American Indian Youth in Crisis: Tribes Grapple With a Suicide Emergency

It feels like wartime,” says Diane Garreau, a child-welfare official on the Cheyenne River Sioux Reservation, in South Dakota, 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 and rising, 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, who chaired the Senate Committee on Indian Affairs for four years. Since leaving the Senate, he has founded the Center for Native American Youth (CNAY), which promotes Indian child health, with a focus on suicide prevention. He claims the IHS, which serves the nation’s 566 federally recognized 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. Many Native kids face extreme poverty, hunger, alcoholism, substance abuse and domestic violence. 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 ones. Bullying and peer pressure pile on more trauma.

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. 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 the age of 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 has become an acceptable solution for times when burdens build up, says Alex Crosby, medical epidemiologist with the Centers for Disease Control and Prevention’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/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 and 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 calls 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 may dare one another to try it, says Ira Vandever, a Navajo chef in western New Mexico. He works with Music Is Medicine Inc., 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.”

According to Alvin Rafelito, Ramah Navajo, and director of his community’s health and human services department, some of those boys misunderstand the warrior tradition that is integral to Native male identity. “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. He points out that on his reservation, it’s typically young men who are dying by suicide. “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 says.

According to Crosby, tradition is one source of all-important protective factors that counter the risk factors—even the deeply embedded ones that afflict tribes. For indigenous people, the protective factors are distinctive and powerful, says 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?”

Alaska Native Tessa Baldwin was a 17-year-old high school student when she learned that connectedness is vital. At the age of 5, she 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 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, 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. “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 Superintendent of Schools Hayes Lewis, 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—13 deaths between 1980 and 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 reassume 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 Dorgan and other committee 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 coordination 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 CNAY 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 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 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! E-mail 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, 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 is hopeful. He is standing in a Ramah Navajo community garden, surrounded by ripening squashes, corn and other heirloom crops. He notes that today’s Native people and their traditions endure, despite centuries of depredations and violence. “Look at our history,” he says. “It has been survival of the fittest. We’re the smartest and the toughest anyone can be. Our message to our kids should be, ‘We’re okay.’”

FINDING HELP
• 1-800-273-TALK is a free, confidential 24/7 hot line 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.
• The U.S. Substance Abuse and Mental Health Services Administration (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.
• SAMHSA offers technical assistance, on grant-writing and more, through its Native Aspirations program (NativeAspirations.org) and publishes a prevention guide, To Live to See the Great Day That Dawns, available online. The agency also maintains a registry of evidence-based (scientifically tested) suicide-prevention practices.
• For Indian Health Service resources, check the agency’s website.
• Two nonprofits, the One Sky Center and the Northwest Portland Area Indian Health Board, offer much helpful information.

Stephanie Woodard wrote this story, the first in a series on preventing Native youth suicide, with the support of the Fund for Investigative Journalism and the California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism. The series is being co-published with 100Reporters.com.

A version of this story also appeared on NBC's Open Channel.

Photo Credit: Joseph Zummo