[Thorpe] Welcome to Beyond the Data.
I'm Dr. Phoebe Thorpe, and here
with me today is Dr. Spero Manson distinguished Professor
of Public Health and Psychiatry.
[Manson] Thank you.
[Thorpe] Thank you for joining us Spero.
[Manson] Not at all.
[Thorpe] Today's session was about suicidal behaviors
in American Indian and Alaska native especially in the youth.
We heard, in the session, how high the rates are,
the suicide rates are for these youth,
and it's tied to health equity.
How is it tied to health equity?
[Manson] Health equity means a number of things
to a number of different people.
I think of it in terms of access to opportunity.
Often and I think this is still characteristic
in the field are assumptions, about the risk
of suicide especially among American Indian
and Alaska native youth and younger adults.
Focus on individual deficiencies,
lack of coping abilities, other types of personality,
etc. I believe that in fact most
of that camouflages the inequities that are afoot
in terms of the opportunity structures in the committees
within which we live and work.
So that matters of poverty matters of lack
of employment opportunities,
difficulties acquiring an education dampened the
aspirations that many youth
and young adults have in our communities.
And, when you dampen those aspirations, it leaves you
with a sense of hopelessness and helplessness.
[Thorpe] So, as we heard in the session today, it really sounds
like a comprehensive approach to suicide prevention is important,
but we also know that it's important to bring
in culturally appropriate prevention strategies.
Can, and you've had some success with that in your approach,
can you tell me a little bit about that?
[Manson] Of course.
When we talk about comprehensive approaches,
it recognizes the fact that American Alaska native youth
and young adults live in many different worlds.
Not only just white world and native world but in schools,
among their peers, within their families,
within the broader community, and so, the importance
of marshaling our strategies
that recognize the different worlds
in which our young people live is the essence
of comprehensiveness.
My work has focused on one of those particular worlds.
Dr. Lafromboise who presented just before me focused
on schools.
Very important.
Place where most American Alaskan of youth live and work
so too is primary care.
And as I mentioned in my particular remarks,
there is a conspiracy of silence around suicide
because of the stigma that frequently attached to that
and the disclosure of the risk related to that condition.
And primary care, the white coat phenomena,
the very special contract between a provider
and patient allows those conversations to emerge in ways
that might not otherwise happen outside of such contacts
because the notion threat of being...
[Thorpe] Exposed.
[Manson] Exposed.
Exactly with respect to that risk of suicide
and the conversation that it occasions is much lower.
And so, this kind of a program
in a evidence-based practice called screening brief
intervention referral for treatment Espurt seeks
to capitalize on that very special relationship,
and to use one's visit to the primary care setting
as an opportunity to initiate that conversation and build
from there towards intervention.
[Thorpe] I also heard in your presentation
about the importance.
How you've brought in traditional medicine
as as treatment options.
Can you tell me a little bit more
about the importance of that?
[Manson] One of the lovely examples from each
of the three programs that I described,
which are not my programs, programs I've consulted with,
and been privileged to have a partnership with.
The detection of this risk of suicide is intended
to provide readier access to more biomedical tools
that are available to us to reduce that risk.
That they have all used this as an opportunity
to increase the access that that individual at risk has
with respect to the traditional healing resources.
That each has built into their own setting as well
as what exists out in the greater community,
and the nature of those traditional healing resources
varies regionally...
[Thorpe] Of course.
[Manson] as one would imagine from one setting.
[Thorpe] From one tribe to the next.
[Manson] Exactly.
[Thorpe] Exactly.
And, can you tell me a little bit more
about Dr. Lafromboise' work with the schools?
She has done some phenomenal work about building,
problem solving, and resiliency
in younger Native American and Alaska youth.
[Manson] It's similar.
It's similar for several reasons,
and I've had the privilege
of knowing Dr. Lafromboise for three decades.
Although she's much younger than me, you'd never know.
And her work really began to capitalize on note
that her program is called life skills development.
You don't see explicit recognition or conversation
about suicide early in the course of that intervention.
And it's really about recognizing the strengths
and skills in assets that all youth have
and particularly American and Alaska native youth in figuring
out how to enable them to recognize
that they possess those strengths and skills
and then enabling them to act on those to build
and enhance those skills towards improving their protection
from suicide.
It builds upon the sense
of resilience that's always been there in native communities,
but it's not been recognized in terms of its potential
until her work around suicide with native youth.
[Thorpe] It's interesting
that we were doing this session how a lot of the folks here
in public health recognize the importance of working
in schools, so it's very very important work.
[Manson] It is.
[Thorpe] And her presentation is very interesting.
So when we're talking about comprehensive changes,
and comprehensive includes changing norms,
what could you tell us
about changing norms to prevent suicide?
[Manson] That's a wonderful question.
So we talk about the norms surrounding the behaviors
that place people at risk, on particularly young people.
Like suicide.
What do we do?
We usually cite statistics with behavioral risk survey
that indicates the 27% of youth in our middle schools
and high schools have reported thinking about suicide
and taking their lives within a one month period of time.
Important of concern demanding our attention,
but in native communities were now pointing out that that means
that 83% of our youth do not think that way.
And so you're beginning to see movements afflict now
within American and Alaskan native communities.
Under the rubric of most of us, indicate that most
of us don't have suicidal thoughts or ideation.
What is that about?
How can we understand that better?
What does that reflect under this notion
of resilience in assets?
How can we translate that into ways that those who are
at risk can benefit and change the conversations that we have
in our respective communities?
So I think that's one of the very exciting initiatives
that are underway not just in native communities
but many communities probably,
but they have a particular residence in native communities
because of this emphasis on strengths,
resilience, and assets.
[Thorpe] And gatekeepers?
[Manson] The notion
of gatekeepers is actually very very consistent with life
in native communities.
We talk about gatekeepers in the native way of looking
at the world in terms of individuals who will sponsor us
for ceremonies over a variety of different types.
For example, among the Navajo, there's the notion
of the corn pollen path among the Lakota
from the northern plains that of the red road, among my people
of the Ojibway or Anishinaabe
from the eastern woodlands the notion of peace madadalin
which means a person of integrity.
And what these refer to are developmental life courses.
Has if you will to becoming a contributing member
of one's community, and at each point
in that developmental trajectory there are specific individuals
who are charged with helping us navigate
that path acquiring the skills.
Emulating the behaviors of that are consistent with that,
and they are the original gatekeepers.
Gatekeepers with respect to health and wellness
and that progression throughout developmental lifespan.
So this notion of gatekeepers that's come
from the public health arena actually resonates quite well
among native communities.
For the most part, in the public health arena, we think about it
as teachers, as first responders,
as primary care providers, as members of the faith community,
etc. Well, those are just the counterparts
to the spiritual paths that we've identified long ago
that one wants to navigate and becoming a person
of integrity is not that they will win so.
[Thorpe] So if somebody wants to find out some more information
about preventing suicide, where would they look?
[Manson] It's a great question
because if you'd asked me this 40 years ago
when I first entered the field it was relatively nothing.
I'm impressed that today that there's a wealth of resources,
and at the end of today's presentation,
I believe there were series of slides that provide the viewer
with immediate reference points.
I have been privileged to be a part
of SAMHSA the Substance Abuse
and Mental Health Services Administrations.
On Initiative on Garrett Lee Smith, youth suicide prevention,
and related initiative entitled native connections
which are focused very specifically
on one the translation evidence-based practices
from the general mainstream to native communities
and their application in hopes of reducing the risk of suicide.
And secondly, identifying these intrinsic strength
and resilience within native communities
and illustrating how our people have been able
to build upon them and to codify them in ways
that others can benefit.
And so, I think that those two initiatives particularly are
especially important and relevant
to the interested party.
[Thorpe] Okay.
And also, are there some from the Indian Health Service
and [Manson] There are.
There's a special initiative currently underway
for the last eight years in the Indian Health Service.
That is of benefit as well.
It's less well-documented than those in SAMHSA.
So, I think the best approach is to seek out all possibilities.
[Thorpe] Thank you so much for joining us.
[Manson] My pleasure.
[Thorpe] And thank you so much
for joining us for Beyond the Data.
See you next month.