Suicide Epidemic Among Youth in Indian Reservations

In case you haven't been thinking of equality in the treatment of depression and mental health when it comes to the whole healthcare issue, think again. This story from the NYT illustrates the impact on a small community in extreme poverty when there are few or no mental health services available, especially the threat to the lives of adolescents:

ROSEBUD, S.D. — The two suicides struck the Rosebud Sioux Reservation like a random virus. No one saw them coming.
At the reservation, Luke and Gaylord Black Spotted Horse. Suicide has become the second-leading cause of death for Indian youths.
The young man, 19 years old, played varsity football and basketball at Todd County High School. He was admired across the reservation, in that way small towns follow and celebrate their teenage athletes. The girl, weeks shy of her 14th birthday, made straight A’s at Todd County Middle School, played volleyball and basketball and led a traditional Lakota drum corps.

They hanged themselves. This happened at the end of a particularly brutal two and a half months, from Jan. 1 to March 13, when tribal authorities were called to three suicides and scores of attempts. The next day, with the reservation (population 13,000) reeling, tribal officials declared a state of emergency.

Since then, a woman in her early 20s killed herself with pills, and scores more young people have tried to kill themselves — a total of 144 so far this year, at doctors’ best count; the computer used for recordkeeping was down for six weeks. In May, seven youths who tried hanging, poisoning or slashing themselves to death were admitted to the reservation hospital in one 24-hour period.

What is happening at Rosebud is all too common throughout Indian Country. American Indian and Alaska Native youth 15 to 24 years old are committing suicide at a rate more than three times the national average for their age group of 13 per 100,000 people, according to the surgeon general. Often, one suicide leads to another. For these youths, suicide has become the second-leading cause of death (after accidents). In the Great Plains, the suicide rate among Indian youth is the worst: 10 times the national average.

Here at Rosebud, when six high school girls were approached at the Boys and Girls Club one recent afternoon for their reactions to the suicides, four said they had tried suicide. The four compared notes on their methods — two slashed their wrists, two overdosed on pills — and their motives. “There are a lot of reasons,” said Areina Young, a 16-year-old cheerleader at Todd County High who overdosed on sleeping pills and codeine in February. “We have a lot of issues.”

Plains reservations are among the poorest places in the country, with all of poverty’s consequences. But the why of the suicide phenomenon — why American Indian youth, why the Great Plains — is complicated, experts say. The traumas Plains tribes have experienced over the last 175 years — massacres like the one at Wounded Knee, the decimation of their land and culture — are part of it.

“Very generally, adolescence is a time of trouble for all youths,” said Philip May, a professor of sociology at the University of New Mexico who has been studying suicide among American Indians for more than 35 years. “But in many American Indian communities, it’s compounded by limited opportunities, historical trauma and contemporary discrimination. The way the Lakota people and other Plains tribes have experienced history in the last 100 years has reduced the mental health factors that are available to them to cope.”

Tribal leaders at Rosebud took a survey of Todd County students in March. The students’ biggest complaint was that they did not feel safe for fear of gangs. They said that they had no refuge, that their parents were not present, and that they saw too much tragedy, alcoholism and hopelessness.

In response, tribal and community leaders have redoubled their efforts to stem the reservation’s gang problem. They have organized after-school programs, sponsored talks by motivational speakers and made school counselors widely available.

At the same time, schools and the community at large are not commemorating those that kill themselves, said Victoria Sherman, the principal at Todd County High School. She refused, she said, to allow an elaborate memorial during this year’s graduation for a student who killed himself last year on graduation day. “We don’t want to encourage desperate acts,” Ms. Sherman said.

Federal lawmakers are also beginning to address the problem. Senator Byron L. Dorgan, Democrat of North Dakota and chairman of the Senate Indian Affairs Committee, recently introduced a bill to combat child abuse and Indian youth suicide. The legislation would provide increased resources for suicide prevention training and treatment.

With few places for students on this sprawling reservation to congregate — some commute as far as 40 miles each way to school — the Boys and Girls Club, a former bowling alley, opened before it was ready so students could have a place to gather after school.

Rosebud and the neighboring Pine Ridge reservation, using a $400,000 federal grant, have started training community members and school employees in suicide prevention and intervention.

But tribal leaders say they need more concrete help to turn the situation around. The reservation has only four full-time mental health professionals, and two are leaving soon, said the Rosebud tribal president, Rodney Bordeaux.

“We did the emergency declaration because we needed to get attention,” Mr. Bordeaux said. “We’re saying, we need more funding, more help, now.”

Health services are seriously underfinanced on reservations nationwide. For over a decade, Congress has failed to reauthorize a law that would increase aid.

Officially, three youths at Rosebud committed suicide last year and 193 tried. But not all suicides or attempts involve calls to the police, officials here said.

The group of girls who had attempted suicide said they all knew others who had tried several times.

“A lot of people are just trying to get attention,” Areina Young said.

One girl in the group, a 15-year-old, had swallowed a bottle of Tylenol on April 14 and spent two weeks in the hospital.

“Me, I had a really good explanation,” she said. She started into a horrific story of being raped by her half-brother for years before he was arrested two years ago; of her and her siblings being routinely abandoned for months at a time by their mother, an alcoholic; of her grandmother beating her.

“But now I know that suicide is the permanent solution to temporary problems,” she said. “Counseling really helped me a lot. Put down that we need more counseling. For me, right now, I need it every day.”
http://www.nytimes.com/2007/06/09/us/09suicide.html

Copyright 2007 The New York Times Company