Suicide is a major health challenge in American Indian/Alaska Native (AI/AN) communities, particularly among the youth. In 2004, suicide was the second leading cause of death for AI/ANs of all age groups. Among individuals between ten and fourteen years old, 13.5% of deaths were from suicide, which is nearly twice the national rate of 7.2%.1 Many factors contribute to the high prevalence of suicide in AI/AN communities, including individual factors (mental illness, substance abuse, feelings of hopelessness or isolation, impulsive behavior, and a history of violence, substance abuse, or family history of mental illness) and group factors (historical trauma, poverty, unemployment, and geographic isolation).2
Actions are needed at both the federal and tribal levels to prevent suicide, and some initial important steps have been taken. To address the challenges of youth suicide in Indian Country, a bill titled 7th Generation Promise: Indian Youth Suicide Prevention Act of 2009 was incorporated into health care reform legislation enacted in March 2010 (Patient Protection and Affordable Care Act, 2010).3 This legislation authorizes two demonstration projects aimed at preventing youth suicide in AI/AN communities. To assist tribes in preventing youth suicide, the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS) published [End Page 77] a detailed guide in 2010.4 The guide, To Live to See the Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults, is an excellent resource.
Below, we present fifteen policy and practice recommendations for further supporting tribally based suicide prevention efforts. By “tribally based” we mean efforts that are tailored to the unique contexts of individual tribes and Native communities, which may include adaptations of mainstream programs or newly designed local suicide prevention programs, such as those based on spiritual or cultural traditions. The aim of this project was to review the range of approaches being used in tribally based suicide prevention programs and make recommendations about how policy makers, tribal communities, health care providers, and other service providers might better support locally tailored efforts to prevent suicide. As we describe in the next section, our goal in this paper was not to capture an exhaustive list of strategies being used in tribally based suicide prevention programs. Rather, we reviewed existing literature and consulted a select group of key informants in order to broadly describe the landscape—the commonalities and distinctive elements of these strategies—at a level of detail necessary to identify practice and policy change recommendations for a tribal leader and program staff audience. While these recommendations are targeted to supporting suicide prevention efforts in AI/AN communities, we also believe they have broader relevance for other community-based suicide prevention programs.
PAPER DEVELOPMENT AND RESEARCH METHODS
We developed this paper in collaboration with expert, key informant interviewees. For a list of the organizations and individuals who were interviewed or consulted by e-mail, please see Figure 1. This paper was originally intended to be a white paper for tribal leaders, not an academic research paper. Our initial goal was to write a paper for tribal communities that would review existing academic literature on suicide prevention and develop resulting recommendations about best practices and policies specifically for tribal governments. However, the initial literature review and conversations with experts in the field revealed that many successful tribal suicide prevention programs were not included in published academic articles, and that there was a need for publications about culturally appropriate tribal strategies. For this reason, we sought to review the landscape of tribally based suicide prevention programs. We conducted this broad review by reading published academic literature and “gray” literature (i.e., policy reports, white papers, program brochures, Web sites) as well as interviewing and corresponding with key informants working in the field of tribal suicide prevention. [End Page 78]
In reflecting on key informants’ comments, we felt that there was a great deal of important information shared which was not already available in the academic literature. We also felt that this information...