Suicide and Suicide Prevention on the Navajo Reservation

In the United States, suicide is the tenth leading cause of death. Over fifty thousand individuals are subject to suicide annually. By definition, suicide is defined as death caused by self-directed injurious behavior with intent to die as result of the behavior (Webster's Dictionary, 2018). White teenagers aged 15-24 have a suicide rate of 25.5 per 100,000 deaths per year. On the other hand, Native American teenagers aged 15-24 have a suicide rate of 43 per 100,000 deaths per year. Within that portion, suicide rates for the Navajo people averages at 17.48 per 100,000 (National Institute of Mental Health, 2018). The high prevalence of mortality by suicide within the Navajo Nation raises questions about why this happens and what can be done to reduce and possibly even prevent this epidemic from plaguing the Navajo youth.

Population

The Navajo reservation is over 27,000 square miles and spans into New Mexico, Arizona, and Utah. The Navajo people have a population of over 300,000 enrolled tribal members. There are only five federal service units that provide healthcare to the Navajo people. More surprisingly, there are only 10 grocery stores. The median household income is $22,000 versus the United States average of $42,000 (Navajo Nation Division of Economic Development, n.d.).

Analyzing Potential Suicide Causes

According to Kathryn Murphy NP, CS, MSN, suicide can occur due to but not limited to the following reasons: relationship problems, substance abuse, depression, and sexual or physical abuse (Murphy, 2005). These same reasons hold true for the Navajo community but at increased rates. There are many environmental factors and social determinants that increase the likelihood of depression, substance abuse, and relationship problems.

Social Isolation

Native Americans have long experienced disconnection from the rest of the country ” their reservations are generally placed on harsh, remote, and sparsely populated lands with little economic potential, separated from modern-day markets for goods, as well as higher education and health care. The isolation of these communities presents a host of challenges. These challenges include the lack of access to even the most basic of services, such as running water and electricity, transportation issues, and very few employment opportunities. Unemployment rates as of March 2018 for the Navajo Nation was approximately 7.6%, which is more than twice the national average (CDC, 2018). Rural and destitution of the reservation makes unemployment rates high, and rough and very distant terrain makes it difficult to travel to and from work. In fact, many Navajo do not have sufficient transportation to get to work. Largely disconnected from the rest of the American economy, Navajos have generally been denied a share of national prosperity, so being out of sight means that reservations are often overlooked when improvements come to more populated areas (Smith, 2012). This form of social isolation for the Navajo Nation occurs via remote location but is reinforced by the digital age. Fiber optics cables along with satellite and wireless links could deliver the benefits of modernity to reservations, helping lift Native American communities out of isolation and poverty. But often times, cable companies offering service may not want to support such isolated reservations, and the cost of monthly internet payments also inhibit many individuals to purchase service. Less than ten percent of homes on tribal lands have broadband Internet service ” a rate that is lower than in some developing countries (Smith, 2012). Without reliable access to the Internet, many Native Americans find themselves increasingly isolated, missing out on opportunities to secure jobs, earning degrees through online classes, and reaching health care providers.

Historical Trauma & Cultural Disconnectedness

Similarly, to the Tuskegee syphilis study, much of the distrust from the Native Americans have stemmed from very traumatic events that still linger within many Native American reservations. One attempt at eliminating Native Americans was an event called the Long Walk, which occurred in the mid 1860's. This genocidal event, in which the federal government forced as many as 8,500 Navajo to leave their native lands and walk nearly 300 miles in harsh winter conditions to Bosque Redondo in New Mexico, killed nearly 2,000 Navajo people (Legends of America, 2018).

Youth suicide was once virtually unheard of in Indian tribes. A system of child protection, sustained by tribal child-rearing practices and beliefs, flourished among Native Americans, and everyone in a community was responsible for the safeguarding of young people. But these child-rearing practices were often lost as the federal government sought to assimilate native people and placed children ” often against their parents' wishes ” in boarding schools that were designed to immerse Indian children in Euro-American culture (Braveheart and Bird, 2013). The federal government was under the impression that forcing Navajo children to attend and actively participate in white boarding schools would assimilate the Navajo people and force them to accept white men's beliefs and values. For many Navajo parents who refused to put their children in the boarding schools, children were seized and sent to live with white families. Children were given white clothing, new names, and were forbidden from speaking their native language, which was then replaced with English. Historical trauma has afflicted generations of the Navajo communities and has created a generation gap of cultural loss between the older and younger generations of Navajo.

Cultural connectedness can be defined as the integrated system of learned behavior patterns-the religion, customs, manners, traditions, food, music, dance, art, history, and language which are characteristic of the members of a society (Bhatt, 2015). In some ways, our culture and our cultural beliefs become part of who we are. A strong sense of cultural identity is important to a child's mental health and wellbeing, because sharing a strong cultural identity gives 1. A development and sense of belonging to a particular community, and 2. Engage and connect socially, and even spiritually with others. In turn, this exchange of cultural knowledge and acceptance create ease and confidence, reducing the risk of depression and anxiety. However, much of the cultural disconnect in the Navajo community have therefore, turned into family disconnect, often accompanied by neglect, abuse, and eventually substance abuse by a culturally sensitive adolescent in their proceeding adult years.

Prevention

Currently, there are five Indian Health Service units that serve over 244,000 people. The community health department and the Navajo Nation Behavioral Health Services have attempted to raise more awareness by hosting community outreach events and through educational approaches. The behavioral health department has also implemented their own counselors to further serve the Navajo people. Although there are mental health providers, the statistics show that improvement is still needed.

To reduce the suicide rate in the Navajo Nation, we can make a more focused approach to the youth of the community. Our youth strategy would identify development challenges and issues facing youth today, and more importantly offer a forward-looking outlook for their future. We would have strategic entry points and engagement of a broad range of partners, including young people themselves, in addressing youth empowerment issues in their community. By Implementing the Youth Empowerment Strategy in elementary schools, we hope that students can freely discuss their environment, their home setting, and the things they see around them. By engaging young students in conversation, we hope that it will empower them to look past issues related to poverty, substance abuse, etc., and give hope to the children, so they will not fall victim to suicide, substance abuse, poverty, etc.

A simple yet effective way of reducing the suicidal rate in the Navajo community is to identify youth that are at risk of suicide. We can be knowledgeable and correctly identify at risk youth through first aid. We will implement a Youth Mental Health First Aid Program into local reservation high schools, that is not limited to just students but to the rest of the community as well. The program called YMHFA or Youth Mental Health First Aid is an 8-hour certification course that will teach those are interested how to identify mental health problems like anxiety, depression, substance use, disorders in which psychosis may occur, disruptive behavior disorders (including ADHD), and eating disorders. As a first aider, you are also trained to refer youth to appropriate services, and reduce stigma surrounding mental health issues. The Youth Mental Health First Aid program would allow the youth to talk to other youth from their community who understand what they are going through. It is difficult to explain reservation life and all it entails to an outsider; this program would also increase awareness and destigmatize mental health. If Parents are educated about mental health through the Youth Mental Health First Aid program, it would also reduce the suicide rate. Parents see their child on a daily basis and the YMHFA would educate the parent about mental health. The parent would be able to see the warning signs and reach out to their child.

A long-term solution would be to build a community center. The community center will offer services and activities such as sports/recreational activities, academic enrichment (tutoring, academic activities), arts and humanities, family engagement that would include cultural activities, character development, mentoring programs (college/career), mental health/substance abuse counseling and employment services. The ultimate goal of the community center aims to prevent youth from entering the vicious cycle of drug and alcohol abuse and bring a sense of community to the Navajo Nation.

Conclusion

Mortality through suicide continues to be the second main cause of death for adolescents aged 10-19 in the Navajo community. Often times suicide is looked at more clinically, such as through the lens of mental health instability and depression. But for many of the adolescents in the community, the exposure to poverty, substance abuse, social isolation, poor diet, lack of community and familial connection, and lack of access to adequate care are risk factors of suicide. In other words, suicide is more than just a set of symptoms, but can be reflected in what an individual experiences. 60% of our health and wellness can be correlated to our social prevalence in the community, the surrounding environment, and our behavior and interactions with others. Our health is our mental stability, and without any adequate support, it is easy for an adolescent to be affected by the impoverishment and limited opportunities given.

This is why instead of addressing the issue of suicide as ways to cope with emotion as a juvenile, support starts now. A pre-preventative method should be established to schools in the community from elementary schools for students to free express their emotions and problems with others that may have difficulty living without strong parental bonds, resources, and role models. In addition, an effort to recognize symptoms displayed by individual adolescents who may have thoughts of suicide can be easily addressed by being trained to properly handle someone. And lastly, as a long-term solution, community stability and community connection can be achieved by providing a safe space with resources for both children and adults utilize in order to establish financial and mental stability and promote a healthy physical and mental being within the entire community suicide should not be a leading cause of mortality within any youth group. Preventing suicide is achievable through our proposed plan that is both achievable and inexpensive.

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