Individuals in custody are a group at particularly high risk with respect to completed and attempted suicides. Completed suicides are among the most dramatic, tragic, and shocking events within the detention and correctional environment, especially when involving an adolescent. Suicidal behavior can be one of the most frustrating and embarrassing management problems of those who are held responsible for inmates' health; i.e., administration and direct line officers. The perception that Indians commit suicide frequently in correctional settings is common throughout Indian and non-Indian country, but actual data are difficult to obtain. This paper begins to address issues concerning suicidal behavior among Indian adolescent detainees, the on -reservation detention environment, individual risk factors that have been associated with suicidal behavior, hindrances to collecting data within this environment, and recommendations for continued basic and applied research in this unique treatment arena.
Suicides and suicide attempts among American Indians and Alaska Natives have received periodic national media attention. Such coverage has been viewed by Indian/Native communities as a negative portrayal (Tower, 1989). Research on American Indian suicide to date primarily addresses completed suicides, which occur at a rate almost twice the national U.S. average. Some efforts have been made at outlining community intervention and prevention responses that can be planned and practically implemented (May, 1987, 1991 ). This paper outlines a system of community planning strategies that can be utilized to address suicide and other behavioral crises when they arise in Indian and Native communities. It also includes steps for developing plans that may be particularly useful for small, tightly knit reservation-based populations. A basic principle underlying all such planning is that it should include and respect the particular histo ry and culture of the tribe to ensure culturally sensitive programming. The planning components discussed in this paper include
A recent review indicates that Indian adolescents have disturbingly high rates of both depression and suicide (Office of Technology Assessment, 1990). Although a number of known risk factors for white adolescent suicide have now been defined, their relevance for Indians has yet to be established (May & Van Winkle, see this issue). Brent, Kolko, Allan, and Brown (1990) and Kashani, Rosenberg, and Reid (1989) , studying inpatient and community samples of white youth, have shown that prior depression is a powerful predictor of later suicide. However, adolescents attempting suicide and those completing suicide are probably distinct populations, each with its own pattern of risk factors (Shaffer & Fisher, 1981 ). Berlin (1986), Shore (1974), and Office of Technology Assessment (1990) have shown that Indian suicide rates vary widely by tribe and location. Thus, cultural factors must play some role in the development of this form of psychopathology. Given that prior depression is an important risk factor, at least in adolescent suicide attempters, and that Indian adolescents are at high risk for affective disorders, suicide attempts, and suicide completion, a number of obvious questions follow: Are such symptoms also more prevalent in Indian latency-aged children than in their white counterparts? If present, do depressive symptoms persist? Do such symptoms erode the functional capacities of these children? Do Indian children report more symptoms of suicidal ideation in latency than white children? These questions caused us to re-examine for data generated by a large-scale study entitled the Flower of Two Soils in an attempt to find answers.
In what has become a macabre trend, authorities discovered the body of an Indian suicide victim Saturday - the eighth suicide victim in seven weeks on the reservation. The body of a 24-year-old male was found Saturday morning in the man's bedroom said the county coroner. The coroner said it appears the unidentified man used a leather strap to hang himself from a doorknob in his bedroom. The man's death is the latest in a series of suicides that began in mid-August. The coroner has said the deaths have left the community frustrated in its attempts to understand the incidents. ''We don't know what's going on and we don't know how to combat it,'' the coroner sid. ''The whole community is frustrated.'' He added the suicides are especially distressing because they have involved young people ''who have not begun to live yet.'' The first suicide occurred when A., 20, hanged himself in the city jail. He had been jailed for intoxication. Four days later, B., 16, committed suicide (also by hanging). Four days later, the body of C., 14, was found hanging from a tree. C. and B. had been close friends. Twenty-eight days later, 23 year old D. was found hanged with a coat hanger in a closet in his parents' home. D. also was friends with B., who was said to be one of the most popular students at his school on the reservation. One day later, E., 22, hanged himself with a cord tied to a beam in the basement of his home. Four days later, F., 19, hanged himself from a cross-bar in his cell at the city jail (where A. first committed suicide), where he had been placed on intoxication charges. The body of G., 14, was found the next day hanging from a corral panel at the family ranch. Reservation residents were burying F. Saturday and still planning G.'s funeral for Tuesday when they received word of the latest suicide.
Mental health professionals within the reservation community in this study became concerned with the apparent steady increase in suicide attempts and behaviors among the American Indian residents. From 1984 through 1989, 194 suicide attempts were recorded, with a total of 4 completions. A 5-year assessment indicated both an attempt rate and a suicide completion rate at least 2.5 times the U.S. average. Claymore (1988) reported a high recent attempt rate for Pine Ridge, South Dakota, at 1,281 per 100,000 population; the reservation assessed in this study had a 5-year prorated frequency average of 38.8 attempts per year, or 1,021 per 100,000 population annually. Mental health professionals observed that attempters offered a variety of explanations regarding when the attempts occurred, where they occurred, how and under what circumstances they occurred, and why (the motivating conditions/perceptions prior to the attempts). Attempters also evidenced a variety of behavioral responses immediately following the attempt, as well as differences in recovery periods. Adolescent attempter responses to some of the questions offered by assessment professionals appeared to differ somewhat from the responses of adults. It was felt that a clearer definition of attempter perceptions and behaviors just prior to, during, and immediately after a suicide attempt would be helpful to the establishment of more effective prevention, intervention, and follow-up programs. There has been encouragement for gathering of data on Indian suicides that provide nonstereotypical and more accurate information regarding suicide among American Indians and that offer distinctions between adult and adolescent causal factors (Thompson & Walker, 1990). We were interested in assessing the descriptive characteristics of suicide attempters as well as other conditions surrounding the attempts. including stressors, motivations, and other behavioral data. This information
IThis article describes the development, implementation, and pilot evaluation of a skills-based suicide prevention curriculum for the Zuni Pueblo. The Zuni Life Skills Development curriculum takes a skills training approach to reduce the risk factors for suicide among Zuni adolescents. This article presents some background information about skills training and its applicability to Indian cultures and suicide prevention. The process by which curriculum development was initiated and maintained is described, with an emphasis on the collaborative efforts between the Zuni community and Stanford researchers and the challenges faced by each to develop a culturally sensitive, effective curriculum. Results of the process and outcome evaluation of a pilot test are described in detail as background for the reasoning behind modifications made in a revised curriculum and evaluation design that met the needs and concerns of the community, school, and researchers. An overview of additional efforts in the community to develop a more comprehensive approach for suicide prevention that moves beyond a curriculum-only intervention is presented. (Abstract Adapted from Source: American Indian and Alaska Native Mental Health Research, 1994. Copyright © 1994 by the National Center for American Indian and Alaska Native Mental Health Research) For more information on the American Indian Life Skills Development Curriculum, see VioPro 2942. Late Adolescence Early Adolescence Senior High School Student Native American Juvenile Native American Suicide School Based Suicide Prevention Juvenile Suicide Juvenile Development Youth Development Social Skills Development Prosocial Skills Curriculum Prevention Program Program Evaluation Program Effectiveness New Mexico 10-04
This paper is presented from the viewpoint of a regional state administrator for mental health services who has observed the implementation of Alaska's suicide prevention programs for several years. Other observers, or participants in those programs, might see their strengths and weaknesses in a different light. The region observed, Region Ill , is the most rural of the three mental health regions and has the highest percentage of Alaska Natives. It covers roughly three fourths of the state and includes only one urban area, Fairbanks. Although many Alaska Natives, like Indians in the "lower 48, " have migrated to urban areas, the majority still live in rural areas (about half live in communities with less than 1,000 population). These villages are extremely isolated by the standards of the contiguous United States; however, they have been massively influenced by Western technological society in the past 50 years. particularly so in the past 20. In the 1940s the Natives of Alaska still were the majority popu lation; less than 50 years later, in 1988, the estimated 81 ,200 Natives made up only 15% of the state's residents. In spite of a high birth rate and a decreasing infant death rate, they have been overwhelmed by a tide of white immigrants. With this tide came the many mixed blessings of the technological society, among them snow machines, television, schools, welfare checks, and the cash economy. Also considered a mixed blessing by some was the 1972 Alaska Native Claims Settlement Act (ANCSA), which created 12 regional Native corporations and many village corporations. These corporations were to manage the lands and resources to which the Native claims were now recognized. They also generated sister corporations that manage health and social services funded by state and federal governments through a variety of agencies. Three fourths of Region Ill's Community Mental Health Centers (CMHCs) are funded through a Native corporation. The Native population's relative political and economic impact was enhanced by ANCSA, which brought 11% of the state's land under the control of Native corporations. ANCSA was expected to raise Native standard of living and wellbeing. Native family incomes rose almost 40% between 1970 and 1980, educational levels rose, and the quality and quantity of housing stocks also rose. However, while the proportion of Native women working increased to equal that of Native men, the employment profile of Native Am er ic an I nd ia n an d Al as ka N at iv e M en ta l H ea lth R es ea rc h
The Flathead Reservation, located in northwestern Montana and occupying approximately 1.5 million acres of land, was established for the Confederated Salish and Kootenai Indians in 1855. In 1910, President Taft opened the Flathead Reservation to settlement by non-Indians; by the mid-1900s, Indians had become a minority on their own reservation. The Indian people now living on the reservation are called Flathead by most whites. However, the population actually represents three tribes, although two of thesethe Salish and the Pend d'Oreille (or Kalispel) are closely related because of intermarriage during the past two centuries. The other tribe, the Kootenais, shared hunting grounds with the Pend d'Oreilles. The Salish befriended the Lewis and Clark expedition in 1805. The white explorers mistakenly believed that the Salish were Fiatheads, a tribe that lived on the Pacific Coast. The name has stayed with the tribes since. The Confederated Salish and Kootenai Tribes are considered to be among the most progressive tribes in the nation.
A theoretical model for understanding the impact of social change on human health begins with examining societies, families, social support, and health. In 1982, the Institute of Medicine, after a series of conferences, proposed a framework linking the health of individuals to larger social systems (Hamburg, Elliott, & Parron, 1982). We will frrst outline the specifics of this framework and discuss the significance of considering Alaska as a case in point, that both corroborates and expands this purview. Secondly, our chapter will outline a theoretical model to supplement the framework. Finally, we will discuss directions for future research which provide a way to differentiate more clearly the variables at worlc in the cycle that incorporates the person, societalenvironmental change, and health.
The chapter entitled "Major Mental Disorders and Behavior" from Health and Behavior: Frontiers of Research in the Biobehaviora/ Sciences (Hamburg, Elliott, & Parron, 1982) takes a highly biological view of major mental illness in the United States. This biological orientation to mental health reflects several . decades of research and clinical experience in the statistical and neurobiological sciences in this country and other Western nations. From the work in these sciences a great deal has been learned about the function of the brain in health and illness. The last several decades of work have produced a revolution in psychopharmacological treatments for major mental disorders, a phenomenological approach to diagnosis, a new understanding of neurochemistry, diurnal rhythms, neuroendocrinology, brain physiology, and functional neuroanatomy. There now exists a much improved understanding of the genetics of mental illness and the social environment of the psychiatric patient from the majority American culture, particularly those patients living in cities. These fields promise to contribute even more substantially to our understanding of human behavior in the near future. In contrast to the impressive body of work in the neurosciences with the majority American culture, relatively little is actually known about major mental disorders among American Indian and Alaska Native people. In the majority culture, decades of research have produced highly refined diagnostic categories for major mental illness. The development of a system of good phenomenological diagnosis, based on statistical clustering of symptoms rather than assumed etiological similarities, has provided a foundation upon which, for example, to describe familial patterns of mental illness, diagnostic instruments that could accurately identify and distinguish cases from noncases were needed. In order to identify aberration in neurotransmitter systems in the brain, diagnoses needed to have sufficient refmement to produce homogeneous groups of subjects with the same symptoms of illness. Because of the difficulties of accurately diagnosing mental illness in Indian people, for reasons discussed below, the very foundation for the application of these biological and statistical insights to Indian people is lacking. Diagnoses of major mental illness in Indian cultures are not yet sufficiently refmed to permit the applications of many of the sophisticated biological models of "Major Mental Disorder and Behavior" to Indian patients.
The topic considered here is health for Indian children. By necessity, however, this paper focuses on death and disease patterns of Indian and Alaska Native children. The ages considered are from conception through 14 years. As was necessary in the treatment of this topic in Health and Behavior: Frontiers of Research in the Biobehavioral Sciences by the National Academy of Sciences (Hamburg, Elliott, & Parron, 1982), consideration will be given to some adult behaviors and some broader issues which affect the health of children. While limiting the focus to the youthful ages is difficult, in some ways arbitrary, and not a completely accurate representation of reality, it will hopefully serve a heuristic function. It should be particularly useful for the topic of prevention and will allow the health professional to focus far "upstream" to deal with many problems at the source. As will be evident below, a focus on the young is both needed and particularly appropriate for the American Indian population.
