In the fall of 2009, four young people in the southeastern part of the state died by suicide. Three were Mescalero Apaches.
Just a few months later, in the spring of 2010, five Navajo teens also died by suicide in Thoreau, a town in Western New Mexico of fewer than 2,000.
The series of Native American teen suicides those two years made it clear: New Mexico was experiencing a crisis.
Yet despite a growing awareness of the problem and repeated requests for help, the New Mexico Legislature has failed to dedicate sustainable funding to suicide prevention and intervention programs for Native American youth.
Lawmakers and the governor will again be asked to fund programs focused on suicide prevention for Native American youth when the Legislature convenes a 30-day session this month.
The reasons for suicide are often unclear. The risk factors are complicated and regularly intertwined. Among Native youth, in particular, experts point to everything from a lack of available and accessible behavioral health services to untreated mental illness, poverty and historical trauma.
One of the most significant risk factors? Knowing someone who has died by suicide. For Native youth, who often live in small, isolated communities, that's a real issue. The rate of suicide among Native American youth in New Mexico is nearly four times the national rate of suicide among all 15-24 year olds, according a recent report from the state's Health Department.
Many communities, agencies and families are wrestling with those complexities. They know effective suicide prevention requires acknowledging the dynamic interplay of multiple risk factors.
Sabrina Strong likens it to walking along a river and spotting people who are being swept downstream.
"You're going to try to rescue as many people as possible. But someone has to run upstream and see why people keep falling into the water," said Strong, of the New Mexico Suicide Prevention Coalition. "In public health work, we're trying to back up and ask, 'Where do things go wrong?'"
She adds people can't just look for a simple answer, like bullying or a breakup.
"OK, but there were 12 signs along the way," she said. "It doesn't just happen."
Not all Native communities in New Mexico have problems with youth suicide, and suicide and its effects transcend race and age, said Doreen Bird, a community-based research specialist at the UNM Center for Rural and Community Behavioral Health.
"As human beings, we can all be faced with these issues," she said. "You can see someone every day and not know what they were going through, not know what they are feeling."
'We don't want just an idea'
The problem isn't limited to New Mexico: In some places, including the Upper Midwest and Great Plains, the youth suicide rate in Indian Country is five to seven times the national average.
In March 2010, the U.S. Senate Committee on Indian Affairs convened a hearing on youth suicide in Indian Country. Calling it a "preventable epidemic," senators listened to behavioral health experts and others discuss problems and potential solutions.
Coloradas Mangas, a Chiricahua Apache from the Mescalero Apache Reservation in Southern New Mexico and, at the time, a sophomore at Ruidoso High School, testified. Identifying himself as a "survivor of teen suicide," he listed friend after friend who had died by suicide in recent years -- six friends total, plus his grandmother. Mangas also recalled receiving a distressed friend's text message. Not knowing what to do, he called law enforcement. When no one responded, he said he walked for three hours, looking for her in the forest. He found her.
"It was a good thing I found her when I did," Mangas told the Senate committee. "Otherwise, she would have been gone forever."
He knew then he needed help, too -- that helping his friends "was bigger than I could handle by myself."
Mangas found help, he said, but feared other teens might not.
"I am more of an exception than the rule because most youth would not go to the mental health clinic," he told the senators. "The stigma and shame keeps people away."
He also offered recommendations: boosting mental health services, streamlining Medicaid approval for people who are referred to residential treatment centers, making sure tribes provide their young people with access to activities and overcoming the stigma and taboo of talking about death and suicide.
"I am also from a new generation of young men and women who believe in breaking the silence and seeking help," Mangas told the committee, adding: "I believe in change."
As U.S. senators were seeking to address the problem, changes were happening in New Mexico, too.
After the 2010 deaths in Thoreau, an ad hoc group of community leaders, educators and health workers gathered to discuss ways to address suicide among Native American youth in New Mexico. Their work grew into a proposal for a clearinghouse that would connect people from the state's diverse Native American communities with culturally appropriate prevention initiatives.
Then, in March 2011, Gov. Susana Martinez signed the Native American Suicide Prevention bill, which officially created the statewide clearinghouse.
Flanked by students, lawmakers and educators at Shiprock High School on the Navajo Nation, Martinez sympathized that young people feel so devastated that taking their own lives "is the only option."
"What we need to do is make sure they understand that there are other options, that they don't have to take that ultimate step, and that they matter," Martinez told The Associated Press.
The bill's sponsor, former state Sen. Lynda Lovejoy, D-Crownpoint, was there, too. At the time, she told the AP: "We want this to be effective. We don't want just an idea."
But the bill included none of the funding requested for the clearinghouse or prevention programs for Native youth. The Legislature had stripped $150,000 for the clearinghouse and $300,000 for prevention programs for Native youth before the legislation reached Martinez's desk.
Established but unfunded, the clearinghouse was set up through UNM's Center for Rural and Community Behavioral Health, with technical assistance from the New Mexico Department of Health. According to the department's spokesman Kenny Vigil, the state initially helped supervise an AmeriCorps volunteer to assist with the project; the state's youth suicide prevention coordinator also offered guidance and attended workgroup meetings.
The next year, 2012, lawmakers and the governor approved $100,000 for UNM's work on the clearinghouse in fiscal year 2013, which ended June 30.
What didn't make it into the state budget was $300,000 sought by Rep. James Roger Madalena, D-Jemez Pueblo, for three culturally-based Native American youth suicide prevention initiatives. That bill failed.
Funding that focuses on Native American youth suicide prevention is needed, advocates say. Although there is state and federal money for suicide prevention, those resources are spread thin across the entire state and serve all demographics.
Supporters of funding for Native American youth are readying themselves for another attempt to win state dollars: In mid-December, members of the Legislature's Indian Affairs Committee voted unanimously to try to secure money in the upcoming session. Madalena has pre-filed such legislation for the upcoming session.
Given the diversity of the state's Native communities and the long miles between many of them, suicide prevention work can be challenging -- especially when programs originate from outside the community.
Researchers and public health workers must engage directly with individual tribes and draw on the experts already present within each community, said Robyn Atencio, a mental health counselor at Five Sandoval Indian Pueblos, a nonprofit that administers grants and provides services for the pueblos of Cochiti, Jemez, Sandia, Santa Ana and Zia in central New Mexico.
"Intervention needs to be unique," she said, "and tailored to communities."
Tribal input is important for another reason: Historically, university researchers have visited tribal communities, gleaned stories and information, and then taken ownership of that "data," Atencio said. In other words, Native American people would talk about their culture, religion, and family and cultural histories. Departing from the community, researchers would weave that information into books, academic dissertations or articles. Oftentimes, trust was betrayed; but almost always, that information was co-opted by "experts" whose work never reached -- or benefited -- Native people.
"We don't want to do that," said Sheri Lesansee, Native American behavioral health program manager at UNM's Center for Rural and Community Behavioral Health, which houses the clearinghouse.
A tribal consultation board, created by the Legislature and made up of leaders within Native American communities, is supposed to advise UNM on the clearinghouse. The group held its first meeting in December.
Bird, the community-based research specialist at the UNM center, has spent time listening to tribes' concerns, meeting leaders and community members. Building trust is critical, she said.
For Bird and Lesansee, both of whom are Native, recognizing risk factors and problems is crucial to addressing the problem of youth suicide. So is emphasizing resiliency and hope.
In May, the center and its community and agency partners sponsored a summit for tribal leaders, policymakers, community members and young people to share the experiences and best practices for intervening when someone is at risk. Young people created a video in which they tell tribal leaders what they need.
"The youth are ready to talk about it, to be engaging on it," Lesansee said. "We don't want to lose their voices in this."