PLAN FOR SUICIDE
PREVENTION AMONG THE
SÀMI PEOPLE IN NORWAY,
SWEDEN, AND FINLAND
EnglishVersion
SÀMINORWEGIANNATIONALADVISORYUNITONMENTALHEALTHANDSUBSTANCEABUSE(SANKS)
&
SAAMICOUNCIL
©SANKS2017
SANKS,Postboks4,9735Kárášjohka/Karasjok,Norway
Visitingaddress:Stuorralouhkka34,Kárášjohka/Karasjok,Norway
Phone:+4778469550
Email:[email protected]
www.sanks.no
1
Preface
TheSámiareanindigenouspeopleandhavethereforespecialindigenousrights,ascodifiedinthe
UNDeclarationontheRightsofIndigenousPeoples(1).AllNordiccountrieshaveaccededtothe
Declaration,which,amongotherthings,focusesonindigenouspeople’spoliticalrightsaswellas
theirrighttoself-determination.Italsodescribestheirhealth-relatedrights,suchasnotbeing
discriminatedagainstorsubjectedtoviolence,aswellastherighttothebestattainablephysicaland
mentalhealth.AlsoincludedintheDeclarationistherighttoinfluenceone'sownhealthsituation.
Thisisthefirst“PlanforsuicidepreventionamongtheSámipeopleinNorway,Sweden,andFinland”
andshouldbeviewedinlightofthehealthrightsoftheSámi.Itsstrategiesarebasedonboth
availablescientificknowledgeaboutsuicideanditscausesaswellasconsultationswiththeSámi
peopleinvolvedinsuicideprevention.Theplanshouldthereforebeviewedasanexpressionofthe
Sámipeople’srighttoinfluencetheirownhealth.
TheplanhasbeendevelopedinacollaborativeprojectbetweentheSámiNorwegianNational
AdvisoryUnitonMentalHealthandSubstanceUse(SANKS)andtheSaamiCouncilsectionsin
Norway,Sweden,andFinland.TheworkhasbeenfundedbytheSámiParliamentofNorwayand
NordRegio,whichispartoftheNordicCouncil.Theprojectteamhascollaboratedwiththe
NorwegianInstituteofPublicHealthandtheresearchproject,RISINGSUN(ReducingtheIncidenceof
SuicideinIndigenousGroups–strengthsthroughnetworks),whichisaninitiativeunderthe
Americanchairmanship(2015-2017)oftheArcticCouncil.
Theteamwasledbypsychologist/PhDstudentJonPetterStoor(SANKS)andincludedtheSecretary
GeneralMarjaKatarinaPåveGaup(SaamiCouncil),licensedpsychologist/ResearchDirectorAnne
Silviken(SANKS),DoctorHeidiEriksen(UtsjokHealthCareCentre),DepartmentManagerGunn-Britt
Retter(SaamiCouncil),DirectorofSANKSGunnHeatta,SaamiCouncilPresidentÁileJavo,andPer
JonasPartapuoli(SaamiCouncil).
Wewouldliketothankallofthose,includingpartnersandfunders,whohaveenabledthe
developmentofthefirstSámisuicidepreventionplan.AspecialthankstoallthededicatedSámi,so
passionateaboutsavingthelivesoftheirfellowcitizensandsogenerousinsharingtheirexperiences
andknowledgewiththeprojectteam.Manythanks!
Suicidehas,foratleastthelast40-50years,beenarelativelylargepublichealthproblemamongthe
SámiinNorway,Sweden,andFinland.Wehopethatthisplanwillultimatelycontributetochanging
thisandhelpingtheSámipeopletocontinueliving.
TheSámiarenotworthmorethanotherpeople;neitheraretheyworthless!
JonPetterStoor
ProjectManager,SANKS
GunnHeatta
DirectorofSANKS
ÁileJavo
PresidentoftheSaamiCouncil(2013-2017)
2
About the strategies for suicide prevention among the Sámi
Thestrategiesinthisplanaredesignedtosupplementthesuicidepreventionworkalready
conductedinthecountriesofNorway,Sweden,andFinland–forallcitizens,regardlessofethnicity.
ThestrategiesthuspointtospecificchallengesandneedsoftheSámipeoplethatcannotbe
consideredcoveredinthecountries’generalsuicidepreventionefforts.
ThereisalackofknowledgeaboutsuicideandrelatedproblemsontheRussiansideofSápmi.Dueto
thislackofknowledgeandthedifficultiesinobtainingnewknowledge,ithasn’tbeenpossibleto
designthesestrategiestobedirectlyapplicableontheRussiansideofSápmi.Thiscanonlybe
deplored.
TheplaniscreatedwiththeintenttohelpputfocusonsuicidalityamongtheSámipeople,informof
researchfindingsandotherrelevantknowledge,andinspirediscussionsandactionbothinsideand
outsidetheSámicommunity.Thestrategiesshouldbeviewedasrecommendationstoallsocial
forcesworkingtopreventsuicideinSápmi.
Themainobjectivesofthesestrategiesaretohelpstrengthenthementalhealthandpreventsuicide
amongtheSámipeople.
Strategy1:FocusingeffortsontheSámimen
Strategy2:ProducingstatisticsandstrengtheningresearchonsuicideamongtheSámi
Strategy3:StrengtheningSámiself-determination
Strategy4:Initiatingeffortstorecogniseanddealwithhistoricaltraumas
Strategy5:StrengtheningandprotectingtheSámiculturalidentity
Strategy6:ReducingtheSámi'sexposuretoviolence
Strategy7:ReducingtheSámi'sexperiencesofethnicdiscrimination
Strategy8:IncreasingdiversityandacceptanceintheSámicommunity
Strategy9:SecuringtheSámi’srighttoequal,linguisticallyandculturallyadaptedmentalhealth
care
Strategy10:EducatingandmobilisingtheSámicivilsocietyforsuicideprevention
Strategy11:Initiatingandstrengtheningcross-bordercooperationforsuicideprevention
3
Contents
Preface....................................................................................................................................................2
AboutthestrategiesforsuicidepreventionamongtheSámi................................................................3
Abbreviations......................................................................................................................................5
Suicide.................................................................................................................................................5
Sápmi..................................................................................................................................................6
TheSámiasanindigenouspeople......................................................................................................6
Generalinformationaboutsuicide.....................................................................................................8
Suicideamongindigenouspeoples.....................................................................................................9
SuicideamongtheSámipeople..........................................................................................................9
FactorsinfluencingsuicideamongtheSámipeople.........................................................................10
SuicidepreventionamongtheSámipeople.....................................................................................13
Approach...........................................................................................................................................15
Strategy1:FocusingeffortsontheSámimen..................................................................................16
Strategy2:ProducingstatisticsandstrengtheningresearchonsuicideamongtheSámi................16
Strategy3:StrengtheningSámiself-determination..........................................................................16
Strategy4:Initiatingeffortstorecogniseanddealwithhistoricaltraumas.....................................17
Strategy5:StrengtheningandprotectingtheSámiculturalidentity...............................................17
Strategy6:ReducingtheSámi'sexposuretoviolence......................................................................18
Strategy7:ReducingtheSámi’sexperiencesofethnicdiscrimination.............................................18
Strategy8:IncreasingdiversityandacceptanceintheSámicommunity.........................................18
Strategy9:SecuringtheSámi’srighttoequal,linguisticallyandculturallyadaptedmentalhealth
care...................................................................................................................................................19
Strategy10:EducatingandmobilisingtheSámicivilsocietyforsuicideprevention.......................19
Strategy11:Initiatingandstrengtheningcross-bordercooperationforsuicideprevention...........20
4
Abbreviations
SANKS/SÁNAG SámiNorwegianNationalAdvisoryUnitonMentalHealthandSubstanceUse
www.sanks.no
SSHF
CentreforSámiHealthResearch
Suicide
Suicideiscommonlydefinedas“aconsciousanddeliberateself-directedactionoftheindividualthat
leadstodeath”(2).Whileemphasisingthis,the“father”ofcontemporarysuicidology,Edvin
Schneidman,alsostressedthatsuicidemustbeunderstoodincontext,asanactcommittedwhenan
individualisinacrisisinwhichhecan’tmeethispsychologicalneedsandbelievessuicidetobethe
“best”solution(3).
ThenorthernSámiwordforsuicideis“iešsoardin”where“ieš”means“self”and“soardit”canbe
translatedas“harm”or“oppress”.
5
Sápmi
TheSámiareahasneverhadanexactborderbutsincetimeimmemorialtheSámihaslivedinSápmi,
whichextendsacrossthenorthernpartofScandinaviaandintotheKolaPeninsula(seeFigure1
below).AsNordiclegislationprecludesregistrationonethnicgrounds,thereisnoreliablestatistics
onthenumberofSámiinindividualcountriesorSápmiasawhole.Thenumbersusuallylistedvary
dependingonthecriteriaused,i.e.whocountsasSámiandwhodoesn’t.Commonfigures,however,
indicatethatthereare50,000–65,000SámiinNorway,20,000–40,000inSweden,approx.10,000in
Finland,2,000–3,000inRussia,andatotalof80,000–100,000SámiinSápmi.
TheSámipeoplehaveacommonlinguisticandculturalaffiliationwithregionalandlocalvariations.
ThethreemainvariationsoftheSámilanguageareinturndividedintoninedialects,notnecessarily
bycountry.ThemainvariationsoftheSámilanguageinclude:EastSámi,spokenontheKola
PeninsulainRussia;CentralSámi,spokeninFinland,Norway,andSweden;andSouthSámi,spokenin
NorwayandSweden.Thelanguageboundariesarenotclearandchangegradually.
Figure1.MapofSápmi–Sámicountry–andapproximaterangeandbreakdownofSouth,“Lule”,North,andEastSámi
culturalandlinguisticareas.
Illustrator:AndersSunesson.Themapisusedwiththepermissionoftherightsholder,SámiInformationCentre.
Source:www.samer.se
Traditionally,theSámihaveengagedinindustriessuchasreindeerhusbandry,seaandriverfishing,
hunting,farming,and“duodji”(Sámicrafts).Whilealltheseindustriesarestillofgreatimportance,
botheconomicallyandculturally,theyhaveinthelast100yearsbeensupplementedwithother
livelihoods,andtodaytheSámipeopleworkinallsectorsofthelabourmarket.
The Sámi as an indigenous people
TheSámiaretheindigenouspeopleofSápmi,constituting“anindigenouspeopleonaccountoftheir
descentfromthepopulationswhichinhabitedthecountry,orageographicalregiontowhichthe
countrybelongs,atthetimeofconquestorcolonisationortheestablishmentofpresentstate
boundaries,andwhoretainsomeoralloftheirownsocial,economic,culturalandpolitical
institutions”(fromtheUNDeclarationontheRightsofIndigenousPeoples,2007).
6
Asanindigenouspeople,theSámihavespecialrights,asoutlinedbytheUNIndigenousDeclaration.
Thedeclarationaddresses,amongotherthings,indigenouspeoples’healthrightsandtherighttobe
involvedandinfluenceone’sownhealthsituation–towhichsuicidalityandsuicidebelong:
United Nations Declaration on the Rights of Indigenous Peoples, article 23
Indigenouspeopleshavetherighttodetermineanddevelopprioritiesandstrategiesforexercising
theirrighttodevelopment.Inparticular,indigenouspeopleshavetherighttobeactivelyinvolvedin
developinganddetermininghealth,housingandothereconomicandsocialprogramsaffectingthem
and,asfaraspossible,toadministersuchprogramsthroughtheirowninstitutions.
United Nations Declaration on the Rights of Indigenous Peoples, article 24
1.Indigenouspeopleshavetherighttotheirtraditionalmedicinesandtomaintaintheirhealth
practices,includingtheconservationoftheirvitalmedicinalplants,animalsandminerals.Indigenous
individualsalsohavetherighttoaccess,withoutanydiscrimination,toallsocialandhealthservices.
2.Indigenousindividualshaveanequalrighttotheenjoymentofthehighestattainablestandardof
physicalandmentalhealth.Statesshalltakethenecessarystepswithaviewtoachieving
progressivelythefullrealizationofthisright.
7
General information about suicide
TheUNWorldHealthOrganisation(WHO)hasfoundthatnearlyonemillionpeoplediebysuicide
eachyear,makingitapublichealthproblemworldwide(5).Suicideoccursinallcountries,cultures,
andgroupsofpeople.Thenumberofpeoplewhodiebysuicidevariesfromyeartoyear.Inthe
Nordiccountries,thenumberhasdroppedsincethe1980s.Acrossalmosttheentireworld,suicideis
morecommonamongmenthanwomen,includingtheNordiccountrieswheremorethantwiceas
manymenaswomendiebysuicide.In2014,548peoplediedbysuicideinNorway,1,148peoplein
Sweden,and789peopleinFinland(seeFigure2).Expressedinage-standardisedmortalityrates
(basedonworldstandardpopulation1),thiscorrespondsto9.4peopleper100,000yearsoflifein
Norway,9.9/100,000inSweden,and12.8/100,000inFinland.
Figure2.NumberofsuicidesinNorway,Sweden,andFinland,2010–2014(6).
1400
1200
1000
800
600
400
200
0
2010
2011
2012
Norway
Sweden
2013
2014
Finland
Figure3.NumberofsuicidesinNorway,Sweden,andFinlandper100,000age-standardisedyearsoflife,1990–2014(6).
30
25
20
15
10
5
0
1990
1995
2000
Norway
2005
Sweden
2010
2014
Finland
Internationalsuicideresearchpointsparticularlyatmentalill-healthasanunderlyingcausefor
suicide,butalsostatesthatthereisrarelyorneverjustonecauseforapersontoendhislife.Causal
1
“Worldstandardpopulation”isusedbytheWHOtopreventcountries’varyingagestructuresfromhavingtoo
muchsignificancewhencomparingcountries.SincetheNordiccountrieshaveanolderpopulation,theselfreportedfiguresofthesecountriesarenotconsistentwiththoseofWHO(presentedhere).
8
relationshipsarecomplexandincludeeverythingfromindividualfactors,suchasaperson’sabilityto
copewithadversity,tolargersocialandculturalfactors.Asuicidecrisisisoftentriggeredbyacute
“situational”causessuchasthebreakupofarelationship.Suicidepreventioninvolvestryingto
reducethenumberofsuicidesinagroupbyreducingthefactorsthatincreasetheriskofsuicide(e.g.
introducingguncontroltomakeweaponaccessmoredifficult),andstrengtheningthefactorsthat
reducerisk(e.g.positivelyinfluencepeople'sattitudestowardsseekinghelpfrommentalhealth
care)(5).
WHOencouragescountriestoestablishnationalplansforsuicidepreventiontogovernandfocus
effortsinthefield.Norway(7)andSweden(8)havesuchplansforsuicideprevention.Finlandused
tohaveonebutnolongerdoes(9).NeithertheSwedishnortheNorwegianplanincludesanyfocus
onsuicidepreventionamongtheSámipeople.
Suicide among indigenous peoples
Suicideisamajorpublichealthproblemamongtheworld’sindigenouspeoples,especiallythosein
theArctic(10).Causesoftencitedhavetodowithsocioeconomicconditionsbeingweakercompared
tothoseincentralareasandwiththehistoryofnorthernareasbeingcolonisedbyforeignpowers,
whichhaspartiallyshatteredtheoriginal(i.e.indigenous)socialsystems.Suchupheavalscanhave
immediateeffectsoncommunitiesandindividualsbutalsogeneratesufferingforgenerations–so
calledhistoricalandintergenerationaltrauma.It'sclearthattherapidsocialchangesoccurringduring
themodernisationoftheArcticinthe1900splayacentralrole,notleastbecauserapidsocial
upheavalsinthemselvesconstitutemajorlifechallengesfortheindividualswho,timeandagain,are
forcedtoadapttonewrealities.
Suicide among the Sámi people
Sincewedon’tregisterethnicityinNorway,Sweden,andFinland,weknowrelativelylittleabout
suicideamongtheSámi.Threedifferentresearchstudies,however,havebeenconducted,
successfullyidentifyingSámiindividualswhohavediedbysuicideindifferentperiodsindifferent
partsofthedifferentcountries.Areviewarticlerecentlynotedthatageneralexcessmortalityby
suicideseemstoexistamongtheSámi,comparedtothecountries’majoritypopulations(10).The
differenceisbelievedtobelargestamongtheSámiinFinland(11)andsomewhatsmalleramongthe
SámiinSweden(12)andNorway(13).Therelativerisk,comparedtothemajoritypopulations,is
consistentlyhigherandmorestableamongmen,whiletheSámiwomendon’tseemtodiebysuicide
moreoftenthanwomeninmajoritypopulations.Table1showsthe“standardisedmortalityratio
(SMR)”forsuicideamongtheSámipeopleinrelationtoNorwegians,Swedes,andFinns.AnSMR
above1meanshighermortalitycomparedtothemajoritygroup.Forexample,50%moreSámidied
bysuicideinFinnmark(SMR=1.50)between1970and1998thanwhatwouldbeexpectedbasedon
howmanyotherFinnmarkresidentsdiedofthesamecauseduringthesameperiod.
Table1.SMRamongSámigroupscomparedtomajoritypopulationsinSweden,Norway,andFinland.Swedish(14),
Norwegian(13),andFinnish(10,11)data.TableadaptedfromYoung,Revich,andSoininen,2015(10).
COHORT
MEN
2
WOMEN
NORTHERNSWEDEN
1961–2000
Entirecohort
1.17 Nonreindeerherders 1.05
0.762
0.67
Reindeerherders
1.12
NORTHERN
Entirecohort
1.50
3
1.27 2
3
Ratioswheretheobserveddifferenceisstatisticallysignificant(95%confidenceinterval).
Menandwomentogether
9
NORWAY
1970–1998
Finnmark
1.502
1.55
Troms
0.74
1.00
Nordland
0.42
3.17
2
Coreareas
1.54 1.31
Coast
1.24
1.21
South
0.41
1.51
1970–1980
1.17
1.14
1981–1990
1991–1998
1.36
1.20
1.92
0.81
Nonreindeerherders 1.302
1.34
Reindeerherders
1.06
0.66
2
NORTHERNFINLAND Entirecohort
1.78 1.26
1979–2010
1979–1987
1.83
(Nosuicide)
1988–1996
1.07
1.93
1997–2005
2
2.55 1.2
2006–2010
2.32
1.2
Alsoknownisthatit'smorecommonamongyoungadultsandSàmireindeerherdersinSwedento
havelostarelativeoutsidetheimmediatefamilytosuicide,comparedtoSwedesinthesameareas
(15,16).
Factors influencing suicide among the Sámi people
WelackknowledgeaboutwhatmakessuicidemoreprevalentamongtheSámipeoplethanamong
Norwegians,Swedes,andFinns.Neitherdoweknowiftheremightbespecificcausesforsuicide
amongtheSámicomparedtopeopleinmajoritypopulations.WhatwedoknowisthatSámimen
moreoftendiebysuicidethanSámiwomen,thattheSámigenerallyuse“rougher”(moreviolent)
methods,whichinitselfmaybeacauseofhighermortality,andthatsocalled“suicideclusters”
(whereseveralpeopleinalimitedgroupdiebysuicideduringashortperiodoftime)seemtobe
morecommoninSápmi(10).Anotherpattern,particularlyevidentamongmen,isthatmoreyoung
Sámipeoplehavediedbysuicidecomparedtoyoungpeopleinmajoritypopulations(seeFigure4)
(13).
10
Figure4.Suicideper100,000yearsoflifeamongtheSámiinNorthernNorway,bygenderandage,1970–1998inSilviken,
Haldorsen&Kvernmo(12).
60
50
40
30
20
10
0
7-14
15-24
25-34
Sámimen
35-44
45-54
55-64
65+
Sámiwomen
Historical traumas
Historically,therearemanyexamplesofpracticesoppressingtheSámipeople,deprivingthemof
theirself-determination,andresultinginnegativehealthconsequencesforboththegroupandthe
individuals.Practices,stressedbytheSámiasharmful,includeskullmeasurementsto“proveracial
inferiorityoftheSámipeople”,boardingschoolsforcingchildrentoseparatefromtheirparentsand
deprivingthemoftheirlinguisticandculturalidentity,compulsorytransfer,andassimilationpolicies.
ThereisnoacademicknowledgeonhowthesehistoricaltraumashaveaffectedtheSámipeople,and
towhatextenttheystillaffectthemthroughintergenerationaltrauma(17).MoreandmoreSámi–
includingthoseparticipatinginproducingthisplan–demandthatthecountriesexaminethese
traumasandwhateffectsonhealth,includingsuicidality,theyhavetoday.Thiscanbedone,for
example,intheformoftruthandreconciliationcommissions.
Mental ill-health
Giventhatmentalill-healthisconsideredcentralinsuicide,andthattheSámipeopleareoverrepresentedinsuicidestatistics,youwouldexpecttofindahigherdegreeofmentalill-healthamong
them.Butstudiesmappingmentalill-healthamongtheSámishowamixedpicture.Onthe
NorwegiansideofSápmi,severalstudiesshowthatthereisnosignificantdifferencebetweenthe
mentalhealthofSámiandNorwegianyouth(18-22).OntheSwedishsideofSápmi,however,the
picturelooksdifferent.YoungSámiandSámireindeerherdersarefoundtohavepoorermental
healththanSwedishcomparisongroups(23,24).Thereisalsoasignificantdifferenceamong
reindeerherders,withamuchhigherproportion–nearly50%amongmalemiddle-agedmen–that
suffersfromsymptomsofanxietyanddepression(24).Researchersdescribethepoormentalhealth
situationamongSámireindeerherdersinSwedenasfullyunderstandableonthebasisofthegreat
pressureputonreindeerherders,particularlyfromthesurroundingcommunity(includinggreat
predationonreindeer,interferencewithgrazinglandintheformofforestry,windandhydropower,
tourism,andsocialinfrastructuresuchasroadsandrailways)(25).Thisdescriptionwasconfirmedin
agroupdiscussionstudywhereSámipeoplefromtheSwedishsideofSápmistatedthatthecauseof
themanysuicidesamongyoungreindeer-herdingmenisthetoughsocialsituationratherthanpoor
mentalhealthinitself(26).
11
Culture and identity
TherearelikelyseveralfactorsofparticularsignificancetotheSámi'smentalhealth.ForyoungSámi
growingup,itmightbeespeciallyimportanttohaveaccesstoavibrantSámicommunity,includinga
strongSáminetwork,andtomastertheirSámilanguageasthisstrengthensyoungpeople’sresilience
andcreatesresourcesthatcanpreventill-health(27)–justlikeitdoesamongotherindigenous
peoples(28).Unfortunately,astrongSámiidentitytodaycanbelinkedtopoormentalhealth(20,25,
29).ThisinturncanbelinkedtomanySámilivinginachallengingminorityposition,experiencingand
dealingwith,amongotherthings,ethnicdiscrimination(17,30-32).
Ethnic discrimination
Experiencingbeingethnicallydiscriminatedagainstisdetrimentaltohealth(33).Commontothe
studiesfromboththeNorwegianandSwedishsideofSápmiisthataconsiderablyhighernumberof
Sámipeopleexperiencebeingethnicallydiscriminatedagainstcomparedtopeopleinmajority
populations(29,31).TheSámiwhofeeldiscriminatedagainsthavepoorermentalhealthanda
higherrateofsuicidalitythanthosewhodonotexperiencebeingsubjectedtoethnicdiscrimination
(15,23,30,32,34).Ethnicdiscriminationisthuslikelyafactorofsignificanceforsuicideamongthe
Sámipeople.
Alcohol
Alcoholabuseiscommonamongpeoplewhodiebysuicide,buttherearenoindicationsthatthe
Sámipeopleasagroupconsumemorealcoholthanothers(35-37).StudiesfromtheFinnishand
SwedishsidesofSápmi,however,indicatethatthereisahigh-riskgroup(withhazardousalcohol
consumption)amongthemaleSámireindeer-herders(37,38).
Suicidal behaviour among the Sámi people
Agreatdealofpeopleinacommunitywill,atsomepointinlife,experiencesomedegreeof
suicidality,butthevastmajorityofthesedonotdiebysuicide.Suicidalbehaviourisusually
categorisedaccordingtoseverity,frommild;suchaswishingyouweredeadorhavingsuicidal
thoughts,tomoreserious;seriouslyconsideringorplanningtocommitsuicide,tothemostsevere
form;havingattemptedtocommitsuicide.Themoreseriousthesuicidality,thegreatertheriskof
actuallycommittingsuicide.
Suicidality(regardlessofseverity)ismorecommonamongyoungadultSámiandreindeer-herding
SámiinSwedenthanSwedishcomparisongroups.Whenitcomestothemostseriousdegree–
suicideattempts–nodifferencehasbeenfoundbetweenneithertheSámiinSwedenandSwedes
northeSámiinNorwayandNorwegians(15,16,39).NostudiesexistofsuicidalityamongtheSámi
peopleinFinlandorRussia.
Attitudes towards suicide
Howpeopleinacommunityviewandrelatetosuicideandsuicidalitycanbesignificantforthe
prevalenceofsuicide.Thisisreflectedinthegreatvariationinnumberofsuicidesglobally,whichis
believedtobepartlyduetoculturaldifferences(5).
WhenexaminingattitudestowardssuicideamongSámireindeerherdersinSweden,minor
differenceshavebeenfoundbetweenthemandcomparableSwedes(16).Thedifferencesare
somewhatlarger,however,betweenyoungadultSámiandtheirSwedishpeers.MoreSámiagree
withthestatementsthat“youcanalwayshelpsomeonewithsuicidalthoughts”and“mostpeople
havehadsuicidalthoughts”.TheSámiarealsomorecriticalthanyoungadultSwedesto“notasking
aboutsuicidalthoughtssincedoingsomaybringthemon”(15).Whatcausesthesedifferencesand
whethertheyhaveanyrealsignificanceisnotknown,butitgenerallyseemsasthoughtheyoung
SámiinSwedencantalkandaskaboutsuicidemoreeasilythantheirSwedishpeers.
12
Exposure to violence
Beingsubjectedtodifferenttypesofviolence,especiallysexualviolence,increasestheriskofmental
ill-healthandsuicidality.Thereisanoknowledgewhatsoeveronexposuretoviolenceamongthe
SámiinFinland,Russia,andSweden.ButdatafromtheNorwegiansideofSápmiindicatethatthe
Sámi,likeotherindigenouspeoples,aremoreexposedtoviolencethanmajoritypopulations.The
studyinNorwaysuggeststhattheSámigenerallyexperiencemoreofalltypesofviolence,including
psychological,physical,andsexualabuseinchildhoodandadultlife.ReducingtheSámi’sexposureto
violencecanthuspotentiallyreducesuicidalityamongtheSámipeople.
Health care encounters
Havingaccesstoprofessionalhealthcareandenoughtrusttodaretalkaboutaproblematiclife
situationcanbevitalforasuicidalperson.Communicationinmulti-culturalhealthcareencountersis
complex.Thelanguageandculturalcompetenceofboththeindividualandthecaregiverplayamajor
roleindetermininghowtheencounterisexperiencedandwhethermutualrespectandtrustcan
arisefromit(40,41).
SámispeakersinNorwayaremoredissatisfiedwithprimarycarethannon-Sámispeakers(42),the
SámiinFinlandarelesssatisfiedwithsocialandhealthcareservicesthanthemajoritypopulation
(43),andSámireindeer-herdersinSwedenhavelowertrustinprimarycareandmentalhealth
services(44).SeveralresearchreportsalsoindicatethatmanySámipeopletrytoadapttohealth
carebyhidingordownplayingtheirSámiidentity.Inordernottoriskreceivingsubstandardcare,
theybecome“perfectpatients”whopresentclearsymptomsanddon’trequire“specialtreatment”
(45-47).Mentalhealthproblems,suchassuicidalthoughts,areoftendifficulttodescribeinaclear
mannerandcanbeevenmoredifficulttodescribeif,atthesametime,youtrytohideordownplaya
centralpartofyourownidentity.TheSámipeoplemayalsohavesocioculturalandlinguisticnorms
thatdifferfromthesurroundingmajoritycommunities(48),whichcouldfurthercomplicatetalking
aboutseriousillnessandmentalproblems,includingsuicidalthoughtsandplans.
The situation for LGBTQ Sámi
Oneoftheproblemsthatmayarisewithinalimitedandtightlyknitgroup,liketheSámi,isastrong
socialpressureonhowtobeinordertobeacceptedinthegroup.Thereisverylittleknowledge
abouthowpeople,whoviolatesuchsocialnorms,fareinSápmi.Thestudiesthatdoexist,however,
andthetestimoniesofgay,bisexual,transgender,andqueerSámipeople,clearlyindicatethatthe
lifeofa“minoritywithintheminority”meansparticularvulnerabilitythatmayresultinmentalillhealthandthusincreasetheriskofsuicide.
Suicide prevention among the Sámi people
In1990,theSámiPsychiatricYouthTeam(PUT-SANKS)wasestablishedinKarasjok,asaconsequence
of,andresponseto,asuicideclusteramongyoungSámimeninthemid-1980s.Initially,theteam
wasrunasoneoftheNorwegianGovernment'sdirectlyfundedprojects.Theunitworkswith
suicidalityandalcoholanddrugabuse,andcametoformoneofthecornerstonesofwhatin2001
becametheSámiNorwegianNationalAdvisoryUnitonMentalHealthandSubstanceUse(SANKS).
Inadditiontoclinicalpsychiatricwork,SANKS,andinparticularPUT-SANKS,hasworkedwithsuicide
preventionbyeducatingespeciallyimportantoccupationalgroupsaswellasthegeneralpublic
throughtheprogram“Suicideintervention”4inSámiareasontheNorwegiansideofSápmi.They've
alsoattemptedtomobiliselocalcommunitiestoworkactivelywithsuicidepreventionthrough
4
”Suicideintervention”isaNorwegianversionofASIST-AppliedSuicideInterventionsSkillsTraining.
http://vivatselvmordsforebygging.net/
13
variousprojectssuchas“SuicidepreventionindifferentSámiareas”,“Transparencyandcloseness”
(incollaborationwithTanaMunicipality),“Finnmark,asuicide-safecommunity”(incollaboration
withRVTSNord-Regionalresourcecentreonviolence,traumaticstress,andsuicideprevention,and
FinnmarkCountyGovernor),aswellastheinternationalArcticprojects“HopeandResilience”and
“RISINGSUN”(aworkshopcollaboratorofthisplan).
Akeycomponentinsuicidepreventionistobettermobilisethenetworkalreadyexistingaround
peoplewhoareindangerofcommittingsuicide(5).Supportingfamilymembers,relatives,
colleagues,friends,andotherscaninvolvetrainingthemtorecognisesignsofsomeonebeingatrisk
ofdevelopingsuicidalityortodaretalkaboutsuicidalthoughtswiththepersonthey’reworried
about.Itcanalsoinvolvegenerallyhelpingtobreakthetaboosurroundingthesetopics,makingit
easierforthosesufferingfromsuicidalitytodarespeakopenlyaboutitandseekhelpfromrelatives,
friends,orprofessionals.
Forthepasttenyearsorso,theSámiontheSwedishsideofSápmi–andSámiorganisationssuchas
theyouthorganisationSáminuorraandtheSwedishSámiAssociation–haveexpressedincreasing
concernformentalill-healthandsuicideamongtheSámipeopleinSweden.ManyindividualSámi
havebeguntoopenlyspeakabouttheirmentalill-healthandsuicidalityinordertohighlightthe
issueandmakeiteasiertotalkabout.Severalnon-profitinitiativeshavealsobeenimplemented,
includingSáminuorras”Vaajmoe”Choir5thatsingsandjoikstosupporteachotherandcontributeto
greateropennessaboutmentalill-healthintheSámicommunity.
Image1.TheSámiyouthassociation,Sáminuorra'sVaajmoeChoir,performingandjoikingtostrengtheneachotherand
drawattentiontotheissueofmentalill-healthamongyoungSámi.Photo:Anna-MariaFjellström.
AnincreasingnumberofSàmipeopleinSwedenhaveturnedtoSANKS(inNorway)formentalhealth
care,onthegroundsthattheydon’tfeelthatthey’rebeingunderstoodintheSwedishhealthcare
system.Thisstreamofpatientshascalledforincreasedcooperationbetweencareprovidersand,
since2015,acooperationagreementbetweenSANKSandRegionJämtlandHärjedalen(thatprovides
healthcaretothepeopleintheprovincesofJämtlandandHärjedaleninthesouthSámiareaof
Sweden)supplementsanagreementfrom2007betweenFinnmarkHospitalHF(whereSANKSis
included)andLappihospitaldistrict,inthenorthernmostpartofFinland.Thisagreementenables
SANKStoreceiveSámi-speakingindividualsfromtheLappihospitaldistrict.
GiventhattheSámiindifferentpartsofSápmihavesuchvaryingaccesstomentalhealthcareand
suicidepreventionthatmeetthedemandsonculturalandlinguisticadaption,theinternational
5
«Vaajmoe”issouthSámiandmeans“heart”.
14
SaamiCouncilresolved,byactofCongressin2013,ontheneedformorecross-bordercooperation
toimprovethepsychosocialhealthoftheSámipeople.
Thisplanisalsoanattempttoinitiatemorecoordinatedcross-bordersuicidepreventioninSápmi.
Approach
ThestrategiesarebasedonscientificallydocumentedknowledgerelatedtosuicideamongtheSámi
peopleaswellasondialoguesheldinworkshopswithSámi“grassroots”andexperts.Twoworkshops
havebeenconducted.InFebruary2015,aseminarwasheldinJokkmokk,Sweden,withSámi
grassroots,researchers,andexpertsinSámipsychosocialill-health.InMay2016,aworkshopwas
heldinTromsø,Norway,withdialoguesbetweenSámiinvolvedinsuicideprevention,andsuicide
researchersfromtheArctic(Norway,Sweden,Finland,Alaska,Canada,Greenland,andRussia).This
workshopwasconductedincollaborationwiththeNorwegianInstituteofPublicHealthandthe
RISINGSUNproject(aninitiativeundertheAmericanchairmanshipoftheArcticCouncil2015–2017).
TheentireprojecthasbeenfundedbytheSámiParliamentofNorwayandtheNordicCouncil,
throughNordRegio.
Image2.PsychologistLarsHelanderpresentstheNorthernSámiworkgroup'sprioritiesforsuicidepreventionamongthe
Sámipeople,duringtheTromsøworkshop,May2016.Photo:CanadianInstitutesforHealthResearch(CIHR)
15
Strategy 1: Focusing efforts on the Sámi men
AllavailabledataindicatethatmanymoreSámimenthanwomendiebysuicide(10,11,13,14).This
isalsothesituationintheNordiccountriesthatSápmiispartof,intherestoftheArctic–especially
amongtheindigenouspeople(10),andintheworldatlargewiththeexceptionofChina.Sámimen
standoutwithlesseducationthanSámiwomen(25)andstudiesfromSwedenandFinlandindicate
anunusuallylargegroupwithhazardoususeofalcoholamongreindeer-herdingmen(37,38).
Overall,itseemsthattheSámiwomen,invariousways,managebetterthantheSámimenintoday's
society.
Thisplandoesnotincludeanyconcretesuggestionsonhowtofurtherworkwithfocusonmenother
thanthatallsuicidepreventionamongtheSámipeopleshouldplacespecialemphasisonmen,given
thatwiththeirhigherrateofsuicide,theydoconstitutethemajorriskgroup.
Measures
-
PlacespecialfocusontheSámimeninsuicidepreventionamongtheSámipeople.
Strategy 2: Producing statistics and strengthening research on suicide among the Sámi
Withoutstatisticsontheoccurrenceofapublichealthproblem,it'sverydifficulttocreatean
overviewandtounderstandthetrendandwhethermeasurestakenhaveanyeffect.TheNordic
countriesdonotallowregistrationofethnicity,includingSámiidentity,inpublicrecords.Thismakes
obtainingstatisticsonsuicideamongtheSámipeopleverycomplicated,andobtainingcurrent
(updated)statisticsimpossible.Individualresearchprojectshaveneverthelessproducedhistorical
dataonsuicideindifferentSámigroupsinNorway(from1970–1998),inSweden(from1961–2000),
andFinland(from1979–2005,latersupplementeduntil2010).Thisresearchisincrediblyvaluable
becausewithoutit,itwouldbedifficulttoevenpointtoproblemssuchasthesituationonthe
RussiansideofSápmi.
Knowledgeofothertypesofsuicidality,suchassuicidalthoughts,suicideplansandattempts,vary
widely.ThereissomeknowledgefordifferentSámigroupsinSwedenandNorwaybutnone
whatsoeverinFinlandorRussia.
IncreasingknowledgeofsuicideamongtheSámipeople,includingcontinuouslymonitoringitstrend,
couldstronglysupportspecialeffortsrelatedtosuicideamongtheSámi.Gainingbetter
understandingofthecausesforsuicideamongtheSámi,andhowtobestpreventthem,would
greatlyhelpachievethegoaloffewersuicidesinSápmi.
Measures
-
EnhancetheabilitytoproducestatisticsontheoccurrenceofsuicideamongtheSámiandits
trendovertime.
InitiatenewresearchprojectsthatexaminesuicideamongtheSámipeople,includingcauses
andthebestwaystopreventsuicideamongtheSámi.
Strategy 3: Strengthening Sámi self-determination
TheSámi,asanindigenouspeople,havetherighttoself-determinationoftheirsituationandfactors
affectingthem.Sámiorganisationsandrepresentativeinstitutions(theSámiParliamentsofNorway,
Sweden,andFinland)havepaidincreasingattentionto,andprotestedagainst,decisionswith
consequencesfortheSámi'ssituationbeingtakenwithouttheSámihavinganyrealinfluence.Such
16
decisionsmayrelatetoallareasoftheSámicommunity,buthaveparticularlyseriousandfarreachingconsequenceswhenrelatedtotheuseoflandandwaterinSápmi,whicharethe
fundamentalresourcesfortheSámipeople'sabilitytoworkintraditionalindustries,suchasfishing,
reindeerhusbandry,hunting,and“duodji”(crafts).WhentheSámiaredeniedtheopportunityto
influencesuchissues,theyarealsodeniedtheopportunitytodeterminetheirownsituation,
includingtherighttomaintainanddeveloptheSámiwayoflife.Organisations,(49)aswellas
researchers,(25,29,50)havestressedhowimportantitisthattheSámipeoplebeallowedthis
opportunity,andhowlong-termdestructiveandhazardoussituationscanotherwisearise.TheSámi
havepointedout,bothinthedialoguesofthisplanandinpreviousresearch(26),thattheir
experiencesofpowerlessnessinrelationtothemajoritycommunity’sprioritiesareabreeding
groundfordespair,inwhichdyingbysuicidemaybeconsidereda“wayout”.EnhancingtheSámi
people'sabilitytodeterminetheirownsituationwouldthuspreventtheriskofsuicideamongthem.
Measures
-
EnsurethattheSámiaregivenrealopportunitytoself-determinationbyallowingthemto
influencedecisionsthathavedirectorindirectimpactontheirabilitytocontroltheirown
situation.ThisincludesallaspectsoftheSámicommunity,suchaseducation,culture,and
language,butisparticularlyimportanttotheSámiworkingintraditionalindustriesinwhich
theymustbeallowedtherighttoinfluenceprocessesthatthreatentodestroythebasisof
theirsubsistence.
Strategy 4: Initiating efforts to recognise and deal with historical traumas
Unlikeotherpartsoftheworld,wherehistoricalabuseofindigenouspeoplesandthe
intergenerationalconsequencesofsuchhistoricaltraumasarewelldocumented,hardlyany
informationisfoundinSápmi.Thisissurprising,consideringthatmanyoftheprocessescitedas
destructiveinotherpartsoftheworldhavealsotakenplaceinSápmi,includingboardingschoolsfor
childrenwithnegativeconsequencesforfamilytiesaswellaslinguisticandculturalidentity.More
knowledgeisneededbothonthehistoricaltraumasintheSámicommunityandamongtheSámi
individualsandonwhatsignificancetheyhavetodayonthehealthoftheSámi,includingsuicidality.
Measures
-
Initiateefforts,includingresearch,toclarifyhowhistoricalandintergenerationaltraumas
affectthehealthandsuicidalityoftheSámipeopletoday.
Initiatebroadsocietaleffortstobetterdealwithandprocesstheconsequencesofhistorical
traumasontheSámipeopleandindividuals.
Strategy 5: Strengthening and protecting the Sámi cultural identity
Internationalresearchfromotherindigenousareas,aswellasexistingresearchfromSápmiandthe
experiencesoftheSámipeople,suggestthatthosewithastrongandwell-rootedSámiidentityare
betterpreparedtofacelife’schallenges.TheSámialsohaveaneedandrighttotheirownSámi
culturalenvironment,whichplacesdemandsonmajoritysocietiestobothacceptandactively
strengthentheSámiculturalandlinguisticenvironments,includingeducationandtraditional
industries.
17
Measures
-
-
WorkactivelytostrengthenyoungSámipeople'sculturalidentitythroughlanguageenhancingeffortsandopportunitiestopartakeinculturalactivities.
ProtectanddevelopexistingSámiculturalandlinguisticenvironments,includingthe
opportunityforSámieducationandtraining,especiallyinareaswheretheSámiarein
minorityandwhereexistingSámiculturalandlinguisticenvironmentsaredependenton
individualsorotherwisefragile.
EstablishSámiculturalandlinguisticenvironmentsinareaswheretheSámipeopleliveand
wheretherearenosuchenvironments.
Strategy 6: Reducing the Sámi's exposure to violence
ExistingknowledgeindicatesthattheSámipeopleexperiencemoreviolencethanothersduringtheir
lifetime,bothinchildhoodandadultlife.Sinceexposuretoviolence,especiallysexualviolence,
increasestheriskofsuicidality,therearestrongreasonstobelievethatsuccessfuleffortstoreduce
exposuretoviolenceamongtheSámiwouldalsoreducesuicidality.
Measures
-
StrengthenSámiorganisationsandinstitutionsthatworktoreducetheSámi'sexposureto
violenceandcombatbullyingandethnicdiscrimination.
EnsurethatSámivictimsofviolencehaveaccesstoSámi-speakingandculturalexpertiseif
theyseekhelpandsupporttogetoutofrelationshipswheretheyaresubjectedtosomekind
ofviolence.Today,accesstothisvarieswidely,andsupportsystemsareonlyfoundin
Norway.
Strategy 7: Reducing the Sámi’s experiences of ethnic discrimination
AlotsuggeststhattheSámi'sexperiencesofbeingethnicallydiscriminatedagainstisakeyfactorin
reducingmentalill-healthandsuicidalityamongtheSámipeople.Minimisingtheseincidentsand
experiencesisimportanttoallSámiinallSámiareas,butperhapsparticularlyimportanttothose
withastrongSámiidentitylivinginaminorityposition,astheyaremorealoneandvulnerable.
Measures
-
-
ReduceethnicdiscriminationagainsttheSámipeoplethroughgeneralawareness-raising
workinthesurroundingmajoritypopulations.
StrengthenSámiorganisationsandinstitutionsandensurethattheyactivelyworktohelp
individualSámidealwiththenegativehealthconsequencesfromethnicdiscrimination.This
includes,amongotherthings,takingresponsibilitytorecogniseandstandupagainstethnic
discriminationagainstSámiindividuals.
StrengthentheSámi'sresilience,i.e.resistance,againstnegativehealthconsequencesof
experiencingethnicdiscrimination.
Strategy 8: Increasing diversity and acceptance in the Sámi community
ManyoftheSámithat,invariousways,violatethenormsof“howtobe”intermsofsexualityand
genderidentity,feelthattheirlivesareburdenedbythesurroundingcommunity’sinabilitytoaccept
themforwhotheyare.Thisleadstopeopleleadingunfreelivesaswellassufferingfrommentalill18
healthandbeingatgreaterriskofsuicide.Changingthiswouldlikelydoagreatdealforsuicide
prevention.
Measure
-
Breakthetaboo,stigma,andnegativeattitudesrelatedtonon-normativesexualityand
genderidentitythroughoutSápmi.Thismeansactivelystrengtheningtheforcesand
organisationsworkingtowardsthesegoals.
Strategy 9: Securing the Sámi’s right to equal, linguistically and culturally adapted
mental health care
Providinggoodhealthcareencountersforsuicidalpeopleseekinghelpisalwaysachallenge,butcan
beevenmorecomplicatedifthepersonseekinghelphasnotrustinthecaregiver,orifthereisalack
ofcommonculturalandlinguisticgroundsonwhichtobuildcommunication.Accesstosuchmental
healthcarevariestoanunreasonableextentinSápmitoday,whichhascausedsomeSámiinSweden
tofeelforcedtoseekhelpinNorway,farawayfromhome(51).EnsuringthatmoreSámihaveaccess
toequal,linguisticallyandculturallyadaptedhealthcarehasthepotentialtogreatlypreventsuicide
amongtheSámipeople.
Measures
-
EducatehealthcareprofessionalsinSámiculture.
EnhanceaccesstoSámi-speakinghealthcareprofessionals.
Strengthenanddevelopexistingorganisationsthatprovidelinguisticallyandculturally
adaptedmentalhealthcaretotheSámipeople.Competencemustbeavailablebothlocally
wheretheSámiliveandintheformofmorespecialisedhealthcare.TheSANKSmodelofa
centrallylocatedunitandsmallersatelliteofficescanbeextendedtoothercountries.
Strategy 10: Educating and mobilising the Sámi civil society for suicide prevention
ToensurethattheSámiareincludedinsuicidepreventiontraining,it'snecessarytoadapttraining
linguisticallyandculturally,forexamplebyhavingeducatorswithrelevantSámilanguageand
culturalskills.Tailoredsolutionsmayberequiredtoreachouttoreindeer-herdingenvironments,
whichhavestrongSámilanguageandculturaltiesandwherepractitionersarebothcolleaguesand
competitors.TomobilisetheSámicivilsociety,youmightalsohavetointroducenewinformation
channels,includingsocialmedia,sincetheSámicommunityissparselypopulatedwithlarge
distances.
Measures
-
Communicatetheimportanceoftheentirecommunityparticipating,notjusthealthcare
providers,andthatallcontributionscanmakeadifferenceinsuicideprevention.
EnhancesuicidepreventioncooperationbetweendifferentpartsoftheSámicivilsociety,
includingSámiorganisations,institutions,careproviders,privateindividuals,andothers.
Initiateandconductfurthertraininginsuicideprevention,suchasASISTandSafeTalk,
targetedatespeciallyimportantprofessionalgroupsandtheSámicommunity.
19
Strategy 11: Initiating and strengthening cross-border cooperation for suicide
prevention
TheSámipeopleliveinfourdifferentcountries:Norway,Sweden,Finland,andRussia.Historically,
theSámihavemovedacrossthesenationalborders,bothbyfamilytiesandinpracticingtraditional
occupations.Thetiesacrossbordersarestillverystrongtoday,andmaintainedparticularlythrough
socialmedia.ItisalsoverylikelythattheSámipeopleinthedifferentcountriessharelifechallenges,
includingsuicide-relatedproblems.Toaddressthis,it’snecessarytoincreasecross-border
cooperation,notleastinordertomoreeffectivelyusethelimitedresourcesofhealthcare
professionalswiththenecessarylanguageandculturalskills.Withthisinmind,itisverypositivethat
thereisnowacooperationagreementbetweenSANKS,asaSámipowerhouseonmentalhealth
care,andhealthcareorganisationsinbothFinlandandSweden.
TofurtherincreasecooperationacrossborderswithinSápmiwouldinvolvesharingknowledgeand
experiencesbutalsoprovidingservices,includinghealthcare,inamoreeffectivemanner.Thiswould
resultingreateraccesstotheresourcesavailable,whichwouldgreatlyhelpsuicideprevention
amongtheSámipeople.
Measures
-
-
Initiatecooperationbetweenallparties,includinggovernments,healthcareproviders,
regionalandmunicipalorganisations,Sámiorganisations,andotherswhohaveanimportant
partinsuicidepreventionamongtheSámipeople.
IncludetheSámiperspectiveincountries’generalsuicidepreventionefforts,bothnationally
andinternationally.Thisentailsincludingspecialfocusonthespecificneedsofindigenous
peoplesinnationalsuicidepreventionprograms.
20
-
1.
UnitedNationsDeclarationontheRightsofIndigenousPeoples.2007.p.9.
2.
RetterstølN,EkebergØ,MehlumL.Selvmord–etpersonligogsamfunnsmesssigproblem.
Oslo:GyldendalAkademisk;2002.
3.
SchneidmanE.DefinitionofSuicide.NewYork:Wiley;1985.
4.
NationelltochStockholmslänslandstingscentrumförsuicidforskningochpreventionav
psykiskohälsa.Förslagtillnationelltprogramförsuicidprevention–strategierochåtgärdsförslag
inriktademothälso-ochsjukvården,socialtjänstenochskolhälsovården/elevhälsan2006.
5.
WorldHealthOrganization.PublicHealthActionforthePreventionofSuicide:aFramework.
Geneva,Switzerland:WHODocumentProductionServices;2012.
6.
WorldHealthOrganization.WHOMortalityDatabase.2017.
7.
Helsedirektoratet.Handlingsplanforforebyggingavselvmordogselvskading2014–2017.
Oslo:Helsedirektoratet;2014.
8.
Socialstyrelsen,StatensFolkhälsoinstitut.Förslagtillnationelltprogramförsuicidprevention
–befolkningsinriktadeochindividinriktadestrategierochåtgärdsförslag2006.
9.
UpanneM,HakanenJ,RautavaM.Cansuicidebeprevented.ThesuicideprojectinFinland.
1992;1996.
10.
YoungTK,RevichB,SoininenL.Suicideincircumpolarregions:anintroductionandoverview.
IntJCircumpolarHealth.2015;74:27349.
11.
SoininenL,PukkolaE.MortalityoftheSamiinnorthernFinland1979-2005.IntJCircumpolar
Health.2008;67(1):43-55.
12.
HasslerS,SjolanderP,JohanssonR,GronbergH,DamberL.Fatalaccidentsandsuicide
amongreindeer-herdingSamiinSweden.IntJCircumpolarHealth.2004;63Suppl2:384-8.
13.
SilvikenA,HaldorsenT,KvernmoS.SuicideamongindigenousSamiinArcticNorway,19701998.EurJEpidemiol.2006;21(9):707-13.
14.
HasslerS,JohanssonR,SjolanderP,GronbergH,DamberL.CausesofdeathintheSami
populationofSweden,1961-2000.IntJEpidemiol.2005;34(3):623-9.
15.
OmmaL,SandlundM,JacobssonL.SuicidalexpressionsinyoungSwedishSami,acrosssectionalstudy.IntJCircumpolarHealth.2013;72.
16.
KaiserN,SalanderRenbergE.SuicidalexpressionsamongtheSwedishreindeer-herdingSami
population.Suicidologyonline.2012;3:114-23.
17.
StoorJPA.Kunskapssammanställningompsykosocialohälsablandsamer.Kiruna:
Sametinget;2016.
18.
BalsM,TuriAL,SkreI,KvernmoS.Internalizationsymptoms,perceiveddiscrimination,and
ethnicidentityinindigenousSamiandnon-SamiyouthinArcticNorway.EthnHealth.
2010;15(2):165-79.
19.
HeyerdahlS,KvernmoS,WichstromL.Self-reportedbehavioural/emotionalproblemsin
Norwegianadolescentsfrommultiethnicareas.EurChildAdolescPsychiatry.2004;13(2):64-72.
20.
KvernmoS.MentalhealthofSamiyouth.IntJCircumpolarHealth.2004;63(3):221-34.
21
21.
KvernmoS,RosenvingeJH.Self-mutilationandsuicidalbehaviourinSamiandNorwegian
adolescents:prevalenceandcorrelates.IntJCircumpolarHealth.2009;68(3):235-48.
22.
SilvikenA,KvernmoS.SuicideattemptsamongindigenousSamiadolescentsandmajority
peersinArcticNorway:prevalenceandassociatedriskfactors.JAdolesc.2007;30(4):613-26.
23.
OmmaL,JacobssonLH,PetersenS.ThehealthofyoungSwedishSamiwithspecialreference
tomentalhealth.IntJCircumpolarHealth.2012;71:18381.
24.
KaiserN,SjolanderP,Edin-LiljegrenA,JacobssonL,SalanderRenbergE.Depressionand
anxietyinthereindeer-herdingSamipopulationofSweden.IntJCircumpolarHealth.2010;69(4):38393.
25.
KaiserN.MentalhealthproblemsamongtheSwedishreindeer-herdingSamipopulation:in
perspectiveofintersectionality,organisationalcultureandacculturation[dissertation].Umeå:Umeå
Universitet;2011.
26.
StoorJPA,KaiserN,JacobssonL,Salander-RenbergE,SilvikenA."Wearelikelemmings":
makingsenseoftheculturalmeaning(s)ofsuicideamongtheindigenousSamiinSweden.IntJ
CircumpolarHealth.2015;74:27669.
27.
NystadK,SpeinAR,IngstadB.CommunityresiliencefactorsamongindigenousSami
adolescents:aqualitativestudyinNorthernNorway.TranscultPsychiatry.2014;51(5):651-72.
28.
AllenJ,HopperK,WexlerL,KralM,RasmusS,NystadK.Mappingresiliencepathwaysof
Indigenousyouthinfivecircumpolarcommunities.TranscultPsychiatry.2014;51(5):601-31.
29.
OmmaL.UngsameiSverige:livsvillkor,självvärderingochhälsa[YoungSamiinSweden:life
circumstances,self-evaluationandhealth][dissertation].Umeå:Umeåuniversitet;2013.
30.
HansenKL.Ethnicdiscriminationandhealth:therelationshipbetweenexperiencedethnic
discriminationandmultiplehealthdomainsinNorway'sruralSamipopulation.IntJCircumpolar
Health.2015;74:25125.
31.
HansenKL.Ethnicdiscriminationandbullyinginrelationtoself-reportedphysicalandmental
healthinSamisettlementareasinNorway:theSaminorstudy.Tromsö:UiT-NorgesArktiske
Universitet;2011.
32.
HansenKL,SørlieT.Ethnicdiscriminationandpsychologicaldistress:astudyofSamiandnonSamipopulationsinNorway.TranscultPsychiatry.2012;49(1):26-50.
33.
ParadiesY,BenJ,DensonN,EliasA,PriestN,PieterseA,etal.RacismasaDeterminantof
Health:ASystematicReviewandMeta-Analysis.PLoSOne.2015;10(9):e0138511.
34.
OmmaL,PetersenS.Health-relatedqualityoflifeinindigenousSamischoolchildrenin
Sweden.ActaPaediatr.2015;104(1):75-83.
35.
SpeinAR.SubstanceuseamongyoungindigenousSami--asummaryoffindingsfromthe
NorthNorwegianYouthStudy.IntJCircumpolarHealth.2008;67(1):122-34.
36.
OmmaL,SandlundM.AlcoholuseinyoungindigenousSamiinSweden.NordJPsychiatry.
2015;69(8):621-8.
37.
KaiserN,NordströmA,JacobssonL,SalanderRenbergE.Hazardousdrinkinganddrinking
patternsamongthereindeer-herdingSamipopulationinSweden.SubstUseMisuse.
2011;46(10):1318-27.
38.
PoikolainenK,NayhaS,HassiJ.Alcoholconsumptionamongmalereindeerherdersof
LappishandFinnishorigin.SocSciMed.1992;35(5):735-8.
22
39.
SilvikenA.Prevalenceofsuicidalbehaviouramongindigenoussamiinnorthernnorway.IntJ
CircumpolarHealth.2009;68(3):204-11.
40.
DagsvoldI,MøllersenS,StordahlV.Whatcanwetalkabout,inwhichlanguage,inwhatway
andwithwhom?Samipatients'experiencesoflanguagechoiceandculturalnormsinmentalhealth
treatment.IntJCircumpolarHealth.2015;74:26952.
41.
DagsvoldI,MollersenS,StordahlV."YouneverknowwhoareSamiorspeakSami"Clinicians'
experienceswithlanguage-appropriatecaretoSami-speakingpatientsinoutpatientmentalhealth
clinicsinNorthernNorway.IntJCircumpolarHealth.2016;75:32588.
42.
NystadT,MelhusM,LundE.Samispeakersarelesssatisfiedwithgeneralpractitioners'
services.IntJCircumpolarHealth.2008;67(1):114-21.
43.
HeikkiläL,Laiti-HedemäkiE,PohjolaA.Saamelaistenhyväelämäjahyvinvointipalvelut.
Rovaniemi:LaplandUniversityPress;2013.
44.
DaergaL,SjolanderP,JacobssonL,Edin-LiljegrenA.Theconfidenceinhealthcareandsocial
servicesinnorthernSweden--acomparisonbetweenreindeer-herdingSamiandthenon-Sami
majoritypopulation.ScandJPublicHealth.2012;40(6):516-22.
45.
HedlundM,MoeA."Deforstårikkehvasomerviktigfoross":helsetjenesterogsørsamer.
Steinkjer:Nord-Trøndelagsforskning;2000.
46.
MelbøeL,JohnsenB-E,FedreheimGE,HansenKL.Situasjonentilsamermed
funksjonsnedsettelse(r).HøgskoleniHarstad,Seksjonforvernepleie;2016.
47.
NessTM,EnmarkerI,HellzènO.Experiencesofbeingoldandreceivinghomenursingcare.
OlderSouthSaminarrationsoftheirexperiences—Aninterviewstudy.OpenJournalofNursing.
2013;03(01):1-7.
48.
BongoBA."Samersnakkerikkeomhelseogsykdom"–Samiskforståelseshorisontog
kommunikasjonomhelseogsykdom.Enkvalitativundersøkelseisamiskkultur.Tromsø:
UniversitetetiTromsø;2012.
49.
InternationalCentreforReindeerHusbandry,AssociationofWorldReindeerHerders,UArctic
EALÁTInstitute.Youth.TheFutureofReindeerHerdingPeoples.ArcticCouncil´sEALLINReindeer
HerdingYouthProject2012-2015.;2015.
50.
SilvikenA.Reindriftpåhelsalös.Arbeidsrelatertstressireindriftsnäringenilysavmark
Williamsmodell"CryofPain".Suicidologi.2011;16(3).
51.
StoorJPA.VarförsökersvenskasamervårdiNorge?-omkulturochkontextisamisk
psykiatri.Socialmedicinsktidskrift.2015;1.
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