Helping communities address suicide and violence: the special initiatives team of the Indian Health Service.

The Special Initiatives Team of the Mental Health Programs Branch, Indian Health Service, was formed to provide crisis and prevention consultation to American Indian/Alaska Native communities in response to violent behaviors: suicide, homicide, domestic violence, child abuse, child sexual abuse, elder abuse, and other forms of family and community violence. The team incorporates cultural and historical factors in assisting communities to develop programs to combat violent behaviors, and encourages community-based, community-controlled efforts. Violent behaviors in the United States, recognized as major public health problems, include suicide, homicide, injuries inflicted by self or others, spouse abuse, rape, child abuse, child sexual abuse, and elder abuse (Rosenberg, Starke, & Zahn, 1986). Among American Indians and Alaska Natives, violent behavior constitutes a serious array of problems affecting individuals, families, and communities. Although rates fluctuate across communities, between 1981 and 1983, age-adjusted suicide and homicide rates for all American Indians were 1.5 and 2 times higher, respectively, than for the United States, all populations (National Center for Health Statistics [NCHS], 1985). Concerning child abuse and neglect, there is a wide variation in incidence from one tribe to the next. Like many social variables, child abuse and neglect are difficult to measure. However, available statistics indicate that off-reservation American Indian cases are reported at a rate of 5.7 per 1,000 children (Fischler, 1985). Two reservation studies, Navajo and Cheyenne River Sioux, have yielded rates of 13.5 and 26 per 1,000 children, respectively (White, 1977; Wischlacaz, Lane, & Kempe, 1978). Most forms of violent behavior among American Indians and Alaska Natives have not been adequately measured. It is clear, however, that these forms of violent behaviors, either through increasing numbers and/or reporting of cases, have grown visibly and have become significantly more common among American Indian communities over the past 2 decades. When studied systematically, violence in all its forms is likely to reflect intergenerational patterns associated with alcoholism, poverty, low self-esteem, and/or family history of violent behaviors (Berlin, 1986). Where violent behaviors hurt but do not destroy life, an American Indian community may deny that such problems exist or, when recognized, may feel helpless to address them effectively. These communities often experience chronic or endemic crises as expected, normative behaviors; the crises have lost their shock value because the community is in continuous mourning. Aware of AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 1(3), MARCH, 1988, pp. 56-65. 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) 57 LEMYRA DeBRUYN, KAREN HYMBAUGH, and NORMA VALDEZ these individual violent episodes, the community may be so desensitized to violent acts that they are unable to perceive the patterns of violence across families and generations, or the inherent strengths in the community itself that can be mobilized to counter such violent behaviors. The Special Initiatives Team (SIT) of the Mental Health Programs Branch, Indian Health Service, was formed to provide assistance to tribes and American Indian/Alaska Native communities--reservation, rural, and urban--which are concerned about violence issues and wish to address them. This paper outlines the philosophy which created SIT, explains the method of operation, and describes some of the projects with which SIT has been involved since its inception in 1987. It also emphasizes the team's commitment to community-based and community-controlled programs which reflect local positive values, cultural strengths, and the belief that individuals, families, and communities can effect