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Gender-Based Violence
Mental Health

As rates of suicide for Native American youth increase, culture is key to prevention

Faculty Research Fellows Talk with Teresa D. LaFromboise

Suicide rates for Native American youth are four times higher than that of any other racial or ethnic group in the United States. In the past decade, these rates have only increased. At a recent Clayman Institute Faculty Research Fellows talk, Teresa LaFromboise (Miami Nation) drew upon her lifelong work in Native American youth suicide intervention to discuss cultural and contextual considerations for Native American youth suicide prevention. What LaFromboise demonstrated is that the most powerful sources of healing for Native youth are located within Native communities themselves, through the development of community-based, culturally specific, and culturally focused mental health programming.  

LaFromboise, professor of education in developmental and psychological sciences and director of the Native American Studies Program at Stanford, has worked extensively in Native American youth suicide intervention since the 1980s. A clinical psychologist by training, LaFromboise is perhaps most well-known for having developed the American Indian Life Skills curriculum (AILS), a foundational text in Native American mental health that is still widely used today. When LaFromboise first got involved in Native youth suicide intervention work, research on the subject did not yet exist and there was little to no interest in it. LaFromboise repeatedly witnessed high rates of suicidal ideation and suicide attempts amongst Native American youth at the communities she worked in, with girls reporting significantly higher rates of suicidal ideation than boys.

LaFromboise repeatedly witnessed high rates of suicidal ideation and suicide attempts amongst Native American youth at the communities she worked in, with girls reporting significantly higher rates of suicidal ideation than boys.

LaFromboise developed the AILS collaboratively during her work with the Zuni Highschool District in New Mexico in the late 1980s. Over a three-year period, LaFromboise developed and evaluated a suicide intervention curriculum with community members of the Zuni Pueblo. Primarily a cognitive behavioral intervention, the Zuni Life Skills curriculum was delivered three days a week to students through language arts classes and provided skills for basic crisis intervention, problem-solving, and goal-setting. When LaFromboise began the study among Zuni high school freshmen, she found that 36 percent of the student body had already attempted suicide. After students completed the Zuni Life Skills curriculum, they self-reported experiencing less hopelessness, more confidence, and more ability to manage anger. Outside evaluators determined the impact of the curriculum on Zuni high school and middle school students in the following outcomes: overall decreased suicide risk; increased collective esteem; and increased self-efficacy and self-awareness to manage depression, cope with stress, enlist community support, and enlist social resources. Since then, LaFromboise has continued to refine the AILS and has trained behavioral health specialists to use the AILS intervention model in over 100 different Native communities. The AILS curriculum is still widely used today.

LaFromboise identifies one of the biggest challenges to doing this work in Native communities as heterogeneity, with nearly 1,000 tribes in the so-called United States (574 of which are federally recognized) and so much diversity in every Indigenous community. Thus, when it comes to national data sets on suicide statistics, “we’re looking at an ethnic gloss to some extent,” says LaFromboise, noting that, nonetheless, “[they] give us a sense of the gravity of the situation.” What such data tell us unequivocally is that Native youth are at higher risk of suicide than any other racial or ethnic group (in the United States) and that what were already staggeringly high rates of suicide for Native youth have significantly increased over the past decade. 

LaFromboise associates this rise in suicide rates with a preponderance of re-traumatizing current events pertaining to colonial violence. For example, 2021 saw the launch of Interior Secretary Deb Haaland’s Federal Indian Boarding School Initiative, marking the first time in U.S. history that the federal government has officially acknowledged its operation of 408 boarding schools from 1819 – 1969, which forcibly removed and disappeared tens of thousands of Indigenous children from their families and communities. As part of the initiative, Secretary Haaland is conducting a year-long listening tour with survivors and descendants of the boarding schools in Indigenous communities across the country. At the same time, the Supreme Court is preparing a vote to overturn the Indian Child Welfare Act (ICWA), a milestone piece of legislation passed in 1978 that protects against the forced removal of Native children from their homes and communities by public and private agencies. Finally, LaFromboise identifies one of the most significant factors in Native American youth suicide rates to be the ongoing crisis of missing and murdered Indigenous women, girls, and two spirits (MMIWG2S).

Given the magnitude of such historical and ongoing violence aimed at the eradication of Indigenous communities and cultures, perhaps it may come as no surprise, then, that the approaches LaFromboise has witnessed to have had the most significantly positive impact on Native American youth suicide prevention are those that emphasize enculturation, or what she calls "culture as prevention." Examples of culture as prevention include teaching Native youth their languages, cultures, histories, methods of food sustainability, participation in ceremonies, and the cultivation of connectedness with land. Research has shown that Indigenous communities with greater control over their resources (such as health services and schools), stewardship of land, and cultural revitalization have significantly lower rates of suicide.

Presently, LaFromboise is working with a community in Northern California that offers mental health services to Native youth through a variety of programming centering culture as prevention, such as the practice of coming-of-age ceremonies. Over the coming summer, LaFromboise, along with two Native Stanford graduate students, will be conducting focus groups with the community and will use the data to update the AILS curriculum to be more relevant to today’s Native youth. Thanks in great part to LaFromboise’s contributions, such community-based approaches in Native American suicide prevention are increasing, yet they remain understudied.