6 March 27th-april 2nd, 2025 phoenixnewtimes.com PHOENIX NEW TIMES | NEWS | FEATURE | FOOD & DRINK | ARTS & CULTURE | MUSIC | CONCERTS | CANNABIS | Lives at Stake Arizona has a Native American suicide crisis. Here’s why. BY SAHARA SAJJADI D uring the most vulnerable years of her young life, Kristin Payestewa-Picazo felt hopelessly alone. As a Navajo and Hopi girl growing up in Flagstaff, she was bullied by classmates because she was Native American. Her mother struggled with alcoholism and other mental health issues. Payestewa-Picazo struggled, too, and felt that she had no one with whom she could share her burdens. She began to cut herself on her thighs and eventually her wrists, rationalizing that she was “taking control of my mental health by taking it out on myself.” By 16, she made peace with the possibility that one wrong cut could end her life. Anything to make her psychic pain fade away. When her stepfather discovered her cuts and urged her to stop, shame consumed her. She stopped eating and became dangerously thin. When she nearly passed out at her high school graduation, her grandmother begged her to eat and to heal. Payestewa-Picazo ate, but she also drank. By 20, alcohol had become a problem. Deep down, she knew she was trying to die. It wasn’t until Payestewa-Picazo turned 24 and met her now-husband that she finally sought help. She has steered out of the skid that defined her adolescent years, but to that point, her story had been an all- too-common tale among Native Americans. In Arizona, Indigenous people — those that belong to the American Indian and Alaska Native demographics, as tracked by the Arizona Department of Health Services — kill themselves at a far higher rate than the overall population. Last year, there were 31.9 suicides per 100,000 Indigenous people in the state, compared to an overall rate of 19.7 per 100,000 Arizona residents. That was actu- ally a slight dip in Native suicides from 2023, when the rate was 35 per 100,000. In Arizona, no other racial demographic comes close. Those numbers signal a crisis, and one that has persisted in Arizona for years. In 2022, the state health department outlined a plan to collaborate with tribal leadership and other agencies to support mental health initiatives in Maricopa County and surrounding areas. Native Americans’ suicide rate may have dipped, but it’s still devastatingly high. The reasons for that are several. Discussing mental health remains taboo for many, and those who do seek help — especially those living in tribal communi- ties — find that care facilities are too far away. When they make the trek, they too often find doctors who aren’t Native and are not able to bridge cultural divides. Growing up, Payestewa-Picazo’s family never discussed mental health. She never knew there were resources for people like her who were struggling. When she finally sought help, it took about a year of cycling through therapists to find one who shared her cultural identity. Now, at 37 years old, she is a PhD candidate studying health equity for Indigenous nurses and physicians. She feels ready to talk about her strug- gles, break these cycles and encourage healing for Native youth. She knows that if there were more mental health resources and less hesitancy to talk about it, she might have spared herself years of suffering. The numbers don’t lie — this is a full-blown mental health emergency. And until it’s treated like one by those with the power to fix it, Native health advocates like Payestewa-Picazo know that an alarming number of Native people who feel there is no way out will attempt to take their lives. “The world is burning,” Payestewa- Picazo said. “We need to have people that hold power, whether you’re in health care, whether you’re in government, to speak out.” Too many obstacles Darien Fuller remembers going to an Indian Health Services facility as a child growing up in the Navajo Nation. The drive was long, as were the wait times. The staff weren’t Native and didn’t look like her. Could she trust them? “It was scary, rushed and not very comforting,” said Fuller, a member of the Prairie Band Potawatomi and Diné tribes. “A little kid is scared of all the noises. It was very cold and it didn’t feel like a very safe place to go to seek care.” Fuller’s family didn’t have much of a choice — the IHS clinic was the only one around. But it often took so long to be seen or receive simple prescriptions that they felt discouraged from coming back. If they were referred to a specialist, that just meant driving to see someone who was even farther away. How seriously would you have to need the doctor to drive an hour there and back? When accessing healthcare is such a burden, people dismiss their own physical and mental health challenges. A 2023 report by Native Health, a nonprofit orga- nization that provides health and wellness services to Native Americans, found that The suicide rate for Native Americans in Arizona is far higher than that for any other racial demographic. (bojorgensen/Adobe) 27% of people in Arizona’s Indigenous communities said they couldn’t access care because they lacked transportation. Another 27% pointed to the long distances to healthcare facilities. On top of long commutes, a lot of Native communities are less likely to be insured than the population as a whole. Arizona has some of the highest uninsured rates, a gap that the Arizona Health Care Cost Containment System, the state’s Medicaid program that provides coverage for lower- income communities, is meant to address. However, accessing AHCCCS requires heaps of time-consuming paperwork. “There’s so many hoops to jump through, and the websites can get confusing,” said Fuller, who is now an epidemiologist specializing in health disparities in tribal communities. “If you have an elder that you’re taking care of, they’re not going to have the digital knowl- edge to navigate a confusing government website.” Fuller advocates for prioritizing community-based services in rural Native communities. A report by The Commonwealth Fund found that when marginalized groups receive health care services from medical professionals of the same background, health outcomes improve. Doctors understand patients and patients trust doctors more when they share a cultural understanding. That was certainly the experience for Christina Andrews. A longtime advocate for public and mental health for Indigenous people, Andrews felt lost when she spiraled into depression at 52 years old. The idea of going to a doctor at IHS, an institution run by the U.S. government, was out of the question. That distrust of federal institutions is well-earned in Native communities, baked into family histories. Andrews’ grand- mother was a child when she was abducted while playing in a field and placed in one of Arizona’s 47 government-run boarding schools. The school cut Fillman Childs Bell’s hair, demanded she stop speaking her native tongue and forced her to dress in Western clothing. After three months, her family rescued her, but the trauma stayed with her for years to come. Thousands of Indigenous children were subjected to the same traumatic experi- ence, with consequences that reverberate for their descendants. Childs Bell struggled with mental health, as did her daughter, Mary Louise. Children whose parents struggle with depression are three to four times more likely to develop mental health issues. How a parent copes (or doesn’t) with a mental health crisis affect their chil- dren, whose own battles affect their chil- dren and so on. Too many Native Americans battling that kind of generational trauma are unable to find professionals who can genuinely connect with them. Patients who >> p 10 Kristin Payestewa-Picazo is a PhD candidate studying health equity for Indigenous nurses and physicians. (Courtesy of Kristin Payestewa-Picazo) | NEWS | | NEWS |
