Mental Health Promotion, Suicide Prevention
Based on a decade of mounting concern about an increasing youth suicide problem, the White Mountain Apache Tribe passed a tribal law mandating that any suicidal incident occurring on tribal lands—including suicidal ideation, suicide attempts, suicide completions, and non-suicidal self-injury—be recorded into a tribal suicide surveillance system.
Johns Hopkins Center for American Indian Health has worked with the tribe to develop data collection forms, design a computerized data gathering system, and employ and train the Apache Suicide Prevention Team (ASPT). The ASPT is responsible for tracking and maintaining the award-winning surveillance system for the tribe, as well as providing case management follow up visits to support community members' wellbeing. We analyze data within the surveillance system and provide regular reports to key Apache leaders and stakeholders.
Need for a surveillance system
Suicide rates among American Indians aged 10 to 24 are the highest of any U.S. racial or ethnic group, and suicide is the second leading cause of death for American Indians aged 15 to 24. Surveillance has been recommended as part of the National Strategy for Suicide Prevention, but many challenges have precluded widespread and timely implementation of reporting. The White Mountain Apache Tribe (Apache), with technical support from Johns Hopkins, has been able to address these limitations through a comprehensive system which can serve as a model for other communities.
How the surveillance system works
Surveillance forms are collected on all tribal members on the White Mountain Apache Reservation and entered into the computerized data gathering system. Once a form is collected, a member of the ASPT visits the individual’s home/school/other known location to conduct a brief interview to determine if the event occurred as it was reported and collect details of the event from the individual. The ASPT also uses this visit to refer the individual to available mental health services and offer continued follow up visits. In recent years, reports increased from 519 to 627 for a community of ~17,500, which appear to be related to greater awareness and willingness to report events. In addition, the proportion of individuals referred who report subsequently seeking treatment has nearly doubled in five years from 39% in 2007 to 71% in 2011.
Mandating reporting of self-injurious behavior is an innovative public health approach to suicide prevention reflecting the tribe’s dedication to give similar attention to mental health as to infectious diseases and child abuse. The system holds promise to reduce morbidity, mortality and burden to the health care system through use of paraprofessionals to promote identification, engage and connect at-risk individuals, and develop prevention strategies based on the resulting data. This project has been supported in part by the Native American Research Center for Health of the National Institutes of Health and Garrett Lee Smith funds. Read more about this project in the SPRC's Surveillance Success Story.
Decreases in Suicide Deaths and Attempts
The overall Apache suicide death rates dropped by 38% and the rate among 15- to 24-year-olds dropped by 23% from 2001-2006 to 2007-2012. The annual number of attempts also dropped from 75 (in 2007) to 35 individuals (in 2012). Although national rates remained stable or increased slightly, the overall Apache suicide death rates dropped following the suicide prevention program. The community surveillance system served a critical role in providing a foundation for prevention programming and evaluation.
This surveillance system was recently adopted by the San Carlos Apache Tribe, the Hualapai Tribe, Cherokee Nation, areas of Navajo Nation, and Colville Confederated Tribes in Washington State.