Talking Circles on Suicide Among American Indians and Alaska Native Youth Reveal Help-Seeking Strategies, Barriers and Need for Intergenerational Engagement

Background: Suicide is the leading cause of death among American Indian/Alaskan Native (AI/AN) youth aged 10-24 (Heron, 2016). The purpose of this study, via collaboration between American Indian Health and Family Services of Southeast Michigan, Inc. and the University of Michigan, was to conduct Community Readiness Assessment (CRA) Talking Circles with adults/elders and youth to examine changes in knowledge and perceptions of suicide, and utilization of means of prevention of suicide within their AI/AN community.

Methods: We conducted six Talking Circles (N = 3 adult/elder; N = 3 youth) between March 2015 and April 2017. Both qualitative and quantitative data were collected via demographic surveys with questions regarding cultural identity and socioeconomic status; Likert scale surveys (range 1 to 10) (e.g. “How much of a concern is AI/AN youth Suicide in the community?”); and a Talking Circle protocol (e.g. “Can you give some examples of sources of information that the community may or may not know or learn about suicide prevention efforts at AIHFS?”) Each participant was provided a meal and compensation for their time. Demographic data were analyzed via SPSS for descriptives and frequencies; Circles were recorded, transcribed and analyzed using inductive analysis.

Results: All Talking Circle participants identified as AI/AN, and included 39 males, 35 females and 2 Two-Spirit individuals; 44 adults/elders (ages 18-83) and 32 youth (ages 7-17). Three themes were identified: 1) help-seeking strategies 2) help-seeking barriers and 3) intergenerational engagement. Many reported improved capacity building as a result of increased knowledge of suicide prevention as a support to help-seeking. One youth explained: “Sometimes we can be a source of information cuz we can tell our family and sometimes they can tell other friends;” Many also felt “frustrated” by Western mental health services, and spoke to a need to incorporate traditional healing practices into mental health. One adult discussed the connection between historical trauma and suicide as another barrier: “I look at the big picture…the genocidal practices have taken away their roles and stopped them and killed them…where they can't see what’s worth living.” The majority of youth cited parents and adult figures as people whom they would talk to if they were feeling depressed or suicidal. Subthemes related to help-seeking varied by age group and were influenced by cultural values, loss histories, mental health status, and trauma.

Conclusions and Implications: The results highlight an increase in community awareness of suicide and prevention strategies, emphasizing cultural practices. Increasing intergenerational engagement, maintaining cultural identity, and community connectedness were cited as protective factors across both Circles. Participants felt an obligation to “pass on knowledge” to the youth, to “teach them how to drum and sing” in order to increase youths’ connectedness to cultural identity to prevent suicide. Through an increased sense of knowledge and capacity-building, community members are empowered to support one another, creating a stronger and healthier community. This study ultimately uplifts the voices of AI/AN individuals, as they put forth their own recommendations for preventing suicide. It is up to service providers to “listen to them.”