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[Thorpe] Welcome
to Beyond the Data.

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I'm Dr. Phoebe Thorpe, and here

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with me today is Dr. Spero
Manson distinguished Professor

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of Public Health and Psychiatry.

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[Manson] Thank you.

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[Thorpe] Thank you
for joining us Spero.

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[Manson] Not at all.

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[Thorpe] Today's session
was about suicidal behaviors

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in American Indian and Alaska
native especially in the youth.

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We heard, in the session,
how high the rates are,

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the suicide rates
are for these youth,

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and it's tied to health equity.

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How is it tied to health equity?

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[Manson] Health equity
means a number of things

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to a number of different people.

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I think of it in terms
of access to opportunity.

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Often and I think this
is still characteristic

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in the field are
assumptions, about the risk

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of suicide especially
among American Indian

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and Alaska native youth
and younger adults.

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Focus on individual
deficiencies,

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lack of coping abilities,
other types of personality,

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etc. I believe that in fact most

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of that camouflages the
inequities that are afoot

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in terms of the opportunity
structures in the committees

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within which we live and work.

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So that matters of
poverty matters of lack

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of employment opportunities,

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difficulties acquiring
an education dampened the

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aspirations that many youth

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and young adults have
in our communities.

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And, when you dampen those
aspirations, it leaves you

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with a sense of hopelessness
and helplessness.

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[Thorpe] So, as we heard in the
session today, it really sounds

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like a comprehensive approach to
suicide prevention is important,

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but we also know that
it's important to bring

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in culturally appropriate
prevention strategies.

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Can, and you've had some success
with that in your approach,

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can you tell me a
little bit about that?

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[Manson] Of course.

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When we talk about
comprehensive approaches,

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it recognizes the fact that
American Alaska native youth

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and young adults live in
many different worlds.

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Not only just white world and
native world but in schools,

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among their peers,
within their families,

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within the broader community,
and so, the importance

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of marshaling our strategies

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that recognize the
different worlds

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in which our young
people live is the essence

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of comprehensiveness.

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My work has focused on one
of those particular worlds.

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Dr. Lafromboise who presented
just before me focused

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on schools.

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Very important.

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Place where most American
Alaskan of youth live and work

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so too is primary care.

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And as I mentioned in
my particular remarks,

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there is a conspiracy of
silence around suicide

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because of the stigma that
frequently attached to that

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and the disclosure of the risk
related to that condition.

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And primary care, the
white coat phenomena,

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the very special contract
between a provider

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and patient allows those
conversations to emerge in ways

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that might not otherwise
happen outside of such contacts

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because the notion
threat of being...

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[Thorpe] Exposed.

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[Manson] Exposed.

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Exactly with respect
to that risk of suicide

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and the conversation that
it occasions is much lower.

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And so, this kind of a program

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in a evidence-based practice
called screening brief

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intervention referral for
treatment Espurt seeks

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to capitalize on that
very special relationship,

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and to use one's visit to
the primary care setting

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as an opportunity to initiate
that conversation and build

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from there towards intervention.

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[Thorpe] I also heard
in your presentation

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about the importance.

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How you've brought in
traditional medicine

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as as treatment options.

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Can you tell me a
little bit more

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about the importance of that?

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[Manson] One of the
lovely examples from each

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of the three programs
that I described,

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which are not my programs,
programs I've consulted with,

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and been privileged to
have a partnership with.

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The detection of this risk
of suicide is intended

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to provide readier access
to more biomedical tools

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that are available to
us to reduce that risk.

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That they have all used
this as an opportunity

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to increase the access that
that individual at risk has

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with respect to the
traditional healing resources.

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That each has built into
their own setting as well

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as what exists out in
the greater community,

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and the nature of those
traditional healing resources

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varies regionally...

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[Thorpe] Of course.

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[Manson] as one would
imagine from one setting.

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[Thorpe] From one
tribe to the next.

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[Manson] Exactly.

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[Thorpe] Exactly.

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And, can you tell
me a little bit more

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about Dr. Lafromboise'
work with the schools?

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She has done some phenomenal
work about building,

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problem solving, and resiliency

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in younger Native
American and Alaska youth.

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[Manson] It's similar.

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It's similar for
several reasons,

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and I've had the privilege

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of knowing Dr. Lafromboise
for three decades.

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Although she's much younger
than me, you'd never know.

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And her work really began
to capitalize on note

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that her program is called
life skills development.

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You don't see explicit
recognition or conversation

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about suicide early in the
course of that intervention.

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And it's really about
recognizing the strengths

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and skills in assets
that all youth have

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and particularly American and
Alaska native youth in figuring

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out how to enable
them to recognize

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that they possess those
strengths and skills

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and then enabling them
to act on those to build

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and enhance those skills towards
improving their protection

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from suicide.

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It builds upon the sense

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of resilience that's always been
there in native communities,

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but it's not been recognized
in terms of its potential

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until her work around
suicide with native youth.

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[Thorpe] It's interesting

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that we were doing this session
how a lot of the folks here

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in public health recognize
the importance of working

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in schools, so it's very
very important work.

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[Manson] It is.

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[Thorpe] And her presentation
is very interesting.

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So when we're talking about
comprehensive changes,

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and comprehensive
includes changing norms,

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what could you tell us

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about changing norms
to prevent suicide?

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[Manson] That's a
wonderful question.

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So we talk about the norms
surrounding the behaviors

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that place people at risk,
on particularly young people.

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Like suicide.

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What do we do?

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We usually cite statistics
with behavioral risk survey

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that indicates the 27% of
youth in our middle schools

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and high schools have
reported thinking about suicide

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and taking their lives within
a one month period of time.

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Important of concern
demanding our attention,

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but in native communities were
now pointing out that that means

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that 83% of our youth
do not think that way.

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And so you're beginning to
see movements afflict now

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within American and
Alaskan native communities.

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Under the rubric of most
of us, indicate that most

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of us don't have suicidal
thoughts or ideation.

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What is that about?

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How can we understand
that better?

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What does that reflect
under this notion

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of resilience in assets?

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How can we translate that
into ways that those who are

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at risk can benefit and change
the conversations that we have

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in our respective communities?

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So I think that's one of the
very exciting initiatives

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that are underway not
just in native communities

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but many communities probably,

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but they have a particular
residence in native communities

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because of this emphasis
on strengths,

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resilience, and assets.

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[Thorpe] And gatekeepers?

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[Manson] The notion

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of gatekeepers is actually
very very consistent with life

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in native communities.

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We talk about gatekeepers
in the native way of looking

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at the world in terms of
individuals who will sponsor us

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for ceremonies over a
variety of different types.

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For example, among the
Navajo, there's the notion

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of the corn pollen
path among the Lakota

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from the northern plains that
of the red road, among my people

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of the Ojibway or Anishinaabe

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from the eastern woodlands
the notion of peace madadalin

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which means a person
of integrity.

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And what these refer to are
developmental life courses.

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Has if you will to becoming
a contributing member

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of one's community,
and at each point

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in that developmental trajectory
there are specific individuals

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who are charged with
helping us navigate

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that path acquiring the skills.

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Emulating the behaviors of
that are consistent with that,

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and they are the
original gatekeepers.

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Gatekeepers with respect
to health and wellness

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and that progression throughout
developmental lifespan.

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So this notion of
gatekeepers that's come

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from the public health arena
actually resonates quite well

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among native communities.

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For the most part, in the public
health arena, we think about it

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as teachers, as first
responders,

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as primary care providers, as
members of the faith community,

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etc. Well, those are
just the counterparts

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to the spiritual paths that
we've identified long ago

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that one wants to navigate
and becoming a person

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of integrity is not
that they will win so.

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[Thorpe] So if somebody wants to
find out some more information

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about preventing suicide,
where would they look?

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[Manson] It's a great question

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because if you'd asked
me this 40 years ago

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when I first entered the field
it was relatively nothing.

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I'm impressed that today that
there's a wealth of resources,

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and at the end of
today's presentation,

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I believe there were series of
slides that provide the viewer

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with immediate reference points.

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I have been privileged
to be a part

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of SAMHSA the Substance Abuse

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and Mental Health
Services Administrations.

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On Initiative on Garrett Lee
Smith, youth suicide prevention,

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and related initiative
entitled native connections

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which are focused
very specifically

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on one the translation
evidence-based practices

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from the general mainstream
to native communities

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and their application in hopes
of reducing the risk of suicide.

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And secondly, identifying
these intrinsic strength

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and resilience within
native communities

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and illustrating how our
people have been able

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to build upon them and
to codify them in ways

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that others can benefit.

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And so, I think that those two
initiatives particularly are

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especially important
and relevant

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to the interested party.

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[Thorpe] Okay.

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And also, are there some from
the Indian Health Service

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and [Manson] There are.

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There's a special
initiative currently underway

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for the last eight years in
the Indian Health Service.

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That is of benefit as well.

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It's less well-documented
than those in SAMHSA.

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So, I think the best approach is
to seek out all possibilities.

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[Thorpe] Thank you so
much for joining us.

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[Manson] My pleasure.

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[Thorpe] And thank you so much

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for joining us for
Beyond the Data.

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See you next month.