dentiality of mental health provider reports and to include data from Reservists, National Guard, and Department of Defense members.

If analysis of the Air Force LINK model finds it effective in reducing suicide, exporting it to other communities could prove valuable. However, difficulties are anticipated. For example, the Air Force is a controlled environment in which commanding officers can forcibly refer individuals deemed at high risk for suicide to mental health services. Moreover, given personnel assignments to units, military service membership creates a salient community. Program elements establishing social support, sense of belonging, and social responsibility therefore take root much more easily in such a setting than in the broader society. Furthermore, the Air Force can routinely include suicide/mental health education into staff development and can form system-wide policies aimed at specific suicide-reduction efforts more quickly and with greater power to enforce such policies than the United States government as a whole. The Centers for Disease Control thus recommends first using the Air Force’s LINK model in occupation-related communities such as law enforcement and investigative agencies (CDC, 1999). The Department of Defense is currently implementing the LINK model, which should yield more information about its effectiveness in reducing suicide.

Suicide Prevention Programs for Rural American Indian Communities

Integrated approaches to suicide prevention have been used effectively in several American Indian reservation communities in the United States and Canada for at least three decades. These efforts were in response to either high suicide rates or apparent suicide clusters. They utilized universal, selected, and indicated intervention/prevention methods through community and public service agencies.

In the 1960s, the Shoshone-Bannock Tribal Council worked to reduce the high rate of suicide of 98 per 100,000 (mostly involving adolescents and young adults) in their community (Dizmang, 1969; Dizmang et al., 1974; Shore et al., 1972), but the rate continued to rise into the early 1970s. A partnership was formed among the tribe, NIMH, and the Indian Health Service (IHS) in 1968 in response to this crisis. Epidemiological research during the early part of this program identified acute alcohol intoxication, arrest for minor infraction, and high family disruption as risk factors for suicide, and services were designed to reduce these risks (Dizmang et al., 1974; Levy, 1988; May, 1987; Shore et al., 1972). This program included social and economic improvements, traditional Indian cultural enhancement programs, and increasing mental health services (Dizmang, 1969).



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