Tribes Fight to Prevent Youth Suicide


Versions of this story appeared in October 2012 on NBCnews.com and 100Reporters.com and in Indian Country Today (print and online). 

It feels like wartime,” says Diane Garreau, a child-welfare official on the Cheyenne River Sioux Reservation, in South Dakota (shown left), speaking of the youth-suicide epidemic sweeping Indian country. “I’ll see one of our youngsters one day, then find out a couple of days later she’s gone. Our children are self-destructing.”

Native teens and twenty-somethings are killing themselves at an alarming pace. For those 15 to 24, the rate is 3.5 times that of other Americans, according to the Indian Health Service (IHS). Tribes have declared states of emergency and set up crisis-intervention teams. The federal government included 10 tribes or tribal organizations in a recent round of 23 youth-suicide prevention grants; most will receive nearly $500,000 per year for three years. That brings to 43 the number of indigenous groups that have received this funding.

That’s good, but hardly enough, says former North Dakota senator Byron Dorgan (below). Dorgan chaired the Senate Committee on Indian Affairs for 18 years. Since leaving the Senate, he has founded the Center for Native American Youth, which promotes Indian child health, with a focus on suicide prevention (below from left, program associate Josie Raphaelito and director Erin Bailey). Dorgan claims the IHS, which serves the nation’s 566 tribes, is chronically underfunded.

“We need more mental-health funding and services to save the lives of our youngest First Americans,” Dorgan says. “Tribes and nonprofits may get two- or three-year grants to address an issue that cannot possibly be resolved in that amount of time. We fund programs, then let them fall off a cliff. The perception may be that tribes have a lot of gaming funds, but that is simply not true for more than a few.”

The suicide risk factors for Native youth are well known and widely reported. In their communities, many Native kids face extreme poverty, hunger, alcoholism, substance abuse, domestic violence and health disparities. Diabetes rates are sky-high and untreated mental illnesses such as depression are common. Unemployment tops 80 percent on some reservations, so there are few jobs—even part-time or after-school ones. Bullying and peer pressure pile on more trauma during the vulnerable teen years.

Native youngsters are particularly affected by community-wide grief stemming from the loss of land, language and more, researchers reported in 2011. As many as 20 percent of adolescents thought daily about certain sorrows—even more frequently than adults in some cases, the researchers found.

“Our kids hurt so much, they have to shut down the pain,” says Garreau, who is Lakota. “Many have decided they won’t live that long anyway, which in their minds excuses self-destructive behavior, like drinking—or suicide.”

Suicide figures vary from community to community, with the most troubling numbers in the Northern Plains, Alaska and parts of the Southwest. In Alaska, the suicide rate for young Native males is about nine times that of all young males in the United States, while Native females kill themselves 19 times as often as all females their age, according to the Alaska Native Tribal Health Consortium (ANTHC). After a cluster of suicides in 2001, the White Mountain Apache Tribe wanted to develop a prevention program. They mandated reporting of all suicides and attempts on their Arizona reservation and discovered that between 2001 and 2006, their youth ended their lives at 13 times the national rate.

The trauma behind the numbers is excruciating. “When my son died by suicide at age 23, I didn’t even know how to think,” says Barbara Jean Franks, who is Tlingit and was living in Juneau, Alaska, at the time. “I couldn’t imagine that hope existed.”

The tragedies ripple through entire communities. Reservations are essentially small towns, and tribal members are often related, whether closely or distantly, says Garreau. “People are overwhelmed. Sometimes they’ll say, I just can’t go to another funeral.”

Because suicide is so common in some Native communities, it’s become an acceptable solution for times when burdens build up, says Alex Crosby, medical epidemiologist with the CDC’s injury-prevention center: “If people run into trouble—a relationship problem, a legal problem—this compounds the underlying risk factors, and one of the options is suicide.”

“It crosses your mind,” says Jake Martus, whose mother is Cahuilla and Tongva and whose Yupik/Eskimo/Athabaskan father was born in a tiny, remote village on the Yukon River. “I’ve never acted on suicidal thoughts, but they’ve been there my entire life. It’s sad, it’s shocking, but in our communities it’s also somehow normal.”

Martus, who is 26 and a patient advocate at the Alaska Native Epidemiology Center, says suicide is so frequent among his people, he has to ask, “Is it in our blood?” He inherited this terrible legacy from his father, who died by suicide when he was taken to jail for drunk driving. Behind his dad’s alcoholism were overwhelming memories of sexual abuse by his village’s Catholic priest, Martus says. A similar story is reported throughout Indian country, and lawsuits against the Catholic Church have detailed sexual, physical, and emotional abuse by clerics in parishes or on staff at the notoriously violent boarding schools Native children were forced to attend until the 1970s.

The lasting effect of the abuse and the loss of land and culture is often called historical trauma. Martus called it genocide. “They set us up to kill ourselves. The point of all the policies was ‘take them out.’”

In some communities, suicide is so ordinary that boys in particular may dare each other to try it, says Ira Vandever, a Navajo chef in western New Mexico. He works with Music Is Medicine, a local group that brings guitars, drums and lessons from rock and traditional musicians to Native youngsters. Speaking after dinner at his restaurant, La Tinaja, he said, “Around here, some who have died by suicide weren’t depressed. They were just responding to a dare.”

Incredible as it sounds to adults, adolescents may not fully understand that shooting or hanging themselves can have permanent results, says social worker Patricia Serna, who helped develop a nationally recognized suicide-prevention program for a New Mexico tribe. “Youth who survived suicide attempts would tell us they just wanted a break from their problems, a little time off.” She explains that important decision-making parts of the brain are not fully developed in adolescents—of all population groups, not just Native youngsters. As a result, they don’t necessarily foresee the consequences of their actions.

Part of the boys’ difficulty is misunderstanding the warrior tradition that makes up much of Native male identity, according to Alvin Rafelito, Ramah Navajo and director of his community’s health and human services department. “We have a prayer that describes a warrior as someone who goes the distance spiritually for his people. Nowadays, that ideal has been reduced to fighting and violence. In teaching kids to be modern warriors, we have to convey the term’s full, traditional meaning.”

Tradition is key, says Anderson Thomas, Ramah Navajo and director of the community’s behavioral health program. On his reservation, he points out, it’s typically young men who are dying by suicide, not young women. “I’d say more than 90 percent of girls here go through their traditional coming-of-age ceremony,” he says. In contrast, little is done for young males. In large part, he says, that’s because traditional male activities like hunting have diminished, so rituals related to them have dropped off as well. Though Ramah Navajo men and boys can obtain conventional therapy, they also need ceremonies, Thomas said.

 “It was my tradition that brought me to safety,” says Franks. As time went on, she went back to school, got a degree and these days promotes suicide prevention statewide on behalf of the Alaska Native Tribal Health Consortium. “Now, I can move forward. Instead of saying my son died by suicide, I can say he gave me 23 years of his life.”

According to Crosby, tradition is one source of all-important protective factors that effectively counter the risk factors—even the deeply embedded ones that afflict tribes. For indigenous people, the protective factors are distinctive and powerful, say researchers. These include family and clan relationships, reverence for elders and a deeply held spiritual life. Supporting these culturally based positives makes Native kids feel valued and able to seek help, U.S. and Canadian scientists conclude in study after study. 

Bottom line, it’s about connectedness, Crosby says: “How strong is the person’s social network? In the case of adolescents, how connected are they to family, to adults at school, to positive peers?”

You don’t have to be a scientist to figure this out. Alaska Native Tessa Baldwin was a 17-year-old high school student when she learned that connectedness is vital. At age 5, she had lost an uncle to suicide and in succeeding years, several friends and a boyfriend. “I finally realized it wasn’t something affecting just me,” she says. “It was a lot bigger.” In 2011, she founded Hope4Alaska, one many small grassroots suicide-prevention groups in Indian country.

Through Hope4Alaska, Baldwin worked with student governments to travel to schools in Alaska Native villages, tell her story and find out what other teens thought would help. “We had youth–elder discussions, and the kids said they felt useless. They wanted to better their communities but saw no way to make a contribution. The elders were touched, and the kids felt they’d connected with them in an important way,” recalls Baldwin, who has just started her freshman year at the University of California, San Diego.

To make sure Cheyenne River’s children feel part of a community that values them, Diane Garreau’s sister, Julie, shown above left, runs the Cheyenne River Youth Project, a busy after-school facility offering fun, meaningful activities. Kids listen to elder storytellers, play basketball and tend a two-acre organic garden. They get healthy meals and homework help. They study in a library, go online in an Internet café, stage fashion shows and organize local beautification projects. In 2011, a youth-leadership group visited the White House. (Art and business classes shown left.)
“Everything we do—from serious to seemingly frivolous—is about letting our kids know we care,” says Julie Garreau.

“You could define many things—a school camping trip, a traditional dance group—as suicide prevention,” says Zuni Pueblo’s Superintendant of Schools Hayes Lewis, shown below. He is co-creator in the late 1980s of the Zuni Life Skills Development curriculum, one of the first suicide-prevention programs designed for Native Americans. The school-based lesson series includes coping skills like stress management, as well as role-playing for dealing with suicide threats. It was created in response to rising youth-suicide rates at Zuni—thirteen deaths between 1980 to 1987, according to a paper Lewis co-wrote in 2008.

After the curriculum was put into place in 1991, youth suicide stopped almost immediately, according to Lewis’s co-author, Stanford University education professor Teresa LaFromboise. Fifteen years later, the pueblo’s schools shelved the program. Suicides crept back, and the shocked community asked Lewis to resume the post of school superintendant and re-establish the curriculum. Over the past two academic years, he’s done just that, he says.

When the Zuni school system ended its program, the officials there didn’t realize “how fragile the peace was,” Lewis testified to the Senate Committee on Indian Affairs in 2009, telling then-Senator Byron Dorgan and other members: “Suicide prevention and intervention require constant vigilance.”

Numerous federal agencies and foundations provide grants and services to programs trying to maintain that vigilance. Yet many of the programs struggle to keep their doors open. That’s because the funders lack the co-ordination needed in a time of shrinking budgets, says Dorgan: “They are doing extraordinary work, but in isolation. When I left the Senate, I wanted to tear down the silos among these organizations and figure out how we could address Native children’s issues in a sustained and sustainable way.”

In early 2011, he founded the Center for Native American Youth with $1 million in leftover campaign funds and housed it in the D.C. offices of the Aspen Institute think tank. This past July, CNAY hosted 50 representatives (shown left) from the White House, Congressional offices, federal agencies, the National Congress of American Indians, Native Americans in Philanthropy, Northwest Area Foundation, Casey Family Programs and more. In the interactive session that followed, the attendees described their Native-youth programs and began the search for new ways to collaborate on Indian-country issues.

In addressing the meeting, Dorgan said, “We will never know the names of those we save, but we will make a difference.”

Personal diplomacy is central to CNAY’s efforts. Dorgan travels to reservations to learn first-hand what people, including kids, are thinking and doing; he also lets them know how CNAY can help. He and his staff recently traveled to New Mexico to tour two Navajo communities and San Felipe and Zuni pueblos. One stop was Pine Hill, New Mexico, the capital of the Ramah Navajo reservation, where CNAY staffer Josie Raphaelito (shown below with Dorgan) grew up. Speaking to an enthusiastic group of teens in the school gymnasium, Raphaelito, now 25, reminisced about playing sports there as one of the Ramah Navajo Warriors. “I love being back!” she exclaimed. She introduced Dorgan, saying, “This is your chance to tell him what concerns you and what makes you proud.”

After Dorgan’s homily—about growing up on the North Dakota prairie, life in the Senate, starting CNAY and more—he stayed around to chat and listen to kids’ plans for the future. He then toured tribal offices to see their many innovative projects—traditional gardening for health, fitness and heart-healthy programs and more. He talked to the tribal dentist about budget shortfalls he’s facing. He met with student council members, who said they wanted more law enforcement on their reservation, among other things. Meanwhile, CNAY director Erin Bailey was quick to hand students her business card, exhorting them, “Call me! Email me!”

Later, Bailey explained, “We can make connections to internships, explain ways to pay for college. And we enjoy balancing positive things that can happen today with our long-term goals.”

Agencies, nonprofits, foundations and others can partner with tribes in the effort to protect Native children. Ultimately, though, it’s up to the communities, says Lewis. “We adults have to practice our core cultural values of compassion, respect, cooperation and concern for our children. We have to talk to youngsters about relationships, clans, societies—all the connections they’re a part of.”

“We have to tell our kids how wonderful they are,” adds Julie Garreau. “We have to give them safe places to learn and have fun and reassure them that they can have a productive life with healthy relationships.”

Franks recently participated with grieving family members in a memorial walk. The group circled a lake in one direction to honor those they’d had lost lost, and the other direction to express support for those who remain. “Prevention includes acknowledging the bereaved and helping them talk about what happened,” Franks says.

Rafelito was hopeful. He was standing in a Ramah Navajo community garden, surrounded by ripening squashes, corn and other heirloom crops. He noted that today’s Native people and their traditions endure, despite centuries of depredations and violence. “Look at our history,” Rafelito said. “It’s been survival of the fittest. We’re the smartest and the toughest anyone can be. Our message to our kids should be, ‘We’re OK.’”
  
Stephanie Woodard wrote this story, the first in a series on preventing Native youth suicide, with the support of the Fund for Investigative Journalism (fij.org) and The California Endowment Health Journalism Fellowships (reportingonhealth.org), a program of USC’s Annenberg School of Journalism.

FINDING HELP
• 1-800-273-TALK is a free, confidential 24/7 hotline for anyone who is in crisis about any issue and wants to talk to a trained counselor. You can also call if you know someone in crisis and want advice about what to do. 
• SAMHSA administers youth-suicide prevention funds provided by the Garrett Lee Smith Memorial Act, named for a senator’s son who killed himself in 2003. The agency hopes that going forward more tribes will apply for them, says Richard McKeon, chief of SAMHSA’s suicide prevention branch. “We want to help as many as possible reduce their suicide risk factors, such as substance abuse and depression, and increase the all-important protective factors.”
• SAMHSA offers technical assistance for grant-writing and more, through its Native Aspirations program (www.nativeaspirations.org) and publishes a prevention guide, To Live to See the Great Day That Dawns (http://www.sprc.org/library/Suicide_Prevention_Guide.pdf). The agency maintains a registry of evidence-based (scientifically tested) suicide-prevention practices. Those directed toward indigenous people include the Model Adolescent Suicide Prevention Program and American Indian Life Skills Development.
• For Indian Health Service (IHS) resources, check the agency’s website or call area offices. The IHS is launching a telebehavioral health project; this supplements counselors available to communities, says Cheryl Peterson, spokesperson for the IHS behavioral health department. The agency’s Methamphetamine and Suicide Prevention Initiative (MSPI) supports youth camps and other activities: Caring for horses means Gila River Indian Community kids in Arizona learn traditional values and build self-esteem. Meanwhile, St. Regis Mohawks in New York have filled local airwaves, newspapers and roadside billboards with exhortations that “it’s ok to seek help.” “We also want to help tribes get their own successful practices on the SAMHSA registry, especially holistic ones that include traditional activities,” says Peterson.
 • Two nonprofits, the One Sky Center (www.oneskycenter.org) and the Northwest Portland Area Indian Health Board (www.npaihb.org), offer much helpful information.

c. Stephanie Woodard; photographs by Joseph Zummo and Stephanie Woodard.