3Risk Factors What are “risk factors”? Risk factors are those things in a person’s life that might take them to thinking about suicide.The factors vary for every person.There are some common themes to look for and to listen for.
4Risk Factor Information Suicide rates amongst Canada’s Aboriginal people are higher than those of other Canadians.Health Canada (1996) data suggests suicide rates amongst First Nation males are 2.6 times and for women 4 times higher than for the Canadian population in general.Aboriginal youth are at 5-6 times greater risk than their non-Aboriginal peers
5Suicide Risk FactorsThe literature is clear that being a First Nation, Metis or Inuit person in and for itself does not pose a risk for suicide.As with all people, context and perception are critical in determining suicide risk in First Nations, Metis or Inuit youth.The document Choosing Life: Special report on Suicide Among Aboriginal People (1995) indicates that general risk factors for suicide such as mental illness, life history and life situations are common to all people.
6First Nation, Metis and Inuit face additional life circumstances that increase their risk of suicide Psychobiological factors such as depression and grief, which are made worse for many by the sheer number of deaths in small close-knit communities.Life history factors including cultural discontinuity, disruption of families by outside intervention and prevalent substance use and abuse.
7Additional Life Circumstances Continued Socio-economic factors in which “living conditions are generally inferior to those of most Canadians. High rates of poverty, limited employment and education opportunities as well as deficiencies in sanitation and water quality are part of the context of the lives of many First Nation, Metis or Inuit.Cultural stress results when people go through a massive, imposed change. The loss of land, pervasive breakdown of cultural norms, customs and institutional racism, as well as loss of identity are some of the stressors experienced by Aboriginal people since their contact with dominant cultures.
8Additional Life Circumstances Continued Colonial relations have resulted in damage to all the elements of First Nation, Metis and Inuit culture, which define the essence of identity: language, customs, values, and beliefs. Kirmayer, Brass and Tait (2000) and Mussell (2002) report these factors are particular to Aboriginal people. The Health of Off-Reserve Aboriginal Population (2002) reports similar findings with respect to overall health determinants.
9FinallyMany First Nations, Metis and Inuit experienced exclusion from the dominant society and alienation from a traditional lifestyle. They have “the terrible emptiness of feeling strung between two cultures and psychologically home to neither.” (Choosing Life p. 30)
10Emerging Themes Loss Connected to dislocation; in care, separation Social and economic conditionsMental Health concernsSubstance abuseTwo-spiritedStreet involvedHomelessnessExposure to violenceChangeContact, conquest, residential schoolsEarly Loss; dislocation, being in care: Early childhood loss and separation, familiy instability, conflict and violence are potential contributing factors to suicidal behaviours. The literature suggests that youth in care and those who have experienced abuse often have multiple risk factors, which could result in heightened vulnerability to suicide thoughts, attempts and death by suicide.Alberta researchers Charles and Matheson (1991) suggest that children in care need to be considered as a vulnerable population when considering suicide risk. Characteristics such as poor problem solving ability, poor social skills, and family turmoil, are heightened for children in care due to the attachment and loss issues they face. They also point to the need for training and support as well as clear communication about risk among all of the professionals of the child’s world.Smith and Beautrais (1999) found that youth receiving Child, Youth and Family Care were nearly 6.9 times more likely to attempt suicide that thoses with no contact with the agency.Exposure to Violence: Youth who have been abused are at risk for suicide. The Canadian Incident Study of Reported Child Abuse and Neglect (2001) found that in one year over 7500 complaints were investigted. Of thoses, 3375 were substantiated and another 1600 were unproven, that is, abuse was believed to have occurred but was not substantiated. The literature suggests that many of the children who were the subjects of these 3375 investigations may have also been at risk for suicide.Calgary based, Bruce Perry (2000) has done extensive research on the effect exposure to violence has on the brain development of children. His work suggests that exposure to violence alters brian development which may result in increased and chronic arousal, hyper vigilance, and a foreshortened sense of the future. What this means to a child is that learning is blocked, delayed gratification is almost impossible and they are in a constant state of alarm; react reflexively, and aggressively to a perceived threat.Street Youth Homelessness, Sex Trade WorkersKidd and Kral (2002) interviewed 29 Toronto street youth involved in the sex trade about their understanding and experiences with suicide. A central theme of family trouble/abuse, including sexual and physical abuse, emerged. Additionally the themes of low self worth and a sense of powerlessness were identified. They also spoke of the superficial natures of friendships on the street. These friendships based on whether the person had money or drugs, heightened feelings of isolation, rejection and betrayal. Most of the youth reported negative experiences with social service agencies and mental health professionals. Based on their findings, Kidd and Kral suggest the need for service providers who approach street youth from a non-judgmental stance with a focus on seeking out and nurturing their strengths and talents.Mental Health Issues: There is a well documented link between some mental health disorders and suicide. An individual or family history of a certain psychiatric disorders may predispose some youth to suicide.. Mental health problems increase the vulnerability for suicide in both youth and adults. In particular youth with a mental health diagnosis and history of contact with statutory services may be at greater risk.berman and Jobes (1991) remind us that approximately 90% of youth who make serious suicide attempts or die by suicide have at least one mental health diagnosis. There is research (Brent et al. 1994), which suggests a strong link between previous suicide attempts, depression, conduct disorder and impulsivity in youth. These facors are made worse by substance abuse. Zeitlin (1990) found that a combination of substance abuse and a mood disorder is prevalent in thoses who die by suicide. In 2003 a study of residential school survivors found that mental health issues was present in over 70% of the people. Post Traumatic Stress Disorder was diagnosed in about 64% of people and about 35% of those also had substance abuse and 30% major depression. (p57)Two Spirited Youth: Youth explore and question their sexual identity. For about 10% of the youth these questions may lead to identifying themselves as gay, lesbian, bisexual or transgendered. This can increase vulnerability for suicidal thoughts and behaviours. Sexual orientation issues are considered to be contributing factor by White and Jodoin (1998). The literature has established that these youth are 2-3 times more vulnerable to suicidal thougts and behaviours than other youth. (Gibson, 1989). This increaed vulnerabilty is associated with higher rates of depression, substance abuse, homelessness and lack of social support (Bagley and Tremblay, 2000; Muehrer, 1995; Remafedi, 1999). Bagley and Tremblay further suggest that the elevated rates of suicide attempts amongst GLBT and questioning youth are a result of the homophobic culture in schools, communities and families.American studies identify self-doubt, loss of peers, rejection, denigration, and substance abuse as stressors associated with an emerging gay and lesbian identity (Seal et al. 2000). Many of these factors are linked to increased vulnerability for suicidal behaviour. There is no doubt that reports GLBT and questioning youth have higher rates of suicide, however there is a link between suicide attempts and higher likelihood for death by suicide.Substance Abuse: Studies show clear links between suicide and substance abuse. In BC a study of suicide of Aboriginal adults estimates that 70 – 90 % were intoxicated at the time of their death. Studies of solvent users suggest they are 8 times more likely to have had a suicide attempt than nonusers. Compared with the general population Aboriginal youth report they begin drinking earlier and more heavily and are more likely to drink on their own away from peers. They report the use of other substances such as gasoline and glue more frequently than non Aboriginal youth.
11Protective Factors What are “protective factors”? Protective factors are those things that give troubled persons reasons for living.Protective factors can be active in the individual, family and community.What is resilience? Many ways to talk about resilience: Persistence in the face of hard times; the ability to bounce back from hardship; success against the odds. A paradox – you struggle and become stronger as a result. Resilience is a process not an outcome. Resilience is something that can be developed, nurtured or destroyed.Family, school and community have a role in building resilience. Some factors are a risk to resilience and others protect it. There is a complex relationahip between risk and protective factors. Resilience is NOT predictive. It is culmulative and collective. To assess resilience one need to weigh the degree of exposure to a number of risk factors against the degree of exposure to a number of protective factors. Risk Factors are dependent on individual personality, physical trauma, temperment, early aggressive behaviour, past trauma, history of abuse, poor self concept and lack of commitment to social norms and values. Risk Factors: Family: Poor attachment, lack of parental/adult supervision; lack of parental/adult monitoring; too little or too much punishment from parnet/adult; parental/adult expectations too low or too high; exposure to conflict, violence and aggression.Risk Factors: Peer and School: Rejection, academic failure, lack of commitment to school, dropping out.Risk Facors: Community: High levels of disorganization, high density, high mobility, poverty, low levels of cohesion, community norms, protective factors and social competence.Problem solving skills, autonomy, sense of identity, ability to act independently, exert some control.Sense of purpose, sense of future, sense of coherence, confidence that the internal and external worls is predictable; purpose, meaningful and hopeful;Protective Factors: Family: Caring and supportive;high expectations, encourage participation; give responsibility;Protective Factors: School: Caring and supportive; high expectations; participation and involvement in meaningful ways, empowermentProtective Factors: Community: Caring and supportive; high expectations; participation and involvement in meaningful ways; empowerment; nurturing resilience.
12ConclusionsThe purpose of the discussion was to listen to one another’s point of view and to understand there are many protective factors.The aboriginal youth Rod interviewed identified self-esteem, connection with others, changing thinking, and cultural community as the four most significant factors in their recovery from suicide ideation.
13Protective Factors Resources Aboriginal Youth: A Manual of Promising Suicide Prevention Strategies White and Jodoin (2003)Suicide Among Aboriginal People in CanadaAboriginal Healing Foundation Research SeriesWhat is Working, What is Hopeful … David Masecar
14Circle of Courage Martin Brokenleg and Larry Bendtro The Circle of Courage is based upon native values and the medicine wheel. The illustration incorporates the medicine wheel as well as the four spirits of the Circle of Courage.Resilience and Belonging: I matter; Resoureces for basic needs; relationship needs; connection with a variety of people whoare supportive and demonstrate prosocial competence; connection with history, culture, customs; belief in something greater- spirituality, faith religion;Resilience and Mastery, Ican; Competence; creativity, problem solving, learn things persevere.Resilience and Independence, I make a difference: I am my own person; I have initiative, and leadership skills; I do the right thing; I have asense of purpose; I ask myself and others tough questions; self discipline; adaptive distancing; I have influence; others listen to me.Resilience and generosity, I care: I care about other people; I contribute to the well being of others; I am a role model; I care about myself; I do things that keep me healthy and safe.
15Belonging: I MatterResources for basic needs: shelter, food, water, health care.Relationship needs: Connection with a variety of people who are supportive and demonstrate pro social competence.Connections with history, culture, customs.Belief in something greater than me; spirituality, faith, religion.
16Mastery: I Can Competence Creativity Creative Problem Solving Learn ThingsPersevereOptimistic OutlookSense of Humour
17Independence: I Make a Difference I am my own personI have initiative and leadership skillsI do the right thingI have a sense of purposeI ask tough questions of myself and othersI have self-discipline.I have the ability to stand away from the negative behaviours; to adapt to negative behaviours by separating myself from the high and unrealistic expectations of myself.I have influence; others listen to me.
18I care about other people I contribute to the well-being of others Generosity: I CareI care about other peopleI contribute to the well-being of othersI am a role modelI care about myselfI do things to keep me healthy and safe
19My Role To listen To learn To question To educate To support To work with communitiesTo advocate for a youth voice.To encourage.To celebrate.To promote, protect and preserve LIFE.
21Naysps visionYouth Identity and EmpowermentYouth Engagement and LeadershipCommunity Involvement and Traditional TeachingsIntegrated, Holistic and Comprehensive ProgramCrisis Response and Grief RecoveryEducation and Awareness
22Youth Identity and Empowerment Advocate and encourage youth involvement and inputYAC (Youth Action Council)Elder InvolvementMTSFLeadership from the Heart
23Youth Engagement and Leadership Engage community at largeFocus on young adultsOpportunities for skill building for youth and adultsYAC formed in 10 communitiesAdvocate for creation of more fun and challenging volunteer opportunities for youth.Creation of PATHLobby for leadership support for youth involvement in all community programs.Violence is the number 1 concern of youth. Goal to decrease violence through ACTION of all but YOUTH is particular.
24Community involvement & traditional teachings Establish strong youth/adult partnerships.Involve community champions.Foster an environment for mentorship; build capacity within the communitiesIntroduce MTSFA holistic approach is involved in creation and delivery of all programsIncorporate healingGood Grief Camp for YouthElders actively involved.Explore history and identity as FN in a respectful way.Spiritual journey invites healing And positive change.
25Integrated Holistic and Comprehensive Program Developed a network of services and programsIntegrated holistic approach in planning and deliveryHOT, Good Grief Camp, Grief Outreach, YACEmbrace Life program monitored and evaluated after every event and annually.Remove the stovepipes (silos) to address change as a community not on behalf of a program or agencyCircle of Courage philosophyInteragencyCommunity Mobilization
26Crisis Response & Grief Recovery PAGC Crisis Response Team; sector approachLocal CRT’s initiated; capacity buildingTeam members trained is CISD, ASIST, MHFA, Healing Circles, and Grief and LossResource lists for 11 communities completedNeed of Mental Health Therapist at PAGCFull time therapists in each community neededGrief Recovery Outreach ongoing at Holistic WellnessAll communities have trained facilitators; more action required
27Education & awareness Strategy has been created Focuses on prevention, intervention and postventionGoal to reduce stigma & lateral violence; and to increase understanding of confidentialityExploring creative & innovative ways to communicate with youthCelebrate and build upon the strengthsIncreased access to training for all community members brings about positive change.Support is always needed. But action and change is up to the community membersTraining available :ASIST, safeTALK, suicideTALK, MHFA, MTSF, HOT, Grief and Loss, Youth Engagement, Youth Leadership, Building Strong Relationships, ….Counseling and treatment available for addictions, mental health issues and gambling.
28What I Know for sure….Suicide is a community problem that needs community ACTION.
29We need to talkWe need to have a serious, honest, respectful discussion about suicide. Over the next two days we will listen to one another’s opoint of view in order to understand that there are many protective factors.
30What I know for sure…We need to have a plan or vision otherwise we will get lost …The past needs to be acknowledgedThe present is here and nowPlan to make a future better, different or more than present
31Stop doing what doesn’t bring the desired results.
32Sustainable change takes patience, persistence and time. P.A.T.H.Planning Alternative Tomorrows with HopeSustainable change takes patience, persistence and time.
33Change is necessaryMany are resistant and fear change; but a change in attitude and habits can promote, preserve and protect LIFE.
34Energy is created through ACTION. Energy is everythingEnergy is created through ACTION.Positive change cannot happen without action.
35Mobilize the Community A safe, vibrant, healthy community where everyone belongs.Break down the silos/barriers.Togethereveryone achieves more.Youth need to feel they belong.With vs. ForVolunteerism grows self esteem.Involvement reduces violence.
36Community Development Strategies Community Development Strategies must address the complex nature of suicide in Aboriginal communities by looking at the following four areas:Community RenewalCultural EnhancementTraditional Healing PracticesInteragency Communication and Support.
37What are some examples of community renewal? Community EducationTraining in ASISTMeans RestrictionYouth Leadership
38What are some examples of community education? SchoolTrainingPolicyClimate Improvement
39What are some of the things that could take place in schools? Family involvementEsteem buildingLife SkillsSuicide awareness information
40What are some examples of family focused strategies? Asset interviewRefer page 56 ofWhat is Working, What is Hopeful…
41. Youth need… To be engaged so that their voice can be heard. To be empowered.To feel they belong and have purpose within the communityTo be taught skills to help themselves and others.40 Developmental AssetsThe opportunity to be responsible and accountableTo learn generosity; serve others…Support from the leadershipSeveral mentors..To mentor others…A Youth Coordinator in each community
42Everyone needs to be trained in suicide first-aid. Applied Suicide InterventionSkills TrainingASIST works.Everyone needs to be trained in suicide first-aid.
43Change happens one person at a time Each person influences growth in a family and each family influences growth as a community.Change happens one person at a time
44strength based approach creates healthy outcomes Change in attitude
45Celebrate what’s right with the world Are YOU ready to be the best FOR the world?Celebrate what’s right with the worldView Video