Suicide Prevention in Indigenous Communities

Proceedings of a Workshop

The Forum on Mental Health and Substance Use Disorders and the Forum for Children’s Well-Being at the National Academies of Sciences, Engineering, and Medicine convened a three-part virtual public workshop on April 22, 2022, May 13, 2022, and June 10, 2022, to examine suicide risk and protective factors in Indigenous populations, discuss culturally appropriate and effective suicide prevention policies and programs, explore existing data systems and how data can be used for tracking suicide rates, and consider opportunities for action.

Statements and opinions expressed are those of individual workshop presenters and participants.1

Improving Culturally Appropriate Approaches to Identifying, Managing, and Preventing Suicides and Suicide Clusters

  • Engage with tribal communities and seek guidance from Indigenous leadership and scholarship to protect communities’ values. (Garnie, Gomez, Haozous, LaFromboise, Peter, Wetsit, White)
  • Improve coordination among the public sector, local and tribal communities, and federal partners to reduce the tragedy of suicide. (Fowler, Garnie, Gomez, Gone, McKeon, White)
  • Integrate cultural teachings, connectedness, and ceremonies in suicide prevention programs. (BigFoot, Gone, Ali, Peter, Rasmus, Wexler)
  • Develop and implement interventions that are culturally based, to address suicide risk factors. (Ali, BigFoot, Gone, Ivey-Stephenson, Nez, Warne)
  • Recognize that Indigenous communities face significant social disadvantages and intergenerational trauma that lead to poor health outcomes compared with the general population. (Ali, Brockie, Fowler, Goklish, Gone, Larzelere, Warne, Wexler)
  • Approach suicide prevention as community wellness promotion. (Brockie, Grund, Warne, Wexler)
  • Teresa Gomez

    “Ensure that the voices of tribal communities are at the various decision-making tables so that we can promote suicide prevention, intervention and post-intervention efforts.”

    Teresa Gomez
    University of New Mexico
    (Pueblo of Isleta)

  • Lawrence Wetsit

    “The cultural people have knowledge and are the knowledge-keeper of our communities. And those knowledge-keepers need to be involved in your project.”

    Lawrence Wetsit (Many Eagle Tailfeathers)
    Johns Hopkins School of Nursing
    (Fort Peck Assiniboine)

  • Elizabeth Fowler

    “In order to bring suicide prevention awareness and crisis services into focus within tribal nations and communities, suicide must be addressed as a public health concern that affects everyone across the US and worldwide.”

    Elizabeth Fowler
    Indian Health Service
    (Comanche Nation, descendancy from the Eastern Band of Cherokee Indians)

  • Dolores BigFoot

    “There’s a lot of cultural teaching around belonging, identity, connection, and circles, that we can incorporate into our suicide prevention programming.”

    Dolores BigFoot
    University of Oklahoma
    (Caddo Tribe)

  • Lisa Wexler

    “Centering community and culture at the heart of interventions that we're doing is really important, because that can support resistance. It can give young people language to better explain what they're experiencing, can give both families, individuals within them, and tribal communities more control over their futures”

    Lisa Wexler
    University of Michigan

  • Jonathan Nez

    “All tribes are different. We share our thoughts, what has worked. Some have not worked, but we have the ability, leadership throughout the country and tribal communities have the ability to look at how these resources can help our people.”

    Jonathan Nez
    Navajo Nation

  • Donald Warne

    “We need to be promoting social connectedness, and having counseling that could be using the best of modern methods, but also our traditional healers have training in culturally based counseling methodologies that need to be incorporated to ensure that we have an equitable approach.”

    Donald Warne
    University of North Dakota
    (Oglala Lakota)

  • Sadé Heart of the Hawk Ali

    “We need to acknowledge that trauma is real, that intergenerational trauma is in the blood. It is blood memory of our people and we need to understand that trauma-informed ways to treat indigenous people.”

    Sadé Heart of the Hawk Ali
    Zero Suicide Institute
    (First Nations Mi'kmaq from the Sturgeon Clan)

Improving Suicide Prevention Research in Indigenous Communities

  • Recognize and address the stigma associated with mental health and suicide prevention. (Ali, Dillard, Larzelere, Shaw)
  • Empower Indigenous communities to engage in research and encourage researchers to partner with Indigenous people across the study continuum. (Allen, Dillard, Shaw)
  • Adopt and adapt interventions that are responsive to community culture and values. (Gone)
  • Consider the strengths and cultural practices of Indigenous populations when developing and implementing interventions. (Gone, Gonzalez, Kahn-John, Peter, Wexler)
  • Advance health care services and research specific to Two-Spirit and lesbian, gay, bisexual, transgender, queer (LGBTQ)-identified individuals. (Ali)
  • Francene Larzelere

    “We know that there is stigma related to suicide. That was the same when we first started working on the suicide prevention efforts within our own community.”

    Francene Larzelere
    Johns Hopkins Bloomberg School of Public Health
    (White Mountain Apache Tribe)

  • Denise Dillard

    “People in Indigenous communities really want more research to be led and conducted by Indigenous people themselves.”

    Denise Dillard
    Southcentral Foundation
    (Inupiaq Eskimo)

  • Michelle Kahn-John

    “Bring forth culturally informed models of care that are tailored to each individual indigenous community, because we’re so diverse in our beliefs, our practices, in our stories, and in our healing interventions.”

    Michelle Kahn-John
    Johns Hopkins School of Nursing

  • Evon Peter

    “Our people need to be in leadership, whether it’s in the context of research, education, teaching, any interventions and preventions”

    Evon Peter
    University of Alaska Fairbanks
    (Neets’ąįį Gwich’in and Koyukon from Vashrąįį K'ǫǫ )

Improving Data Quality and Sovereignty

  • Create data systems that crosslink vital statistics data to improve the quality of data and build health equity. (Haozous)
  • Empower Indigenous communities with data sovereignty and track the use and reuse of Indigenous data for data governance, research reporting and compliance. (Carroll)
  • Partner with Indigenous leadership to determine how data will be collected and used for research. (Dillard, Shaw)
  • Emily Haozous

    “We do have a gold standard for improving the quality of the data that we can use, by creating data linkages that crosslink the vital statistics data. With these linkages we can build a much better sense of where we have health equity concerns.”

    Emily Haozous
    Pacific Institute for Research and Evaluation
    (Chiricahua Fort Sill Apache)

  • Stephanie Russo Carroll

    “Indigenous peoples need de-colonized, indigenized dis-aggregated data for decision-making that shifts the narrative from deficits and deficiencies to wellbeing research. At the same time, tribes are enacting relational responsibilities for their data, governing their data in ways that align with their values and interests.”

    Stephanie Russo Carroll
    University of Arizona
    (Native Village of Kluti-Kaah)

  • Denise Dillard

    “[Researchers should] gain awareness of past research projects in communities and work with the community to find out how to treat collected data and specimens. Each community has stories of research that has happened in their community, some of which went well and some of which are not perceived as going well.”

    Denise Dillard
    Southcentral Foundation
    (Inupiaq Eskimo)

  • Jennifer Shaw

    “We identify an intervention first and then get tribal leaders’ approval to culturally adapt the intervention to ensure that it is, in fact, in alignment in some fundamental way with the community values and priorities.”

    Jennifer Shaw
    Southcentral Foundation

Lisa Wexler

Centering community and culture at the heart of interventions that we’re doing is really important.

Lisa Wexler
University of Michigan

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1 This page is a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants. These views are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.