If suicide among young men living with substance abuse is to be prevented it is not enough to focus on the individual client.
A common warning system for paramedics, care centres and social services has to be developed according to Stian Biong, who has defended his thesis at the Nordic School of Public Health in Gothenburg, Sweden.
"If the number of life-threatening overdoses is to be reduced, it will necessitate structural support in the form of political goals and superior controlling", says Stian Biong. He has worked as a nurse in Oslo for more than 20 years.
"Phenomenon I saw in my work was what made me interested in doing research", he says.
His thesis Between death as escape and the dream of life- Psychosocial dimensions of health in young men living with substance abuse and suicidal behaviour is mainly based on personal narratives from in-depth interviews with young Norwegian men and emergency care and social services in Oslo. It shows that the system perspective is important at several different levels.
"The Norwegian health personnel act requires cooperation with social welfare services but that is not happening in these cases", says Stian Biong.
Stian Biong claims that the possibilities for transferring information about an individual in Norway have to be investigated. Sweden has no corresponding legislation. There is however a pronounced political goal, a "zero-vision" when it comes to suicide, that sends clear signals to those in charge and personnel.
Stian Biong is of the opinion that in order for people to be able to work constructively with ethical challenges the system moreover has to make sure that the concerned personnel is given sufficient support in the form of guidance and feed-back.
"Stigmatization and marginalization can be reduced by the language used when describing the group's problem", Stian Biong points out.
His results indicate that there is indeed a connection between language, the client's sense of self and suicidal behaviour.
When your existence is seen as a balance between death as a liberator from pain and the dream of life, the course of events can be affected in a positive way if the individual sees that there are sufficient resources available for receiving economic and social support.
The system perspective also has a cultural aspect, in how masculinity is expressed. The existing ideals in society affect the suicide behaviour of this group.
"It seems as if this is a particular challenge for people with non-western backgrounds", says Stian Biong.
The reason is because they have to handle different ideals simultaneously. Thesis title: Between death as escape and the dream of life - Psychosocial dimensions of health in young men living with substance abuse and suicidal behaviour