Reducing Suicide Risks
“Start off with questions checking for traditionality and family connectedness,” suggests Dan Edwards, DSW, director of the University of Utah School of Social Work and Native American Studies in Salt Lake City. This information is essential for effective assessment, particularly in the mental health area, such as evaluating suicide risk.
Three first questions, suggests Edwards, might be: Where do you live? Do you know the [tribal] language? Have you ever been to your own tribal ceremonies? (For example, a female patient could be asked, “Have you ever been to a kinaalda [a Navajo coming-of-age ceremony for girls]?”) Then, he says, “as you establish rapport and if the patient seems open to it, you can begin talking about spirituality and religion.”
Edwards is of Yurok heritage, with pre-1970s personal experience with foster care, adoption, boarding schools and assimilation pressures. He has observed the links for bad parenting and high divorce rates, heavy drinking patterns, vulnerability to negative peer pressures and suicide clusters.
Alaska Natives and American Indians rank first among all ethnic groups in suicide rates. While the particulars vary for subgroups--e.g., Indian people living in cities versus rural areas and reservations--the causes can be traced to historical trauma.
“The lost birds--Native Americans who were adopted out or in foster care and have completely lost their culture--are at high risk for suicide and/or risk-taking behavior if they have not successfully taken on their new family’s ways to a level of comfort that will offset these problems or if they have not sought their own culture later in life,” explains Margaret P. Moss, RN, DSN, assistant professor at the University of Minnesota School of Nursing and a Native Investigator (Hidatsa/Lakota background) in research.
Getting the complete family and lifestyle picture is also critical for suicide prevention in Indian teens and young adults, a particularly high-risk group, adds Faye Annette Gary, RN, EdD, the Medical Mutual of Ohio Professor of Nursing for Vulnerable and At-Risk Populations at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland.
Gary, who gave a presentation on Native adolescent health and preventive education at NANAINA’s ninth annual Summit in Park City, Utah, last September, urges Native nurses to recognize the profile: male, between 15 and 24; single; likely to be under the influence of alcohol before suicide attempt; lived with a number of ineffective/inappropriate parental substitutes. Familiar historical trauma issues include “once a resident in boarding schools with frequent moves,” “in confinement centers at early age” and “experienced a loss of a significant other through violence.”