Issue 6: Interrelationship of Mental Health, Domestic Violence, Sexual Assault, Suicide, and Alcoholism
Goal: Assist rural communities in addressing the interrelationship of these problems through a combination of community approaches and outside assistance and support.
Anecdotal and research data indicate an interrelationship between substance abuse, mental health problems, various forms of interpersonal violence and abuse, and self destructive behavior, including suicide. There is an intergenerational pattern to these behaviors; for Alaska Natives, these behavior patterns have been linked to multigenerational, post traumatic stress stemming from losses suffered in the epidemics of the early 1900's. The dramatic changes in lifestyle due to settlement by miners, traders and missionaries, combined with the change from a barter to money-based economy created additional stressors which have contributed to these major social problems in many Alaskan communities.
Despite general recognition of the interrelationship of these problems, services designed to prevent and treat the problems continue to be fragmented. Differences in professional training and education of providers coupled with differences in funding sources, philosophies and program requirements contribute to the fragmentation of services. Special projects designed to enhance collaboration do not appear to have substantially altered the fragmented nature of the basic service system.
The interrelationship among major social problems and lack of integrated service delivery, while true for communities of all sizes, is particularly devastating for smaller, rural communities. For example, high rates of suicide and suicide attempts, especially among young Alaska Native men, cause great pain in rural Alaska communities. It is important to recognize that substance abuse, self destructive behavior, and interpersonal violence/abuse are not isolated acts, but rather actions taken by individuals in the context of family, community and culture. These problems require an interdisciplinary approach to address the multiple psychological, social, economic and cultural factors which contribute to their existence.
There is mounting evidence that integrated, culturally-based approaches to social problems are best addressed from within, i.e., by the community itself. Communities cannot address these issues successfully, however, without support from outside entities that can provide technical assistance and financial resources. The Community-Based Suicide Prevention Program is an example of a partnership between rural communities and outside agencies. This program provides small grants to rural Alaskan communities and assists communities in designing and implementing strategies to reduce suicide and other self-destructive behavior. Data indicates that, as a group, the communities that have sustained suicide prevention projects for three or more years have reduced the rate of suicide at a greater rate than other Alaska communities.
160. Increase funding for the Community-Based Suicide Prevention Program to enhance services and training for existing communities and to allow additional communities to participate in the program. (Since the program's inception in FY 89, the average grant award has actually declined from $15,000 to $13,000.)
Responsible party: Governor's Advisory Board on Alcoholism and Drug Abuse, Division of Alcoholism and Drug Abuse, Alaska Mental Health Board, Alaska Mental Health Trust Authority
161. Provide training funds for communities wishing to develop integrated, community-based teams to address behavioral and social problems. Training should focus on cross training among program disciplines and general skills and strategies related to community problem solving, and project organizing, planning and implementation.
162. Provide training to regional mental health, substance abuse and social service agencies in how to best support integrated, community-based programs.
163. Enhance the ability of communities to share experiences and knowledge regarding integrated community programs through such mechanisms as newsletters, web pages and Internet user groups.
Responsible party (actions 2-4): Governor's Advisory Board on Alcoholism and Drug Abuse, Division of Alcoholism and Drug Abuse, Alaska Mental Health Board, Division of Mental Health and Developmental Disabilities, Division of Family and Youth Services, Alaska Mental Health Trust Authority
164. Explore funding options to develop a Community-Based Behavioral and Social Health Program to address behavioral and social problems in an integrated manner, including:
a. Merging of existing funding streams to develop pilot projects in local communities.
b. Funding for new grants to develop integrated local projects.
Responsible party: Governor's Advisory Board on Alcoholism and Drug Abuse, Division of Alcoholism and Drug Abuse, Alaska Mental Health Board, Division of Mental Health and Developmental Disabilities, Division of Family and Youth Services, Division of Public Health, Division of Public Assistance, regional health corporations