Ethical and Cultural Dimensions in Suicidal Behaviour in Native Americans - Case Study Example

Ethical and Cultural Dimensions in Suicidal Behaviour in Native Americans Suicide is a common challenge throughout cultures. It is filled with religious ramifications in most cultures and it is against the laws of society. Many people feel that life has been too difficult for them that they can no longer live their life. Instead, they commit suicide, leaving their loved ones behind. When this happens in most cultures, people do not know how to respond. For this essay, this researcher has chosen Native American culture to discuss suicide, in the social, ethical, and legal dimensions of the process. The research that was found primarily supported information on adolescent suicide and prevention. Social Interpretation of Suicide According to Garroutte, Goldberg, Beals, Herrell and Manson (2003) Native Americans have a higher incidence of suicide related behaviours than the general population. The attempted suicide rates can range from 15% to 31% in many tribes. Also, suicide behaviour that is exhibited in the general population is 72% more likely to cause a completed suicide among Native Americans. The factors that can cause suicide can be related to socio-demographic information like "age, sex, and educational achievement" as well as mental health conditions that can include "depression, stress and substance abuse" (Garroutte et al., 2003, p. 1572). Native Americans by tradition have a strong sense of spirituality. Like many other cultures, their spirituality becomes a very important aspect of whether the individual experiences well-being. When a Native American experiences challenges or conflicts between feelings of suicide and their religion, it can cause distress, especially when they find themselves in conflict with the dominant cultures values (Garroutte, et al., 2003). Garroutte et al. (2003) studied the importance of spiritual beliefs for Native Americans who considered suicide or actually went through with it. The results of the study found that spirituality did not have a bearing in whether an individual attempted or committed suicide. However, there was an association between cultural spiritual orientations and suicide attempts. In other words, when an individual had a sense of well-being because of cultural spirituality, they had a tendency to release thoughts of suicide. This information indicated that those Native Americans who had a spiritual commitment also had a framework for a sense of well-being because they world was "more orderly and comprehensible" (Garroutte et al, 2003, p. 1576). This allowed the individual to understand that they were more open to doing something about the problems that led to the suicide attempt. Range et al (1999) studied the multicultural perspectives on suicide. They suggested that there were specific needs that each ethnic culture needed in order to work with them regarding suicide ideation. As an example, Native Americans need three areas to be acknowledged: reinforcement of their Native American identity, encouragement of a more extensive knowledge of their cultural and tribal heritage, and for the youth, a facilitation that helps them stay in school. Another factor that must be attended to according to these researchers is that Native Americans deal with the world differently depending on where they were raised. Usually, Native Americans live on reservations, in urban areas and some move back and forth between the city and the reservation. Each of these experiences can be very different experiences. Native Americans in most situations live in poverty which can ad to feelings of suicide or suicidal behaviour. Their rate of unemployment is 1.6% higher than other averages in the U.S. and they are 2.3 times "more likely to be at or below the poverty level" (Range et al., 1999); these living situations are thought to be major contributors to the risk of suicide for this population. At the time of their study, Range et al. saw that the suicide rate was 1.6 to 4.2% higher than other ethnic groups and this varies by tribe; other researchers have found that these statistics continue to be accurate. Native American men are most likely to commit suicide and usually use a firearm to do it. Many men also experience challenges because of the disruption of their culture, which some think can be a contributing factor to suicide. Because most Native American cultures are cohesive units, acculturation aspects like western education, missionaries from the majority religions, legislation, language barriers, undermining o parental influence and being uprooted form their native lands have all contributed to suicidal behaviour (Range et al., 1999). Suicide for adolescents has always been a consideration in every culture. Among Native American ages 15-17, suicide accounts for one in five deaths (Goldston et al., 2008). Many adolescents who live on reservations, especially those that are isolated also seem to have a higher risk for suicide. Suicide in adolescents has always been a consideration in every culture. Among Native American ages 15-17, suicide accounts for one in five deaths (Goldston et al., 2008). Many adolescents who live on reservations, especially those that are isolated, also seem to have a higher risk for suicide. Some of the factors that can cause suicide in these areas include "economic deprivation, lack of education, and limited employment opportunities" (Goldston et al., 2008, p. 20), because these factors contribute to a sense of hopelessness for young people. Add to these factors elevated rates of drug and alcohol abuse for young people it is not difficult to understand how this behaviour can end in suicide. Goldston et al. (2008) add to what Garrotte et al (2003) stated that the early efforts of ethnic cleansing that were moved forward for the Native American population has a bearing on the overall culture. Encultration, or the extent to which Native Americans has embedded their cultural traditions is important. If they are not practicing their traditions, language, spirituality or cultural values, the Native American can lose their foundation and solid ties to their community and/or family. Many researchers have found that youth who have enculturation seem to be more protected factors, the situations that stop youth suicide, like academic success and pro-social behaviours with their peers. However, when adolescents grow up in two cultures simultaneously, that have conflicting behavioural demands, and discrimination can make an adolescent more vulnerable to suicide (Goldston, 2008). Another issue that is important in a discussion of suicide and Native Americans is the issue of healing and how it affects the culture. In most tribes, there is an alternative healer, often called a Shaman or medicine man (woman) who would normally treat mental and physical health problems. Often, this tradition is still carried out because the majority of Native Americans cannot afford Western healthcare (Broome and Broome, 207). There I s also a strong link between medicine and religion. Native Americans believe that "spirit" is the life force and therefore both physical and spiritual health must be treated at the same time. Native Americans will want to know the level of spirituality of anyone working with them because they also understand there is a connection between "Mother Earth/nature, Father Sky and all of life through the Creator, Great Spirit, Great Mystery or Maker of all things" (Broome and Broome, 2007, 0. 162). When Native American healers work, they attempt to re-establish balance in the individuals connection to all things. Taking into consideration this aspect of healing is important to treating Native Americans mental as well as physical health. Ethical and Legal Dimensions of Suicide in Native American Culture The literature does not elaborate on ethical or legal dimensions in terms of how Native Americans perceive suicide. Perhaps this is because they are often the least understood group or ethnicities. The literature had more to say about how healthcare workers should work with Native Americans in order to either prevent or treat suicide behaviour. Alcantara and Gone (2007) suggest that one ethical consideration the cultural heterogeneity of Native Americans. In other words, programs of intervention must understand differences in the nature of suicide. One challenge in working with them is that they usually do not report suicidal thoughts or suicide attempts and many who are on the reservations are more prone to suicidal thoughts (Alcantara and Gone, 2007). Capuzzi (2002) researched the legal and ethical challenges that surrounded counselling students that were suicidal. He suggests that there are several issues that counsellors must understand when they are developing suicide prevention programs. He suggests that all staff are prepared for seeing the signs of suicide form the bus drivers to the principal. They should not provide counselling but only recognize the students risk for suicide and be able to make appropriate referrals. Crisis teams are a good addition to schools especially with the idea of school violence. The school will need to check with their legal staff before they make referrals to see who must pay for the counselling (Capuzzi, 2002). Although Capuzzis study is more geared towards a general student population, he does state that policies and procedures must be in place. However, it would have been more important to mention some of the factors that were important to counselling specific students. As an example, the counsellor working with Native American youth must keep many issues in mind. They must get to know the students and gain their trust before they have challenges. As an example, gaining the trust of the student could allow them to let the counsellor know about any suicide attempt. Counsellors must also understand Native American culture and spirituality and understand how acculturated the student is and how this impacts the student. Another ethical consideration would be in working with the families. If the family is very traditional, the parents may have difficulty talking about family business outside of the family unit. The counsellor may want to integrate work with the shaman or medicine person of the tribe in order to help the Native American youth who has attempted suicide. Confidentiality is another issue that counsellors must face with youth. If the youth has identified that they intend to commit suicide, they must inform the proper authorities in most cases. This may mean telling parents, mental health practitioners or the police. The counsellor or mental health person would have a duty to warn so the confidentiality issue may be very important to consider (American Psychological Association, 2010). If an individual were using illegal drugs or alcohol, they may need legal representation if they had attempted suicide or they may have to go into a psychiatric faculty. Also, many reservations are governed by the Bureau of Indian Affairs which means that the individuals fate may be turned over to the BIA in some situations (Parr, Lomayesva and Griffin, 2008). For some Native Americans, the use of mental health professionals must be coordinated with traditional Native American healers is an ethical way to handle working with Native Americans in a therapeutic setting. The reason this is important is because Native Americans may be embarrassed or there may be stigma attached to seeing mental health professionals (Goldston et al, 2008). Other Factors that Influence Native American Suicide Mullany et al. (2009) suggest that the most important aspect of suicide prevention is to begin with adolescents. They studied the White Mountain Apache tribe in order to understand how suicide happened for these youth. They found that suicide often occurred on Saturdays, especially when alcohol and drug use was a part of the students life. Family conflict was most often the trigger and for this group, most suicides happened in August after seasonal activities where more drugs and alcohol were used, and when school started (Mullany et al., 2009). This study showed how different tribes can have different ways of expressing suicide depending on their specific culture. Suicide Prevention Programs for Native American Youth May, Serna, Hurt and DeBruyn (2005) studied suicide prevention in a suicide behaviour prevention program that had been operating for 15 years. They dubbed the tribe they observed the Western Athabaskan Tribal Nation to preserve their identity. Their study concentrated on teens ages 10-19 because they were most at-risk for possible suicide. The model program integrated many program components that included "Surveillance through constant data and information gathering screening/clinical interventions with extensive outreach in conventional institutions … and unconventional settings … social services … and community education for adults and youth …" (May, Serna, Hurt and DeBruyn, 2005, p. 1239). The results showed that there was a constant reduction in suicidal gestures and attempts that were recorded for the entire program. They also found that when the suicide prevention program caught youth early in their suicidal behaviours. The researchers believed that the program was successful because the program used a public health approach which also included mental health services. They found that these programs should not focus on a small amount of self-destructive behaviours but should concentrate on the root causes as well as developmental, psychological and social issues. They also state that the community should be involved form the beginning of the prevention programs and program development should be flexible. In the program development must also be based on continuous evaluation and continuous feedback from the community and program staff (May, Serna, Hurt and DeBruyn, 2005). Pettingell et al. (2008) examined whether Native American children that had previously attempted suicide would try again if they had protective factors and risk factors were removed. They studied urban Native American youth who were surveyed between 1995 and 1998 as part of another study by the Indian Youth Resiliency Program. These participants were now part of a "Culturally based youth program" or "Attending various schools"(Pettingel et al., 2008, p. 467) with a larger proportion of Native American youth. Their findings were significant for the particular program. They found that girls with risk factors of substance abused were more prone to have had a suicide attempt in their past. Boys had a higher chance of violence when these risk factors were shown. This again shows that each tribe is different in their aspects of suicide challenges. Their study also showed that mental health personnel within suicide prevention programs should understand that when they see violence within a group of youth, one form of Conclusion There is still a need to understand Native Americans and how suicide plays a part in their understanding of the world around them. The literature does not give examples of how they perceive suicide or what it means to their culture when this happens. There are so many Native American youth that are committing suicide that it would seem that more would be done about the causes. Although the literature points out that living on a reservation can have a variety of stresses that make the individual feel hopeless, it would seem that something else would be done in order to help these youth find a better place before they had attempted suicide. References Alcantara, C., Gone, J.P. (2007). Reviewing suicide in Native American communities: Situating risk and protective factors with a transactional-ecological framework. Death Studies, 31 (5). 457-77. Retrieved August 12, 2010 from CINAHL database (AN: 2009569281). American Psychological Association. (2010). Facing dangerous situations: increasing clarity. PsycCRITIQUES, 54 (42): 5. Retrieved August 18, 2010 from http://www.apa.org/pubs/books/4312013c.pdf Broome, B., and Broome, R. (2007). Culture and diversity issues. Native Americans: Traditional healing. Urologic Nursing, 27 (2). 161-3, 173. Retrieved August 13, 2010 from CINAHL database (AN: 2009583518) Capuzzi, D. (2002). Legal and ethical challenges in counselling suicidal students. Professional School Counselling, 6 (1). Retrieved August 15, 2010 from http://www.schoolcounselor.org/files/6-1-36%20Capuzzi.pdf Garroutte, E.M., Goldberg, J., Beals, J., Herrell, R., and Manson, S.M. (2003). Spirituality and attempted suicide among American Indians. Social Science & Medicine, 56 (7), 1571-1579. doi: 10.1016/S0277-9356(02)00157-0 Goldston, D.B., Molock, S.D., Whitbeck, L.B., Murakami, J.L., Zayas, L.H., and Hall, G.C.N. (2008). Cultural considerations in adolescent suicide prevention and psychological treatment. American Psychologist, 63 (1), 14-31. Doi: 10.1027/0003-066X.63.1.14 May, P.A., Serna, P., Hurt, L., and DeBruyn, L.M. (2005). Outcome evaluating of a public health approach to suicide prevention in an American Indian Tribal Nation. American Journal of Public Health, 95 (7). 1238-1244. Retrieved August 13, 2010 from CINAHL database (AN: 2009157264). Mullany, B., Barlow, A., Gooklish, N., and Larzelere-Hinton, F. (2009). Toward understanding suicide among youths: Results from the White Mountain Apache tribally mandated suicide surveillance system, 2001-2006. American Journal of Public Health 99, (10), 1840-1848. doi: 10.2105/AJPH.2008.154880 Parr, J., Lomayesva, D., Griffin, K. (2008). California Indian legal services: Forty years and counting. News from Native California, 21, (3). 10-12. Retrieved August, 18, 2010 from Academic Search Premier database (AN: 31925558). Pettingell, S.L., Bearing, L.H., Skay, C.L., Resnick, M.D., Potthoff, S.J., and Eichhorn, J. (2008). Protecting urban American Indian young people from suicide. American Journal of Health Behaviour, 32 (5) 465-476. Retrieved August 12, 2010 from CINAHL database (AN: 2010003440). Range, L.M., Leach, M.M., McIntyre, D., Posey-Detersa, M.S., Marion, S.H., Kovac, J.H., Banos, J.H. and Vigil, J. (1999). Multicultural perspectives on suicide. Aggression and Violent Behaviour, 4 (4), 413-430. doi: 10.1016/S1359- 1789(98)00022-6 Read More