Promising Approaches to Suicide Prevention in Indian Country

Understanding the Crisis of Suicide in American Indian and Alaska Native (AI/AN) Communities

Suicide is one of the leading causes of death in the United States. According to the Centers for Disease Control and Prevention (CDC), nearly 50,000 individuals died by suicide in 2022— roughly 1 death every 11 minutes. Looking at specific communities, Non-Hispanic American Indian and Alaska Native (AI/AN) individuals have the highest rates of suicide of any group, including an increased prevalence among young AI/AN people. In 2021, the rate of death by suicide was 23% higher among AI/AN youth aged 10 to 24 than among their White counterparts (36 per 100,000 compared with 12 per 100,000). Even more concerning is that suicide rates among AI/AN communities increased nearly 20% from 2015 to 2020, far outpacing the <1% increase among the overall U.S. population.

Suicide risk factors are complex and multi-leveled. They include individual characteristics, as well as familial, community, and structural factors such as poverty, discrimination, and availability of and access to quality and culturally appropriate health care. In addition, these risk factors are linked to historical, cultural, political, and economic issues that specific populations experience. For AI/AN communities, the risk factors are understood in the context of historical and ongoing structural inequities driven by settler colonialism. 

Given the suicide crisis among some AI/AN communities, there has been increasing focus by researchers on suicide prevention. To reduce deaths by suicide within AI/AN communities, culturally informed practices and evidence-based interventions led by Indigenous people are an essential path forward. 

Current approaches to suicide prevention

Over the past decade, several federal agencies, including CDC, the National Institutes of Health (NIH), the Indian Health Service, and the Substance Abuse and Mental Health Services Administration (SAMHSA), have supported suicide prevention efforts among AI/AN communities, implementing a range of culturally specific prevention interventions and strategies. The following are four examples of evidence-based suicide prevention efforts in Indian Country:

• Camp Pigaaq—funded by SAMHSA’s Garrett Lee Smith grants—is run by Maniilaq Association Wellness Program, a tribal health and social service nonprofit organization serving Northwest Alaska. Camp Pigaaq is a culture camp that engages AN youth. This 5-day intervention involves youth in subsistence activities, helps them build new relationships, develops life skills, and teaches traditional knowledge and values as part of a health promotion effort. The program was piloted in 2012 and has inspired the creation of other culture camps throughout Alaska. Although not focused on suicide prevention explicitly, the camp draws on the notion that culture heals. Research indicates that the camp has had positive impacts on youth’s psychosocial outcomes related to wellness and suicide risk.  
   
• Celebrating Life—funded by NIH—was developed through a partnership between the White Mountain Apache Tribe and the John Hopkins Center for Indigenous Health. To support individuals at risk for suicide, the research team set up a local surveillance and follow-up system across northeastern Arizona to measure the prevalence of suicide ideation, attempts, and death and to connect vulnerable youth to appropriate health care services. The program is maintained by community mental health specialists and has been incredibly successful in contributing to reduced suicide rates. In the first 12 years of implementation, White Mountain Apache saw a 38% decrease in suicide deaths and a 53% decrease in suicide attempts. 
   
• The Qungasvik (Tools for Life) toolbox was developed by Yup’ik AN communities to reduce and prevent alcohol use disorder and suicide among youth in rural AN communities. This NIH-funded intervention enhances protective factors— such as reasons for life—to buffer suicide risk, as well as reflective processes about alcohol consequences to buffer alcohol risk. Following the intervention, researchers observed reductions in community organizational fragmentation, increased participation in Indigenous ceremonies, reductions in interpersonal violence, enhanced parental functioning and mental health, and increased place-based connection among others.
   
• The Lumbee Rite of Passage is an academic-community partnership among the Maya Angelou Center for Health Equity, the University of North Carolina at Pembroke, and the Lumbee Tribe of North Carolina that developed and implemented a suicide prevention program for Lumbee youth in North Carolina. With funding from NIH, the project team built a Community Advisory Board to guide the research process, ensure that the process is responsive to and respectful of communities, and create partnerships to promote sustainability and enable expansion. Their community-based participatory research approach demonstrated the feasibility of implementing a tribal-based suicide prevention program and laid the groundwork for future cultural connectedness-based programming to address mental health in Lumbee youth. 

Learnings from innovative suicide prevention programs in Indian Country

Community-led interventions are imperative to address suicide, particularly in Indian Country. These interventions ensure that prevention efforts are culturally relevant, trusted, and sustainable. By empowering communities to take the lead, interventions can effectively address their distinct challenges, uncover unique strengths, and promote long-term well-being and resilience. 

The interventions also emphasize the importance of leading suicide prevention efforts that are culturally centered and holistic and of integrating traditional values and practices into care. Rather than viewing suicide prevention as an individual matter, researchers should also consider how structural, societal, and community contexts can work together to build mental wellness and well-being. Research indicates that suicide risk is influenced by multiple factors; therefore, interventions must consider contexts beyond the individual and highlight the interconnectedness of personal, social, and environmental factors to create a lasting impact on youth. 

Suicide is a dire national emergency, and we can learn from the growing body of AI/AN suicide prevention interventions. As we look to expand the interventions used among AI/AN communities, researchers can build on efforts that are already showing success, offering the promise to reduce risks of suicide death and address the health disparities associated with suicide risk in AI/AN communities. RTI continues to study and evaluate suicide prevention interventions that focus on AI/AN communities and more broadly in hopes of expanding the evidence, and promising programs that can reduce risks of death by suicide. 

Learn more about RTI’s data-driven research on effective suicide prevention.

This piece was supported by Dr. Antonio Morgan Lopez's RTI Fellow Funds.