Arctic Mental Health Working Group: Promoting research to address mental and behavioural health challenges in the Arctic

The U.S. Arctic Research Commission (USARC) is an independent federal agency tasked with recommending national Arctic research priorities, policy, and goals necessary to construct a federal program plan for basic and applied scientific research. An important component of this work involves interaction with Arctic residents, national and international Arctic research programs, institutions, and other organizations to obtain the broadest possible perspective on Arctic research needs. Among other activities, USARC coordinates working groups to examine and develop research needs for specific topics. In late 2015, USARC formed the Arctic Mental Health Working Group (AMHWG) to raise awareness of, and promote research on, the significant mental and behavioural health disparities that exist between Arctic and non-Arctic populations. The working group includes researchers, clinicians, program managers and administrators from a variety of federal, state and indigenous groups focused on improving mental health in the circumpolar North.

In Alaska, the suicide rate is almost twice the U.S. national rate, with even more highly elevated rates reported for Alaska Native communities1. Similarly, high rates of suicide exist across the circumpolar Arctic2. The AMHWG works collaboratively with tribes, health care providers and other stakeholders to encourage and promote research that can be used to help improve mental health in the circumpolar North. As an initial focus, the AMHWG has chosen to address suicide prevention in Arctic communities with a specific emphasis on early intervention approaches for children and youth.

Research has shown that early intervention and prevention programs are critically important in reducing the risk and occurrence of suicide.3,4 Promoting wellness, developing protective factors, and raising awareness of suicide risks are examples of early interventions that can provide support to individuals and communities before a crisis situation arises.3,4 Understanding the nuances of suicide prevention and intervention in remote Northern Indigenous communities, as well as the challenges of providing assistance in these communities are important areas of research. The AMHWG has focused on three main objectives to promote increased capacity and strengthened systems of care for Arctic mental health issues.

The first objective is the collection, integration and analysis of data to improve our understanding of the epidemiology of mental and behavioural health issues, including suicidality, in Alaskan communities.

The AMHWG encourages research and activities that improve communication among the various agencies addressing mental and behavioural health in Alaska. A session was held at the 2017 Alaska Public Health Association Health Summit to highlight how enhanced sharing of information and data would improve current mental health care systems. The session focused on how integration of multiple data streams could improve mental health care and lead to earlier intervention and the provision of prevention services to those needing care. Speakers at this session represented agencies such as the Alaska Office of Children’s Services, the Alaska Violent Death Reporting System, and the Alaska State Division of Behavioural Health. The challenge of data sharing across agencies, the types of data available within agencies and the need for an Alaska suicide surveillance model that could bring data sources together and serve as an early warning system for impending emergencies were discussed. AMHWG continues to explore the development of an Alaska Suicide surveillance model that would aid in providing early intervention approaches in rural communities.

The second objective is improving mental health mental and behavioural health workforce capacity in Alaska.

An obvious and critical component of addressing the mental and behavioural health needs of children and youth in remote Arctic communities is the presence of a well-trained cadre of mental health providers. AMHWG encourages research and activities that will help identify the appropriate number and type of mental health providers needed in remote communities to assist with mental health and wellness promotion, prevention and treatment. Currently the per capita number of mental health providers in remote communities is well below national averages.5 This working group has been gathering information on and raising awareness of the level of unmet mental health provider needs in remote Arctic communities. Promoting research needed to understand and address the observed instability in this workforce is a key goal of the working group’s efforts. Creating research-based alternative approaches to providing mental health care in remote areas is seen as a top priority.

The third objective is to strengthen mental health protective factors of children and youth with a focus on community-based efforts.

Understanding the impact of family, community and cultural protective factors that support and enhance healthy development of youth is key to building effective prevention and early intervention strategies. AMHWG encourages research into present and yet-to-be identified protective factors as the basis of prevention programs in Northern communities and the importance of community and culturally-based early intervention and follow-up support for children and youth at risk. Though evidence-based research and evaluation related to suicide prevention programs in Northern Indigenous communities are presently limited, research into the key components of successful programs and appropriate evaluation metrics is critical. Efforts by the Arctic Council’s “Reducing the Incidence of Suicide in Indigenous Groups – Strengths United through Networks (RISING SUN)” aim to address this gap and provide guidance to prevention programs focused on strengthening mental health protective factors.Research that supports Alaska-based early intervention and prevention is critically important in reducing the risk and occurrence of suicide and other adverse behaviours. Providing Northern communities with the knowledge, capacity and resources to address this crippling issue is necessary to reduce rates of suicide and suicide ideation. AMHWG plans to expand the scope of the working group to include a circumpolar focus as we make headway with the objectives listed above. ◉

Dr. Carrie Eischens is the Research Program Coordinator for the U.S. Arctic Research Commission in Anchorage, Alaska. Carrie facilitates the agency’s Arctic Mental Health Working Group and has a background in program management and marine ecosystem research.

Dr. Cheryl Rosa is the Deputy Director and Anchorage-based Alaska Director of the U.S. Arctic Research Commission. A wildlife veterinarian and wildlife biologist, she has worked with subsistence communities on the North Slope and in the Russian Far East on a wide range of studies involving wildlife health and zoonotic disease, subsistence food safety, marine mammal stranding response, and oil spill/offshore discharge research.

Notes
1. Alaska State Suicide Prevention Council, http://dhss.alaska.gov/SuicidePrevention/Pages/Statistics/aksuiciderate_nativenonnative96-05.aspx
2. Young, T. K., Revich, B., and Soininen, L. 2015. Suicide in circumpolar regions: An introduction and overview. International Journal of Circumpolar Health 74:27349, http://dx.doi.org/10.3402/ijch.v74.27349
3. Borowsky, I. W., Resnick, M. D., Ireland, M., & Blum, R. W. (1999). Suicide attempts among American Indian and Alaska Native youth: Risk and protective factors. Archives of Pediatrics & Adolescent Medicine, 153(6), 573–580.
4. Mackin, J., Perkins, T., & Furrer, C. (2012). The power of protection: A population-based comparison of Native and non-Native youth suicide attempters. American Indian and Alaska Native Mental Health Research, 19(2), 20–54.
5. Alaska 2015-2016 Primary Care Needs Assessment (2016). Health Planning & Systems Development, Alaska Division of Public Health, http://dhss.alaska.gov/dph/healthplanning/Pages/default.aspx


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