Secondary and tertiary prevention strategies applied to suicide among American Indians.

Primary prevention concepts have been widely applied to health problems of American Indian people. When applied to mental health issues, and the problem of suicide in particular, primary prevention intervention methods may not be effective. As an alternative, secondary and tertiary interventions directed at the prevention of suicide are examined, including evidence for their effectiveness, and new potential applications of these techniques. In the 1980s, planners in the Indian Health Service and tribal mental health programs have attempted to bring the concepts of health promotion and disease prevention to bear upon the major health problems of Indian people. Prevention efforts directed at diseases such as Type II diabetes mellitus, tuberculosis, and others have shown great promise. Within Indian health care programs, it is understandable that the concept of preventing mental health problems, one of the major health concerns affecting Indian people (Neligh, in press), should capture the imaginations of health planners and tribal leaders. Indeed, this decade is witnessing the development of a variety of programs aimed at preventing mental health problems among Indian people (Manson, 1982). In spite of the proliferation of programs aimed at the prevention of mental illness and related problems, there is a lack of information about their effectiveness. Many of these programs make intuitive sense to planners and leaders who have initiated the programs. Because of the scholarship and fellowship programs sponsored by the Indian Health Service for leaders to obtain advanced public health degrees, the ideas of these leaders have often originated in public health rather than mental health fields. As a result, the well-intentioned planning efforts of prevention programs in Indian mental health have utilized public health models, but not mental health knowledge and technology, in an attempt to effectively deal with the mental health problems of Indian communities. One of the results of the excitement about efforts to prevent mental illness among Indian people has been the dissemination of the concept of prevention at a rapid rate, and the application of the concept to a variety of health problems. Sometimes the proliferation enthusiasm for prevention interventions has taken place at a more rapid rate than the conceptual framework of mental health technology that would support prevention efforts in mental health. Indian mental health programs may, as a result, rely little upon concepts commonly used in the general mental illness prevention literature. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 1(3), MARCH, 1988, pp. 4-18 American Indian and Alaska Native Mental Health Research Copyright: Centers for American Indian and Alaska Native Health Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)