Applying a public health approach to suicide prevention among Indigenous peoples

Suicide is one of the most serious public health crises faced by Indigenous peoples. Elevated rates of suicide, especially among young people, have been documented for more than half a century and are a tragic symptom of a web of risk factors that tend to be more prevalent among Indigenous populations. These risk factors are linked to social and economic inequities rooted in colonial policies of the past and present such as relocations, residential schooling, and limited access to basic services and supports that are taken for granted in many parts of the U.S. and Canada.

Unlike in the non-Indigenous population, however, suicide among Indigenous populations still tends to be viewed by policymakers and researchers as a unique phenomenon rather than a public health problem warranting evidence-based, public health solutions. As a consequence, suicide is now a multigenerational problem that too many of our families and communities are still struggling with today.

In Alaska where I am from, the rate of suicide among Alaska Natives has remained elevated by at least three times the U.S. national rate among white people for nearly 30 years; specific regions, such as Norton Sound (64.5 per 100,000) and the Northwest Arctic (65.5 per 100,000) experience even higher rates, according to the most recent 2012-2015 data from the Alaska Native Tribal Health Consortium. Inuit in Canada die by suicide at rates ranging from 60 to 275 per 100,000 among the four regions that make up the Inuit homeland, compared to a rate of 11.3 per 100,000 for all Canadians.

Current national data on rates of suicide among First Nations in Canada are not readily available, but some regional data reflect similarly high rates.

Even as public acknowledgement of these high suicide rates grows, some who research suicide among Indigenous populations choose to ignore or downplay the role of the many known risk factors for suicide, such as childhood trauma, while heavily focusing on those risk factors related to cultural loss. Such research can influence policy thinking and potentially even shift focus away from addressing issues that are linked to suicide risk, such as access to family violence shelters and addictions treatment facilities.

We saw how much education is still needed around suicide prevention in April 2016 in the wake of a cluster of suicide attempts among youth on the Attawapiskat First Nation in Ontario. In an emergency debate held in the House of Commons to discuss solutions to the crisis, the Minister of Indigenous and Northern Affairs Canada, Carolyn Bennett – a former family physician – cited research carried out by Michael J. Chandler and Christopher Lalonde. Bennett stated that “when communities have their language…that is huge, as is control over their health care, education, doing their ceremonies. That is how suicide rates went down to zero in some of the communities that were studied.” The policy implication is that, when it comes to Indigenous peoples, suicide does not warrant an evidence-based public health approach that includes social and economic equity, but one that is focused on low-cost solutions that only the community itself can provide.

It often seems like Indigenous peoples have been confined — and often confine ourselves — to an alternative reality when it comes to suicide prevention, one in which we are expected to combat this challenge without access to many of the basic tools and resources available in non-Indigenous communities. For decades we have too often settled for the mental health equivalent of home remedies instead of the evidence-based public health measures that have successfully reduced suicide rates elsewhere. In Quebec, for instance, the rate of suicide was cut nearly in half 10 years after the province began implementing a comprehensive suicide prevention strategy in 1999.

Novel, evidence-based initiatives, such as the 2016 National Inuit Suicide Prevention Strategy developed and led by Inuit in Canada, show that Indigenous peoples are taking leadership on this issue. First Nations in Saskatchewan, led by the Federation of Sovereign Indigenous Nations, are in the process of developing their own provincial First Nations-specific suicide prevention strategy, believed to be the first of its kind in the country.

This issue of Northern Public Affairs magazine features articles that highlight promising approaches to suicide prevention among Indigenous peoples in North America. It advances a more nuanced discussion of risk factors for suicide and suicide prevention initiatives among Indigenous peoples than is commonly available. It is our hope at NPA that these articles serve a practical educational function, and that they are used as references for planned or ongoing suicide prevention initiatives.

Political willpower is required to take action and invest in the things that we know protect against risk factors for suicide and create optimal outcomes for children and families. Our ability to initiate change in this area and help reduce suicide among our communities begins with a clear and shared understanding of a challenge that has existed for far too long. ◉

Tim Argetsinger is a member of NPA’s editorial board.


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