Why an alternative to suicide prevention gatekeeper training is needed for rural Indigenous communities: presenting an empowering community storytelling approach

Abstract

The need for effective youth suicide prevention is uncontested, and is particularly urgent for Indigenous populations. The Indigenous youth suicide rates in some North American communities can be 18 times greater than for other young people. Despite the clear need, evidence in support of Indigenous youth suicide prevention strategies remain mixed. The most common approach to youth suicide prevention -gatekeeper training -may have limited effects in Indigenous communities. Based on recent work undertaken with Indigenous leaders in rural Alaska, we describe culturally grounded, practical alternatives that may be more effective for Indigenous communities. We highlight the ways in which research informed, grassroots interventions can address cultural, practical and systemic issues that are relevant when addressing risks for suicide on a community level. Built on a transactional-ecological framework that gives consideration to local contexts, culture-centric narratives and the multiple, interacting conditions of suicide, the innovative approach described here emphasizes community and cultural protective factors in Indigenous communities, and extends typical suicide prevention initiatives in ways that have important implications for other ethnically diverse communities.

Promoting Community Conversations About Research to End Suicide: learning and behavioural outcomes of a training-of-trainers model to facilitate grassroots community health education to address Indigenous youth suicide prevention

“…Fidelity to the PC CARES curriculum is assessed across each of the 6 standard elements of each LC [ 1 ]: agreements/safe talk [ 2 ], small wins [ 3 ], the LC activity [ 4 ], what we know [ 5 ], what we think, and [ 6 ] what we want to do. Each dimension gets 0–1 for procedural components (i.e.…”

“…AN villages have limited behavioural health care infrastructure [ 1 – 3 ], and require that mental health care providers have local and cultural knowledge context to navigate effectively [ 4 ]. In these settings, many service providers are non-Native, and the measures taken in acute suicide events may cause unintended cultural harms as individual and family liberties are curtailed to promote safety [ 5 , 6 ]. To reduce reliance on crisis-oriented suicide care, a coordinated and sustained community-based early response is warranted.…”

“…This approach can limit the diffusion of information and resources to the rest of the community where they are most needed and most deployable. Many community health workers, religious leaders, social service administrators and tribal office workers are local people who are well positioned to make use of suicide prevention and intervention tools in their daily lives [ 3 , 5 , 6 ]. Mobilising such an array of local service providers can spur multilevel suicide prevention efforts that build on and extend local support systems – including those outside the bounds and scope of clinical intervention [ 4 , 6 ].…”

“…As opposed to didactic education models, LCs aim to be inclusive, engaging and culturally respectful to increase the likelihood that sessions are personally meaningful and foster durable learning and action [ 10 ]. The pervasive didactic suicide prevention educational models, such as gatekeeper training, have had disappointing learning and behavioural outcomes in Indigenous communities [ 5 , 11 ], indicating a need for innovation.…”

Aboriginal identity, world views, research and the story of the Burra'gorang

“…Working from a culturally inclusive approach involving the Aboriginal staff, the use of yarning circles to guide policy saw a stronger level of active engagement of the Aboriginal staff, improved peer-to-peer support, increased levels of self-monitoring and a reduction in the need for policing of the policy itself (thus making it sustainable). In the international context, Wexler, White and Trainor ( 2015 ) highlighted the power of storytelling within a First Nations community as part of a suicide prevention program . The emphasis was on empowering community support networks to create safe communal settings where stories were shared by local members who spoke of personal experiences of both overcoming suicidal inclinations and helping people at risk of suicide.…”