health & science

New plan for community hit hard by suicide

About five years ago, a spike in suicides hit one slice of New Zealand’s island community particularly hard. 

According to Ministry of Health data, in 2011, 11 Tongans took their own lives, and seven more committed suicide in 2012. Most of the deaths were youths. In the preceding and following years [2010, 2013], the number of Tongan suicides stood at three in each year. Now, New Zealand’s first ethnic-specific resource on suicide prevention is being released. Based on research into Tongan youth suicides in New Zealand, the Heilala Malu framework - developed at the Auckland University of Technology - is available in Tongan and English. 

Counties Manukau District Health Board psychiatrist Dr Siale Foliaki, marking his 25th year at Middlemore Hospital this year, said:  “It doesn’t matter how often you have to deal with suicide, it still knocks you round."

“It is the single most difficult thing for a parent or family member. If people die, we can cope. We don’t cope well, but if there’s a car accident or illness, death makes sense. For Tongans, suicide doesn’t make sense, but I think that applies to all cultures.”

A study published in the New Zealand Medical Journal earlier this year highlighted the higher risk of suicide among New Zealand’s Pacific youth aged 12 to 18. In that age group, the attempted suicide rate for Pasifika was 8.6 per cent, compared to 2.7 per cent for Palagi.

Foliaki says the statistics reflect what is happening at the coalface.

“Attempted suicides coming through Middlemore Hospital is high, and it’s getting higher.”

He believes a range of social pressures on Pacific families contribute to the psychological distress levels among Pacific youth - and at various times, when “clusters” of suicides occur in different ethnic groups, it might be indicative of one community being under more stress than another at that particular time.

The most recent Health and Wellbeing of New Zealand Secondary Students survey, taken in 2012, showed about 70 per cent of Pacific kids were happy in their families, enjoyed life and were excelling, Foliaki says.

“In that 30 per cent where things are not going so well ... you’ll find find parental tensions or separation, often a sole parent household. You’ll find a lack of resources and poverty, an increase in alcohol and drug use, you’ll find unstable accommodation and tenancy, you’ll find overcrowding, and you’ll find education underperformance and unemployment.

“These things are not unique to the Tongan and Pacific community - these are the universal factors that make it difficult for a baby, a young child and a young person to grow up and have a stable psychological state by the time they enter early adulthood.

“However, there’s a larger proportion of the Pacific community, and the Tongan community, that experience that,” Foliaki says.

Focusing on the Tongan community, Foliaki says unfair intergenerational expectations are a significant factor in psychological distress and sometimes suicidal thoughts among youth.

“In the Tongan community, parents work hard and have that same expectation of their children. If you set high expectations for your children, you have to have high support. If you set high expectations and low support, you create a sense of psychological tension that is really hard for a child and young adolescent to manage.

"In the village setting, everybody is around during the day, they get time with each other and [while] they put pressure on the child, they also spend time with the child and the child feels supported psychologically.

“What is happening in an urban environment is there are huge expectations, but very little support - and it’s that dynamic that is causing the distress that is leading to not only attempted suicide but completed suicide,” he says.

“Attempted suicides coming through Middlemore Hospital is high, and getting higher.”

Fragmentation of Tongan families as a result of migration to New Zealand also needs to be considered. 

“There’s a lot of migration to New Zealand from the islands where the families have been broken up. When you break families up, the natural support system - no matter how much our aunties and uncles love us - it’s not the same as having your parents around, or your brothers and sisters around,” Foliaki says.

“The Tongan community experiences that much more than the other Pacific communities [because often] the Tongan families are so big that you don’t get migration of mum, dad and all the children. What tends to happen is that dad comes early, and then the older siblings will arrive, and mum and the younger ones later.”

Aulola Fuka-Lino, the Auckland University of Technology doctoral student who led development of the suicide prevention resource, says in addition to familial expectations, Tongan youth in New Zealand often grapple with cultural expectations that could seem out-of-place in New Zealand.

“It is the tension of walking between two worlds, in terms of the expectations that are placed on them, and also other expectations that they have of their parents."

Fuka-Lino’s previous research into Tongan youth suicide in New Zealand indicates communication around these social and cultural expectations was often lacking in families whose loved one had committed suicide.

It is about trying to understand what different people are experiencing - both young and old - and how Tongans who now call New Zealand home can give context to their culture within that space, she says.

Part of that is opening up a discussion on the rigidity and strictness exercised by some Tongan parents.

This resource would hopefully improve and widen these conversations, and assist in giving insight to people that could be struggling with suicide or suicidal thoughts, eventually promoting a wider community discussion around some of the solutions to issues contributing to Pacific youth suicide, Fuka-Lino says.

The resource will be available at health centres, churches and various community centres.

Where to get help:

- Waka Hourua: Māori and Pasifika suicide prevention

- Le Va FLO

- Lifeline: 0800 543 354 (24/7), Youthline: 0800 376 633 (24/7), text free to 234 (8am-midnight) or live chat (7pm-11pm)

- Kidsline: 0800 54 37 54 (24/7; Kidsline Buddies available 4pm-9pm)

- Suicide Crisis Helpline: 0508 TAUTOKO / 0508 828 865 (24/7)

- What's Up: 0800 WHATSUP / 0800 942 8787 (1pm-10pm weekdays, 3pm-10pm weekends) or live chat (5pm-10pm)

- Healthline: 0800 611 116 (24/7)

- Samaritans: 0800 726 666 (24/7)

- Depression Helpline: 0800 111 757 or text free to 4202 (24/7)

- If you feel you or someone you know is at immediate risk, call 111.

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