Life is Sacred: Suicide and Native People

It’s the second leading cause of death among young Native Americans, and we’re dying from it at a rate over one and a half times that of the rest of the country – and yet, it is completely preventable.  Young Native men are at highest risk amongst Native people, experiencing it at rates two and a half times that of same age males in the rest of the United States; almost a quarter of Native youth have attempted one or more times in their lives.  Suicide amongst American Indians and Alaska Natives (AI/ANs) has reached epidemic state in Native communities across the country, so much so that it has drawn national and international attention from health professionals, tribal and federal governments, and of course the communities themselves.

Native men and women are both at heightened risk beyond that of their non-Native peers.  The rate of suicide for Native American youth is far higher — 70 percent higher — than that of any other ethnic group in the United States.  Digging to the root of the problem reveals many of the same causes behind the myriad issues Indian Country faces today; anxiety, substance abuse, depression, disease, poverty, dispossession, disenfranchisement.  The statistics bear witness; according to the National Institutes of Health, Native Americans are 510 percent more likely to die of alcoholism than the general population, 189 percent more likely to die of diabetes, and 229 percent more likely to die of motor vehicle crashes.  Exacerbating the problem is the shortage, and in some cases, outright lack of mental health services available to Native people, stigmas associated with seeking help, culturally inappropriate services, and scarcity and high turnover rates of mental health professionals serving Indian Country.

Many experts agree that acculturation and historical trauma is largely to blame for many of the societal ills which lead to suicidal behavior on Indian reservations throughout the country.  Jacqueline Gray (Choctaw-Cherokee), an assistant professor at the Center for Rural Health University of North Dakota School of Medicine and Health Sciences states that “Acknowledging the role of these events (historical trauma) and appropriately incorporating them into culturally sensitive and relevant interventions are critical to successful suicide prevention and mental health intervention.”  Dr. Gray has worked on various mental health and suicide initiatives and developed a rural crisis intervention program and adolescent suicide prevention program in Oklahoma that was adopted across the state.  Dr. Gray states that suicides also tend to have a ‘ripple effect’ in Native communities; that is, when a suicide occurs in a tight knit community, the risk of more attempts rises.  In Indian Country, “You’re somehow defective if (there is) a mental health issue rather than a physical issue,” she says, adding that at least five Native American reservations have had one or more “clusters” of suicides in the past six years on the Northern Plains.  Clusters are cases in which three or more suicides occur closely, such as in the same family or among youth who spend time together in a short span of time.  “Once someone in your circle commits suicide, suddenly it makes it more of an option to the problem,” Gray says. “Where you might never have considered it, now it’s a possible solution.  It’s called a contagion effect, where suicide becomes almost ‘catching’, like a virus.”

Native communities are regularly scrambling to deal with suicide, and Native health professionals, stakeholders, and community members are doing what they can to understand suicide, share resources, and formulate strategies to prevent it.  For many of these communities, preserving our youth and our future is highly reliant upon reaching back into our past.

According to the Suicide Prevention Resource Center (SPRC), the most significant protective factors against suicide attempts amongst AI/AN youth are

·       The ability to discuss problems with family or friends

·       Connectedness to family

·       Emotional health

Professionals have also noted that strong ties to tribal culture and spiritual orientation were also important protective factors amongst young AI/ANs.  In one study, people reporting strong tribal spiritual orientation were half as likely to report a suicide attempt in their lifetimes.

Programs and initiatives across the country are capitalizing on the protective factors a strong cultural identity offers their youth.  A number of tribes have received Garrett Lee Smith Suicide Prevention grants to start culturally relevant programs on reservations aimed directly at suicide prevention.  Other communities and organizations utilize traditional Native lifeways as a means to help youth and young adults cultivate the identities and personal resilience that was nearly destroyed in prior generations.

An array of resources exists for communities and individuals seeking guidance in dealing with suicide.  The Indian Health Service has dedicated a website to serve as a clearinghouse of information for nationwide programs and initiatives geared towards suicide amongst Native Americans (http://www.ihs.gov/nonmedicalprograms/nspn/).  In May 2010, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a publication titled “To Live to See the Great Day That Dawns:  Preventing Suicide by American Indian and Alaska Native Youth and Adults.”  This free guide is available for download (http://www.sprc.org/library/Suicide_Prevention_Guide.pdf) or by ordering from the SAMHSA website (www.samhsa.gov).  The guide was written to “support AI/AN communities and those who serve them in developing effective, culturally appropriate suicide prevention plans.”  The SPRC or SAMHSA can provide contact information for professionals and organizations that specialize in providing training in suicide prevention programs such as Yellow Ribbon, Peer Mentoring, QPR (Question, Persuade, Refer), Mental Health First Aid, and programs on how to talk with someone who may have thoughts of suicide.

So what do you do if someone you know or you yourself are in crisis?  Talk to someone.  Whether that someone is a friend, family member, spiritual leader, clergy person, or health care provider, it is important that you seek help immediately.  Individuals seeking confidential assistance can call the National Suicide Prevention Lifeline at  1-800-273-TALK  (8255).  Persons with concerns about a friend or a family member can learn to recognize warning signs in others.  Examples of warning signs include the following:

• Appearing depressed or sad most of the time.  (Untreated depression is the number one cause for suicide.)
• Talking or writing about death or suicide.
• Withdrawing from family and friends.
• Feeling hopeless.
• Feeling strong anger or rage.
• Feeling trapped — like there is no way out of a situation.
• Experiencing dramatic mood changes.
• Abusing drugs or alcohol.
• Exhibiting a change in personality.
• Acting impulsively or recklessly.
• Losing interest in most activities.
• Feeling excessive guilt or shame.
• Giving away prized possessions.

A person with acute risk for suicidal behavior most often will show signs such as the following:

• Threatening to hurt or kill him or herself, or talking of wanting to hurt or kill him/herself; and/or,
• Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or,
• Talking or writing about death, dying or suicide, when these actions are out of the ordinary.

Any or all of these signs may occur, and don’t necessarily follow a pattern or checklist.  Suicides do occur where victims do not display any warning signs; however in approximately 75% of cases the victim exhibits some warning signs.  Thus, it is important those around at-risk individuals are able to recognize, and react to them.  What is critical to remember is that you do not have to suffer in silence, nor do you have to be a health professional to save a life.  Counselors, friends, family members, and community members all possess the ability to help save our youth, and our future.  To paraphrase a prominent Native ideology, defeating suicide in Indian Country will require the concerted effort of “all our relatives.”

1. Suicide Prevention Resource Center, (2009).  Suicide Among American Indians/Alaska Natives.  Fact Sheet, accessed August 11, 2010, http://www.sprc.org/library/ai.an.facts.pdf.

CNC News, (2010).  “Native Americans Face Challenges With Suicide”.  Accessed August 12, 2010,  http://www.capitolnewsconnection.org/news/native-americans-face-challenges-suicide.

Twyla Baker-Demaray, Ph.D
Director | National Resource Center on Native American Aging
The University of North Dakota Center for Rural Health
School of Medicine and Health Sciences