Native Americans and Suicide

By Arshya
Vahabzadeh, MD & Brad Zehring, DO





 Mental illness does not discriminate - it affects every age, sex, religion, and ethnic group.

The Indian Health Service conducted a study in 2008 that noted that the rate of suicide for American Indians and Alaska Natives is higher than any ethnic group within the United States. The study reported that suicide in these populations is up to 70% higher, especially in ages 10 to 24. Sadly, this statistic is not decreasing. Mental health professionals and society need to recognize the etiology of the despair that leads to suicide so that treatment and appropriate allocation of resources can be made.

The statistics are alarming, but possibly more alarming is the silence around this tragedy. Since suicide is taboo on most reservations - there are reports that a death by suicide often is not reported or legal authorities classify it as an accident. Due to the silence and misrepresentation, the numbers could be even greater.



It is important to break the silence on the troubling trends within Native American reservations. Native Americans must be willing to discuss their stressors and be open to getting education necessary to cope, deal, and treat their stressors. Mental Health professionals must be willing to understand their culture and adapt. Alex Crosby, MD, MPH, medical epidemiologist of the CDC has been recorded as saying that Native American suicide is so prevalent that it has become acceptable practice when tensions build up. Suicide should never be an acceptable option.



Reasons for troubling trends among Native Americans

There are a lot of thoughts on why mental illness and suicide have increased in the Native American population. There has been a lot of discussion of generational trauma due to the disempowerment and oppression of Native Americans and Alaska Natives. It has been discussed that this has caused adverse childhood experiences that lead to high rates of depression and other mental illness that are precursors to suicide.

While disempowerment and oppression could very well be contributing factors - poverty seems to be a growing problem on reservations. Poverty tends to put stress on educational standards decreasing the educational opportunities for those on the reservation – leading to a viscous cycle. There are few jobs on the reservation causing adolescents and young adults to leave their families and move to where there are jobs. However, parents age and get ill causing tension between the traditional Native American family structures where youth takes care of the elderly and providing for the immediate family.

In addition to poverty, substance abuse is a big problem on the reservation. Substance abuse can affect mood, often negatively, which increases the tension and is a risk factor for suicide. Domestic violence and sexual assault are also known problems on the reservation. These stressors have led to unstable environments for children growing up. Add untreated mental illness to the mix and it is easy to see how hopelessness and despair thrive often leading to the belief that suicide is the only way out.

The Way Forward

Recently, the American Foundation for Suicide Prevention joined a Native American Mental Health panel sponsored by Congressional Native American Caucus and Center for Native American Youth. The panel focused on ways of improving mental health resources and suicide prevention. The IHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) collaborated on targeted suicide prevention programs. The IHS established the Suicide Prevention Initiative and SAMHSA provided funding to the IHS to address youth suicide and provide suicide prevention for high-risk populations.

As we move forward as Mental Health professionals, it will be important to continue to collaborate with the Native American population, especially with Mental Health professionals with experience with the population and their culture. Understanding their culture and etiology of stressors will go a long way in providing the appropriate resources and treatment.

Resources for Help

In the US:

·         Suicide help

·         1-800-273-TALK



Outside the US:

·         International Association of Suicide Prevention (IASP)

…your knee bone's connected to your thigh bone...

Who said this in the Guardian this week?
“I am arguing for a move in healthcare towards a more renaissance time, when there were not the clear barriers between art and medicine.”

Find out by clicking on the Kneebone above...and with a very feeble excuse to link to Dennis Potter, please enjoy the doctors summing up the patients needs below.

The blog will be added too and subtracted from on an ad hoc basis over the next 2 weeks as I am working out of the country. More of that soon, but for now, day 1 - breakfast out and an oh-so-obvious cover on a weekend supplement! Apologies. When I come to Australia I always meet really interesting, dedicated, free thinkers when it comes to end of life care, so after I got past the sharks in today's paper, it was interesting to read about Philip Nitschke's lawyer who in fact, has terminal cancer. Peter Nugent is defending the GP, humanist and euthanasia campaigner who was suspended from practicing as a GP by the Australian Medical Board earlier this year. That Nitschke is being defended by someone whose own life is limited by terminal illness, is a powerful symbol. It will be interesting to see how the trial, which starts on Monday, progresses  The big question here, is who knows best: doctors or competent, well-informed adults? Click on my breakfast option for more on this story.

HUMAN
This picture, the earliest known photograph to include a recognisable human form, was taken in Paris in 1838 by Louis Daguerre. The human in question is standing in the bottom-left of the photograph, on the pavement by the curve in the road. He is having his boots shined.

I recently shared a funding opportunity for cultural exchange with Japan, this week’s tantalising tidbit is India. Go on - let your imagination run wild and tailor a proposal to an arts/health exchange.

New India Cultural Exchange Fund 
A new £1.5million lottery fund will be available in early 2015 to build creative connections between the people of England and India. The new funding will provide English artists and arts organisations with opportunities to develop collaborations and cultural exchanges with their Indian counterparts. The scheme will be run by British Council and the Arts Council England and will give grants of £15,000-£100,000 to support projects that:
Promote creative collaborations Showcase the best of UK and Indian arts across a range of art forms and activities; etc. Applications open in January 2015 and there will be a second round of funding in 2016 with activity expected to peak during 2017 to mark the 70th anniversary of Indian independence.
Read more at https://www.gov.uk/government/news/secretary-of-state-announces-india-cultural-exchange-fund           

“...fake clowns caused panic’

“…real clowns are dismayed by the trend.” For this sad reflection on all things clownish, please click on the not-disturbing-in-the-slightest-bit photograph above. Apologies to any clowns this my cause offence too!

A Recoverist Manifesto
A S P I R I N G   G R A P H I C   D E S I G N E R   W A N T E D 
The first Recoverist Manifesto is complete - written up and with a forward by a very surprising and high-profile contributor! This 9 page publication is due off the press, but we need a graphic designer with a benevolent spirit to lend us a hand with the design. Although the coffers have dried up, we want a hard copy and online version this month. If the graphics are left to your very own blogger - they will be atrocious! So, if you have a few hours spare and an eye for typography and colour, email a link to your online portfolio and we can have a chat. artsforhealth@aol.com 

Being Mortal

Another brilliant piece of writing from surgeon, Atul Gawande who in his new book, Being Mortal, tackles the bigger issues of life and death. Gawande hugely influenced a presentation that I gave at the the 3rd Art of Good Health and Wellbeing international conference in Canberra in 2011, which I wrote up as a book chapter called Towards Sentience in the Handbook of Interior Design and Architecture.

When we think of surgery and our arts/health conversations, it seems like we are a million miles apart. Whilst not being an advocate for the arts as such, Gawande does something that is central to arts/health - he thinks and ultimately acts - differently. His philosophy is one that resonates deeply and alongside the Design Council’s vision statement Design for Care and our very own Dr Rebecca Gordon-Nesbitt’s study, The Long-Term Health Benefits of Participating in the Arts - we should have the basis for designing a very interesting symposium on the 12th February. Thank you to everyone who has expressed interest in being involved in this free event. We are throwing everything into the mix to see what we might come up with, and will be in touch well before the Christmas break. There will be the inevitable 'eventbrite' page to sign up soon too!

26th November 2014
Breaking Out of the Temples of Culture: Exploring Arts, Health and Wellbeing Initiatives in the Community
Institute for Public Policy & Professional Practice (I4P)
This symposium will take as its focus community-based cultural activities that seek to foster greater cultural engagement with the arts, facilitate more widespread active participation in culture, generate social capital and improve health and wellbeing in a variety of ways. To stimulate the discussions, we have invited a number of speakers – artists and representatives of cultural organisations – whose work, in different ways, is characterised by, or interested in, the interplay between cultural value and social capital. These activities include, but are not limited to, socially engaged art to local cultural festivals and the promotion, and exhibition of, arts and culture more broadly within local communities.  http://www.edgehill.ac.uk/i4p/symposium-26th-november-2014/ 

Krip Hop Nation

Krip Hop Nation is an international Hip Hop collective uniquely blending lyricism, activism and breakbeats. Featuring MC’s, rappers, DJ’s and musicians from the USA, Germany, Uganda and the UK, they work internationally as a platform for disabled Hip Hop artists and an independent voice for disability led justice and politics. Leroy Moore, who founded the collective, aims to serve a purpose beyond producing music, believing the movement is about advocacy, education and reclaiming oppressive material. For workshop details and more from CONTACT Theatre, click on the poster above.

The little video below is nothing to do with the Krip Hop Nation, but has some damn fine dancing. The Coup are pretty good and if you enjoy the little film, it may be worth clicking on this Boots Riley link. He's the bands singer and this interview with Fox TV is as good as it gets.

Funding for Creative Young People 

IdeasTap, a non-for-profit initiative supports young creative people between 16 and 30 years of age, has announced that its Ideas Fund Innovators is open to applications. During this funding round the Ideas Fund Innovators aims to offer 20 projects £500 each (10 for those aged 16 - 22 and 10 for those aged 23 - 30) to help get them off the ground. In the past, Ideas Tap have funded everything from dance and film projects to music videos and photography collectives. Applications from any creative field will be considered. Ideas Tap are looking for projects that are inspiring, original, innovative and that Ideas Tap think you can deliver. This brief closes on the 19th December 2014 at 5pm and is open to IdeasTap members aged 16 to 30 on the closing date. Read more at: http://www.ideastap.com/Opportunities/Brief/Ideas-Fund-Innovators-16-to-22-070214#Overview

This year I had the pleasure of speaking at the UK Faculty of Public Health Annual Conference and you can read a small account of the shared presentation The Arts - Authenticity and Exchange in Public Health Today by clicking on the image above.

…all hail - people of the abyss

"The unfit and the unneeded! The miserable and despised and forgotten, dying in the social shambles. The progeny of prostitution - of the prostitution of men and women and children, of flesh and blood, and sparkle and spirit; in brief, the prostitution of labour. If this is the best that civilisation can do for the human, then give us howling and naked savagery. Far better to be a people of the wilderness and desert, of the cave and the squatting-place, than to be a people of the machine and the Abyss."  
Jack London in The People of the Abyss

Possibly the most interesting job out there at the moment...
DIRECTOR - Art for Amnesty 
(click on the Bob and Roberta Smith image for details) 

DESIGN FOR CARE
The Design Council has launched its Design for Care programme, aiming to help transform care for the 21st century. But why does care need transforming, and how can design help? I think this may be a strong theme for the free symposium that I mentioned in last weeks blog-posting on 12 February next year, here at the Manchester School of Art.  I’m thinking a day that in the morning explores arts and health research and in the afternoon, the issues raised here by the Design Council. I very much hope that alongside post-graduates in design here at MMU, we will be joined by people from the industry and care profession. Let me know your thoughts on this.

‘Design Council is launching a major design programme to improve the quality of care. Over the next three to five years Design for Care will apply world-renowned design talent in a drive to invent and develop new systems, processes, products and services to increase wellbeing, to help reduce unnecessary hospital admissions and to help people stay in their own homes. We wish to create a care system that is more personalised, more connected and more preventative.’

‘To meet this demand we will need to broaden the notion of care from eligibility measured services to the responsibility of the community. It's a challenge of wider collaboration between individuals and carers, family and friends, neighbours and volunteers and professionals.’

Click on the logo below to read the vision statement.

‘This more radical approach requires real imagination. We invite you to be a partner in this important mission.’

They have chosen four themes that they believe will make a difference and together with care professionals, technology companies and others, they will start to put shared thoughts into action.

1. Growing informal care
How do we increase the care contribution of family, friends and the wider community?
2. Transforming our homes
How do we make homes that better support wellbeing?
3. Enabling better choices
How can we support people to make effective choices for their own care needs or those of a loved one?
4. Places and spaces for care
What are the best environments in which to deliver collaborative care?

Funding for Links with Japan
The Daiwa Foundation which support closer links between Britain and Japan is seeking applications under its small grants programme. Grants of £3,000-£7,000 are available to individuals, societies, associations or other bodies in the UK or Japan to promote and support interaction between the two countries. Daiwa Foundation Small Grants can cover all fields of activity, including educational and grassroots exchanges, research travel, the organisation of conferences, exhibitions, and other projects and events that fulfil this broad objective. New initiatives are especially encouraged.
The next applications deadline is the 31st March 2015. Read more at by clicking on the sleepy train journey above.

BBC Children in Need Main Grant Programme 

BBC Children in Need has announced that the next applications deadline for its Main Grants Programme is the 15th January 2015. Funding is available to organisations that work with young people who are suffering from:
Illness
Distress
Abuse or neglect
Are disabled
Have behavioural or psychological difficulties
Or are living in poverty or situations of deprivation.
The Main grants programme is open to applications for grants of over £10,000.
http://www.bbc.co.uk/programmes/articles/3XW7FvN20PD3xr2c1T62Xly/main-grants 

   

15 Tips for Talking to Kids about Ebola

By David Fassler, M.D.

Child and adolescent psychiatrist 

Parents and teachers may find themselves faced with the challenge of
discussing the evolving Ebola epidemic with children. Although these may
be difficult conversations, they are also important. There are no “right” or “wrong” ways to talk
with kids about Ebola, but here are some suggestions if you need help. 

1. Provide an open and supportive environment where children
know they can ask questions. At the same time, it’s best not to force children
to talk about Ebola unless and until they’re ready.

2. Answer questions honestly. Kids will usually know,
or eventually find out, if you’re “making things up." It may affect their trust in you or your reassurances in the future.

3. Use words and ideas children can understand. Gear
your explanations to the child’s age, language, and developmental level.

4. Help kids find accurate and up to date
information. Print out Fact Sheets from
the CDC, CNN, WHO and kidshealth.org.

5. Be ready to repeat information and explanations
several times. Some information may be
hard to accept or understand. Asking the same question over and over may also
be a way for a child to ask for reassurance.

6. Acknowledge and validate the child’s thoughts, feelings,
and reactions. Let them know that you think their questions and concerns are
important and appropriate.

7. Remember that kids often personalize situations.
For example, they may worry about their own safety and the safety of family members. They may also worry
about friends or relatives who travel or live far away.

8. Be comforting, but don’t make unrealistic promises. It’s
fine to let children know that they are safe in their home or at school. But you can’t promise that there will be no cases of Ebola in your state or
community.

9. Let kids know that there are lots of people helping
the families affected by Ebola. This time is a good opportunity to show children that when something scary or
bad happens, there are people to help.

10. Children learn from watching their parents and
teachers. They will be very interested in how you react to news about Ebola. They also learn from listening to your conversations with other adults.

11. Don’t let kids watch too much television with
frightening images. The repetition of such scenes can be disturbing and confusing.

12. Children who have experienced serious illness, loss, or other traumatic events in the past are particularly vulnerable to graphic
news reports or images of death. These children may need extra support and
attention.

13. Watch for physical symptoms including headaches and
stomachaches. Often times, kids express anxiety through physical aches and pains.
An increase in such symptoms without apparent medical cause may be a sign that
a child is feeling anxious or overwhelmed.

14. Children who are consumed with questions or worry about Ebola should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional care include:
ongoing sleep problems, frequent fears
about illness or death, or reluctance to leave parents or go to school. If such
behaviors continue, ask your child’s pediatrician, family physician, or school
counselor to help you contact a mental health professional. 

15. Although parents and teachers may follow the news and
the daily updates with interest and attention, most kids just want to be kids. They may not want to think about what’s happening across the country
or elsewhere in the world. They’d rather play ball, climb trees, or ride bikes.

Public health emergencies are not easy for anyone to
comprehend or accept. Understandably, many young children feel frightened and
confused.  As parents, teachers, and
caring adults, we can best help by listening and responding honestly and comfortingly. Fortunately, most children, even those who have experienced loss or illness, are quite resilient.  However, by creating an open environment where
they feel free to ask questions, we can help them cope with stressful events
and experiences.

David Fassler, M.D., is a child and adolescent psychiatrist
practicing in Burlington, Vermont. He is also a Clinical Professor of
Psychiatry at the University of Vermont.

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FOREWARNED IS FOREARMED*

A date for your diaries #1
The People’s Republic of Arts and Health* offers a free event, on Thursday 12th February 2015 at MMU. Call it what you will - a symposium - a conference - a networking event?  It will be a free, full day event that shares research, that encourages debate and that showcases practice in our fair Northern lands. More details will follow in December, but the date is confirmed.
*Also known as the North West Arts and Health Network

The stock price of EBOLA 
A couple of thoughts since I last mentioned ebola here on the blog. First, Giles Fraser has some interesting reflections, of which these are disturbing (but not scare mongering) little nuggets, and I quote:

“...the patent for the Ebola virus is owned by the US government”

“Isn’t it interesting that there is money about to ask scientists to turn a virus into a weapon, but not the money about to ask scientists to find a vaccine? And by the time there’s a market for a vaccine, it’s too late.”

“...market-driven healthcare is incentivised to keep us sick. For what profit is there in a healthy population? If everyone were healthy, it would be the job of the pharmaceutical companies to persuade us that we were not well, that certain things about us needed fixing, putting right (even if they didn’t).”

My second thoughts are that here, in our arguably gated-community of arts/health, we often pontificate about our synergies with public health - how creativity, culture and the arts might promote, protect and prevent. Well - in the face of an evolving public health crisis like ebola - what on earth is the place/role of our agenda? A quick google search brings videos of dancers, music and a plea to create a public recovery exhibition from Shabuta Cultural Arts in Liberia. Obviously, a serious issue demands a serious and coordinated technical response, but if it is a response that comes late and is insensitive to cultural traditions, it’s one that inevitably hits obstacles. Here’s a paragraph and rallying cry from an article in the Liberian Observer from Shabuta Cultural Arts.

“Our artists can remind us of the comfort of unity when isolation fills us with loneliness. Liberian musicians have written songs and more songs about the dangers of ebola. We needed that. Now we need to hear songs of how we are defeating ebola; of how we are empowered with our new knowledge about ebola; our victories over ebola and how we will continue fighting until it is no longer a threat. As we listen to this unifying music, we will connect with it, join in the song and even dance to the rhythm.” 

There is an example of poetic writing from small business owner Patrice Juah, from Monrovia, that you can read by clicking on the title to the taster below.

The Ebola Ride

On the Ebola ride,
paranoia is the driver.
It takes you on a high
leaving your senses hanging in the wild…

Finally, here’s a short educational film made by Firdaus Kharas and Brent Quinn that ‘reflects the co-creators approach of creating non-coercive media for social change, in this case using animation to create a message of love to the living through an African spiritual voice’. 

An idea for a potential date for your diaries #2

Are you a virologist, a graphic designer, a philosopher, a nurse - are you an arts/health free thinker who’d like to mull over some ideas around pandemics - viral mutation - scenario planning and public health promotion, protection and prevention? If you are and you’d like to take part in an informal ‘cultural think tank’ in early December, email artsforhealth@aol.com and if there’s sufficient interest, I’ll facilitate a group session to explore our thinking and maybe our future planning.

Look200 Artist's Day
22nd October 
10am-3pm Manchester Museum
Artists/creative practitioners are invited to join artist Lucy Burscough, as she nears the end of her Look200 arts for health/science engagement residency at Manchester Royal Eye Hospital, to spend a day exploring the ideas, process and practicalities involved in delivering Look200, a project that looks at 200 years of research into vision in Manchester. The day will act as a networking event with practical elements and lots of opportunities to learn more about innovative approaches to Arts for Health provision in Manchester. A free Arts Council England funded event with limited places. Please be aware that there will be some walking between venues involved. If you have mobility problems please let Lucy know beforehand. Contact Lucy@Look200.org to sign up.

…and finally, a ridiculous security guard at a Sainsbury's store told two women who were having a kiss, that they were 'disgusting' and asked them to leave. You know what happened? A Big Consensual Kiss-In. HA! Of course it was Brighton, and good on them.

*From Robert Greene's, A Notable Discovery of Coosnage (a.k.a. The Art of Conny-catching), 1592: "forewarned, forearmed: burnt children dread the fire."

…hey ho

1000 Shadows
Following on from my brief World Mental Health Day posting (below), I caught a glimpse of Brazilian street artist, Herbert Baglione, who has been busy adding shadows to a long-abandoned psychiatric institution in Parma, Italy  The project is called 1000 Shadows. Find out more by clicking on the image above.

The Stirling Prize 2014
Arts for Health is part of the research institute MIRIAD in the Manchester School of Art at MMU, which this year is an outsider in the annual architectural awards, Stirling Prize 2014. OK, so whilst we are outsiders on this esteemed short list, this doesn’t prevent us being very proud of our building, which you can see a short film of, by clicking on the image above. 

The Best Possible Day
A friend has sent me a link to the New York Times and a moving account of terminal illness and the arts, by Atul Gawande. Beautiful. Click above for the full article. Thank you.

The Cosmos

I am a great one for avoiding those Internet links to silly, sensational stories, but this week I did look at these remarkable images of the earth in relation to other planets in and beyond our galaxy. quite, quite profound. Click above.

The Big Love Little Sista Arts Festival - 28th October 2014 
Celebrating creative work with vulnerable women and young girls across the region (funded by Public Health) with a fabulous day of magic, lunch in the party goddess garden, juicy creative healing workshops run by the young women, free gifts and resources made by young women.  This work will be rolled out across the UK in the coming year so if you would like to partner with us this would be a great opportunity to see how we roll! Click below, to buck the trend in clicking.

Creative England and Microsoft Funding for Game Developers 
Creative England and Microsoft have announced that round 2 of their Greenshoots programme is open for applications. Through the programme, 10 grants of £25,000 are available to independent studios to develop games for Xbox one, tablet and mobile devises. The games from Greenshoots Round 1 ranged from underwater shoot ‘em ups and robot-infested puzzle games, to futuristic galaxy battles and crazy golf. All of the games, now released, were showcased back in July to a crowd of industry experts and investors. In addition to the grants, successful applicants will also receive support, mentorship and expertise from Microsoft and industry partners.
Applications close 9am on the 20th October 2014. Read more by clicking on the Spomenik below.