Suicide Among Aboriginal People in Canada - Institut universitaire ...

Chapter 5What Works in Suicide Prevention?Each reserve is different and I find each reserve lacks ... One reserve may get all theresources … well, they can access the funds or programming, but another reserve doesn’thave that opportunity or don’t have the people or committed individuals within theirreserve that could set up programs for them or find the money where they could help outtheir community members or the youth (First Nation youth).Conventional mental health approaches to suicide emphasize the identification and treatment of individualsat risk. This is one essential component of any effective intervention. Most Aboriginal communities areunderserviced, and it is not always possible for individuals with depression, substance abuse problems, andfamily crises to obtain appropriate help. Basic services must be made accessible to Aboriginal people livingin remote communities and in urban centres. At the same time, the very high rates of suicide, attemptedsuicide, and suicidal ideation among youth in many Aboriginal communities indicate that the problem is notjust individual but involves community-wide issues. As such, a community-based approach to preventionis essential.Recent reports from government and professional advisory groups agree that there is an urgent need for moreresearch to identify effective ways of preventing suicide (Silverman, 2001; Goldsmith et al., 2002; AmericanAcademy of Child and Adolescent Psychiatry, 2001b). Reviews of prevention programs specifically designedto reduce suicide among Aboriginal people have found that there are very few well-evaluated studies todate (Middlebrook et al., 2001; Advisory Group on Suicide Prevention, 2003). Nevertheless, there is someconsensus on current best practices at the levels of individual and community healing, clinical intervention,and prevention. Similar strategies have been outlined in documents prepared by various groups in Canada,Australia, and the United States (American Academy of Child and Adolescent Psychiatry, 2001a; 2001b).Several useful reviews of strategies and programs appropriate for Aboriginal communities in Canada arealso available (e.g. Devlin, 2001a; 2001b; Gardiner and Gaida, 2002; White and Jodoin, 2003).This chapter reviews available information on what types of programs and interventions may be effectivefor suicide prevention, the treatment of suicidal individuals, and support for those affected by the suicideof a friend or family. The first section briefly outlines the levels and types of prevention. The next sectionreviews the elements of successful suicide prevention programs and discusses the few programs that havebeen shown to be effective in systematic evaluation or outcome studies. Chapter 6 discusses issues inadapting prevention programs to Aboriginal communities and summarizes guidelines for best practices.Appendix A describes some recommended programs in more detail.Levels of PreventionPrimary prevention (acting “before the fact”) aims to reduce suicide risk by improving the mental healthof a population. This kind of prevention strategy can address a wide range of social or mental healthproblems, and its positive impact goes well beyond the problem of suicide (Mrazek and Haggerty, 1994).Examples include life skills education in schools, parenting programs, and provision of accessible andeffective mental health services for a population.81