1. In the past couple of years, we have heard about people committing suicide in Vanuatu. Some of them have been identified as students. What challenges do young people face in a school environment?

The school environment is complex. It is a community of children and teenagers from different backgrounds and personalities, who have different ways of thinking and influences. Some go to school to learn, develop and grow, while others go to escape and find a safe place. For others, school is a place to find answers and approval from peers.

School age (up to secondary school) is an opportune time for a young person to develop and flourish, but it can also be a challenging and difficult time. It is during the secondary school age that young people begin to ‘find their identity’ or a ‘sense of themselves’.

This can be seen in the kind of groups of friends they hang out with, which celebrities they become fans of and copy their style, the hobbies they pick up and the activities they commit to. They become self-conscious about what others think of them. This is a normal development pathway of every teenager.

The challenge is when there is bullying or if they are rejected from joining a certain group or face some sort of harassment. That can be very distressing for a student. It becomes even more concerning if a student goes to school as an escape from trauma, violence or difficulties experienced at home and then faces more challenges in school and is unable to find help within the school community.

2. What role can schools play to support young people’s mental health and prevent suicide?

Suicide is complex and cannot be predicted, but it can be prevented. Identifying students who are going through a hard time, or are distressed, is a start. These are the students who are quiet or isolated, or not doing well in school. It also those students we consider to be ‘strong headed’ and those who frequently visit the school clinic or are always absent/sick.

It is about time that schools begin to have an open discussion about mental health. On a personal, relational and day-to-day approach, teachers and staff need to be empathetic and to take a little bit more interest in students beyond academics. Maximise the teacher-student relationship dynamics by reaching out to students Simply asking ‘are you OK?’ can make a huge difference.

It would be good if schools provided options for students to express their distress or concerns in a safe environment. Mental Health could even be included in curriculum. Teachers and staff could liaise with Ministry of Health Mental Health Unit if they need assistance in how to navigate in this space.

3. What would you say to people who believe that suicide is ‘caused’ by not going to church?

Suicide is complex, as stated earlier. There are many reasons for suicidal tendencies, from genetics to situational risk factors. In my professional experience in Vanuatu, with the cases I have attended to, I have seen that church or spirituality is a protective factor. This is in the sense that meaning or value to life that the church or spirituality can bring to a person is important.

People find meaning in life through church, family, children and loved ones, relationships, jobs and responsibilities, possessions and so forth — if that is lost, then that person is more likely to commit suicide.

4. What are the symptoms of a suicidal person?

People with severe mental illness (e.g. psychosis) are at a high risk of suicide. People who have been abused or severely and constantly traumatised are also at risk. Nevertheless, suicide cannot be predicted.

The signs of suicidal persons include people who are emotionally distressed and say things like ‘I wish I could just sleep and not wake up’ or ‘I just want to go far, far away and not come back’. It is someone who has a sudden change in behaviour, abuses alcohol or illicit drug use, isolates and keeps to themselves, gives out their belongings, tries to amend past wrongs, says they want to commit suicide and goes as far as writing a suicide note.

5. If we identify the signs of someone, how can we support them?

Persons at that point are vulnerable. Stay with that person. Active listening and being empathetic is important. Validate their situation, distress and what it is they are going through.

You might say something like ‘Brata, wan hard situesen true ia...mi luk save nomo se yu harem no gud from hemi hard tru ia’, instead of ‘Yu relaaaax. Hemia smol samting nomo ia. Life ia’. (Remember, what you consider a ‘small issue’ might be a big deal for that person. So do not belittle their experience)

Know your limitations. Sometimes, you might be dealing with your own challenges and what you have learned, can be of help to that person. But if you feel that you cannot help them, tell them that you are unable to help and that you can take them to a person who is able to. Do not make promises and not follow through. Be truthful and genuine.

Know your contacts of professional help, and refer accordingly — any counsellor or a health worker. Connectedness is key. Surrounding that person with a web of support goes a long way.

6. Does the mental health care unit have the resources to manage people who are suicidal? What services does the Mind Care unit provide?

When a person comes in to hospital for suicidal behaviour, the Mental Health Team gets called in to assess their suicidal risk and manage them according to their risks assessment. If the risks are high, they might require hospital admission, strong family involvement and support and frequent reviews until the risks are minimised. Part of the management involves identifying the triggers or stressors that led to the behaviour.

We have family conferences to educate family about suicide and encourage family support, highlighting the stressors around that person’s life that need to be addressed, of course with the person’s consent.

More often than not, presentation to hospital is after a failed suicide attempt. Depending on their method, the mental health team co-manages them with other health disciplines, commonly Surgical and Internal Medicine Teams. So we have a multidisciplinary team approach to ensure the person gets the most support.

7. While it is wonderful that Vanuatu has strong community networks, what are some issues that come from a close community that may affect a person’s mental health? And how can we address this?

That is a challenging issue across the board. Our practise and approach is a ‘bio psychosocial and cultural’ model which basically means a holistic approach to mental health, and health in general. We are moving away from a paternalistic approach, that encourages an authoritative doctor-patient relationship dynamic, to one that is more engaging with the patient and their caregivers, allowing all parties (treating team, patient and caregiver) to have discussions. This is done through our family conferences where we have discussions and educate family on the mental health aspects of things.

When it comes to issues prevalent within our communities, like abuse and the trauma, we not only manage the mental health aspect of the trauma, but also have discussions on issues and give the family information to other relevant services that they can access e.g. Women’s Centre.

While the patient is our primary focus, we also check in on the wellbeing of caregivers.

Cultural beliefs is something we encounter often in our practise and we understand that while it is very much an integral part of our communities’ functioning, it can also hinder access to timely mental health service when needed. When they do come, we tell the families and caregivers that while they go to their ‘klevas’, they must not miss their clinic appointments with us.

Community networks are vital for the support and recovery of our patients. The work we do is not limited to treating the patient but emphasises on rehabilitating them back into the community. More mental health education and advocacy is needed at the community level.

A community’s mental health literacy will improve if community leaders can see the importance of mental health and commit and drive initiatives in their own communities. The community also has to take ownership of the mental wellbeing of its people. The Ministry of Health through the Mental Health Team can provide support, but might not be able to drive it.

8. How can the media appropriately report on suicide?

The media is a powerful platform that has the potential to influence people’s understanding, judgement and perception of suicide, or any other mental health issues. Media reporters must be conscious of the impact of their stories.

Responsible and ethical reporting is what I would advise. In regards to suicide, respect for the deceased and consideration of the bereaving family is important. Do not intrude and avoid divulging personal and sensitive information. Avoid using language or graphics that glorifies, trivialise or romanticise suicide. Do not simplify the cause of death — suicide is complex and there is often more than one reason for the act.

Get your information from a reputable source and provide a balanced report, there is no need for finger pointing. If it is a rumour or speculation, say so. There is no need to detail the method of suicide or the location in your story — death by suicide is sufficient. Be straightforward, factual and concise.

More importantly, provide extensive information in your story around help and support for people who might be reading your story.

The Mind Care Unit is located in Vila Central Hospital. If you, or anyone you know, is seeking help, do not hesitate to visit the Mental Health team.

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