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

BOXES AND FIGURES

ACRONYMS AND ABBREVIATIONS

PROCEEDINGS OF A WORKSHOP

WORKSHOP OVERVIEW

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

Policy Opportunities

Research Opportunities

WRAP-UP

REFERENCES

APPENDIX A: STATEMENT OF TASK

APPENDIX B: WORKSHOP AGENDA

Boxes and Figures

BOXES

1 Goals of the American Indian/Alaska Native National Suicide Prevention Strategic Plan (2011–2015)

2 Suggestions from Individual Workshop Participants to Advance Suicide Prevention in Indigenous Communities

3 COVID-19 Pandemic and Suicide Implications in the Navajo Nation

4 Tribal Strengths and Cultural Aspects for Wellness Promotion and Suicide Prevention

5 Two-Spirit People

FIGURES

1 2020 leading causes of death by age groups, 10–14 and 45–54, in the Indigenous population

2 A proposed model for the intergenerational basis for chronic disease disparities among Indigenous people

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

6 Indigenous data sovereignty

7 The CARE principles for Indigenous data governance

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Acronyms and Abbreviations