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November is National Native American Heritage Month in the USA and I thought this is a good opportunity to not only talk about mental illness and suicide in Native American and Alaskan Natives children and teenagers, but also to highlight mental illness and suicide in other indigenous populations around the world. Mental health is multi dimensional and embedded in cultural, historical, spiritual, psychological, structural and social domains. Western style health care which is based on the medical model is often in direct conflict with the person centrered approach and cultural and spiritual needs of the indigenous child/teenager. Furthermore, increased ethnic discrimination is a strong contributory factor to poor mental health and well being.
USA
Approximately 1.2 percent of the US population identifies as Native American/Alaskan Native, and of those, 21 percent had a diagnosable mental illness in the past year. This is over 830 thousand people, enough to fill every major league baseball stadium on the East Coast TWICE. There are 554 federally recognized tribes in the US which include 226 native villages in Alaska. Cherokees comprise the largest tribe
Suicide among NA in the USA is more prevalent than in any other racial/ethnic group in the USA, and the rate has been steadily increasing since 2003. Among U.S. adolescents ages 12 to 17, native youth have the highest lifetime prevalence of major depressive episodes. Suicide is the second leading cause of death, 2.5 times the national rate for Native male youth in the 15 to 24-year-old age group. Interestingly, the medical terms depression and anxiety are absent from some NA/AN languages. The closest word which describes depression is ‘ghost sickness’ and ‘heartbreak syndrome,’ whilst PTSD is called ‘wounded spirit.’ Among U.S. adolescents ages 12 to 17, native youth have the highest lifetime prevalence of major depressive episodes.
We know from previous blog posts that traumatic events, toxic stress and ACEs (adverse childhood events) all contribute to the likelihood of a child/teenager developing a mental disorder/illness. Also, research has shown that over the last few centuries, Native American/Alaskan Native people have experienced significant challenges due to the impact of colonization. For example, the breakdown of families, communities, loss of language, culture and traditions, socio economic factors, exposure to abuse (intergenerational transmission of trauma). This disempowerment and oppression, historical trauma plus ACEs have all contributed to the higher rates of depression, PTSD and other mental illnesses and higher rates of suicide among native youth. Among other issues, underage drinking increases the risk of suicide and homicide, physical and sexual assault, use and misuse of other drugs, and is a risk factor for heavy drinking later in life.
Fact:
- Native children are 70 percent more likely to be identified in school as students with an emotional disturbance
- Native Americans experience serious psychological issues 1.5 times more than the general population
- Native Americans experience Post Traumatic Stress Disorder more than twice as often compared to the general population
- In 2013, among persons aged 12 or older, the rate of substance dependence or abuse was higher among NA/ANA than any other population group
- 61 percent of native kids have experienced a significant traumatic event
- In 2013, 38.7 percent of native adolescents aged 12 to 17 years had a lifetime prevalence of illicit drug use.
Compared with the national average for adolescents aged 12 to 17, native adolescents had the highest rates of lifetime tobacco product use, marijuana use, nonmedical use of pain relievers, and nonmedical use of prescription-type psychotherapeutics
From 2003-2011, Native American/Alaskan Natives were more likely to need alcohol or illicit drug use treatment than persons of other groups by age, gender, poverty level, and rural/urban residence
In 2012, almost 69 percent of native youth aged 15 to 24 who were admitted to a substance abuse treatment facility reported alcohol as a substance of abuse compared to 45 percent for non-AI/AN admissions
Approximately 26 percent live in poverty compared to 13 percent of general population
Contributory Factors to Child/Teenager Developing a Mental Disorder
- Absence of family/cultural rituals
- Parental psychiatric problems
- Alcohol use and related violence: abuse, crime
- Lack of adult role models to nurture children/teenagers
- Overuse of discipline: physical, sexual, verbal
- Poor spiritual foundations
- Parents: uninvolved, punitive, non-nurturing, authoritarian
- No sense of identity and place in the world
Preventative Interventions
Studies have found that the preventative interventions that work best concentrate on improving the child/teenager’s relationship with parents, family, peers and teachers and enhancing the quality of child/teenager’s interaction (bonding) with the environment and community. We also know that teenagers who identify with their culture are less likely to drink alcohol. Specialized programs that help support the NA/AN child/teenager and family vary amongst tribes and reservations, however, the most common programs include:
- Substance Abuse and Mental Health Services Administration (SAMHSA) – makes substance use and mental disorder information, services and research more accessible
- Promote Alternative Thinking Strategies (PATHS) – promotes emotional and social competencies, reducing aggression and acting out behaviours in children
- Strengthening Families Program (SFP) – parenting/family skills development strategies to reduce problem behaviours in children
- PRIDE program – substance abuse educational and intervention
- Life skills training programs
- Preparing for the Drug Free Years – teaches parents skills to increase their children’s opportunities for family involvement
- Stress Inoculation Training 1 – teaches coping skills to manage stress and anxiety
Treatment Plan
- Ceremonies
- Community support – HTUG (historical trauma and unresolved grief intervention)
- Native values
- Cultural beliefs
- Elder involvement
- Cognitive behavioural therapy
- Spirituality
- Native staff and peer support
According to Leach (2006), “accumulative stress often occurs when an individual is trying to adjust to a new culture. This stress can manifest through the victim’s feelings of marginality, depression, anxiety and identity confusion.” The effects of colonization include:
- Forced relocation from one community to another
- Marginalization – e.g. denial of existence of these populations
- Forced adoptions, foster care
- Residential boarding schools
- Eradication of culture and erosion of traditional values
- Loss of traditional family stability
Australia
Indigenous Australians, Aboriginals and Torres Strait Islanders, comprise three percent of Australia’s population. Research has found that health problems especially mental health problems are 2.7 times higher among the aboriginal community. For example, 80 percent of suicides in youth age 10 to 24 yrs. were aboriginal and in any given year, at least 95 percent of aboriginal people are affected by suicide. In fact, it has become the ‘new norm’ where kids feel it is the only coping mechanism they have left. Factors that contribute to the increase in mental disorders and suicide include poverty, racism, deplorable living conditions, contagion effect, exposure to violence/abuse and lack of understanding between western and indigenous concepts of mental disorders. The general consensus is that these suicides are directly related to trauma which has been passed on from generation to generation, marginalization and the subsequent suppressed rage and hostility. Research finds that prior to 1980, suicide and self harm amongst the aboriginal population was almost non-existent, in fact, there is no word on their language which describes suicide.
According to Professor Pat Dudgeon, Bardic woman and Australia’s first Aboriginal psychologist,
“youth suicide is not just an issue for Australian indigenous people but other indigenous people from Canada, the USA and New Zealand, as well. And the one thing… in common is the story of colonization”
New Zealand
Indigenous populations in NZ comprise Maori and Pacific peoples and presently, the country is in the midst of a tsunami of mental illness, addiction and suicide. In fact, NZ has one of the highest rates of adolescent suicides and the suicide rate in Maori youth is 40.7 per every 100,000. In fact, NZ has been without a suicide prevention plan since 2016. Contributory factors to the increase in suicide includes the influence/effect of social media and bullying. New Zealand is recognised as having the poorest response to bullying in school globally.
Canada
Indigenous people comprise Inuit, Metis and First Nations and make up 4.3 percent of national population. Suicide In Inuit youth is eleven times higher than non-indigenous youth. Suicide rate for males 15 to 24 is 126 per 100,00 compared to 24 per 100,000 for non-indigenous; for females the rate is 35 per 100,00 compared to 5 per 100,000 for non-indigenous.
In my next Blog #24
I will discuss schizophrenia in children and teenagers