Extract from the Cochrane Library page:

Indigenous peoples of Australia, Canada, USA, and New Zealand experience disproportionately high rates of suicide. Prevention strategies look for a holistic view of mental, physical, cultural, and spiritual health and have an early-intervention focus that works to build strong communities through more community-focused and integrated approaches to suicide prevention.[1–3]

This Special Collection brings together systematic reviews of suicide prevention interventions with a focus on Indigenous peoples in Australia, United States, Canada, and New Zealand. There is not a great amount of evidence on suicide prevention in general, and a dearth of topical studies for Indigenous peoples in particular. The list of Cochrane Reviews is in fact disappointingly short and directed towards pharmacological treatments aimed at reducing suicidality. The reviews provide complementary information on approaches to suicide prevention in university settings and a wealth of information on the potential harms of drug therapies, especially for adolescents and young adults. Some of the reviews deal with combined pharmaco- and psychological or psychosocial therapy. None of them deal purely with non-drug-based interventions, and yet this is what Indigenous communities are saying they want. Communities are seeking ways of achieving wellness through application of Indigenous knowledge and Two-eyed Seeing (i.e. combining the best of Indigenous and Western approaches).[4] Further, only one of the studies included in the systematic reviews appears to have involved Indigenous peoples, particularly those living in Indigenous communities.[5]

Recently, Canada and a number of Nordic regions (Norway, Greenland, and USA – Alaska in particular) supported a study of best and promising practices in youth suicide prevention in circumpolar regions. Two international teams produced a synthesis report of best practices, which were presented at a conference in Iqaluit, Nunavut in March 2015.[6] Both of the teams highlighted promising practices on the basis of a number of community-based pilot studies. Some common themes emerged. All of the projects involved youth participation, in some cases with Elders, in others with local paraprofessionals. None of the six case studies highlighted had pharmacotherapy as its basis. These were community-based studies, and when community participants were involved in the study design and/or the carrying out of the intervention, the approaches did not involve the testing of pharmaceuticals.

Although drug and alcohol use are among the proximal causes of mental health conditions and contribute to suicide, they are not the root causes, certainly not in Indigenous populations. Distal causes include historical and current traumas common to Indigenous peoples worldwide – racism, displacement, cultural disconnection – that are the products of failed colonial policies in all of our countries.[7] The solutions to these problems lie in interventions with and by, not on and for, Indigenous people themselves.[8] Indigenous leadership is key to making these interventions successful.