This is meant as a preventive fact sheet to prevent suicide in this population.

The American Indian most inclined toward a completed suicide has the following social characteristics:

• He is often a male between 15 and 24 years of age.
• He is single.
• He is under the influence of alcohol just before his suicide attempt.
• He has lived with a number of ineffective or inappropriate parental substitutes because of familial disruption.
• He has spent time in boarding schools and has been moved from one to another.
• He has been raised by caretakers who have come into conflict with the law.
• He has often been jailed at an early age.
• He has experienced an emotional loss, such as divorce, desertion, or death in the family.
• He has experienced a past loss through violence of someone to whom he felt attached.

Ten Preventive Steps:

1. Listen.
   The first thing a patient in a mental crisis needs is someone who will listen and really what he is saying. Every effort should be made to really understand the feelings behind the words.
2. Evaluate the seriousness of the suicidal patient's feelings.
   All suicidal talk should be taken seriously. If the patient has made definite plans, the problem is apt to be more acute than when his thinking is less definite.
3. Evaluate the intensity or severity of the emotional disturbance.
   It is possible that the patient may be extremely upset but not suicidal. If a person has been depressed and then becomes agitated and moves about restlessly, it is cause for alarm.
4. Take every complaint and feeling the patient expresses seriously.
   Do not dismiss or undervalue what the person is saying. In some instances the person may express his difficulty in a low-key manner.
5. Do not be afraid to ask directly if the person has entertained thoughts of suicide.
   Suicide may be suggested but not specifically mentioned in the crisis period. Experience shows that harm is rarely done by inquiring directly into the person's thoughts. In fact, the individual welcomes it and is glad the counselor enables him to open up and bring it out.
6. Do not be misled by the suicidal person's comments that he is alright and is past the crisis.
   Often the suicidal person will feel initial relief after talking of suicide, but many times on second thought he will try to cover it up. The same thinking will come back later, however. Follow up is crucial to insure a good treatment program.
7. Be affirmative but supportive.
   Strong, stable guideposts are extremely necessary in the life of a distressed individual. Provide him with strength by giving him the impression that you know what you are doing and that you intend to do everything possible to prevent him from taking his life.
8. Evaluate the resources available
   The person may have both inner psychological resources, such as various mechanisms for rationalization and intellectualization which can be strengthened and supported, and outer resources such as ministers, tribal elders, relatives and others whom one can call in. If these are absent, the problem is more serious. Careful observation and support are necessary.
9. Act specifically.
   Do something tangible; that is, give the patient something definite to hang onto, such as arranging for him to see someone else. Nothing is more frustrating to the patient than to leave the counselor's office and feel as though he received nothing from the interview.
10. Don't be afraid to ask for assistance and consultation
    Call upon whomever is needed, depending upon the severity of the case. Don't try to handle everything alone. Convey an attitude of firmness and composure to the suicidal person so he will feel that something realistic and appropriate is being done to help him.

(Source: American Indian and Alaskan Native Mental Health Research)

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