One of the hallmarks of this program was the active and enthusiastic participation of the local tribal members. Community awareness and organizing was used, and a tribal holding facility was established for youths “at risk” for suicide, or who had made low lethality suicide attempts. Here they received informal counseling, help, and support from volunteers from the Shoshone-Bannock tribal members who were on call around the clock. These volunteers had been trained by local mental health professionals and had ongoing support from health, mental health, and law enforcement officials. The suicide rate fell from a high of 173.1 per 100,000 in 1972–1976 to 21.5 in 1977–1980, but then rose again to 45.4 in 1981–1984 (May, 1987).
The suicide rate had also been very high in another Native American community, the Jicarilla Apache Tribe of northern New Mexico; 41 to 61 per 100,000 for a 10 year period (1969–1979) (VanWinkle and May, 1986; 1993). The rate was extraordinarily high among adolescents and young adults, exceeding 160 per 100,000 among those aged 15–24 during this same time-span (VanWinkle and May, 1986; 1993). Again, as with the Shoshone-Bannock, a partnership was formed between the Jicarilla Apache Tribal Council and Tribal Health Programs, with the Indian Health Service, and later the CDC. The program utilizes multiple agencies in the community including the IHS clinic, tribal mental health and substance abuse programs, the high school, and law enforcement. As a result of this partnership, this Jicarilla Apache community has had a comprehensive youth suicide prevention program since 1989 targeting 15–18 year olds in school and in the community with a variety of measures including public education, risk assessment, counseling, and alcohol abuse prevention initiatives (Serna et al., 1998).
Like the Shoshone-Bannock community program, the Jicarilla Apache program emphasized the use of “Natural Helpers” (local, indigenous persons trained to recognize symptoms of self-destruction and perform lay counseling) as key vehicles for prevention. The Natural Helpers work with the support and utilization of mental health professionals who serve as therapists for the highest risk and most serious cases. Professionals also provide training, advice, and support to community and staff alike. The program has drastically lowered the rate of suicide gestures, attempts, and completions combined (Serna et al., 1998). One of the consistent effects is not only a significant lowering of the rate of attempted and completed suicide in the targeted ages of 15–18, but a gradual lowering of the rates in older age brackets (e.g., 19–24), as the target population ages (P. May, University of New Mexico, personal communication, December 2001; VanWinkle and Williams, 2001).
Since the majority of suicides among American Indians occur among the young, schools have been a primary focus of some American Indian