Innovation summary

From 1994 to 2008, the rate of suicide among Inuit youth under 18 years of age was 30 times higher than that of their counterparts in the general population1. Similar results were found in Russia’s far north. According to the Russian Federal State Statistics Service, the Nenets Autonomous Okrug, a region where Indigenous Nenets constitute about one-sixth of the population, has one of the highest suicide rates in Russia2.

In recent years, communities have begun to connect across borders in Arctic regions to share best practices from suicide prevention programs and learn from one another. The Reducing the Incidence of Suicide in Indigenous Groups – Strengths United through Networks (RISING SUN) initiative was developed as a web-based toolkit comprising key correlates and measures associated with evaluating suicide prevention interventions across Arctic states.

Impact summary

The RISING SUN toolkit is designed to include:

  • Information on the determinants of suicide across the Arctic
  • A general introduction to suicide prevention efforts in circumpolar Indigenous communities
  • Guidance on how to alleviate this public health threat and lessons learned from communities that have successfully implemented effective suicide prevention interventions
  • A collection of community-based, prioritized outcomes and measures to assess the impact and effectiveness of suicide prevention interventions being implemented across the circumpolar Arctic
  • Strategies with best practices for using the toolkit

“When you have a strong sense of who you are, there is no room in your heart for self-destruction.”

-  Alaska Native Elder

Innovation details

The high rates of suicide deaths in the Arctic are indicators of several underlying phenomena: the trans-generational effects of colonization3-4, rapid social and cultural change and economic and political marginalization, forced assimilation through residential schools and changing gender roles5-6. Studies have also identified a link between adaptive capacities, cultural continuity, community control and action, and resilience and wellbeing for global Indigenous populations7-10.

Suicide in circumpolar regions is a pressing health policy concern and is understood within a complex socio-economic historical context of the Arctic’s Indigenous Peoples. Suicide accounts for over 800,000 deaths per year worldwide11. Nowhere, however, does suicide have such an impact and social burden as among Indigenous populations, particularly those in the circumpolar north.

In response to the high burden of suicide in the circumpolar North, there has been a promising rise in the number of successful collaborations between Indigenous Peoples, policy makers, and health care professionals to continue to actively discuss how to best support and foster suicide prevention locally and on the ground. In 2015, the Arctic Council, an international forum which brings Arctic States and Indigenous Peoples’ organizations together, identified suicide prevention as a priority area for international collaboration. The RISING SUN initiative was developed and led by NIMH’s Office for Research on Disparities and Global Mental Health (ORDGMH) and is co-sponsored by the Governments of Canada, Norway, Denmark and the Inuit Circumpolar Council.

Key drivers

Locally led initiatives

The RISING SUN initiative finds strength in the creativity and resilience of continued Arctic youth involvement in circumpolar mental health and wellbeing, and builds from gatherings like the Nuuk conference on “Hope and Resilience: Suicide Prevention in the Arctic” in 2009 and the “Circumpolar Mental Wellness Symposium” in 2015. In their ongoing involvement with research projects across the circumpolar region, young people remind us that enough is known about the problem, and it is now time to focus on the solutions on how to best support and foster suicide prevention locally.

Challenges

Contextual limitations

The vast geography, high number of rural and remote communities, and the breadth of cultural diversity (including language barriers) pose numerous challenges for developing and implementing systematic and evidence-based approaches to suicide prevention and for delivering accessible mental health care services in the Arctic.

Continuation

In the United States, the National Institute of Mental Health (NIMH) is committed to furthering research focused on reducing the burden of suicide and promoting resilience among Indigenous youth. NIMH aims to provide funding to establish and support regional collaborative hubs whose research teams will:

  1. Conduct preventive interventions research, including strengths-based/resilience-focused approaches, with the goal of reducing suicide in Indigenous youth,
  2. Conduct outreach and dissemination activities to promote community engagement in research activities and enable community decision-makers to use science-based information to develop and assess mental health policies and programs.
  3. Promote further development and dissemination of culturally relevant measures and shared use of these measures to evaluate suicide prevention interventions across the Arctic.

Evaluation methods

Building the RISING SUN toolkit employed diverse approaches including an adaptation of the consensus-building technique known as the Delphi. Following the selection of a Scientific Advisory Group, RISING SUN recruited and selected members for a Delphi panel—from eight Arctic States and five of the six Permanent Participants of the Arctic Council—for a diverse representation of advocacy, clinical practice, Indigenous populations, policy, and research groups, as well as communities whose interests are covered within the initiative’s scope of suicide prevention among Arctic Indigenous groups.

A process was added to incorporate the viewpoints of key local stakeholders through face-to-face meetings across circumpolar regions. In addition, to achieve a shared vision and inclusive priority-setting, the RISING SUN initiative held a series of regional meetings in September 2015 (Anchorage, Alaska, United States), May 2016 (Tromsø, Norway), and March 2017 (Iqaluit, Nunavut, Canada). Collectively, participants at these meetings reviewed the international community’s understanding of suicide. Participants also learned from one another about and assessed various local activities over the past five years pertaining to evidence gathering and intervention strategies. During the final meeting, project co-leads reported on the findings from RISING SUN including:

  • The outcomes from the Delphi process
  • A discussion of methodological approaches
  • The form and function of the RISING SUN toolkit
  • The knowledge gaps that remain
  • Future opportunities for dissemination, implementation, and research

To supplement information collected through the Delphi process, Scientific Advisory Group members convened several regional focus group discussions in Canada and the United States. These focus groups were designed to ensure that additional community and Indigenous participants (who did not otherwise attend the workshops or participate in the Delphi) could provide input and feedback to the RISING SUN initiative. These activities included interviews conducted with Indigenous leaders, Elders, youth and other stakeholders. The purpose was to evaluate what local assets are already in place and that lead to the outcome of healthy communities, and to prioritize the outcomes identified through the Delphi process. In a qualitative analysis of the interviews, one emergent theme arose acknowledging the wide variety of relationships that are held sacred and kept in balance when it comes to the health and wellbeing of Indigenous communities.

Cost of implementation

An analysis of costs was not conducted as part of this initiative. Costs will vary by municipality and region.

Impact details

Developed through the combined engagement of Arctic Council Permanent Participants, community leaders, and mental health experts, the common outcomes and their measures produced are built into the toolkit which facilitates the use of a common language for data sharing, assessments, and interpretation of research findings across service systems in the Arctic region.

The principal goal of RISING SUN is to:

  1. Generate shared knowledge to aid health and community workers in better serving their communities
  2. To help policy-makers measure progress, evaluate interventions, and identify regional and cultural approaches to implementation.

The RISING SUN initiative under the 2015-2017 US Chairmanship of the Arctic Council made strides toward facilitating efforts to reduce suicide among Arctic communities; used community-driven stakeholder engagement, consensus-building and priority-setting processes; and built a narrative around outcomes and measures that can be used to evaluate the effectiveness of suicide prevention programs that are being implemented among Arctic Indigenous communities.

References

  1. Oliver LN, Peters PA, Kohen DE (2012) Mortality rates among children and teenagers living in Inuit Nunangat, 1994 to 2008. Ottawa: Statistics Canada.
  2. Sumarokov YA, Brenn T, Kudryavtsev AV, Nilssen O (2014) Suicides in the Indigenous and non-Indigenous populations in the Nenets Autonomous Okrug, Northwestern Russia, and associated socio-demographic characteristics. International journal of circumpolar health: 1;73(1):24308.
  3. Wexler L (2009) Identifying colonial discourses in Inupiat young people's narratives as a way to understand the no future of Inupiat youth suicide. American Indian and Alaska native mental health research (Online): 1;16(1):1.
  4. Wexler LM, Gone JP (2012) Culturally responsive suicide prevention in Indigenous communities: Unexamined assumptions and new possibilities. American Journal of Public Health: 102(5):800-6.
  5. Evans-Campbell T (2008) Historical trauma in American Indian/Native Alaska communities: A multilevel framework for exploring impacts on individuals, families, and communities. Journal of interpersonal violence: 23(3):316-38.
  6. Nymand Larsen J, Fondahl G, Schweitzer P (2010) Arctic social indicators: a follow-up to the Arctic Human Development Report. Nordic Council of Ministers.
  7. Allen J, Hopper K, Wexler L, Kral M, Rasmus S, Nystad K (2014) Mapping resilience pathways of Indigenous youth in five circumpolar communities. Transcultural psychiatry: 51(5):601-31.
  8. DeCou CR, Skewes MC, López ED (2013) Traditional living and cultural ways as protective factors against suicide: perceptions of Alaska Native university students. International journal of circumpolar health: 1;72(1):20968.
  9. Kral MJ et al. (2003) Unikkaartuit: Meanings of well-being, sadness, suicide, and change in two Inuit communities. Health Canada.
  10. Kral MJ et al. (2009) Canadian Inuit community engagement in suicide prevention. International Journal of Circumpolar Health: 1;68(3):292-308.
  11. World Health Organization (2014) Preventing Suicide: a global imperative. Geneva, Switzerland.
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