The suicide rate for American Indian youth is more than three times the national average, but on the isolated expanses of the Great Plains, the numbers are grimmer still. Young people there are 10 times more likely than their non-Native peers to kill themselves. The Indian Health Service recently cited the Rosebud Sioux Indian Reservation, in South Dakota, as having the highest suicide rate in the world for males age 10 to 24.

On the surface, such factors as family violence and substance abuse play a role, but more systemic factors, including poverty and longstanding cultural oppression, are the deeper causes, says University of South Dakota psychologist Beth Boyd, PhD, on faculty at the school's Disaster Mental Health Institute. In fact, it was illegal to practice traditional Native American spiritual and ceremonial forms of healing until 1978, when Congress passed the American Indian Religious Freedom Act, she notes.

"So, Native communities experienced many generations of trauma and loss, with no traditional ways of addressing and healing them," Boyd says.

Boyd is part of a team of Native mental health professionals and tribal spiritual leaders working to redress that imbalance by helping communities heal after these tragedies, which often involve multiple or "cluster" suicides. Using a blend of psychological support and Native spiritual teachings and practices, the team conducts a variety of interventions with the community at large, with leaders and mental health workers, and with families and individuals.

"It's not so much that we come and do anything earth-shaking," Boyd says. "It's that we help them to reconnect to the strengths they already have."

While it is hard to say definitively that the approach prevents suicides since the team is usually called in after suicides have occurred, the work does seem to make a difference, Boyd says.

"In most cases, the interventions have helped," she says. "But like anything else, if a community's attention gets diverted, things can start to happen again."

Community building

Often the first thing the team does is to meet with the entire community so members can express their grief and concerns. Here, team members take an "active listening" approach to understanding people's issues, thoughts and feelings. While people's initial reactions are often to assign blame—school personnel may blame parents and vice versa, for example—the more people communicate, the more everyone comes to understand that no one factor is the cause, says Boyd.

"If anything, the problem is poverty, isolation and years of oppressive conditions," which in turn can lead to depression, anger, low self-esteem, despair and other factors that can drive young people to commit suicide, she says.

Boyd and the team also provide community members with "psychological first aid," an approach that helps people to stabilize emotionally, provides practical assistance and connects people with the natural social supports in their communities. The team may encourage communities to hold gatherings, to take part in traditional cultural ceremonial practices aimed at healing trauma, and to launch activities that foster young people's leadership skills and help them share feelings, for example.

Basic psychoeducation is often effective as well: Just learning that their reactions are normal in the face of intense traumatic events helps people feel more able to cope, she says. In addition, the team helps communities form or re-energize their own crisis response teams, she notes.

Taken together, these interventions help communities to activate their own natural healing mechanisms and begin the healing process, Boyd emphasizes. "Some people need grief counseling or more serious mental health intervention, but many don't," she says. "They just need to feel connected to other people and to their community again."

Reconnecting with tradition

The community also relies on the support of the team's spiritual leaders—Gene Thin Elk, a nationally known spiritual leader, and Rick Thomas, a former tribal chair at the Santee Dakota Nation in Nebraska. The two are co-founders of the Red Road Approach, a Native approach to healing and wellness. The men have worked with many tribes across the United States and Canada to revitalize Native traditional culture and spirituality and to apply it to a variety of health, mental health and substance-abuse issues.

As team members, Thomas and Thin Elk reintroduce people to Lakota and Dakota teachings about suicide, which can help to restore meaning and peace of mind. One teaching, for instance, holds that the deceased person had an important spiritual purpose while he was here, and that he is still part of the community.

"It's an understanding that we still have a relationship to those who are no longer in this physical world, so that we do things that would be important to them, and honor those things they have taught us or tried to do," Boyd says.

In a similar vein, Lakota philosophy holds that everything is connected, including all beings in the natural, human and spiritual worlds. "We all have the same spark of the creator within us, which makes us all relatives—and that includes those who have gone to the spirit world," she says.

Boyd notes that the team is starting to make inroads into prevention as well. One tribe in the region, for instance, recently asked the team to help them develop a suicide prevention plan.

"It's nice to work with a community that is not in the midst of the crisis of multiple suicides," Boyd says. "They are doing their best to prevent that from happening and to educate their tribal members to know what to do if someone expresses suicidal intent."

Tori DeAngelis is a writer in Syracuse, N.Y.