NORTH DAKOTA PROGRAM DECREASES YOUTH SUICIDES

Matthew Gever           

After reaching frightening heights in the 1990s, youth suicide rates in North Dakota have steadily decreased in the 2000s. State and tribal leaders attribute much of the progress to the North Dakota Adolescent Suicide Prevention Project.

Launched in 2000, the Project focuses on teens and young adults because of their disproportionate rates of suicide. During the 1990s, suicide rates for the 15-24 age group averaged 20.0 per 100,000 residents, almost twice the national average of 12.5 per 100,000 for the same age group. For teens and young adults, suicide “is our number two cause of death,” said Mark LoMurray, director of the Project.

The program has proven to be so successful that it received a national award from the American Public Health Association. From 2000 to 2004, youth suicides fell by 47 percent, according to LoMurray.

Project leaders work with dozens of tribal and rural communities to develop strategies such as training professionals and peers to recognize and help troubled youth, establishing mentoring programs and increasing access to treatment. (A survey showed that about 70 percent of youth and young adults who had contact with medical professionals due to a suicide attempt in rural and tribal North Dakota had received no services two weeks later.)

One of the key parts of the Project involves training adolescents to recognize the risk factors that can lead to suicidal ideation. There was some debate as to whether youth should be so intimately involved. However, “kids are already dealing with suicide issues in their peer groups,” said LoMurray.

Warning Bells

Traditional suicide prevention efforts focus on treating individuals who have clear symptoms of suicidal ideation, such as severe depression or talking about suicide. One goal in North Dakota was to reach out to people before such symptoms developed.

A key piece of the Project involves training youth to become “gatekeepers” who can identify the risk factors—such as substance abuse, trauma and conflict—that may exist even before clear signs of suicidal ideation. In addition, teens are taught to ask a series of questions that emphasize sources of support and help determine if an individual needs further counseling. Teens may suggest “informal sources” for counseling—adults and institutions they know personally—and “formal sources”—professionals who deal with suicide. So far, the gatekeeper program has trained about 8,500 teens on how to deal with friends who may be at risk.

An additional resource, funded by the Mental Health Association in North Dakota (MHAND), is 211, a free 24/7 phone number that refers people to help and crisis intervention. The phone service has been in operation since 2004, and is used also by people in border towns in Minnesota.

A High Toll

The Suicide Prevention Project has a special focus on Native Americans, who make up just over 4 percent of North Dakota’s population but account for 10 percent of all suicides in the state. In the 1990s, the suicide rate for this group was nearly triple that of white residents, reaching an average of nearly 30 suicides per 100,000 residents. Factors that lead to the high rates among Native Americans include “depression, mental illness, bullying, access to lethal means, alcohol and other drugs, loneliness and isolation, historical trauma and very limited access to mental health services,” said Dennis Renville, chairman of the National Tribal Steering Committee for Injury Prevention.

The Project has a variety of efforts aimed at reaching youth in tribal areas. For example, over 60 third-year medical students and 80 nursing students were trained in evidence-based suicide and substance abuse prevention methods, and in a holistic model for suicide interventions. The students then participated in a year-long mentoring program for middle school adolescents in tribal areas. A survey of the mentored adolescents found a 35 percent reduction in suicidal ideation and a 38 percent drop in feelings that their families did not care about them.

Substance abuse plays a major role in many youth suicides. Susan Helgeland, executive director of the MHAND, noted that the state has a “culture of acceptance of beer drinking” for youth. Heavy drinking it tied to depression, and “ninety percent of completed suicides are related to depression,” said Helgeland. Additionally, in approximately 65 percent of teen suicides, the youth is drunk or high at the time of an attempt or fatality, according the Project’s web site.

The Project has drawn on a wide variety of funds, tapping 12 different sources since its inception including the state Departments of Health and Human Services, private foundations and the state Mental Health Association. Project leaders now plan to work with the Department of Health, which has received a grant of $400,000 from the Substance Abuse and Mental Health Administration under the Garrett Lee Smith Memorial Act for youth suicide prevention.