Epidemic: Suicide in Indian Country

Transcription

1 10/8/15 sgcoe.org Epidemic: Suicide in Indian Country Jacqueline S. Gray, Ph.D. Seven G enerations Center of Excellence in Native B ehavioral Health Center for R ural Health University of North Dakota National American Indian and Alaska Native ATTC Webinar October 7, 2015 Indian Country Ø 566 Federally recognized tribes in U.S. ü 229 Federally recognized Alaska Native Villages Ø 2010 Census estimated 5.2 million AI/AN Ø 70% AI/AN live off the reservation in urban areas Ø 25% live in poverty ü AI/AN children 31% live in poverty ü More than 2 times the U.S. rate. Ø 33% AI/AN have no health insurance Source: American F oundation for Suicide Prevention, Washington, D.C. 1

2 Health Care in Indian Country Ø Indian Health Service (IHS) operates at 59% of need. Ø Estimates indicate IHS would need $21.12 billion to achieve parity with general population Ø Behavioral Health at IHS has a total budget of $267 million, only 6.7% of the entire IHS budget. Ø Of 242 Tribal Health facilities 10% reported no mental health services were provided. Source: American Foundation for Suicide Prevention, Washington, D.C. 2

3 Mental Health Ø AI/AN have more serious mental health disorders compared to other racial/ethnic groups including anxiety, depression, substance abuse Ø Mental health services are not easy to access: Ø Lack of funding (IHS Mental Health 25% need) Ø Culturally inappropriate services Ø Mental Health professional shortages/high turnover Native Suicide Contributing Factors Behavioral Health Diagnosis & Stigma Substance Use/Abuse Cultural Distress Family Disruption/ Domestic Violence Suicide Edu., Econ., Rec. Impulsiveness Hopelessness Family History Negative Boarding School Psychological Vulnerability Historical Trauma Suicidal Behavior 6 3

4 Suicide Rates for AI/AN Ø Among American Indians/Alaska Natives (AI/AN) aged years, suicide is the 2 nd leading cause of death. Ø Suicide rate among AI/AN adolescents and young adults ages years (22.5/100K) is 1.4 times higher than the national average for that age group in Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web- based Injury Statistics Query and Reporting System (WISQARS) [online]. (20150). [cited 2015 Oct 4 Available from 4

5 Suicide Rates Among Males Aged Years by Ethnicity United States, White 50.0 Black Latino 40.0 As ian/ PI AI/ AN Source: Centers for Disease Control & Prevention 12.0 Suicide Rates Among Females Aged Years by Ethnicity United States, White 2010 Black 10.0 Latino 8.0 As ian/ PI AI/ AN Female Data not available for AI/AN Females Source: Centers for Disease Control & Prevention 5

6 General Suicide Rates AI/AN 2010 per 100,000 Male Female White White 5 AI/ AN 2 AI/ AN > >64 Years of Age Years of Age Source: CDC, Health United States, Table

7 10/8/15 Mental Health Status Ø Serious psychological distress Ø 170% AI/AN 5.2 White 3.1 Ø worthlessness, everything is an effort Ø Worthlessness AI/AN 2.6 Ø Everything is effort 11.0 White Models of Care sgcoe.org 14 7

8 Ethnic & Cultural Considerations Ø Higher rates of poverty, poor educational achievement, substandard housing, & disease Ø Colonization acculturation Ø Mission & boarding schools Ø Weakening parental influence Ø Dislocation from native lands Ø Few evidence based programs that are adapted for AI/AN cultures Suicide Prevention Programs Among American Indian Youth: Three Main Approaches Do them All Ø Adoption of mental health focus on Risk and Protection factors across life span Ø Adaptation of public- health based interventions that promote opportunities for youth to gain self- esteem and avoid substance abuse/risky behavior Ø Incorporation of traditional tribal responses as effective prevention strategies Source: The Suicide Prevention Resource Center, supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services 8

9 What are some promising strategies? AI/AN Prevention, Treatment, and Rehabilitation Interventions ü Story Telling ü Talking Circles ü Sweat Lodge ü Ceremonies and Ritual Purification Passages Naming Grieving ü Drumming, singing, dancing ü Vision Quest ü Flute playing/meditation ü Reconciliation ü Mentoring ü Service learning ü Traditional Experiences Preservation 9

10 Integrated Treatment Premise: treatment at a single site, featuring coordination of treatment philosophy, services and timing of intervention will be more effective than a mix of discrete and loosely coordinated services Findings: ü decrease in hospitalization ü lessening of psychiatric and substance abuse severity ü better engagement and retention (Rosenthal et al, 1992, 1995, 1997; Hellerstein et al 1995.) 10

11 10/8/15 Cultural and Integrated Model Partnered Collaboration State/Federal Grassroots Groups Community-Based Organizations Research-Education-Treatment 11

12 Reasons for Not Seeking Formal Help When Suicidal Reasons for Not Seeking Informal Help When Suicidal 12

13 Common Characteristics of Successful Native Programs ü Leadership ü Mobilization Community driven ü Public health approach ü Strength based ü Culturally informed ü Proactive 13

14 Five Key Principles Evidence-based predictors of change ü Understand & Involve the Community ü Focus on major problems ü Select the right change agent ü Seek ideas from outside the field and organization ü Evaluate SGCoE For more information about SGCoE and its programs contact SCGoE at: Phone: