Suicide Prevention in
Indigenous Communities
__________
Francis K. Amankwah,
D. S. Red Haircrow, and
Sharyl J. Nass, Rapporteurs
Forum on Mental Health and
Substance Use Disorders
Board on Health Care Services
Health and Medicine Division
Forum for Children’s Well-Being
Board on Children, Youth, and
Families
Division of Behavioral and Social
Sciences and Education
Proceedings of a Workshop
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was funded by the Office of the Assistant Secretary for Health (Contract No. HHSP233201400020B [Task Order No. 75P0012F37112]), with support from the Indian Health Service. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-69474-2
International Standard Book Number-10: 0-309-69474-4
Digital Object Identifier: https://doi.org/10.17226/26745
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Suicide prevention in Indigenous communities: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26745.
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WORKSHOP PLANNING COMMITTEE1
WILLIAM R. BEARDSLEE (Co-Chair), Director, Baer Prevention Initiatives, Boston Children’s Hospital; Distinguished Gardner Monks Professor of Psychiatry, Harvard Medical School
TERESA BROCKIE (Co-Chair), Assistant Professor, Johns Hopkins School of Nursing
JAMES ALLEN, Professor, Memory Keepers Medical Discovery Team—American Indian and Rural Health Equity, Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth Campus
SADÉ HEART OF THE HAWK ALI, Tribal Lead and Senior Project Associate, Zero Suicide Institute
M. JUSTIN COFFEY, Chair, Department of Psychiatry & Behavioral Health, Geisinger Health System; Professor of Psychiatry, Geisinger Commonwealth School of Medicine
VICTORIA M. O’KEEFE, Mathuram Santosham Endowed Chair in Native American Health, Johns Hopkins University; Associate Director, Center for Indigenous Health; Assistant Professor, Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health
KATHY PHAM, Director, Policy and Professional Affairs, American College of Clinical Pharmacy
LISA WEXLER, Professor, School of Social Work; Research Professor in Research Center for Group Dynamics, Institute of Social Research, University of Michigan
Project Staff
FRANCIS AMANKWAH, Program Officer (from May 2022)
ADRIENNE FORMENTOS, Research Associate
ANESIA WILKS, Senior Program Assistant
ARZOO TAYYEB, Finance Business Partner
ALEXANDRA ANDRADA, Director, Forum on Mental Health and Substance Use Disorders
SHARYL NASS, Senior Director, Board on Health Care Services
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
FORUM ON MENTAL HEALTH AND SUBSTANCE USE DISORDERS1
MARGARITA ALEGRÍA (Co-Chair), Harvard Medical School
HOWARD H. GOLDMAN (Co-Chair), University of Maryland School of Medicine
ERIN BAGALMAN, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
CARLOS BLANCO, National Institute on Drug Abuse, National Institutes of Health
CHRIS M. CROWE, U.S. Department of Veterans Affairs
W. PERRY DICKINSON, University of Colorado
ANTHONY T. ESTREET, Morgan State University
SYLVIA K. FISHER, Health Resources and Services Administration
RICHARD G. FRANK, Harvard Medical School
ROBERT HEINSSEN, National Institute of Mental Health, National Institutes of Health
KRISTIN KROEGER, American Psychiatric Association
LAUREN B. LOWENSTEIN, Centers for Medicare & Medicaid Services
HUSSEINI K. MANJII, Janssen Research & Development, LLC
R. KATHRYN MCHUGH, Harvard Medical School
BEN MILLER, Well Being Trust
ANNIE PETERS, National Association of Addiction Treatment Providers
KATHY PHAM, American College of Clinical Pharmacy
JOE PYLE, Scattergood Foundation
DEIDRA ROACH, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health
MARY ROACH, Substance Abuse and Mental Health Services Administration
GLORINDA SEGAY, Indian Health Service
RUTH SHIM, University of California, Davis
MATTHEW TIERNEY, University of California, San Francisco, School of Nursing and Office of Population Health
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
FORUM FOR CHILDREN’S WELL-BEING
CHERYL POLK (Co-Chair), Safe & Sound
DAVID W. WILLIS (Co-Chair), Center for the Study of Social Policy
WILLIAM R. BEARDSLEE (Co-Chair), Boston Children’s Hospital; Harvard Medical School
SANDRA BARRUECO, Catholic University of America
HAROLYN M.E. BELCHER, Kennedy Krieger Institute
RAHIL D. BRIGGS, ZERO TO THREE; Albert Einstein College of Medicine
C. HENDRICKS BROWN, Northwestern University Feinberg School of Medicine; Johns Hopkins Bloomberg School of Public Health; University of Miami
TINA CHENG, Cincinnati Children’s Hospital Medical Center; University of Cincinnati
NATHANIEL COUNTS, Mental Health America; Albert Einstein College of Medicine
ROBERT DUGGER, Hanover Provident Capital LLC; ReadyNation
BETH DWORETZKY, Family Voices
KIMBERLY EATON HOAGWOOD, New York University
MARY A. FRISTAD, Nationwide Children’s Hospital; Ohio State University
STEPHANIE M. JONES, Harvard Graduate School of Education
LAURA KAVANAGH, Health Resources and Services Administration
AMY WIMPEY KNIGHT, Children’s Hospital Association
LAUREL K. LESLIE, American Board of Pediatrics; Tufts University School of Medicine
GABRIELA S. LÓPEZ, Chan Zuckerberg Initiative
MARY ANN MCCABE, George Washington University School of Medicine
TYLER NORRIS, Well Being Trust
LARA ROBINSON, Centers for Disease Control and Prevention
CARLOS E. SANTOS, University of California, Los Angeles
DEBRA B. WALDRON, American Academy of Pediatrics
DEBORAH K. WALKER, Boston University School of Public Health
LESLIE R. WALKER-HARDING, University of Washington; Seattle Children’s Hospital
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Reviewers
This Proceedings of Suicide Prevention in Indigenous Communities: A Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by PATRICK H. DELEON, Uniformed Services University of the Health Sciences. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The Forum on Mental Health and Substance Use Disorders and the Forum for Children’s Well-Being wish to express their gratitude to the expert speakers whose presentations and discussions helped inform efforts to prevent death by suicide in Indigenous communities. The Forums also wish to thank the members of the planning committee for their work in developing excellent webinar agendas.
The Forums are grateful to the Office of the Assistant Secretary for Health and the Indian Health Service for their support of this workshop.
The Forum on Mental Health and Substance Use Disorders is sponsored by the American College of Clinical Pharmacy, American Psychiatric Nurses Association, American Psychological Association, Association for Behavioral Health and Wellness, Council on Social Work Education, Janssen Research & Development, National Academy of Medicine, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health, Office of the Assistant Secretary for Planning and Evaluation, Optum Behavioral Health, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter and Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust.
The Forum for Children’s Well-Being is sponsored by the Administration for Children and Families, American Academy of Pediatrics, American Board of Pediatrics, Centers for Disease Control and Prevention, Chan Zuckerberg Initiative, Children’s Hospital Association, Family Voices, Global Alliance for Behavioral Health and Social Justice, Health Resources and Services Admin-
istration, Society for Child and Family Policy and Practice, Society of Clinical Child and Adolescent Psychology, Substance Abuse and Mental Health Services Administration, Well Being Trust, and Zero to Three.
Contents
DISPARITIES IN SUICIDE MORTALITY TRENDS
Intergenerational Trauma and Indigenous Suicides
SUICIDE PREVENTION ACROSS INDIGENOUS POPULATIONS
Rationale for Evidence-Based Practice
Evidence Base for Mainstream Suicide Interventions
Evidence Base for Indigenous Suicide Interventions
Suicide Prevention Resource Center
Examples of Suicide Intervention Models in Indigenous Communities
RESEARCH IN INDIGENOUS COMMUNITIES
Data Governance in Indigenous Communities and Community Wellness
OPPORTUNITIES TO IMPROVE INTERVENTIONS FOR SUICIDE PREVENTION
Boxes and Figures
BOXES
1 Goals of the American Indian/Alaska Native National Suicide Prevention Strategic Plan (2011–2015)
3 COVID-19 Pandemic and Suicide Implications in the Navajo Nation
4 Tribal Strengths and Cultural Aspects for Wellness Promotion and Suicide Prevention
FIGURES
1 2020 leading causes of death by age groups, 10–14 and 45–54, in the Indigenous population
3 The Zero Suicide framework realized as the medicine wheel
4 The White Mountain Apache model for strengthening and protecting youth
5 Fort Peck Assiniboine and Sioux Tribes: Timeline of collaborative activities
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Acronyms and Abbreviations
AASB | Alaska Area Specimen Bank |
ACE | adverse childhood experience |
AI/AN | American Indian/Alaska Native |
AILS | American Indian Life Skills |
CARE | Collective Benefit, Authority to Control, Responsibility, and Ethics |
CDC | Centers for Disease Control and Prevention |
FAIR | Findable, Accessible, Interoperable, and Reusable |
GLS | Garrett Lee Smith |
IHS | Indian Health Service |
LGBTQ | lesbian, gay, bisexual, transgender, queer |
NIMH | National Institute of Mental Health |
PC CARES | Promoting Community Conversations about Research to End Suicide |
PTSD | posttraumatic stress disorder |
QPR | question, persuade, refer |
SAMHSA | Substance Abuse and Mental Health Services Administration |
SPRC | Suicide Prevention Resource Center |
UNM | University of New Mexico |