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Chapter 1: Introduction to the Guide

Introduction

Suicide and suicidal behavior are preventable. This fact has led communities across the Nation, including many American Indian and Alaska Native (AI/AN) communities, to implement programs that successfully reduce factors known to contribute to suicide by young people and strengthen factors known to help protect them against suicide. The approaches taken by these communities are based on the public health model, which means that they are proactive and holistic. Such approaches do more than help young people choose life. They also help young people choose to live their life wellful of hope in themselves and their ability to accept the challenges and gifts that life has to offer. 

All of America’s young people deserve a life well-lived, which will have sound mental health as its foundation. To help achieve this goal, the Substance Abuse and Mental Health Services Administration (SAMHSA) has created this guide as a resource for community-based efforts to prevent suicide by AI/AN youth and young adults. The need is urgent, and the reasons are clear. More 
than 38 percent of AI/ANs are under age 19. Another 23 percent are between the ages of 20 and 34. In total, AI/AN youth and young adults make up 61 percent of all Native populations. They are the center of hope for the survival of their people and their culture. They also are the living spirit of our country’s past and a vital part of its future. And yet AI/AN youth and young adults 
have the highest suicide rate of any cultural or ethnic group in the United States.

The purpose of this guide is to support AI/AN communities and those who serve them in developing effective, culturally appropriate suicide prevention plans. Its intended users include Tribal and Village leaders, Elders, healers, and youth activists; State and county injury and suicide prevention program leaders; community organizers and program directors; school administrators; and other community members. In short, this guide is for everyone who has a stake in the health and well-being of AI/AN 
youth and young adults.

This guide lays the groundwork for comprehensive prevention planning, with prevention broadly defined. Prevention is not limited to programs that just address the needs of individuals who may be at risk of suicide. Prevention also includes programs that 
a community can use to promote the mental health of its young. It also is the actions that a community can take in response to a suicide that has occurred—or postvention—to help the community heal and thereby prevent related suicidal behaviors. 

A comprehensive suicide prevention plan will involve community-based assessments of risk and protective factors, one or more programs or strategies that respond to those factors, and the building of coalitions to help fund, carry out, and sustain the plan. Therefore, this guide: 

•    Explores some of the cultural issues around prevention;
 •    Describes approaches that respectfully address these issues as part of prevention planning; and 
•    Provides practical tools and resources that a community can use for assessment, program selection, coalition-building, and implementation of the strategies it incorporates as part of a comprehensive plan. 

This guide also reflects SAMHSA’s support of a public health approach to suicide prevention. The Institute of Medicine (IOM) defines public health as “what society does collectively to assure the conditions for people to be healthy.” The premise of a public health approach is that caring for the health of a community protects the individual, while caring for the health of an individual protects the community—with an overall benefit to society at large. The public health approach also assumes that it is inherently 
better to promote health and to prevent illness before an illness begins. By being proactive, the public health approach offers both a humane and cost-effective way for individuals, families, and communities to be spared the needless pain, suffering, and costly consequences of suicide.

Content and Structure 

The content of this guide represents a gathering of wisdom from many sources. Many Native individuals as well as many other caring individuals and organizations graciously shared their knowledge and experiences. A preliminary guide to suicide prevention prepared by the One Sky Center was the foundation on which this guide was built. 

While much of the content may seem to apply most directly to AI/ANs living on reservations and villages, a great deal of it also is applicable to preventing suicide by urban Natives. Many urban areas have Indian health and community centers that can be the focal point for prevention efforts. Efforts undertaken by these centers also must be based on an understanding of how culture can profoundly affect health and healing. Respect for cultural appropriateness in health care has no boundaries. As Shankar Vedantam noted in Culture and Mind: Psychiatry’s Missing Diagnosis, “no matter how much science learns about the brain, culture and the environment will continue to play a huge role in why people develop emotional problems, what treatments they respond to, and whether they recover.”

We have organized the guide in a way that is intended to help readers understand the complex, but necessary, process of developing suicide prevention plans within a cultural context. 

The focus of each of the remaining chapters is summarized below. 

  • Chapter 2: Culture, Community, and Prevention explores risk and protective factors and the ways in which AI/AN cultures can help promote the mental health of a community’s young people. 
  • Chapter 3: Breaking the Silence Around the Suicide Conversation is intended to help break down the silence and the myths that too often surround suicide and are barriers to a community’s open discussion of potential solutions.
  • Chapter 4: Responding to Suicide deals specifically with actions that a community might take after a suicide occurs. Young people appear to be particularly susceptible to suicidal behavior when exposed to the suicide death of another person. As a result, a community’s effective response to one suicide may help to prevent others.
  • Chapter 5: Community Readiness discusses the stages of change that any community must go through before it can confront the possible causes and solutions to suicide. This chapter emphasizes that an AI/AN community may need to first heal from historical trauma as its foundation for change.
  • Chapter 6: Community Action describes the public health approach to prevention, with SAMHSA’s Strategic Prevention Framework as a model for action. 
  • Chapter 7: Promising Suicide Prevention Programs examines some of the issues around “evidence” of effectiveness and also describes programs that hold promise for preventing suicide among AI/AN youth and young adults.
  • Chapter 8: Federal Suicide Prevention Resources summarizes suicide prevention programs and resources offered by SAMHSA as well as resources, including possible funding opportunities, available from other Federal agencies. 
  • Chapter 9: Conclusion to the Guide briefly states SAMHSA’s hopes for the conversations about culturally appropriate suicide prevention that this guide may inspire.

 Many of these chapters include text boxes entitled “Questions for Seeking the Wisdom of Elders.” The questions in each box are designed to explore a community’s traditional ways of maintaining “balance” or “harmony” among its members. This exploration will be beneficial to both AI/AN community members and those involved with them in laying the groundwork for a prevention plan. Not all cultures use the same language, concepts, or values in discussing or understanding the causes and 
prevention of suicide. “Mental illness,” for example, is not a universally accepted concept. Many cultures, including some AI/AN populations, understand health in holistic terms. Wellness, therefore, is a state of balance between a person’s mind, body, and spirit. Someone experiencing an emotional crisis would be considered as being out of balance or out of harmony with nature, including with possible spiritual forces.

 In this guide, we use the terms, mental health and balance or harmony, interchangeably. Developing a common language for understanding and discussing mental health will be essential to any effort to create culturally appropriate prevention plans and evaluate their effectiveness. 

This guide also includes four appendixes that contain a wealth of information.

  • Appendix B: Glossary of Terms contains definitions of mental health terminology used in the guide. These terms have been taken primarily from the National Strategy for Suicide Prevention: Goals and Objectives for Action.
  • Appendix C: Statistics Related to Suicide by American Indian and Alaska Native Youth and Young Adults is a compilation of statistics that a community may find useful in completing a needs assessment for grant applications. A community also might use these statistics to direct media attention to the issue of suicide—without a precipitating tragedy. 
  •  Appendix D: Decision-making Tools and Resources contains a copy of the American Indian Community Suicide Prevention Assessment Tool. It also includes contact information for State suicide prevention planning team leaders, a list of other tools that may be helpful to prevention planning, and an order form for resources available from SAMHSA’s National Suicide Prevention Lifeline.
  •  Appendix E: Web Site Resources and Bibliography categorizes numerous sources of online information about suicide prevention and Native American health as well as a bibliography for each chapter.
Themes

 If there are any primary “themes” within this guide, they are the overlapping themes of resilience, empowerment, and—ultimately—hope.

 First, this guide recognizes and pays honor to the resilience of AI/AN communities in resisting cultural suppression and overcoming a legacy of historical trauma. In many cases, it is by revitalizing their culture—and drawing upon their traditional values, beliefs, and practices—that AI/AN communities are successful in addressing the variety of social and economic challenges that confront them.

 This guide acknowledges historical trauma as an underlying and continuing threat to the balance and harmony of AI/AN communities. While some communities already have begun the courageous process of healing from historical trauma, other communities have yet to open up about this painful subject. Where healing circles have been held within small groups, the hope is that healing will move into the entire community, where all can benefit from the natural strengths and resources of its members. For many communities, healing from historical trauma is the first step in dealing with the causes of suicide.

Second, this guide recognizes the power of each community in developing the most appropriate responses to suicide and its related risk factors. This theme also demonstrates respect for the incredible diversity among AI/AN communities and the unique strengths of each individual culture. AI/AN communities have a wealth of traditions and stories to guide them in developing solutions that best meet the needs of their members. This guide provides guidelines on prevention planning. It is based, however, on the recognition that those most familiar with a community and its culture will know best which programs to choose, how they need to be implemented, and how such efforts can be sustained.

 The third theme is hope. This theme is based on an awareness of the power of hope in a future that is grounded in faith and derived from the AI/AN intimate understanding of the cycles of nature. It is the natural continuity of spring following winter and of a world that inevitably turns toward the dawn that becomes the foundation for a young person’s hope in the future.

Conclusion

This guide is a work in progress rather than a definitive guide to preventing suicide by AI/AN youth and young adults. There is a diversity of AI/AN cultures and limited—although growing—research into what strategies may work best within different cultures. Any current discussion of what works in AI/AN communities or what should be considered in prevention planning will be based largely on suicide prevention research within the American population in general, supplemented by the more extensive research that has been conducted among First Nations in Canada. Consequently, it is not possible or even wise for this guide to attempt to offer universal solutions to a problem as complex as suicide. In fact, we believe it is more important for this guide to raise questions about what we still need to learn from AI/AN communities about prevention than to offer any pat solutions. We trust that this guide—which is offered in the spirit of honoring and preserving the uniqueness of individual Tribes and Villages—will be an acceptable starting point for discovery. 

 

“It is time to speak your truth, create 
your community, and do not look 
outside yourself for the leader. We 
are the ones we’ve been waiting for.”

 —Hopi Elders 
Community Works Web site
 http://www.communityworksinfo/hopi.htm 

 

 

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