In Brief

With the suicide rate for American Indian youths more than twice the national average, suicide prevention needs to be a top priority for native communities and the government agencies that support them, said American Indian psychologist Joseph Stone, PhD, at a Senate Indian Affairs Committee hearing held in June to examine the problem of youth suicide among Native American groups.

Stone, who is the program manager and clinical supervisor of the Confederated Tribes of the Grande Ronde Behavioral Health Program in Oregon, detailed how economic hardship, a lack of health insurance and a shortage of mental health-care providers are linked to high suicide and violent crime rates in American Indian populations. In addition, American Indian children are twice as likely to suffer an accidental death as the average child, and violent deaths--accidental injury, homicide or suicide--make up 75 percent of all the deaths among tribal people, Stone said.

"Tribal youth are raised in native families and communities subject to ongoing cultural oppression, health disparities and lack of equal access to services, lack of economic opportunity and chronic poverty," Stone said to an audience that included Sen. John McCain (R-Ariz.). He added that the cumulative intergenerational effect of historical trauma and chronic situational stress surrounding native families and communities creates an environment where parents are too stressed to provide children with optimal developmental conditions, and children then develop less than adequate control of their emotions.

"Because the parent is so busy coping with situations of unremitting stress or historical trauma, including economic, social or political oppression in the moment, that parent sacrifices their capacity to provide a fully adequate developmental framework within the family or community for the child," Stone said in his written testimony. "The consequence of chronic situational stress surrounding native adults, families and communities from post-colonial stress and historical trauma sets up and perpetuates an intergenerational cycle of unregulated arousal leading to lowered resilience to situational psychological insults and traumas and increased risk of developing and exhibiting behavioral disorders as adults."

Others who spoke at the hearing included Native American community members who have witnessed youth suicide problems first-hand and U.S. Surgeon General Richard Carmona, MD, who agreed that preventing suicide in native communities needs to be a priority.

"We need to understand the uniqueness of the culture and work hand-in-hand with our Indian colleagues to develop solutions," Carmona said.

Stone, who spoke on behalf of APA's Public Interest Directorate, said sometimes one suicide can start a chain reaction of sadness and despair within a group and can lead to further suicides.

"What I'd like to recommend is that we look at making suicide prevention a top priority for native communities," he said. He then offered suggestions for how federal and local public health efforts can do that, including:

  • Improving suicide prevention initiatives. He recommended developing a national center for excellence for suicide prevention in tribal communities and stepping up school-based mental health services to promote a positive school environment and prevent youth suicide.

  • Increasing the collaboration between county and state mental health system gatekeepers and tribal mental health providers to ensure that suicidal clients get the treatment they need.

  • Increasing the number of qualified native mental health professionals to a number proportionate to that in the general population.

  • Providing an additional $170 million to the Indian Health Service for health and mental health care.

--K. KERSTING