Neha Sharma

Culturally Informed Treatment of Suicidality with Diverse Youth: General Principles

The growing number of culturally diverse youth in the USA implies a social and professional responsibility to provide culturally informed mental healthcare to address their common and diverse needs. Suicidality in diverse youth requires a culturally informed clinical approach both in the immediate aftermath of a suicidal crisis and also in the treatment of underlying psychopathology, precipitating conflict, or perpetuating dynamics. This chapter outlines principles for culturally informed treatment associated with suicidality and useful tools and guides that can assist in such treatment.

Family and Community Intervention in Suicide Prevention and Management

Suicide is a challenge for every community since it is a social problem and not just a mental health issue. Thus, successful suicide prevention and intervention programs must involve the family and community, specifically when concerned with youth of various races, ethnicities, sexual orientation, and non-binary genders. These programs need to be attuned to the community’s financial and social needs, expressions of distress, unique risk factors for suicide, and preference of language. Such knowledge about the community allows programs to anticipate barriers in prevention and intervention models and to develop plans to overcome those barriers. This chapter reviews suicide prevention programs that used education to pediatricians, families, and communities to destigmatize mental health disorders while encouraging the use of appropriate resources and community protective factors. Additionally, the authors discuss interventions that target cultural and social factors of acute instances of suicide. Interventions like cognitive behavioral therapy, dialectical behavioral therapy, attachment-based family therapy, and strategic structural-systems engagement were noted to be particularly effective for high-risk individuals. To further increase the effectiveness of these interventions, programs need political and financial support to allow adequate capacity in order to engage as many individuals as possible. More research focused on suicide prevention and interventions specific to minority youths is necessary for highlighting areas that are yet to be addressed.

Cultural Aspects of Suicidality Among Youth

Suicide in any culture or society is associated with distress and loss and particularly so with youth suicide given the unfulfilled life and future being lost. However, suicide differs widely across cultures in how frequently it occurs, how openly it is dealt with, which explanatory spiritual and religious beliefs are associated, and the interpersonal and individual context within which it occurs. This chapter provides an introduction to suicidality and suicide within a cultural context, a review of basic terminology to use in this discussion, and a cross section of religious and cultural beliefs across populations. The rising patterns of racial ethnic disparities around suicidality within the United States are introduced with some initial consideration of associated risk factors.

Suicide Among Eastern European Immigrant Youth

Suicidality in Eastern European immigrant youth is a vastly under-researched topic. The socioeconomic climate of the region has been in a state of constant flux in the last few decades with wars, atrocities, and mass migration. Children who were born in this region have a high risk of being exposed to psychosocial adversity and trauma, which can be directly responsible for the manifesting of self-harming behaviors. Major risk factors for suicide could build on one another quickly and unexpectedly in this vulnerable group. It is important to have a thorough understanding of the sociopolitical background of each client from this multiethnic area. This helps mental health (MH) providers have cultural knowledge specific to the population that informs them of risk factors, strengths, early symptom manifestations, and modalities of depression and suicide. Available information and data regarding the MH and acculturation experiences of this community from the home region and host countries in the European Union can enable US MH services to design interventions and protocols suiting the needs of these immigrants.

Suicide Among South Asian Youth in America

Asian Americans are the fastest growing minority population in the United States (US). South Asians (SA) comprising Bangladeshis, Burmese, Indians, Nepalis, Pakistanis, and Sri Lankans form the third largest subgroup of Asians in America. SA children are raised with values of respecting elders, obedience to parental authority, and prioritizing the family’s needs over the individual’s. This upbringing, in conjunction with acculturation stress, intergenerational conflict experiences of racial discrimination, and stigma surrounding mental health treatment, likely plays a role in placing SA American youth at increased risk for suicidal ideation and behavior. The scope of the problem is difficult to determine as research studies so far have tended to focus on Asian Americans as a group with few studies focusing on SA in particular. However, the experiences of SA Americans as a group are worth examining as there are differences in culture of origin, immigration history, and phenotypic differences, to name a few, that set them apart from the larger Asian American community. The following chapter aims to discuss the interplay of the history and experiences of SA Americans with mental health. It offers a culturally informed perspective on symptom presentations and approach to treatment interventions.

Lessons from the Launch: Program Directors Reflect on Implementing the Child and Adolescent Psychiatry Milestones

Beginning in July 2014, the Accreditation Council for Graduate Medical Education (ACGME) required all psychiatry residency programs in the USA to implement milestonebased assessments as a critical component of the Next Accreditation System (NAS). Milestones are competencybased developmental outcomes (i.e., knowledge, skills, attitudes, and performance) that a trainee is expected to progressively attain over the course of training [1]. The new milestone-based assessment was derived from the ACGME’s original six core competencies of patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills, which are assessed among all medical specialties. The ACGME Psychiatry Milestone Working Group developed 22 sub-competencies for assessment within general psychiatry. A year later, the Child and Adolescent Psychiatry (CAP) Milestone Working Group derived 21 CAP-specific sub-competencies from those established for general psychiatry.Within each sub-competency are five levels, each of which details specific milestones that are achieved before one progresses to the next level. This national approach to assessment was developed to ensure that residents and fellows in graduate medical education are capable of independently providing high-quality, safe patient care upon completion of training [2]. Prior to the formal July 2014 implementation, there were publications describing the purpose and intent of the Psychiatry Milestones Project, the development process, potential evaluation tools and techniques to assess milestone acquisition, and a resident perspective on the potential utility of milestones [3–5]. Since implementation of the milestones, some educators have raised concerns about whether the shift to milestone-based assessments was premature. One concern is that the milestones were based solely on consensus expert opinion in the absence of empirical evidence of their validity in assessing meaningful markers of psychiatric competence that actually translate to positive patient outcomes. Another