Suicide is the leading cause of death in the United States, with nearly 45000 lives lost to suicide in 2016. Between the years 1999 and 2016, suicide rates have gone up by 30% in nearly every state. It was also noted that more than half of the people who died by suicide had not been diagnosed with a mental health condition.
An alarming number of suicides come from Native American communities, and American Indian/Alaska Natives show comparatively higher rates of suicide than any other racial/ethnic group in the United States. Since 2003, the rates of suicide in this population have been effectively rising.
Suicide in Native American Communities:
In comparison to the general American population, suicide cases are very different in Native American communities. On a national level, a majority that dies by suicide are middle-aged. Amongst Native Americans however, suicide is found prevalent amongst young adults who are between the ages of 15-24 years old.
Suicide among Native American youth is effectively a crisis. As per a study carried out by CDC in 2015, the suicide rate was noted to be the highest in the American Indian/Alaska Native population for both males and females and made up for 34.3 and 9.9 deaths in a population of 100,000. Due to the inaccuracy of the data available on Native American deaths, the suicide rates of these young adults are also likely to be an underestimated figure. In reality, death by suicide in the AIAN population is said to be underreported by 30%. The lack of accuracy was attributed to the fact that individuals who might identify themselves as Native American may not have their ethnicity listed on their death certificate.
While collectively, the AIAN population makes up for the highest suicide rates in the U.S., these numbers vary enormously from one Native American tribe to another. Some tribes may have a youth suicide rate that is noted to be three times above the national average. Others may have a suicide rate that is ten times above the national average.
For young adults, belonging to Hispanic, API and AIAN populations that committed suicide, suffocation was the most common method. This was followed by the use of firearms. Poisoning and falls were also found to be common within some communities.
Any individual can be prone to suicide, and most warning signs are common. Individuals that are most likely at risk may exhibit some set patterns such as making comments about killing themselves(suicidal ideation), increased intake of alcohol and drugs, behaving in an aggressive manner or showing recklessness and impulsiveness, withdrawing from friends and family and exhibiting dramatic mood swings.
While individuals from the Native American population may or may not behave in similar ways, a closer look at the most significant risk factors that have put the AIAN population on the top of suicide list in the USA tells us the following:
Drug use and Alcohol
According to the reports obtained from the National Violent Death Reporting System in 2003-2009, 36% of the AIAN suicide decedents were found to be intoxicated at the time of death and had alcohol levels above the legal limit. This was higher than any other racial or ethnic group.
A study carried out in 2007-2010 found that 64% of young adults belonging to the White Mountain Apache tribe were intoxicated or “high” when found dead by suicide. An additional 75.7% exhibited a similar state of intoxication and drug use during a suicide attempt or during suicide ideation (49.4%).
Another study of Alaska Natives, carried out in 2001-2009, had similar conclusions. It stated that 60% of the individuals exhibiting suicidal behavior had a history of substance abuse. Additionally in 2011, AIAN populations, especially those among the ages of 12 years or older, exhibited the highest rate of illicit drug use (Around 13.4%). This was higher than any other racial or ethnic group where drug use was mostly found to be around 8.7%.
History of Trauma
Multiple generations of AIAN people are shown to be affected by historical trauma, especially the kind involving attempts to eliminate their culture. Some of the factors that contributed to this include forced relocation, prohibition from practicing their cultural traditions, outlawing of traditional religious practices and being sent to boarding schools at a young age. Historical trauma has in effect contributed to high rates of suicide among Native American populations.
Alienation is a primary cause of suicide as it results in a loss of well being, with the individual feeling emotionally disconnected from their family or culture. Among Native Americans, it was found to be a significant risk factor. Upon analyzing suicide notes, twice as many Native Americans were found to have committed suicide due to alienation as compared to Whites.
Members of the Alaska Native tribal population who had attempted to adopt mainstream culture reported that they were suffering from increased levels of psychosocial stress. They were also found resorting to a greater use of alcohol and drugs in order to cope with the pressure of adapting and navigating the differences between two different cultures.
This conflict, involving their traditional cultural practices and an increased pressure to acculturate, has contributed to a high suicide rate among the adolescents and young adults of the Native American population.
Studies of Native American youth found discrimination to be a leading cause of suicide ideation. As a resulting effect, most of these individuals suffer from depression and poor self-esteem. Discrimination was found to be more prevalent in AIAN youth living on reservations as compared to those residing in urban areas. AIAN youth who belong to the LGBT community experience even more discrimination and prejudice than heterosexual AIAN youth and LGBT people belonging to other racial or ethnic backgrounds. Consequently, they are also seen to have higher rates of suicide deaths, attempts, and ideation.
Violence within the community
Young American Natives are nearly 2.3 times more likely to be exposed to violence and trauma than non-AIAN individuals. This usually involves AIAN youth being victimized by perpetrators of non-AIAN origin or trauma resulting from family violence. As a result, the rate of abuse and neglect in Native American children is found to be twice as more as that of the general population, and their rates of post-traumatic stress disorder are nearly the same as that of veterans returning from Afghanistan.
Lack of Access/Use of Mental Health Services
The percentage of Native American adolescents who seek help from professional mental health services is as low as 10-35%. There are several factors that contribute to this. In one study, primary reasons for not seeking out professional medical help in a suicide episode were embarrassment, helplessness, self-reliance and lack of realization that a problem existed.
Lack of Native American mental health professionals is also a cause. There are also staffing issues and shortages of skilled mental health professionals, even of non-native origin. Of the facilities surveyed, 82% did report to provide mental health services. However, the presence of staffing issues affects access to these services. Some facilities reported the use of pharmacotherapy instead by social workers, nurses and counselors. In addition, most AIAN people live in rural areas. Getting to the few mental health professionals that are located with reasonable distances can be difficult for these people. A lack of trust for mental health professionals and their disassociation with the Native American culture is also a hindrance.
The Indian Health Services Department that delivers healthcare to 2.2 million American natives is also severely underfunded. With the budget allocated to the IHS, the amount that can be spent per person for healthcare is found to be nearly 63% less than the amount dedicated to the general population.
Evidence suggests suicide contagion to be one of the risks leading towards suicide deaths, attempts and ideation. Suicide rates have been noted to be higher on reservations where AIAN adults and youth have been exposed to suicides, thus resulting in a chain reaction of sorts.
High rates of poverty and unemployment have also contributed to the sense of loss and despair among the Native American youth and to the suicide vacuum that has developed.
Counter-Measures for Protection against Suicide
There has been limited success in reducing suicide rates in the U.S. The causes are usually complex and include several factors. Attempts to counter suicide across all populations involve the following:
- Reconnecting to family, community and social institutions
- Effective mental healthcare
- Creating protective environments
- Teaching problem solving skills and methods to cope
- Providing financial support
In addition to these, some of the most significant factors that can help reduce the risk of suicide in AIAN populations include:
According to a Canadian study, tribes with virtually no suicides exhibited more cultural continuity. Comparatively, they had a stronger infrastructure with cultural facilities present as well as sovereignty. Self-government, having title to their lands and better provision of basic necessities within the community such as education, child and family services, and personal safety all helped elevate the quality of life.
At present Native American communities are working towards improvement by advocating for the power to prosecute crimes committed on a reservation by Non-Indians. This is especially crucial to reduce the number of domestic violence cases. Attempts are also being made to reduce bullying and sexual abuse. Community control efforts that help design and carry out a suicide prevention program can also be effective.
Alaska Native tribal members that observe a more traditional approach to life and make use of religion and spirituality to cope with stress report a better quality of life and improved states of happiness. They also report less use of drugs and alcohol to cope with stress.
Two studies involving Native American youth of the Midwest concluded that tribal members that had a strong sense of cultural and ethnic identity were able to cope with stress from acculturation in a better way and were also less inclined towards suicide ideation.
Increased commitment to tribal culture spirituality has also been shown to help in the reduction of suicide attempts. Tribal cultural spirituality is basically forms of spirituality that are derived from traditions predating Native American contact with Europeans. People who exhibited increased levels of orientation towards cultural spirituality were seen to have a much lesser prevalence towards suicide as compared to their counterparts.
Improved connections with family
Stronger connections to family and inculcating a habit of sharing and discussing problems with friends and family members can help reduce suicide attempts and protect against suicide ideation in Native American youth.
It is disconcerting how the crisis is not receiving as much attention as it should. The Native American people are facing nothing short of an epidemic that is taking their children away from them. For public health practice, the crisis doesn’t merely require focused yet comprehensive efforts towards suicide prevention and intervention. We also need to ensure that these efforts incorporate strategies that are culturally relevant across all levels and improve matters for both the individual and the community.
In 2012, the U.S. government dedicated $1,500,000 ($500,000 per year for 3 years) to youth-suicide prevention grants. However, only 7.58% of the federally recognized tribes received these grants.
Similar to the U.S., Canada is also grappling with high suicide rates among its First Nations people. In 2016, a state of emergency was declared in their Attawapiskat First Nation community when 11 people died due to suicide in one night. Like American tribal areas, the community also battles with poverty and violence. It is also 300 miles away from the nearest city. This severely limits their access to mental healthcare. The Canadian Prime Minister Justin Trudeau responded to the situation by proposing an $8 billion dollar budget in the coming years to improve healthcare and infrastructure in the First Nation communities.
The United States must pay the same kind of attention to the Native American Suicide issue. Efforts need to be made to provide Native Americans with better education, healthcare and housing. Otherwise, poverty, depression, and a feeling of hopelessness will continue to exist among the people.