The Aboriginal Mental Health & Wellbeing Workforce Forum 2017 HOW CAN WE REDUCE THE RATES OF SUICIDE IN THE ABORIGINAL COMMUMITIES?

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Alexia Stephens
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1 The Aboriginal Mental Health & Wellbeing Workforce Forum 2017 HOW CAN WE REDUCE THE RATES OF SUICIDE IN THE ABORIGINAL COMMUMITIES?

2 The rate of suicide among young Indigenous men is the highest in the world, according to a new report highlighting the challenges facing young Australians. The first ever Australian Youth Development Index (YDI) was compiled as part of International Youth Day.

3 Among the reports findings were alarming statistics on youth suicide, which showed Aboriginal and Torres Strait Islander men between 25 and 29 had the highest suicide rates in the entire world whttp://

4 How to prevent suicide is poorly understood for both the general population and Aboriginal and Torres Strait Islander peoples. As noted by the National Mental Health Commission in its 2013 National Report Card on Mental Health Services and Suicide Prevention,

5 There is in fact surprisingly little evidence about what works in suicide prevention. They conclude, in terms of what works for suicide prevention, we are only just starting to scratch the surface.

6 In a preventative approach, the developmental factors that can predispose a person to suicide must be addressed at a relatively early age. As noted in the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy: 10 Department of Health and Ageing. (2013). National Aboriginal and Torres Strait Islander suicide prevention strategy. Canberra:DOHA.

7 Preventive responses should include parenting programs and therapeutic interventions for high risk families and children, + a mix of therapeutic, supportive and competency-building or life skills interventions for

8 Youth in schools or in post-secondary training, as well as for those who are unemployed or entering the workforce. In many contexts, young people leaving school struggle to undertake further training or to stay in work and are in need of counselling and support...

9 It is increasingly important that prevention policies focus on their common precursors in human development. There needs to be a shift towards collaborative, cross-sectoral approaches to treatment and prevention to treat both current risk and its developmental precursors. 11 Department of Health and Ageing. (2013). National Aboriginal and Torres Strait Islander suicide prevention strategy. Canberra:DOHA.

10 ADVERSE CHILDHOOD EXPERIENCES (THE ACE STUDY) Suicide is a leading cause of death in the United States. An expanding body of research suggests that childhood trauma and (ACE) can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults

11 ADVERSE CHILDHOOD EXPERIENCES (THE ACE STUDY) The conclusions of the ACE study state, A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span Alcoholism, depressed affect and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship

12 ADVERSE CHILDHOOD EXPERIENCES (THE ACE STUDY) The recognition that ACE are common and frequently take place as multiple events may be the first step in preventing their occurrence Identifying and treating persons who have been affected by such experience may have substantial value in our evolving efforts to prevent suicide

13 Generation 1 CHILD ABUSE Aggress ion Conduct Problem s Depress ion PTSD Anxiety School Proble ms Child Revictim -ization Depression PTSD Anxiety School Dropout Substance Abuse Adolescent Parenting Problems Domestic Violence Maternal Depression PTSD Poverty Substance Abuse Adult Generation 2 CHILD ABUSE

context of a positive affective relationship between

15 INFANT BRAIN DEVELOPMENT The baby s brain literally requires brainbrain interaction and occurs in the context of a positive affective relationship between mother and infant. (Trevarthen - primary inter-subjectivity)

16 Neglect and stress hurts. Depriving an infant of loving talk and touch releases steroids that damage the brain's hippocampus, Chronic stress such as poverty, abuse or violence can impair the development of the amygdala, Brain Based Learning and Brain Development About the Brain retrieved 2007

17 CORTISOL If levels of cortisol get too high, the heart rate, digestive system and ability to think are affected The presence of a loving caregiver during stress reduces production of cortisol. In other words, a loving, consistent relationship can offset even the most stressful situation. Phyllis Porter EARLY BRAIN DEVELOPMENT-What parents and caregivers need to know! November 19, 2006.

Cortisol cont. According to (Gunnar 1998), the brain is the major target of cortisol. Early experiences effect later emotional, behavioural and hormonal stress reactivity.

18 Cortisol cont. According to (Gunnar 1998), the brain is the major target of cortisol. Early experiences effect later emotional, behavioural and hormonal stress reactivity. Secure emotional relationships with sensitive and responsive caregivers may protect the developing brain and thereby reduce later stress reactivity. Phyllis Porter EARLY BRAIN DEVELOPMENT-What parents and caregivers need to know! November 19, 2006.

19 How Stress Harms Early, frequent, and intense stress tunes the brain to set stress regulation mechanisms at high levels. This often results in a child operating in a persisting fear state. Healthy Child Care America, Volume 3, Number 1, January 1999 Early Brain Development and Child Care - Discoveries about the growth and development of the young child's brain have important implications for child care

20 Under Any Type of Perceived Threat (physical, intellectual or emotional) The Brain: loses ability to take in subtle clues reverts to tried & true behaviours becomes more automatic & over reactive is less able to use higher order thinking skills loses some memory capacity Source: J R Lally 2007 Program for infant & toddler care reproduced with permission

21 Cortisol Kills brain cells Reduces number of cell connections Shrinks Hippocampus Impairs selective attention Impairs thinking Creates anxious behaviour Source: J R Lally 2007 Program for infant & toddler care reproduced with permission

22 Childhood Abuse Long term effects

23 Impact of Trauma on Brain Development If a child s early environment is abusive or neglectful, the brain creates memories of these experiences, colouring the child s view of the world The pathways developed under negative conditions prepare children to cope in a negative environment

24 So... Chronic stress over-develops specific regions of the brain related to anxiety, fear, and survival But other regions are underdeveloped, such as those involved in complex thought

25 Inadequate care giving focuses the child on survival, not emotional development Children may not develop emotionally or cognitively Child does not develop appropriate social skills Lack of empathy

26 The relationship of adult health status to childhood abuse & household dysfunction. Study conducted on 9,508 adults recently medically evaluated. A 68 question survey about 7 categories of childhood trauma (adverse childhood experiences (ACEs) was completed. Charles L. Whitfield MD Felitti VJ, Anda RF, Nordenberg D et al: American Journal of Preventive Medicine 14(4): , May 1998

27 1) Lived with problem drinker, alcoholic or street drug user 2) Sexually abused (overt abuse only) 3) Lived with mentally ill person 4) Mother treated violently 5) Emotionally abused 6) Physically abused 7) Household member went to prison

Whitfield MD Felitti VJ, Anda RF, Nordenberg D et al:

28 Relation between Adverse Childhood Experiences (ACE) Score and smoking status. ACE score Charles L. Whitfield MD Felitti VJ, Anda RF, Nordenberg D et al: American Journal of Preventive Medicine 14(4): , May 1998

29 A person with a ACE score of 4 is 390 times more likely to have chronic obstructive pulmonary disease than is a person with an ACE Score of 0 A person with ACE score 4 or more was 460 times more likely to be depressed than a person with ACE score of 0. Charles L. Whitfield MD Felitti VJ, Anda RF, Nordenberg D et al: American Journal of Preventive Medicine 14(4): , May 1998

30 For groups with higher ACE scores, incidence of attempted suicide increases thirty fold to fifty-one fold! They found that more than two thirds of suicide attempts could be attributed to adverse childhood experiences. A male child with an ACE score of 6 has a 4600% increase in the likelihood of later using intravenous drugs

31 The Cycle of Abuse 25% - 35% of abused children grow up to abuse their own offspring physically or sexually 40% of children who witness either parent striking the other will themselves become spouse beaters over 1/2 of abused children experience emotional problems in adulthood

32 Impact of Trauma on Mental Health AUSTRALIA (Jorm et al.1997 n = over 2,000) PEOPLE WITH SCHIZOPHRENIA HAVE BEEN SHOWN TO HAVE: Day-to-day stress 94% Childhood problems 88% (eg abuse, loss of parent) Recent trauma 85% Unemployment 72% Inherited/Genetic 59% Reid, J., et,al WAAMH

33 Teicher, 2000, p. 67 Our brains are sculpted by our early experiences. Maltreatment is a chisel that shapes a brain to content with strife, but at the cost of deep, enduring wounds

34 Take-Home Messages There are some environmental adversities, especially those that are long-standing or repeated, that seem likely to induce a mental disorder in all but the hardiest of children. Mental Health: A Report of the Surgeon General Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

35 The Role of Professionals Educate yourselves re effects of maltreatment on early brain development, and effective interventions Educate yourselves on attachment theory and the effects of disorganised attachment on later child development Become a secure base for our families

36 The Role of Professionals Move beyond blaming parents, communities, business, or government Be a secure base for parents by being reliable, attentive, caring and supportive

38 Australian Broadcasting Commission Australian Psychological Society The Adverse Childhood Experiences Study Child Trauma Academy Zero to Three

ACES: Adverse Childhood Experiences

ACES: Adverse Childhood Experiences Melissa L. Hoffmann, Ph.D UT Division of Child & Adolescent Psychiatry UT Center of Excellence for Children in State Custody University of Tennessee Health Sciences