Research for Practice 

JUN. 05 

American Indian Suicides in Jail: 

Can Risk Screening Be Culturally Sensitive? 

U.S. Department of Justice 

Office of Justice Programs 

National Institute of Justice 
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of the National Institute of Justice can be 

National Institute of Justice 

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Alberto R. Gonzales 

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Tracy A. Henke 

Acting Assistant Attorney General 

Sarah V. Hart 

Director, National Institute of Justice 
JUN. 05 

American Indian Suicides in Jail: 


Can Risk Screening Be Culturally Sensitive?


Findings and conclusions of the research reported here are those of the 

authors and do not reflect the official position or policies of the U.S. 

Department of Justice. 

This research was supported by the National Institute of Justice under 

grant number 99–IJ–CX–0016. The study was conducted by the University 

of Kansas School of Social Welfare and the University of Colorado Health 

Sciences Center in the Department of Family Medicine. 

NCJ 207326 
RESEARCH FOR PRACTICE / JUN. 05 

ABOUT THIS REPORT 

Culture can affect how inmates view suicide and, consequently, how they react to 

authorities’ attempts to assess their risk for suicide. In 

a county detention center 

in a Northern Plains State 

where American Indians are 

the dominant cultural minority in both the jail and the 

community at large, the jail 

administrator became concerned about the extent of 

suicidal behavior in the facility and asked researchers to 

help find the reason. 

The study findings 

Discomfort with the interview 

process appeared to be the 

major reason the detainees 

were not candid in answering 

questions in the suicide risk 

assessment. American Indians 

were less open in answering 

questions about health and 

use of drugs and alcohol. The 

wording of the questions and 

the setting of the interview 

seemed to have more of an 

effect than the nature of the 

questions. 

The researchers found that 

the American Indian concept 

of mental illness may cause 

them to interpret questions 

about this condition differently, and that a relationship of 

trust with the interviewer 

may produce more openness. 

The findings suggest that suicide risk assessment protocols tailored to the cultural 

backgrounds of detainee populations might be more effective than an impersonally 

administered one-size-fits-all 

approach. In view of American 

Indians’ high incarceration rate 

and risk for suicide, their experiences could be used to design more culturally sensitive 

risk assessment protocols. 

The study’s limitations 

Only the experiences of Northern Plains Indians were studied. Although they are similar 

to other tribes in some ways, 

local experiences prohibit generalizing the results to all tribes. 

The study was exploratory in 

nature, yet the findings suggest that modifications to current screening protocols may 

sharpen risk determination. 

Who should read this 

report 

Jail administrators, particularly those whose detainees 

include cultural or racial 

minorities. 

ii 
AMERICAN INDIAN SUICIDES IN JAIL 

Margaret Severson and Christine Wilson Duclos 

American Indian Suicides in Jail: 

Can Risk Screening Be Culturally 

This Research for Practice 

is based on “Assessing 

Suicide and Risk Behaviors in an Incarcerated 

American Indian 

Population: Investigating 

Culturally Sensitive Risk 

Assessment Instruments 

and Procedures in a Border Jail,” final report to 

the National Institute of 

Justice, June 2003, NCJ 

199363, available from 

the National Criminal 

Justice Reference Service 

Web site at www.ncjrs. 

org/pdffiles1/nij/grants/ 

199363.pdf. 

About the Authors 

Dr. Severson is with the 

School of Social Welfare, 

University of Kansas; 

Dr. Duclos is with the 

Department of 

Family Medicine, 

University of Colorado 

Health Sciences Center. 

Sensitive? 

When jail inmates are screened 

for suicide risk on admission, 

their culture may make a difference in the outcome of the 

assessment. For any group 

of people, culture—or way 

of life—is the prism through 

which group members see 

the world and respond to it. 

Culture shapes people’s view 

of concepts like trust and 

authority and can even affect 

their perceptions of physical 

and mental health. 

With the help of researchers, 

the administrator of a jail in a 

Northern Plains State found 

out how culture can help identify detainees’ risk for suicide. 

American Indians are the dominant cultural minority at the 

facility,1 located near reservation lands in a region of the 

country where Plains Indians 

tribes live (see “Characteristics of American Indian Detainees”). The rate of suicidal 

behavior at this facility was of 

concern to the administrator, 

who asked researchers to find 

out why the behavior was occurring and what could be 

done about it. 

The study was conducted 

over a 2-year period between 

1999 and 2001. In the first 

year, 677 detainees participated in a survey that explored 

their level of risk for suicide. 

In the second year’s survey, 

742 detainees were asked 

about the openness of their 

responses to the risk assessment procedure and whether 

they felt at ease with it. In 7 

focus groups convened in the 

first year, 42 detainees reviewed the procedure.2 

Culture and suicidal 

behavior 

Suicide is the second leading 

cause of death among jail detainees,3 but little is known 

about the possible roles of 

ethnicity and culture in suicidal behavior in jail. Until now 

there have been no studies 

of suicidal behavior among 

American Indians in jail. 

Researchers expected the 

rate of suicidal thoughts 

(ideation) and gestures to be 

higher among the incarcerated 

1 
RESEARCH FOR PRACTICE / JUN. 05 

C AMERICAN INDIAN D

American Indian inmates in this Northern Plains detention 

center differed from other inmates in certain demographic 

and other characteristics. In the survey conducted at 

booking, the researchers found that American Indians 

were more likely than other detainees to— 

■ 

■ Have more children. 

■ Be unemployed or underemployed. 

■ Have had more alcohol-related charges. 

■ Have been arrested more often. 

■ Have served more time in jail. 

■ Have been hospitalized more often for alcohol problems. 

■ Have used services for emotional and other health problems in the past 6 months. 

that, at times, only Indian female detainees were housed 

Auto-related offenses (excluding driving while intoxicated/ 

driving under the influence [DWI/DUI], and including driving with a revoked or suspended license) were the most 

common charges for detainees overall. Among American 

Indians, the most common offenses were such nuisance 

non-Indians, the most common offense was DWI/DUI. 

HARACTERISTICS OF ETAINEES 

Be older. 

Additionally, among female detainees, American Indians 

were overrepresented in this facility. Researchers noted 

in the facility. 

charges as disorderly conduct, littering, and vagrancy. For 

American Indian population, 

but the data did not support 

this hypothesis. In fact, suicide ideation rates were similar for American Indian and 

white detainees. Yet the problem of suicide in this population is still compelling, not 

only because American Indians have the highest jail confinement rate of any racial 

and ethnic group, but also 

because they are much more 

likely than Americans in general to take their own lives.4 

What detainees think 

of the screening 

In the 2-year National Institute 

of Justice-sponsored study, 

the researchers found that the 

detainees, whether American 

Indians or others, were not 

completely candid in answering the screening questions, 

which explored issues like 

hopelessness, family history 

of suicide, anxiety, and depression (see “Trauma and 

Suicide Risk”). American Indians tended to be less candid 

than other detainees when 

asked about their physical 

and mental health and use 

of drugs and alcohol. 

The reason for this lack of candor seems to be discomfort 

with the interview process. 

But the nature of the questions was not as important 

2 
AMERICAN INDIAN SUICIDES IN JAIL 

as the process itself, the way 

the questions were worded, 

and the setting. This was true 

for detainees in general, but 

especially for American Indian detainees. In this facility 

as in others across the country, suicide screening is routinely conducted by a 

uniformed stranger, the 

process is sometimes 

rushed, and the interview 

may not always take place in 

a private setting. Focus group 

sessions held to find out 

what detainees thought of 

the screening procedure 

brought these concerns to 

light. 

The researchers found that the 

detainees, American Indians 

and others, considered many 

of the screening questions intrusive, dealing with intensely 

personal matters, and that 

detainees feared the consequences of admitting to being 

suicidal or to having thoughts 

of harming themselves. Though 

detainees indicated that they 

understood the questions and 

they agreed that these risk 

assessment questions needed to be asked, they also felt 

ill at ease answering these 

highly personal questions because of the absence of a 

caring and empathetic dialogue between interviewer 

and interviewee. The officers 

who conduct the screening 

T SUICIDE RISK 

Many detainees who participated in the study—American 

Indians and others—had experienced several stressful 

events, involving either themselves or others, over the 

course of their lives. These events included experiencing 

a life-threatening illness or accident; being the victim of 

force in a robbery; being seriously injured or in danger of 

death; and being present when someone else was killed, 

injured, or assaulted. 

Detainees who were suicidal were much more likely to 

have experienced one or more of these stressful events. 

More than 90 percent reported experiencing at least one 

such event during their lifetime. Overall (with the exception of automobile accident-related trauma), no statistically 

significant difference was found in the stressful experiences of American Indian and non-Indian detainees. 

jail suicide. The fact that extraordinarily stressful experiences were so common in the lives of detainees, especially 

those who are suicidal, indicates that trauma could be included in suicide assessments. 

RAUMA AND 

Thus far, trauma has not been identified as a risk factor for 

are often seen as simply following a routine procedure, 

one often devoid of a sense 

of genuine caring about the 

emotional state of the 

detainee. 

American Indian 

culture affects their 

response 

American Indian detainees 

were found to have different 

reactions than their non-Indian 

counterparts to the framing 

or wording of the risk assessment questions. Many of 

3 
RESEARCH FOR PRACTICE / JUN. 05 

“Indians don’t 

have that 

psychiatric 

history all 

that much. 

I’ve never 

known any.... 

A lot of white 

girls, I notice, 

have real 

bad psychiatric 

problems.” 

— Indian

woman 

these differences are thought 

to stem from their culturally 

distinctive worldview as well 

as from the history of their 

association with non-Indian 

American culture. For example, 

American Indian detainees 

suggested that the negative 

wording of risk assessment 

questions discouraged accurate responses. Further, the 

sterile environs of a booking 

area combined with the asking of questions requiring 

only yes or no responses inhibits the opportunity for selfdisclosure in the narrative 

style common to American 

Indian dialogue. 

Mental health and mental 

illness. The majority of 

detainees in the focus group 

sessions thought that having 

a history of psychiatric problems is stigmatizing, but 

American Indians were more 

inclined to accept someone’s 

social deviance than to label 

the person as mentally ill. In 

fact, in American Indian culture, such people may be considered gifted, and thus very 

spiritual. In some American 

Indian cultures, people with 

special needs are considered 

“waken,” or holy, and belong 

to the creator. They are therefore treated accordingly. 

Many American Indians view 

certain mental and emotional 

problems as externally caused 

rather than rooted in psychological conflict. Unwellness 

introduced externally is considered unnatural (overindulgence 

in alcohol is an example), while 

“natural” unwellness stems 

from biological, social, and/or 

cultural violations or taboos. In 

some American Indian communities, mental illness is 

considered a white person’s 

disease and mainstream society is seen as labeling mental 

illness to be shameful and unnatural. As such, American 

Indians may see mental health 

as a mainstream concept that 

does not really apply to them. 

In fact, some communities do 

not even have a concept of 

“mental health.” Rather, they 

see wellness as an inseparable connection, or harmony, 

among body, mind, and spirit. 

All these differences mean that 

if an American Indian detainee 

is asked about his mental 

health history, he or she may 

not interpret the question the 

way the interviewer intends 

for it to be understood. 

Respect, community, and 

communication. The American Indian conception of 

respect, also different from 

that of mainstream culture, 

prohibits prying deeply into 

the innermost thoughts and 

feelings of another person, as 

is done in suicide screening. 

4 
AMERICAN INDIAN SUICIDES IN JAIL 

One lives in harmony with all 

other beings because it is 

spiritually necessary to do so. 

All parts of life are interrelated 

and thus worthy of respect. To 

be in a state of conflict with 

people or to offend them is to 

be in disharmony and thus in 

a dangerous and vulnerable 

state. 

Non-Indians may view “community” as a term defined 

solely by geography, but the 

researchers found that American Indians may see it as 

broader both spatially and spiritually.5 As a result, risk assessment questions that ask about 

the detainee’s ties to the community may be interpreted 

differently by American Indian 

detainees. Community to 

them may go well beyond the 

boundaries of a city or county 

and beyond the boundaries of 

non-Indian notions of family or 

authority figures. 

The researchers also found 

that in Northern Plains Indians’ view of communication, 

asking direct questions about 

suicidal ideation may actually 

produce the behavior. In focus 

groups conducted by the researchers, American Indian 

detainees said that many in 

their culture feel that such 

questioning can allow spirits 

to enter the person’s essence, 

producing “ghost illness.” 

Talking about suicide may 

evoke the spirits of those 

who previously completed 

suicide in the jail and consequently may provoke suicidal 

behavior among Indian inmates. For this reason, some 

detainees suggested that 

questions about whether a 

person is considering suicide 

could be more positively 

framed as “Are you feeling 

all right?” or “Do you feel 

that you can make it?” 

Relationship to mainstream 

society. History also colors 

American Indians’ worldview. 

The uniformed officer (often 

a white person) who conducts the screening interview 

is an authority figure who 

may symbolize longstanding 

oppression. Building trust 

under such circumstances 

may be difficult. 

Detainees in general said that 

a trusting relationship with 

the officer, especially a relationship in which the officer 

expresses concern about the 

detainee’s well-being, will 

result in greater readiness to 

answer otherwise intrusive 

questions about physical or 

mental health and use of 

drugs and alcohol. American 

Indians were much more likely 

to feel this way. For them, the 

act of deception in answering 

(or not) the risk assessment 

“See, we, in 

our culture, it’s 

taken a little 

differently than 

in other people’s 

culture. See, 

we think that 

they’re gifted.... 

We respect that 

person because 

he’s touched.” 

— Indian man 

5 
RESEARCH FOR PRACTICE / JUN. 05 

“The [Indian] 

community 

recognizes 

[being in jail] 

as a mistake, 

not something 

that is shocking. 

They know 

everybody 

makes 

mistakes.... 

You feel so 

defamed 

[in mainstream 

society.]” 

— Indian man

questions may be a passive 

way to register their objection 

to the process. 

The interview setting 

and the interviewer 

The researchers presumed 

that the personal and professional characteristics of the 

interviewer and the type of 

setting might make a difference; that is, certain changes 

might make detainees feel 

more at ease and as a result 

more open in their responses. 

In the standard screening procedure, a uniformed officer 

conducts the interview in a 

setting that allows little privacy. 

American Indians were much 

more sensitive than other detainees about privacy, even 

though they felt more comfortable than others with the 

booking procedure in general. 

They noted that it would be 

good to have an American 

Indian as the interviewer, but 

among detainees in general, 

the pervasive theme was that 

the interviewer should be 

someone who cared about 

the detainee’s well-being and 

who wants to help. 

The researchers compared the 

standard screening approach 

to two others: one in which 

the interview was conducted 

by a civilian and held in a private setting and one in which 

the interviewer was an American Indian. The researchers 

anticipated that the results 

could aid in developing culturally appropriate procedures 

for American Indians. 

No statistically significant differences were found between 

American Indians and other 

detainees in how they reacted to the different screening 

protocols. Overall, both groups 

responded better to the two 

alternative approaches than to 

the standard screening protocol; that is, they were more 

open in answering questions 

about their physical and mental health and use of drugs and 

alcohol. Specifically, screening done in a private setting 

and by a civilian interviewer 

made detainees feel more 

at ease in addition to being 

more open in their responses. 

Though the researchers wanted to know whether either or 

both alternative approaches 

might help prevent suicidal 

behavior by making detainees 

more confident about managing their depression postbooking, the results of this 

analysis were mixed, perhaps 

due to the small sample size. 

6 
AMERICAN INDIAN SUICIDES IN JAIL 

Toward culturally 

sensitive screening 

Research to date on jail suicide has produced only a very 

general profile of the suicidal 

inmate. Little more is known 

than that these inmates are 

white, male, under age 40, 

and housed in isolation and 

when they take their own life, 

the typical method is hanging. 

Current screening procedures 

and practices are based on the 

presumption that risk assessment and risk prediction are 

transcultural and transracial. 

This study was exploratory 

and consequently the results 

are not conclusive—they do 

not suggest that current 

screening protocols are not 

useful. The results can help 

jail officials better understand 

good practice in suicide risk 

assessment. The researchers 

suggest that developing assessment tools geared to the 

culture of specific subgroups 

would be useful to jail suicide 

prevention efforts. Racial and 

cultural minorities are overrepresented in jails and prisons in this country and, as has 

been suggested here, their 

cultural values and mores may 

influence their responses to 

the phrasing of traditional risk 

assessment questions. The 

same is true of their reactions 

to the physical and emotional 

environment in which the risk 

assessment occurs. 

The American Indian detainees at the facility studied offered many culturally specific, 

unique perspectives on and 

interpretations of the screening questions and process. The 

findings indicate a one-sizefits-all approach to screening, 

used in an impersonal way, 

will not adequately assess 

suicidal behavior among people of any culture, especially 

American Indians. Their culturally specific experiences 

could be used to improve the 

risk assessment process. And 

because American Indian culture has its own healing and 

coping rituals, culturally appropriate programming could be 

developed to include them, 

with the understanding that 

regional and tribal differences 

must be taken into account in 

developing the programming. 

In facilities where American 

Indians are a significant percentage of detainees, risk 

screening would benefit the 

whole suicide prevention 

effort if American Indians or 

other individuals with knowledge of the local culture 

worked with the program. 

Suicide prevention efforts 

overall are likely to be more 

“They say, 

‘Yo, Chief, 

come here.’ 

I’m no chief.” 

— Indian man

7 
RESEARCH FOR PRACTICE / JUN. 05 

“If they had 

somebody who 

sat down and 

really looked 

like they really 

cared, it would 

be a lot better 

on people.” 

— Non-Indian

man 

effective if elements of cultural sensitivity are infused 

throughout and inseparable 

from the very fabric of the 

program itself. 

This study looked only at detainees who are members of 

Northern Plains tribes. American Indian tribes are similar 

to each other in some ways, 

the most important of which 

is a shared history of subjugation. For this reason, the 

findings of this study may also 

apply to other American Indian 

populations. However, local 

experiences that produce suicide ideation and govern the 

response to suicide assessment vary by tribe, so it is not 

possible to simply generalize 

these results to all tribes. 

The wording of the questionnaire is only one aspect of 

screening. Privacy in the interview setting and a trusting 

relationship with the interviewer are just as essential 

in promoting openness, irrespective of the detainees’ 

culture. Their lack of full disclosure during screening is 

an honest commentary on 

the personal impact of an 

impersonal process. 

8 
AMERICAN INDIAN SUICIDES IN JAIL 

Notes 

1. Of the 8,800 yearly average number of intake bookings at the facility, 

about 45 percent involve American 

Indians, although they generally constitute 70 percent of detainees who 

stay any length of time. 

2. In the first year, 2,586 bookings 

were made; of these, 701 (representing 677 detainees) were included in 

the survey. Of the 742 participants in 

the second year’s survey, the responses of only 89 were analyzed because 

it was not possible to identify the different experimental screening procedures tested. Although focus group 

sessions were held the second year, 

the results were not reported 

because they were so similar to 

those from the first year. 

3. Stephan, James J., Census of 

Jails, 1999, Washington, DC: U.S. 

Department of Justice, Bureau of 

Justice Statistics, 2001, NCJ 

186633: 8. The leading causes of 

death in jail are illness (excluding 

AIDS) and other natural causes. 

4. The jail confinement rate of American Indians is cited in Greenfield, 

Lawrence, and Steven K. Smith, 

American Indians and Crime, Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics, 

1999, NCJ 173386: viii. American 

Indians’ rate of incarceration in both 

prisons and jails is 15 percent higher 

than the overall national rate (see 

Minton, Todd D., Jails in Indian Country, 2002, Washington, DC: U.S. 

Department of Justice, Bureau of 

Justice Assistance, 2003, NCJ 

198997: 2). The suicide rate of American Indians and Alaska Natives 

together is 1.5 times the national 

rate; among young men it is 2 to 3 

times higher than the general U.S. 

rate (see Mental Health: Culture, 

Race, and Ethnicity—A Supplement 

to Mental Health: A Report of the 

Surgeon General, Washington, DC: 

U.S. Department of Health and

Human Services, 2001: 87). 

5. Many American Indians regard 

their spiritual experiences as intensely personal, private, and sacred and 

are reluctant to describe them with 

non-Indians. Thus, some of these 

experiences could not be presented 

in detail here. 

9 
The National Institute of Justice is the 

research, development, and evaluation 

agency of the U.S. Department of Justice. 

NIJ provides objective, independent, 

evidence-based knowledge and tools 

to enhance the administration 

of justice and public safety. 

NIJ is a component of the Office of Justice 

Programs, which also includes the Bureau 

of Justice Assistance, the Bureau of Justice 

Statistics, the Office of Juvenile Justice 

and Delinquency Prevention, and the 

Office for Victims of Crime. 
JUN. 05

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