Public Policy Issue Brief 2011

American Indian/Alaska Native Suicide

AFSP PUBLIC POLICY STATEMENT AFSP supports the authorization and funding of Native American suicide prevention and education programs, especially those directed at youth, at the highest levels possible. BACKGROUND Although suicide rates are extremely high among all segments of the AI/AN population, youth are most heavily impacted by this public health crisis as 40% of all AI/AN suicides occur among those ages 15-24 years old. In the AI/AN communities, suicide contagion is a major compounding factor that perpetuates suicide. Contagion occurs when a suicide within the community triggers others to attempt or complete suicide, resulting in multiple suicides or attempts within a short period of time. This is a problem which youth are highly vulnerable to, but AI/AN youth even more so. Among all ages of American Indians/Alaska Natives (AI/AN), suicide is the 8th leading cause of death.

*All rates are age-adjusted to the standard 2000 population and were collected from the Centers for Disease Control (WISQARS Database), http://www.dcd.gov/injury/wisqars/index.html

Most youth wont go to the mental health clinic. The stigma and shame keeps people away.
--Young Apache
Native American testifying before Congress

Mental health concerns. The reasons why suicide rates are high among the AI/AN population, and especially among youth, are multifaceted and complex. In particular, AI/AN individuals tend to have more serious mental health disorders that are related to suicide, including anxiety, substance abuse, and depression. For AI/AN youth, studies suggest that those who died by suicide were frequently responding to external stimuli such as significant family or interpersonal problems, had been using alcohol, drugs, or both, and tended not to have been seen previously in any behavioral health clinical setting. Stigma. In addition to the issues which can lead up to suicide, the stigma associated with receiving mental health treatment keeps AI/AN individuals from seeking and ultimately receiving care. Barriers to treatment. Because 90% of individuals who die by suicide had a diagnosable psychiatric disorder at the time of their death, it is clear that mental health treatment can prevent suicides. However, treatment is not easily accessible in AI/AN communities because of a lack of funding, culturally inappropriate services, and mental health professional shortages compounded by high turnover rates. This harsh reality is further demonstrated by the fact that there are less than 200 doctoral-level American Indian Psychologistsa severely inadequate number to serve the approximately 1.6 million AI/ANs eligible for health care from the Indian Health Service. All of these barriers to mental health care must be removed. Easily accessible treatment that is both evidence based and culturally appropriate must become available to all AI/AN communities. Such programs must also address suicide postvention that responds quickly and appropriately to one suicide in a community, reducing the risk that others in the community will attempt or die by suicide.

While making treatment readily available is crucial to preventing suicides, there is another element to ensuring a reduction in suicides among AI/NA peoples: stigma on mental health must be broken. As with making treatment available, this can only occur through the implementation of culturally appropriate programs to bring about a proper understanding of mental illness and mental health treatment.

AFSP 1010 Vermont Avenue, NW, Suite 408 Washington, DC 20005 (202) 449-3600 phone (202) 449-3601 fax www.afsp.org

2011 STATUS UPDATE

February 28, 2011 AFSP attended the opening of the Center for Native American Youth at the Aspen Institute. The Center for Native American Youth, founded by former Senator Byron Dorgan is dedicated to improving the health, safety, and overall well-being of Native American youth through a number of vehicles and creating more attention around the issues facing Native American youths, especially suicide. In addition to being very vocal about the challenges Native youth faces the Center also provides technical assistance to tribal governments on a number of issues. AFSP believes that the Center for Native American Youth at the Aspen Institute is an outstanding organization to team-up with in order to combat against suicide within the Native American/Native Alaskan youth population and Tribal communities as a whole across the nation. March 17, 2011 100 AFSP Field Advocates visited 260 offices on Capitol Hill during the 2011 Advocacy Forum and delivered recommendations from Tribal Nations toward the prevention of suicide including: $6 million for Tribal set-aside in the Garrett Lee Smith Program Develop and implement a culturally relevant and respectful National Suicide Prevention Campaign that uniquely targets Indian youth and their families. Develop and implement a sustainable behavioral health aide/paraprofessional training program. Funding to implement the behavioral health provisions of the Indian Health Care Improvement Act.

March 29, 2010 AFSP submitted outside witness testimony to the House Appropriations Interior Subcommittee urging the Committee to provide increased funding for the Indian Health Service (IHS) to address its incapacity to provide adequate health care in Indian Country. Currently: The IHS is operating on approximately 59% of what is needed to provide adequate care to AI/AN populations. The National IHS Tribal Budget Formulation Workgroup estimates that the IHS would need a total of $21.2 billion to achieve parity in health care with the general American population. Behavioral health services within the IHS (which includes both mental health and substance abuse) has a total budget of $267 million. This represents only 6.7% of a seriously underfunded IHS budget. Out of 242 Tribal health facilities nationwide, ten percent reported that no mental health services were being provided at all.

AFSP 1010 Vermont Avenue, NW, Suite 408 Washington, DC 20005 (202) 449-3600 phone (202) 449-3601 fax www.afsp.org