Suicidality Amongst Indigenous Peoples

Hey everyone, Monina here! As mental health professionals practicing in the state of Colorado, it is both important and necessary to acknowledge that we reside in the traditional homelands of Indigenous peoples since time immemorial (History Colorado, n.d.),.

The work that we do, the people that we encounter, and the spaces that we occupy, will inherently intersect with the lively cultures of the Indigenous peoples that are strongly embedded throughout the state - therefore, it is our ethical obligation to immerse ourselves in educational and experiential opportunities in order to better serve our community. Those who call Colorado home, often referring to themselves as “locals” or “natives”, would benefit from paying homage to the communities that inhabited the state long before the land was colonized by Europeans. These historic tribes include: the Apache, Arapaho, Cheyenne, Shoshone, and Ute tribes. 

As of today, an estimated 1% of Colorado’s population identify as Native/Indigenous (including those who are Alaskan native), which equals to about 54,000 people (Sadler, 2022). A great portion of this demographic reside in the Denver metropolitan area, being descendants of at least 200 tribal nations (Sadler, 2022). There are two federally recognized tribes in the state of Colorado that have reservations within the state: the Southern Utes and the Ute Mountain Utes (Sadler, 2022)

While there exists a vast amount of diversity within and among Indigenous communities, there are several common cultural threads that serve as protective factors for mental health for this population. These include community connectedness and empowerment, a strong attachment to nature, familial bonds, and fostering meaningful cultural traditions, among others (NAMI, n.d.). On the other hand, there are multifaceted sociocultural, political, and economic adversities that contribute to the mental well-being of Indigenous peoples, such as education disparities, forced removal, forced assimilation, and intergenerational trauma as a result of institutionalized abuse and racism (NAMI, n.d.).

As a result of the continued discrimination and marginalization that Indigenous communities face, we are observing disproportionate rates of mental illness, substance use disorders, and suicide within this population. A study conducted in 2019 showed that almost 20% of those identifying as Native/Indigenous experienced mental illness in the last year, with suicide rates of Native adolescents being more than double the rate of white adolescents (NAMI, n.d.). Furthermore, suicide has been cited as the second leading cause of death among Indigenous youth, with those aged 10-24 having the highest rate of suicide amongst all demographic groups (NAMI, n.d.) There continues to be a wide disparity in health inequity regarding suicide among Indigenous peoples in high-income countries (Pollock et al., 2018).

Indigenous peoples nationwide have called for suicide prevention strategies that are trauma-informed, community-led, and that address the intersecting forms of systemic oppression and sociocultural inequity (Pollock et al., 2018). These calls have yet to be actualized due to persistent barriers to mental health care, including inadequate funding of the Indian Health Service (IHS), geographic isolation leading to limited access (for some), clinicians lacking cultural competence, and a lack of financial resources, among others (NAMI, n.d.)

The effectiveness of suicide prevention and intervention practices for Indigenous peoples has yet to be comprehensively assessed. Traditional beliefs surrounding mental health, and health in general, in North America are culturally determined - through a Western, Eurocentric framework, which generally means they were not created with traditionally marginalized communities in mind. 

There are a multitude of local and national resources available for Indigenous peoples facing mental health crises, including suicide. The National Alliance on Mental Illness lists the following on their website:

• The National Native Children’s Trauma Center

• StrongHearts Native Helpline

• Zero Suicide

Additionally, the U.S. Department of the Interior - Bureau of Indian Education promotes the following resources, including federal agencies and training materials, on Indigenous suicide prevention: 

• Substance Abuse and Mental Health Services Administration Tribal Affairs

• Suicide Prevention Resource Center American Indian and Alaska Native Website

• Center for Native American Youth

• One Sky Center

• Traditional Healing & Suicide Prevention in Native American Communities: Research & Policy Considerations

• Northwest Suicide Prevention Tribal Action Plan

• Ensuring the Seventh Generation: A Youth Suicide Prevention Toolkit for Tribal Child Welfare Programs

Lastly, the following interventions have been noted to be beneficial when it comes to direct therapeutic work members of Indigenous communities (Centre for Suicide Prevention, 2021): 

• Promoting hope through a connection to spirit (identity, values, belief) 

• Emphasizing connectedness with family, community, land and ancestry to increase sense of belonging

• Fostering sense of meaning by knowing who one is and where one comes from 

• Exploring purpose through an understanding of Indigenous perspectives

• Building resilience through culture (e.g. cultivating strong connections between Indigenous elders and youth, practicing spirituality, and speaking one’s Indigenous language)

• Processing trauma via Indigenous service providers, traditional healers, or in mainstream healthcare settings that are informed by Indigenous peoples

• Avoiding one-size-fits-all approaches; adapting for the needs of each individual

Alongside providing tangible resources and interventions for the Indigenous peoples that we may come to serve, it is equally important to address and confront our biases as practitioners as to prevent possible re-traumatization. We must be able to introspect and acknowledge the areas in which we may lack knowledge, skills, and experience, and take action to educate ourselves. We must also be aware of the numerous barriers to mental health care access that Indigenous communities face, and engage in advocacy whenever appropriate. This includes naming the fact that mental healthcare is rooted in, and continues to perpetuate, traditional forms of Western psychology.

We must utilize our positions of power and privilege to elevate the voices of Indigenous peoples, seeking to understand their lived experiences. We must integrate the perspectives of Indigenous community members, placing them at the forefront, as a means of tailoring resources to include cultural considerations. We must continue to bring awareness to the intersection of historical trauma and social conditions at the individual and collective level (Haskell & Randell, 2009; Linklater, 2014 as cited in Centre for Suicide Prevention, 2021). 

References

Indigenous | NAMI. (n.d.). National Alliance on Mental Illness. Retrieved September 24, 2023, from https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Indigenous

Indigenous people, trauma, and suicide prevention. (2021, June 20). Centre for Suicide Prevention. Retrieved September 24, 2023, from https://www.suicideinfo.ca/local_resource/trauma-and-suicide-in-indigenous-people/

Native American History & Heritage. (n.d.). History Colorado. Retrieved September 24, 2023, from https://www.historycolorado.org/native-american-history-heritage

Pollock, N. J., Naicker, K., Loro, A., Mulay, S., & Colman, I. (2018). Global incidence of suicide among Indigenous peoples: A systematic review. BMC Medicine, 16, 1-17.

Sadler, C. (2022, April 25). The Original Coloradans | Native American Tribes and Reservations. Uncover Colorado. Retrieved September 24, 2023, from https://www.uncovercolorado.com/native-american-tribes-in-colorado/