FORT TOTTEN, N.D.-In 2008, Spirit Lake Nation tribe member Cora Whiteman lost her teenaged daughter, Jami, 14, to suicide.
As the Whitemans went through the traditional healing process that follows such a loss, Cora said it was as if they received a message from Jami; to tell other youth contemplating suicide to stay in this life.
From there, Cora and her family went to their community-and to Washington, D.C., for a forum on youth suicide-to speak publicly to prevent others from following that path.
"We wanted to get her message out there," Whiteman said. "Not only that, we wanted to talk about the pain parents go through when they lose someone to suicide. Losing a child, it's not the same as losing another relative, another family member."
Last week, a Spirit Lake suicide prevention program received a federal grant for more than $195,500 in funding. If the program goes as hoped and the money continues to be available through the Legislature, that sum could grow to more than $977,000 over the next five years.
The project is known as the Recovery and Wellness Outreach Suicide Prevention Program. Its scope is broad and includes objectives such as training peer mentors, building awareness of suicide and the red flags of suicide ideation, tearing down stigmas related to mental health and improving the intervention process for at-risk youth.
Through that approach, the tribe wants to decrease the number of suicide attempts among people aged 24 and younger by 10 percent each year over the life of the grant.
In a grassroots strategy, the program has a goal to train 80 youth as peer leaders and 30 adults as mentors. Other checkpoints for the project include screening 400 youth for suicide warning signs and providing prevention services to 900 youth and 300 adults annually.
Spirit Lake Tribal Planning Director Ila McKay said suicide is a prominent public health issue on the reservation lands. She estimated "at least" one case of suicide a month over the last year.
"There's a lot of pain, a lot of confusion and a lot of anger in the community," McKay said.
As of 2015, suicide was the second leading cause of death nationwide among American Indians and Alaska Natives aged 10 to 34 years, according to data from the Centers for Disease Control. Among that same age group, the suicide rate was 1.5 times higher for native populations than for the national average.
In North Dakota, suicide is the leading cause of death for the general population between the ages of 15 and 24.
At Spirit Lake, the latest grant-which comes through the Native Connections program administered by the U.S. Department of Health and Human Services-has yet to be implemented. The tribe maintains a suicide prevention coalition called Wiconi Ohitika, or "Strong Life."
This past fall, McKay said, the coalition encountered a "clustering" of suicidal ideation within a group of children who had formed a pact to commit suicide before returning to boarding schools to begin the academic year.
"We knew who these kids were, so the community, along with the suicide prevention program and the substance abuse program, did some intervention," she said. "The district council hired a night monitor to kind of watch the community as it slept-that really saved at least four lives."
After the interventions, the pact was not completed. McKay said the children went on to receive behavioral health services.
Suicide rates increasing
Alison Traynor, suicide prevention director of the North Dakota Department of Health, said suicide rates have been increasing across the board through both the county and the state.
Though increases in suicide have been widespread, rural communities tend to show higher rates, Traynor said. It's not yet clear exactly why that is, though there are various theories that point to circumstances such as low levels of access to mental health services coupled with a greater prevalence of lethal means, including firearms.
For many rural communities, there are "a lot of factors that create a perfect storm," she said. Rural areas that follow the route of the Rockies Mountains-a region that includes North Dakota-seem to be especially affected by those factors.
"In some previous years and decades, we've done better than, say, Montana and South Dakota and other states, but we're really in that zone now where our rates are higher," Traynor said. "Whatever that is causing the challenge is definitely impacting us."
Native American communities, many, if not most, of which are rural, are doubly impacted by additional variables identified by the North Dakota suicide prevention program as discrimination, historical trauma and acculturation.
In 2015 alone, North Dakota's American Indian population had a suicide rate per 100,000 slightly higher than 30 percent, meaning nearly a third of deaths were attributed to suicide. For the state's white population, that rate for suicides to deaths was 17.3 percent.
According to the CDC, the national overall average suicide rate was about 13 percent as of 2014.
As a subset of both the wider U.S. and North Dakota population, Native Americans are at the highest risk for suicide. While rates have been rising as a whole, the climb has been especially steep for the state's native populations.
The state's general suicide rate sat at just more than 10 percent in 1980, according to state health department data. A trend line drawn from 1980 through 2015 shows a rise to about the current level of more than 17 percent.
Suicide rates among American Indians measured at approximately 25 percent in 1980. The trend line drawn against the more population-specific data ends last year at more than 40 percent.
In 2015, the actual native suicide rate per 100,000 was lower than the trend at a little more than 30 percent. That number represents 11 total deaths against 2010 Census data indicating a total American Indian population of just fewer than 37,000 people in North Dakota.
Traynor pointed out 2014 as the lowest year for suicides for the state's American Indian groups in some time, with a total number of seven deaths and a roughly 19 percent rate.
Though neither rate stacks up to 40 percent, she said the trend is probably more representative of the actual picture. As far as rates go, the relatively small size of the American Indian population can cause clusters of suicides to register as sharp increases, Traynor said.
In 2005, the American Indian suicide rate rocketed to more than 70 percent.
Deaths totals might not be high compared to the larger population, but the human toll remains great, she said.
"One suicide is too many, and spikes shown here represent devastation for families and communities," she said.
Traynor encouraged anyone considering suicide, or who knew of someone else thinking about ending their life, to call the National Suicide Lifeline number at (800) 273-TALK (8255). It is free, confidential and answered locally by the FirstLink call center.
'It's a healing'
Darla Thiele, a Spirit Lake tribal member, only recently became directly involved in community efforts dealing specifically with suicide prevention.
That's not to say she hasn't had experience with the subject. Thiele directs an equine therapy program on the reservation intended to curb substance abuse-a condition closely tied to suicidal ideation-among the tribe's youth through positive interactions with horses.
That program, known by its native name as Sunka Wakan Ah Ku, was recently awarded a grant of its own for more than $340,000.
From her experience, Thiele believes many suicide attempts go unreported on the reservation, but she added interpersonal efforts can make a difference in steering youth towards help.
She credited Whiteman's approach to the subject and said the mother has so far "made a big impact" with her work.
"People will call her, and I'll refer people to her," Thiele said. "(Whiteman) does it on her own time-no matter what time of day or night, she'll get up and go to assist families with services. She'll help with whatever, like any traditional healing or traditional help that they want."
On her end, Whiteman said there's still much to be done to curb suicides at Spirit Lake.
She said she was "overjoyed" with the grant and the opportunity it presented to strengthen existing services while adding new ones. As someone deeply affected by the problem, Whiteman said being involved with the solution gave her a way to move forward.
"It's a healing, not only just for yourself and your family, but it's a healing to help other families that way too," she said.