituals that were performed in order to remember

the deceased, pay respect and the keep the deceased present: – Candlelight ceremonies – Photo of the deceased at home – Spending time wiht the deceased at home before the funeral – Prayers and hymns “I don’t have many people to talk to about this. So, I pray, I pray, (…)”

“A#safe#place#to#grieve”#

• The#analysis#revealed#that#the#rituals#had#two#main#functions:#

– to#create#a#safe#place#for#the#grieving#process#and#to#achieve#acceptance.#

• A#safe#place#as#a#place#for#the#participants#to#grieve,#express#

emotions#and#feel#the#pain#of#loss

(Reeves,#2011)

– rituals#provided#predictability;#they#had#a#beginning#and#an#end#that# created#a#safe#environment#to#grieve.#

Signs and warnings

• Signs&and&warnings&was&a&natural&part&of&their&life,&often&closely&

connected&to&nature

• Reading&signs&in&nature&was&about&paying&attention&to&the&signals&

that&nature&gives.&

A father elaborated on this phenomenon:

“Nature(is(a(part(of(us,(we(are(also(animals,(and(animals(read( nature…((Nature(tells(us(about(things,(but(if(you(don’t(notice(it((…)((I( pay(attention(to(signals,((and(signals(hold(true.(Perhaps(in(Sámi( society(we(are(good(at(this.(We(have(been(part(of(nature,(lived(in( nature,(and(have(been(living(in(harmony(with(nature(for(a(very(long( time”

After death communication

• The most common descriptions of after-death

communication were:

– a sensation and feeling of presence of the deceased:

• sensations, sounds, visualizations, dreams, visits by wild animals , or by

particular natural phenomena.

– contact with the deceased through mediums – a message from the deceased, e.g. that he or she was fine

Acceptance

• The rituals and after-death communication helped the bereaved to

progress in the process towards acceptance of death and adaptation to the new situation without the deceased.

• Without some degree of acceptance it is difficult to achieve an

adaptive outcome of grief and it may imply a higher risk for a complicated grief process

(Prigerson & Maciejewski, 2005)

Bereavement in Sámi areas in relation to the pre-Christian Sámi worldview

• In the traditional Sámi worldview, death did not mean the end of a

person’s existence, but a transition to a different relationship between the living and the dead

(Myrvoll, 2010)

“...and in this way the deceased are still with us and you can both pray and ask for help from them”.

An uncle expressed it this way:

“We must look up and appreciate life. If we refuse to move forward, it won’t be good for the boy. He gets no peace, unless we feel good”

One grieving aunt described

“However, after I got that message, that ‘I am fine’ and other things… it was just like I got another life afterwards. It started to move

• forward. You could see it, life went on”.

Concluding comments

• The results indicate that the Sámi traditional worldview and values

are still parts of modern bereavement processes,

• and in accordance with other studies among Sámi indicating that

traditional folk religiosity is present in modern times and that it exists integrated and/or in parallel with Christianity

(Myrvoll, 2010; Sexton, 2009)

Thank you for your attention !