The Suicidal Indian: Exploring the State of Mental Health and Healthcare in the Native American Community

The Suicidal Indian: Exploring the State of Mental Health and Healthcare in the Native American community

Introduction

In a 1975 article in the Journal of Psychiatry, James Shore tells us the story behind the conception of the stereotype of the "suicidal Indian." In 1968, Senator Robert Kennedy visited the intermountain Indian reservation on the same day the community had experienced a suicide related death. Becoming the topic of conversation for the day, American Indian suicide came to the attention of the U.S. government resulting in the discovery that the rate of suicide within the American Indian population was approximately 100 per 100,000, almost ten times the national average.( Tomren 1999). American Indians and Alaska Indians (AI/AN) exhibit suicide-related behaviors at rates much higher than the general population (Manson 2003). Suicide-related behavior is described as suicide, suicide attempts, and suicide ideation. American Indians and Alaska Natives have the highest rates of suicide of all ethnic groups in the United States (15-24yrs.). Suicide is the second leading cause of death for American Indian youth. As recently as 2001, there were 4 million American Indian and Alaskan American Indian people in the Unites States representing only 1.5% of the total population. They are a fairly young population with the mean age of an American Indian being 26 years. (Cameron2001) Because they are a very small population it is extremely important to bring to light the issues that impact the preservation of the culture. In this paper I hope to tackle the topic of suicide inside the American Indian culture because if continued at this rate of prevalence the culture will indeed become endangered.

There are three aims for this research paper. The first aim is to examine the cultural factors that impact the state of mental health and mental healthcare for American Indians. The second aim is to further investigate how these factors explain the excessive rates of suicide within this population. Finally, third aim is to explore what possible prevention and awareness education is available for the American Indians concerning suicide. I will approach this paper by dividing it up into four important topics. First I will discuss how the combination of both the dominant culture and the American Indian culture impacts mental health within the population. Next I will discuss the dilemmas that American Indians face while seeking mental healthcare. Also I will explain how both factors, mental health and mental healthcare play a vital role in the suicide prevalence. Finally, I will describe the treatments being utilized in effort to combat both the high rates of suicide and the inadequacies in mental healthcare.

It is important to study suicide among these people not only because it impacts a large percentage of this small population, but also, because of their extremely small representation in the United States, there is not a sufficient amount of information known to determine the causes and provide effective prevention measures to ensure that these rates do not continue to increase. Also because this is such a young population, the prevalence of suicide in the youth has become a major player in the extinction of the American Indian culture. To put this issue into context, the Indian Health Services 2001 study reports that the suicide rate of American Indians 15-24 is 2.8

times higher than that of their non-American Indian counterparts. Additionally more than half of American Indian adolescents report being depressed.(Cameron2001) Also the Indian Adolescents Health Survey shows that 20% of all American Indian girls have attempted suicide.

The Conflict of Two Cultures

Acculturation

In the early twentieth century, American Indian children were sometimes forcibly removed to live with white families in order to shed their language, traditions, and become "civilized". The assimilation of American Indian children into a society that was unfamiliar and not their own impacted the tribal structure tremendously. (Ecohawk1997) A pattern that is still being seen today is that the "educated" children are becoming disconnected to the elders in the community. Children who have either voluntarily and forcibly been assimilated have lost the language and skills making it largely difficult to communicate with parents, grandparents and other relatives. (Ecohawk1997). This one impact of history on the American Indian people is not unique. The larger society has played an important part in influencing the stresses put on American Indians. The culture has been repeatedly exploited as well as many attempts have been made to exterminate the tradition and heritage that still exists. The topic of identity is a major issue for many American Indians, old and young alike. A major part of American Indians' history is made up of the continuous effort to change the culture through acculturation. As described by Cameron 2001, acculturation is the way an individual incorporates the values and traditions of a new culture into their currently held values and beliefs; this usually refers to an individual from a non-dominant culture. There are four different ways that American Indians deal with

acculturation that affect their ability to seek out help for their mental illnesses.(Berry and Kim 1988;Cameron2001) To be discussed further in the Seeking Help section, American Indians can respond in one of the following four ways: they can reject the dominant culture, totally assimilate, integrate while maintaining their own heritage, or de-culturate (Cameron2001). Although they are not limited to these four reactions, the overall embrace and influence of the dominant culture plays a large part in determining how an individual views himself and in the example of the school children, how an individual views his community.

Spirituality

It is debated whether or not great spirituality plays an important role in suicide-related behaviors. On one hand we find in Ellison (1991) that strong religious commitments, as those found in many American Indian communities, are associated with greater happiness, a sense of life fulfillment, and a better ability to cope with trauma (coping theory). On the other hand, we also find that those religious commitments may cause stress especially in the case of American Indians, where many of their behaviors are "at odds with the values of the dominant culture." ( Manson 2001). The resiliency and coping theory is utilized by prevention and intervention targeting suicide among American Indians, but scholars argue that perhaps one of the