Thursday, September 10, is World Suicide Prevention Day – or as the National Council of Urban Indian Health celebrates it, Hope for Life Day.
And that hope is very much needed, because Indigenous people in the United States die by suicide at higher rates than any other racial or ethnic group, according to the Centers for Disease Control and Prevention. Consider that…
- Suicide rates among Native communities are up to 3 times higher than the general population. Disturbingly, suicide rates among Native people increased by nearly 20% between 2015-2020. The overall U.S. population saw less than a 1% increase during that period.
- Death by suicide peaks during Native youth and young adulthood. 76% of Native suicide decedents were 44 years old or younger, with 46.9% occurring among those aged 25–44 years. For non-Native people, the largest age demographic for suicide is age 45–64.
What this tells us: we urgently need suicide prevention programs tailored to Indigenous culture and values – and those programs need to begin in childhood.
Historical Trauma and Mental Health
Several factors can make Native people vulnerable when it comes to mental health struggles. One: Native people often live with the weight of more adverse childhood experiences — such as abuse, poverty, substance misuse, parental separation, or incarceration. When these experiences are compounded by intergenerational trauma from colonization and dispossession, mental health challenges are a natural result.
Indian Health Service (IHS) is chronically underfunded, leading to high staff vacancy rates – especially for behavioral health. Also consider there is only one national suicide prevention consultant at IHS to address suicide across all 574 Tribal nations. Compare this to the Department of Veterans Affairs, which has an entire office dedicated to suicide prevention.
Fear of stigma can dissuade many people from seeking mental health support, particularly in a small community where people may worry about their truck being spotted in a clinic parking lot or an awkward waiting room encounter.
Lack of culturally relevant care can also keep people away from formal treatment. Native people who live on reservations or in remote areas often have to travel long distances to access behavioral health resources – and those services can be culturally insensitive to Native people. National campaigns can feel irrelevant to Native communities; past experiences with clinical discrimination can breed skepticism toward treatment.
Rural health and socioeconomic disparities are influential too. Suicide rates tend to be lower in areas with higher incomes, better access to broadband internet, and good health insurance coverage – the opposite of many Native reservations.
Finding Hope: 7 Indigenous Suicide Prevention Practices
Culturally relevant care has become a popular buzzword – but many teams have no idea where to get started. Here are a few practices that can help:
- Address both historical trauma and systemic inequities. Mental health interventions won’t feel honest and genuine to patients unless the dialogues put their challenges in a cultural context and address injustices.
- Blend Indigenous traditions with Western methodologies. Sweat lodges, drumming circles, and ceremonial purification and prayer can be helpful; some tribes are now teaching culture and values to children to give them a strong tribal identity. For instance, the White Mountain Apache Tribe created a youth suicide prevention program with culturally based activities led by Apache elders. This program led to a 38% decrease in overall Apache suicide death rates and a 23% reduction for youth age 15 to 24, as well as a strong reduction in attempts.
- Common suicide screening tools and other mental health resources can be adapted into Native languages; healthcare leaders can work with the community on making them culturally relevant and respectful. The 988 crisis line gave rise to the Native and Strong Lifeline, designed specifically to give Indigenous people culturally appropriate support.
- Include Indigenous voices in developing suicide prevention strategies. This cannot be left to happenstance. Healthcare leaders must proactively seek Native clinicians, community leaders, and mental health professionals and give weight to their input and recommendations.
- Train providers in culturally competent patient encounters. Healthcare providers should understand their patients’ values and cultural background to earn trust and avoid missteps.
- Track data. The absence of Native people from clinical research is an ongoing barrier. Suicide deaths, attempts, and ideation should be documented and studied to gain insight into patterns and inform prevention strategy.
- Work with community leaders to create public education campaigns and events like suicide prevention walks. School staff can introduce after-school programs and workshops on communication and coping skills.
Celebrating Hope For Life Day
To promote mental wellness in Indigenous communities, NCIUH has shared a fantastic toolkit of resources. You or your healthcare facility can use their beautiful posters, social media graphics, and sample copy to share your own campaigns. Take a look – and see how you can promote mental health in your facility and community.
To contact the 988 Suicide & Crisis Lifeline, dial or text 988. To reach the Native and Strong Lifeline, call 988 and press 4 or text N8V to 988.