Local Community Response Team

The Tribe and CRT need to make a decision about the status of the suicide crisis response.

1. Review the evidence and present risk to determine the next step.
2. After review, if the community and CRT agree there is no longer evidence of a suicide crisis and the risk has been satisfactorily mitigated by the response, then steps can be taken to step down the response. These steps may include:
3. Inform the bereaved or affected individuals, families, and group of the step down plan and reinforce the availability of support agencies;
4. Ensure agencies continue to communicate and work together to support those affected;
5. Initiate planning support for significant dates and anniversaries;
6. Ensure community agencies are aware of how to communicate future concerns;
7. Conduct ongoing training to recognize and reduce suicide related behaviors in the area, especially in locations that were hardest hit by the suicide.
8. Evaluation of response goals, objectives, and resources utilized during the response.
9. Determination of which strategies were most effective.
10. Determination of which strategies were least effective.
11. Revisit existing guidelines and make appropriate changes to guidelines in effort to make guidelines more effective for the future.
12. After review, if the Community and CRT agree the risk remains high and deems the tribal response resources have been overwhelmed or exhausted and there is further need then, the Tribe can request aid from the IHS Area Office for ongoing support.

At this time, regardless of the decision the Community and CRT make related to the disposition of whether the suicide crisis has been mitigated, the group will need to consider whether or not a psychological autopsy should be conducted on those who have died by suicide.

1. Psychological Autopsy is a culturally sensitive best practice postmortem procedure to reconstruct the causes of an individual's death by suicide and/or to understand the reason why the death was initiated.
2. The psychological autopsy helps promote the understanding to the often-asked "why?" question raised by survivors regarding the suicide of their loved one.
3. It provides a better understanding of the risk factors for suicide and helps to answer questions of causation in both individual cases of suicide and interconnections between cases (as in clusters of suicides), hence lessons learned to inform prevention efforts in the local community as well in all areas of Indian country.
4. The drawbacks of the psychological autopsy is that they are time consuming, requires independent experts, and can be emotionally upsetting to those being interviewed in the process.

Recommendations for completing a culturally sensitive psychological autopsy begin with utilizing an expert in the field of Suicidology. Once selected, the expert will meet with the Community and CRT to describe, process, and gain their permission to proceed.

1. The Tribe will assign 1-2 tribal representatives to assist the expert in conducting meetings and interviews with important people who had a relationship with the deceased.
2. The entire process will be done in a culturally sensitive manner considering the tribe and family’s needs during this time of loss. The expert will offer to interview each of the individuals identified by the Tribe.
3. Each person participating in the interview will be offered the opportunity to have one of the Tribe representatives accompany them through the intake process.
4. Each person will be asked the same questions which from the semi-structured intake questionnaire.
5. The expert will utilize a semi structured interview process to ensure the process in done in a consistent manner. (An example of the semi-structured intake questionnaire is located in Appendix XI.)
6. Generally, the expert will attempt to interview 8-10 individuals in order to get a thorough understanding of the decedent.
7. Once the interviews have been completed the expert will review the information and develop a written report.
8. The reports will be shared with the community that requested the autopsy, as well as the family members, if willing.
9. The next step will be to identify risk factors specific to this incident and consider ways the community suicide prevention coalition could modify their prevention efforts.