WASHINGTON—Representatives from Indian Country asked Congress last month for more resources to deal with the staggering number of youth suicides that occur on Indian reservations.

“We need to make sure that our communities and our people know how to reach out for help if they need it, and we need to make sure that the help is there when they ask,” Dana Lee Jetty, a 16-year-old American Indian who lost her younger sister to suicide in 2008, told the Senate Committee on Indian Affairs.

Suicide is the second leading cause of death for American Indian and Alaska Native adolescents and young adults aged 10-34. Centers for Disease Control and Prevention data for 2005, the latest data available, indicate that suicide among American Indian and Alaska Native youths and young adults aged 15-24 is twice as high as the national average for that age group.

While federal funding has been made available to address tribal youth suicide prevention programs through various initiatives, such as through the 2004 Garrett Lee Smith Memorial Act, committee members agreed that more must be done.

“There is not readily accessible treatment by professionals that is available. It is something that we have to fi x,” Committee Chairman Sen. Byron Dorgan, D-N.D., said of American Indian and Alaska Native communities at the hearing.

Suicide Prevalent in Indian Country

Members from tribes spoke about the devastation that suicide has caused in their communities. Robert Moore, Rosebud Sioux Tribe Councilman and member of the Great Plains Tribal Chairmen’s Association and Aberdeen Area Tribal Chairman’s Health Board, said that the Aberdeen area is suffering greatly from rates of suicide that are higher than the national average.

“The national death rate from suicide is approximately 10 per 100,000, [it is] 17 per 100,000 in the IHS and in the Aberdeen area alone [the suicide rate] is over 22 per 100,000,” he said. In fact, the suicide rate among young men in the Rosebud Sioux Tribe is now the highest in the world.

“We have been sort of identified as the epicenter of suicides in Indian Country,” he said. “Just yesterday, the Indian Health Service unit at Rosebud released an alarming statistic. Our tribe alone [has a suicide rate of] 200 per 100,000 for males ages 15 to 24, which right now puts us as having the highest suicide rate in the world. It is very alarming. There is not a single family or tribal citizen at Rosebud that has not been directly impacted by overwhelming suicides in our area.”

One recommendation he made in his written testimony was that suicidal behavior be elevated to the status of a reportable event in the Aberdeen area. This would mean that all IHS providers, as well as first responders, would be mandated to report suicidal behavior in a timely manner.

“We need improved collaboration, cooperation and data sharing between IHS and tribes,” Moore said.

Dana Lee Jetty told the committee about the suicide of her 14-year-old sister Jami Rose. She recounted to the committee how her sister Jami Rose woke up the morning that she committed suicide complaining of feeling sick. Dana knew her sister had problems with depression and had asked her that morning if she had taken anything. When her sister said that she had, Dana called her mom. Her mother came home to make some phone calls to find out about what help they could get Jami. While this was happening Dana said that Jami asked for some space so she left her sister alone. When she returned she found her sister dead.

“I saw my sister with a belt fastened to the bunk bed and wrapped around her neck. Jami was sitting lifelessly, her body leaning against the wall,” Dana said.

The family, Dana said, had done everything they knew to get her sister help prior to the suicide. “My mom did all the right things. She took her to the doctor, she talked to counselors, and she even had her evaluated by mental health professionals from Indian Health Services,” Jetty said. “Those mental health providers dismissed my mom’s concerns and diagnosed my sister as being a ‘typical teenager.’”

She asked the committee for more professionals in Indian communities who are trained in helping suicidal people. “I, along with my family, ask you to support our efforts to prevent suicide by funding and developing quality programs and health services in our Tribal communities,” she said. “It is not enough to put a counselor in our community. We need trained professionals who really know how to help our communities.”

Dana said that now she and her family attend meetings in their community telling audiences that suicide should not be considered as an option. “In taking to our community we have found that suicide is a much more common problem than we ever realized,” Dana said.

Addressing Suicide

R. Dale Walker, M.D., director of the One Sky Center, a national resource center that works to improve substance abuse and mental health services in Indian Country, said that his organization provides suicide resources to Indian communities experiencing suicides that are culturally appropriate.

He said that one element of addressing suicides in Indian communities that federal officials must address is making sure that quality healthcare, medical services and mental health services are available on reservations.

“Not all of the Indian health need is performed and completed by IHS,” he said. “We don’t expect that, but we expect the agencies across the federal government to gather together and garner resources in such a way that people can deal with these healthcare problems.”

Teresa D. LaFromboise, Ph.D., associate professor of counseling psychology and chair of Native American Studies at Stanford University, shared with the committee her concerns that initiatives to reduce suicides are often studied on the mainstream population, but not in Indian communities.

Tribes should not have to use federally funded suicide initiatives if they are not culturally appropriate, she said. Instead, technical assistance should be provided to help adapt and implement the initiatives to Indian communities.

“What I am suggesting as a recommendation when we talk about advancing funding is that there be evaluation of the effectiveness of these interventions in Indian communities. If they are found not generalized enough to be appropriate within Indian communities to not require communities, if they receive federal funding, to have to use them,” Dr. LaFromboise said.

Hayes Lewis, director for the Center for Lifelong Education at the Institute of American Indian Arts in Santa Fe, New Mexico, told the committee that tribes, schools and communities must work together to develop strategies to help young people.

“Too often, tribes and supporting community agencies, schools and school districts have not taken the initiative to develop proactive strategies to comprehensively address health and safety issues and challenges in a holistic manner,” he said in written testimony.

Federal Government Addresses Suicides

Substance Abuse and Mental Health Services Administration Acting Administrator Eric Broderick, D.D.S., M.P.H., said that SAMHSA statistics indicate that 900,000 youths in the general U.S. population made a plan to commit suicide in 2003 and an estimated 712,000 attempted suicide. While suicide is a widespread problem in the general population, it is even more prevalent in Indian communities.

“Despite the seriousness of this condition [of suicide] across this country, the situation is more serious in Indian communities,” Dr. Broderick informed the committee.

SAMHSA has a tribal advisory committee that provides guidance on suicide prevention. In addition, Dr. Broderick told the committee that SAMHSA’s work in suicide prevention has increased in recent years. At the start of 2005 there were two competitive grant awards for suicide prevention and by the end of 2005 there were 46.

“Currently, there are over 110 suicide prevention grants going to states, tribes/tribal organizations, territories, colleges and universities and crisis centers across the country,” he said in written testimony.

IHS Director Robert McSwain told the committee that in response to the suicide problem, IHS is involved in many statewide suicide prevention teams and coalitions and is working very closely with SAMHSA, CDC and NIH.

McSwain explained in written testimony that IHS has developed a suicide surveillance-reporting tool to document suicides. “The suicide reporting database is beginning to provide a more detailed picture of who is committing or attempting suicide and identifi es salient factors contributing to the events. Accurate and timely data captured at the point of care provides important clinical and epidemiological information that can be used to inform intervention and prevention efforts,” he noted.

Sen. Dorgan asked how short IHS is in behavioral health funding, but McSwain said he did not know. “I don’t know, and the reason I don’t know is that because there are so many other factors involved. Health is one piece of it. Until we get the whole pie built, the SAMHSAs, the DoJs, all the other folks who enter into helping a community with suicides, when we get that all together if you would take all of the pieces then we would have what projections we would need,” McSwain responded.