Suicide and our youth

Carol Berry
3/31/08

Denver March meeting focused on ways to reverse the numbers

DENVER - Suicide is a major cause of death among American Indian youth and it occurs in the Native population at a rate of one and a half to three times higher than among any other Americans, the acting director of the IHS said March 19.

In fact, the American Indian suicide rate ;'may be the highest suicide rate in the world,'' Robert G. McSwain said in an address to regional tribal health providers.

His presentation was part of the Department of Health and Human Services 2008 Tribal Consultation for tribal nations in Colorado, Utah, Wyoming, North and South Dakota and Montana. Approximately 100 state and tribal officials attended the meeting.

Suicide prevention and mental health issues were discussed in a context of better outcomes among some tribes, but also in light of two recent suicides said to have occurred in mid-March on the Rosebud Reservation in South Dakota.

A DHHS team has been formed to go to reservations where suicides have occurred, along with other measures to ''address the alarming problem we are facing,'' McSwain said.

Related mental health issues can stem from early abuse, he said, advising parents and other caretakers of children to ''start early, keep them healthy, and protect them.''

Half of all lifetime cases of mental illness begin before age 14 and three-fourths before age 24, he said.

Methamphetamine abuse in Indian country remains widespread, and it takes an average of two years to recover from meth addiction, he said.

''Congress has heard you,'' he told tribal leaders, referring to $14 million added to the 2008 IHS budget for suicide and methamphetamine abuse prevention.

At the same time, however, a key program of the DHHS' Substance Abuse and Mental Health Services Administration is ending.

The Circles of Care program - the only SAMHSA program with funds allotted specifically for Natives - was not funded for 2009, although tribes asked for the program to continue, said Estelle Bowman, SAMHSA senior adviser for tribal affairs.

Only 23 of the 562 federally recognized tribal nations have benefited from Circles of Care, which includes substance abuse and mental health components, she said.

Alcohol abuse may actually be a greater problem than methamphetamine abuse and it should be targeted, even though it may be more acceptable among Native people, she said.

In addition to the Circles of Care funding loss, under President Bush's proposed 2009 budget, $11 million would be cut from behavioral health/substance abuse funds.

McSwain said better statistics are needed on suicide and methamphetamine abuse in Indian country because at present, data are not firm but are believed to be ''on the low side.''

He noted decreases in the Bush administration's proposal for 2009 that include cuts of $35 million in urban health programs, $21 million for health facilities construction and $14 million for health professionals, in addition to the $11 million reduction for substance abuse prevention/behavioral health programs.

Sen. Byron Dorgan, D-N.D., and other members of Congress have sought additional funds for Indian health care so that the admonition ''Don't get sick after June'' (when annual IHS funds have been exhausted, in the past) will no longer apply, he said.

Bush's proposed budget would zero out funding for urban Indian health programs for the third time - moves that have been thwarted in the past when Congress restored the funding.

Urban Indian health centers and other programs would be safeguarded with the reauthorization of the Indian Health Care Improvement Act, which has cleared the Senate by a large majority, he said.

Bowman noted that her agency is required to provide block grants to states, and that the remaining grants are very competitive so that tribes may need help in applying for them.

An area of controversy is that statistics from Indian country that may include mental health and substance abuse rates are used in state formulas for SAMHSA funding applications, she said.

She advocated the application of traditional cultural property rights for traditional ceremonies that may be incorporated into IHS-offered services.

Traditional medicine as an option was also cited by McSwain, who said behavioral health approaches ''will need to encompass our traditions and healing practices.''

Gary Collins, a former chairman of the Northern Arapaho Tribe, said that traditional healing methods should be certified so that practitioners could provide services in their areas of expertise.

In addition to substance abuse/behavioral health issues, state and tribal officials from the six-state region discussed needs for IHS/Medicaid coordination, diabetes prevention and treatment, health disparities, emergency preparedness, and general access to comprehensive, affordable health care.

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