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Mental health

Prevention strategies lead to 40% drop in suicides among White Mountain Apache tribe

Johns Hopkins Center for American Indian Health assisted with tribe's efforts to track and prevent self-harm

Suicide rates among the White Mountain Apache tribe in Arizona dropped significantly between 2006 and 2012, according to research from the tribe and Johns Hopkins Bloomberg School of Public Health.

"This study shows how a courageous community, the White Mountain Apache Tribe, used legislation and community mental health workers to successfully address suicide as a public health crisis."
Mary Cwik, researcher at the Center for American Indian Health

The nearly 40 percent reduction compared to the previous six-year period came after tribe leaders helped develop suicide surveillance and prevention programs within their community. The findings are published in the latest issue of The American Journal of Public Health.

The federally recognized White Mountain Apache tribe today consists of about 15,000 members, many living around the Whiteriver area of the Fort Apache Indian Reservation in Arizona.

From 2001 to 2006, the suicide rate among tribe members between the ages of 15 and 24 was 13 times that of the general U.S. population, and seven times the rate for all American Indians and Alaska Natives. When the tribe realized the extent of this disparity, they reached out to their longtime partners at the Johns Hopkins Center for American Indian Health to help design and implement a suicide prevention program.

"This study shows how a courageous community, the White Mountain Apache Tribe, used legislation and community mental health workers to successfully address suicide as a public health crisis," says Mary Cwik, a clinical psychologist and researcher at the Center for American Indian Health.

The program, called "Celebrating Life," moved forward through legislation in the White Mountain Apache's tribal council. One element is a unique community surveillance strategy to track and triage suicide deaths, attempts, and suicidal thoughts. After an incident is reported, Apache outreach workers follow up with in-person visits to provide support and connect the individual to resources. The staff members then continue to monitor the welfare of the individual over time.

The tribe's work has also included two school-based programs, training for adults to identify at-risk youth, a community-based media campaign focused on prevention, and screening and interventions in the tribe's emergency rooms to connect at-risk patients with counseling.

"We are determined to let our Apache people who are hurting know that there is real help for them," says Novalene Goklish, a tribe member who was involved in the Johns Hopkins study.

In the wake of these new programs, suicide deaths and attempts fell significantly among the tribe, the study found. Overall suicide rates dropped by 38.3 percent, which included a 60 percent decrease for ages 25 to 34 and a 37 percent decrease for ages 20 to 24.

From 2001 to 2006, 41 Apache members died of suicide. That number dropped to 29 from 2007 to 2012. The downward trend in suicide deaths appeared to be mirrored in a decrease in suicide attempts. During the study's time period, national suicide rates remained stable or increased.

The researchers and the tribe have been approached by at least 10 other tribes in need of such services. They believe their program will help not only American Indians, but other communities at high risk for suicide.

Read more from School of Public Health
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