Suicide Prevention in Indigenous Communities

Although the overall suicide rate in the U.S. has increased in recent years, specific communities and identities experience disproportionate risks. Suicide is the second leading cause of death among American Indian and Alaska Native youth ages 8 to 24, and American Indian and Alaska Native youth aged 10-24 have the highest rate of suicide of all demographic groups.

It is essential to address this problem and ensure that those struggling within Indigenous and Native communities are getting the help they need.

What Increases The Risk Of Suicide?

The higher risk of suicide in Native communities is a complex issue and depends on many different factors including mental health conditions, substance use disorders, intergenerational trauma and community-wide socioeconomic disparities. It is also critical to recognize the interplay of these different factors. Individual-level poverty and limited access to healthy food and clean water, which are often the legacy of displacement and lack of investment, commonly lead to physical health conditions – compounding an individual’s risk of developing a mental health condition.

Health issues
There are many health issues common among Indigenous people that can increase the risk for suicide including diabetes, depression and substance use disorders.

Generational Trauma
The historical mistreatment, forced displacement and oppression of Native people groups has had long-term multigenerational impacts, including trauma and depression. Understanding this historical context is critical to understand higher rates of suicide in these communities.

Community Issues
Many members of Indigenous communities face poverty, unemployment and an increased risk of homelessness. Those who live on reservations or “treaty land,” the largely rural and isolated environment frequently means less access to health care, services and other resources. These community-based issues can add to the increased risk of suicide.
Misunderstanding within the community
Suicide remains highly stigmatized across cultures, and members of Indigenous communities may be affected by common myths and misunderstandings about suicide. Some of these include:

• The fear that talking about suicide will make it happen
• The belief that suicidality is a cry for attention rather than a sign that a person seriously needs help
• The belief that people who are suicidal are just having a difficult time and that it will pass
• The belief that once a person has decided to end their life, there is no action their loved ones can take to stop them
• The belief that a person with children or strong family relationships would never actually end their life

How Can Communities Take Action To Prevent Suicide?

Watch for Warning Signs
It is essential to be aware of signs that someone may be considering suicide. When looking for these signs, it’s important to consider the cultural context of what you are observing. For example, some cultures have a strong sense or code that requires privacy, and “keeping everyone out of their business.” A warning sign might be a person  increasing their substance use or changes in their mood rather than outright saying they are having thoughts about suicide.

Know When and How to Get Involved
Suicide prevention starts with noticing that someone is struggling, and then asking them how they are doing. You can’t know what they need until you ask them.

Often there is a fear that the person was not actually thinking about suicide, and by bringing it up you will make them consider it for the first time. This is not the case — if you suspect someone is considering suicide it is essential to ask them directly.

The best way to begin is to calmly ask them if they are thinking about suicide. If they indicate that they have been considering suicide, it is essential to connect them with professional help immediately, and not leave them alone. This may require you asking their permission to contact another friend or relative to be with them while you make phone calls with their therapist or family health care professional.

Regardless of a person’s cultural background, there are common warning signs for suicidality and best practices for you to support a community member or loved one. Once they have received an assessment by a health care professional, the next step is for them to receive follow-up treatment.

Build Community Support
Communities can help in the prevention of suicide by fostering more positive experiences and realities. Years of internalizing racism and disenfranchisement, struggling economically and feeling disconnected from cultural heritage can accumulate to a point of crisis. To combat this isolation and foster a sense of hope and connection, communities can commit to getting young people involved with cultural traditions that represent a sense of belonging and unity. Establishing the expectation and promise that everyone has a place within the community is important and valuable for supporting resilience.

Communities can also help people build up positive and productive knowledge about themselves, internalizing that belonging and strength as part of their personal and spiritual identity. For example, teaching young people the pride and strength of being a part of an Indigenous community with a long and rich history can combat the sense of isolation and disconnect.

Finally, communities can help prevent suicide by encouraging a culture of reaching out for help and challenging stigma within the community. For example, community leaders can publicly emphasize the message that if you are not okay, you should talk to a friend, parent or Elder about it and ask for support, and that doing so is a sign of strength.

How To Build A Culturally Competent Suicide Prevention Program

The best way to prevent suicide is to build a comprehensive, culturally competent program within the community.

A suicide prevention program is comprehensive if it encourages people to ask for help when they need it, connects people to effective care, and helps them feel heard and supported, learn coping skills or life skills, and practice resilience.

Treatment programs also need to be aligned with the beliefs, practices and needs of the culture. Research has shown that the “western” treatment model used across most of the U.S. has significant limitations when used with Indigenous populations.

A suicide prevention program is culturally competent if it:

1. Understands the cultural context of the Native community.
   • Use the knowledge of Elders and community members to better understand the issue of suicide in the community.
   • Understand and incorporate non-medical perceptions of suicide within the community. Some groups believe that suicidality is influenced by spiritual entities and rely on traditional ceremonies to remove these negative spiritual influences. For a provider to understand this perspective, they may have to set aside their clinical training and experience and develop treatment plans that are inclusive of spirituality.
2. Includes community representation throughout the planning, implementation and evaluation processes.
3. Tailors the information and resources of the program to include the values and beliefs of the community, creating a shared vision of wellness.
4. Fosters open communication with community members and program participants on any cultural considerations, such as terminology or personal space.
   • Interviewing a program participant before initiating treatment is imperative to learn about their experiences and upbringing, and how if may affect their response to treatment. For a provider who doesn’t share or understand this background, the best course of action is consulting with a community member with similar experiences to increase understanding.
5. Increases protective factors, such as strength, resilience, identity, culture, family connection and a sense of belonging.

The success of the program should be measured by the experience of the participant. Although providers are used to defining “success” as clinical stabilization, the program will be more valuable long-term if success is defined as fostering an environment where people are motivated to live and thrive.

Resources

Please note: The resources included here are not endorsed by NAMI, and NAMI is not responsible for the content of or service provided by any of these resources.

National Native Children’s Trauma Center (405-271-8858)
A SAMHSA-funded program established to develop training, technical assistance, program development and resources on trauma-informed care to tribal communities. Oklahoma City-based center specializes in treatment of Native American children that live with trauma and sexual abuse.

StrongHearts Native HelpLine (844-762-8483)
StrongHearts Native Helpline is a domestic violence and dating violence helpline for American Indians and Alaska Natives, offering culturally appropriate support daily from 7 a.m. to 10 p.m. CT via phone and online chat. StrongHearts Native Helpline’s one-on-one chat sessions with advocates can be accessed by clicking on the “Chat Now” icon at strongheartshelpline.org.

Zero Suicide
A comprehensive approach to suicide care, which aims to reduce the risk of suicide for all individuals seen in health care systems. Zero Suicide represents a commitment to patient safety — the most fundamental responsibility of health care – and to the safety and support of clinical staff who treat and support suicidal patients.