Last week, I was invited along with suicide loss survivors, therapists, and researchers to present recommendations to California’s Statewide Suicide Prevention.

Highlights from Kelechi Ubozoh’s Written Statement to MHSOAC – MHSOAC Question: How are suicide/ suicide attempts experienced in communities of color? What is are some reasons suicide is underreported for people of color? 

There is a widespread misconception amongst many mental health professionals and researchers, that suicide is not a problem in black communities. However, this is not true. Recent studies show that nationwide, suicides among black children under 18 are up 71 percent in the past decade, rising from 86 in 2006 to 147 in 2016, the latest year such data is available from the Centers for Disease Control and Prevention.[1]The truth is, we are not having the right conversations about suicide in the black community. There is a huge myth that the mere mention of suicide, plants the idea of suicide in someone’s head. This is one of the many reasons people avoid the conversation. People are also afraid of saying the wrong thing. We must create resources and venues for communities of color to safely have these important conversations. 

Blue Suicide 

Most of the time black people are missing in the data around suicide, and “traditional research” does not always accurately capture our stories. During my work as a researcher and peer advocate, I interviewed black communities in San Bernardino County about suicide and mental health recovery. Young black men told me stories of losing their friends to blue suicide. They explained that because they grew up in the church, and that faith-based communities warn of the “spiritual consequences” of suicide (e.g. eternal damnation) that instead friends and family members who were struggling with thoughts of self-harm opted to intentionally antagonize police officers as a means to dying. This concept came up across many interviews, because this neighborhood had lost several black community members (mainly young black men) to blue suicide. Community members shared that someone on the outside looking in would categorize these deaths as homicides, which demonstrates one of the ways that suicide in the black community goes underreported. We have to get more culturally responsive approaches to data collection for communities of color to accurately reflect what is really going on. 

Trauma and the Label of Strong Black Women

For many black women, like myself, there is a disbelief that we are struggling because we are “so strong”. According to a recent New York Times article, black women are more likely than white women to have experienced post-traumatic stress disorder resulting from childhood maltreatment and sexual and physical violence, and are more likely to have stress related to family, employment, finances, discrimination and or racism. Yet fewer than 50 percent of black adults with mental health needs receive treatment. Barriers include mental health stigma and shame, and black women also prefer black mental health care providers, and there are not enough[2]. Many of us suffer silently, because we have to take care of our families, hold it down at work, and show up for our communities. Even though many of my black sisters have experienced trauma, discrimination and racism, many of us don’t prioritize our own self-care. If we could shift the paradigm that asking for help is a strength not weakness, we might be able to reduce suicide attempts. However, when we are ready to reach out for help, the help needs to be the ready for us.

How communities of color present in a crisis

For many communities of color, mental health and crisis present differently. What someone may view as “angry” or “aggressive” might actually be trauma. There is a high correlation/connection between trauma and suicide attempt and deaths by suicide (youth and adults). There is also a high correlation between experiencing racism and traumatic stress. Because of a myriad of reasons, (e.g. implicit bias) if communities of color cannot access mental health services because they aren’t presenting in a way that is recognized by providers, they are at risk for receiving mental health services in emergency room settings or in the criminal justice system. Trauma-informed approaches across the life span can address the issues driving suicide.

MHSOAC Question: What are culturally relevant strategies for prevention and intervention that may more effectively address suicide and suicide attempt in diverse communities?

As a mental health advocate who has benefitted from connecting with mental health advocates statewide, I thought it would only be appropriate to include them in this conversation about suicide prevention. Thank you to all of the peers, therapists, crisis intervention service providers, suicide prevention hotline workers, suicide attempt survivors, and suicide loss survivors who contributed to this response.

Culturally Relevant Strategies for Suicide Prevention

1.  Consider employing culturally specific-mental health ambassadors to support suicide prevention planning. While there are many things that communities of color share, each of these communities have a unique way of dealing with mental health and trauma. Include people from these diverse communities as mental health ambassadors and connecters to learn more about what works for them (e.g. art and healing, cultural specific practices).
2. Develop culturally-specific suicide prevention outreach tools that feature communities of color. Suicide prevention needs faces of color and messages that will speak to these diverse communities. PSAs, Social Media, Billboards, Radio Ads can help normalize the conversation and let people know that suicidal ideation is something that many people experience. Include messaging that says they are not the only one or not alone and resources for help, and ensure these messages are available in many languages.
3.  Create opportunities for POC with lived experience or survivors to connect and share their experiences in safe spaces like support groups. This may help decrease stigma and isolation, increase knowledge of wellness tools, and normalize the conversation around suicide in diverse communities.
4.  Involve the voices of suicide attempt survivors and suicide loss survivors. Each county should have consumers and family members representative of their “isolated and underserved” communities involved in the suicide prevention planning. It is important in communities of color to also authentically engage suicide attempt survivors of color (e.g. clear roles and responsibilities) to mitigate the experience of “tokenization”. Financially incentivize and hire more peers that are diverse and other behavioral health providers. This also includes members from the LGBT+ communities.
5.  Alternatives to 911. For many communities of color, calling police can escalate situations and many may avoid seeking help through this venue. Can the suicide prevention plan build networks of mutual aid and crisis-supports from the community? This should include outreach materials that provide information on alternatives to 911. Strengthen discourse and 5150 Education for Law Enforcement. A careful assessment is needed when writing a 5150. Oftentimes putting people on 5150’s and placing them in a locked psych unit often exacerbates the issues. What can we learn as a community around this topic?
6.  Recognize that “outcome-based/evidence based practices” are not always responsive to what consumers need in the moment. Develop culturally responsive research that includes what is working right now and what consumers need [from people on the front line, e.g. crisis workers, warm line & hotline workers]. Involve consumers in how they measure their own success.
7.  Increase overall capacity for County Crisis Support Services. Statewide, crisis support services like warm lines, hotlines, crisis text, and crisis clinical services are seeing a severe increase in both need and calls (e.g. Alameda Crisis Support Services had 457 calls in January, and in March of 2018 had 832 calls). In order to meet the needs of these services (many who are volunteer run) these groups need more human resources, funding and sustainability approaches to attract and maintain staff. Additionally, these groups need bilingual and bicultural staff to respond to the linguistic needs of diverse communities to provide a better option than tele-interpreters.  Strengthen data collection on suicide deaths by incentivizing partnerships with Coroner’s offices. Currently, there is no venue for systematic data collection from coroner’s offices to support the conversation around data trends in suicide. This data could help inform outreach and crisis support needs.
8.  Collaborate with primary care doctors and faith-based congregations/leaderson how to recognize early warning signs and connect their members with mental health support. Learn from existing national models. Create clinical support training for first responders like EMS/EMT and ER Nurses who often interface with mental health consumers after a suicide attempt, but do not have training on how to triage or support them. Integrate the Zero Suicide model in all inpatient hospital programs.
9.  Provide information and resources to family/friends helping someone that is suicidal. Providing support to the loved ones of those who are suffering is important. We need to educate and be supportive of family members, caregivers and friends who are supporting the individual who is at risk for suicide. Include wellness and self-care resources for the families that may be experiencing secondary trauma.  Develop several options for suicide prevention trainings. Provide options from brief training on suicide prevention, “what to say to someone who is suicidal” to more intensive training like “assessment tools”. Ensure trainings are free to the community, and host suicide prevention trainings for adult and youth of color.
10.  Establish Statewide Peer Respite Centers. Many mental health consumers are traumatized by their experiences in hospital settings. Peer respite centers can offer a home like environment that can be an alternative to crisis. Consider investing in crisis respite programs to divert from the Emergency Rooms.
11.  Partner with clinical programs to integrate mandatory intensive and robust suicide prevention traininginto the curriculum for all providers interfacing with mental health consumers, including clinical interns. Trainings should include the intersectionality between systematic oppression (classism, racism, sexism, historical trauma) as risk factors for suicide. Provide ongoing support for their professional development.
12.  Provide more education and training on assessment for suicide risk and ensure it includes cultural considerations. Individuals at risk for suicidal ideation, intention and/or completing suicide look differently. There are cultural differences in relation to religious beliefs about dying and worldviews related to individual’s racial identity. More educational support around assessment for suicide risk is need to aid clinicians in providing more thorough assessments as well as other service providers and officials who may come into contact with an individual who is at risk. Suicide is preventable and we can do so by starting with how we assess for suicide risk.