Grant launches major suicide prevention effort in western N.D.
The goal is zero suicides, says UND’s Thomasine Heitkamp, one of the project’s leads
UND and NORC at the University of Chicago, along with several state government agencies and nonprofit organizations, are partnering on a multi-year, multi-million-dollar suicide prevention grant called North Dakota Healthcare, Opportunity, Prevention, and Education in Suicide prevention (ND HOPES).
ND HOPES will serve disproportionately affected populations in western North Dakota, including rural residents, veterans, and LGBTQ+ youth.
This cooperative agreement was awarded by the U.S. Centers for Disease Control and Prevention and will provide UND with nearly $1 million per year for five years to implement multiple prevention and outreach programs across the 21-county catchment area.
“This grant will provide a lifeline to help western North Dakota reduce rates of suicide, especially among these disproportionately affected populations,” said Ethan Dahl, UND assistant professor in Education, Health & Behavior Studies and principal investigator of the grant.
Thomasine Heitkamp, a research developer in the office of the UND vice president of research and economic development, worked with Dahl and NORC at the University of Chicago on securing the grant for the ND HOPES project. Heitkamp used her years-long relationships with healthcare providers and nonprofit groups across the state to gather partners for the grant. The ND HOPES project requires partnership with several state government agencies, health care providers and national and local nonprofit groups.
“We can’t do this without collaborating with all the partners who are already doing good work out in western North Dakota,” Heitkamp said.
State agencies involved in partnering on the grant include the Department of Health, the Department of Human Services-Behavioral Health Division, and the Department of Veteran Affairs. Additionally, UND has been partnering with the ND Governor’s Challenge to Prevent Suicide among Service Members, Veterans, and their Families, and this funding will expand the capacity to assist in this important effort.
Nonprofit organizations include FirstLink, which operates the 211 helpline and the 988 Suicide & Crisis Lifeline, and Sources of Strength, a North Dakota-developed wellness program focusing on suicide prevention in middle and high schools. More than a dozen state and nonprofit entities are involved in the ND HOPES program, all with the same goal.
“The aspiration is that all suicides are preventable,” Heitkamp said.
Said Dahl: “This is a great way for us to support our existing partners. They’re already doing some of this work, but they’re struggling to find the funding and support to round it out. This grant is going to plug into a lot of what they’re doing and provide them with the tools and support they need to fill gaps and sustain their efforts after the grant ends.”
Significant need for suicide prevention services in western North Dakota
According to CDC data, the suicide rate in North Dakota is greater than the national average and continues to increase. In 2020, the suicide rate in North Dakota was 18.1 people per 100,000, compared to 13.5 people per 100,000 across the United States. In rural counties, the suicide rate is even higher.
Nearly half of the state’s population of about 780,000 lives in rural counties, where the suicide rate is 20.6 people per 100,000. Thirty-eight of North Dakota’s 51 counties are designated as “frontier” counties, meaning there are fewer than seven people per square mile. The suicide rate in the 21-frontier county area to be covered by the grant outpaces the rate for rural North Dakota residents in general, at 26.2 people per 100,000.
The rural population has less access to mental health providers, and the state ranks 37th in the nation in terms of provider availability. In addition to the lack of resources, suicide risk is exacerbated in rural areas due to social isolation and other factors, such a firearm ownership.
Alongside the rural population, North Dakota is home to 55,000 veterans and 20,000 individuals who identify as LGBTQ+. These groups have also been identified by the CDC and the ND HOPES team as being disproportionately impacted by suicide.
“As part of this grant, we will conduct routine and targeted surveillance to identify risk among specific populations and devise tailored strategies to address the risk,” said Brett Harris, project lead from NORC. “We will pay special attention to rural communities, veterans and LGBTQ+ youth and will communicate about our surveillance activities and strategies to all key stakeholders. We will also work to improve the state’s surveillance system so that data are more accurate, timely, and comprehensive.”
A multi-tiered approach to suicide prevention
The ND HOPES program, grounded in routine and comprehensive surveillance, will be carried out in three tiers. The community-based Tier 1 will provide training on suicide warning signs and how to recognize individuals at risk of suicide. Training will be offered to select groups that come into regular contact with the three underserved groups. Those groups that will be offered the training include gun shop and range owners; veteran-serving organizations; staff at Youthworks, a nonprofit group assisting runaway, trafficked, and struggling youth in North Dakota; and affiliates of Dakota OutRight, a program which works to increase connection, visibility, and advocacy for people identifying as LGBTQ+.
In addition to training, ND Hopes will promote safe storage of firearms in conjunction with the gun-owning community as part of Tier 1.
For Tier 2, ND Hopes will strengthen access and delivery of suicide care through the implementation of Zero Suicide. Zero Suicide is both an aspirational goal and a set of tools and strategies to effectively implement suicide care in health and behavioral health care settings. It includes seven elements ranging from gaining leadership buy-in, training clinical staff, and identifying and engaging patients at risk of suicide to providing evidence-based treatment, coordinating care transitions, and conducting quality improvement.
Fidelity to the Zero Suicide model is associated with reductions in suicide across health systems. UND is partnering with the rural healthcare providers Sanford Health-Dickinson and Coal Country Community Health Center, which has locations in Beulah, Center, Hazen and Killdeer in western North Dakota, to implement Zero Suicide.
In addition to Zero Suicide, ND Hopes also will increase resources for crisis intervention as part of Tier 2. To do so, UND and NORC will partner with organizations that operate crisis talk and text lines such as 211, 988, Crisis Text Line, the Veterans Crisis Line and The Trevor Project, an organization supporting people in the LGBTQ+ community that operates talk, text, and chat lines.
As part of Tier 3, ND HOPES will address provider shortages through outreach and delivery of suicide care in Coal Country community clinics, federally qualified health centers, critical access hospitals and inpatient psychiatric settings in the program’s 21-county catchment area in western North Dakota. The program will deliver evidence-based interventions including suicide risk assessment, safety planning intervention, Dialectical Behavior Therapy (DBT) and follow up.
ND HOPES will work with partners ND Cares, the ND Veterans Administration, Dakota OutRight and Community Uplift to provide training and tailor services for the disproportionately affected populations.
John Mihelich, UND interim vice president for research and economic development, said he is excited that UND is participating in the ND HOPES project.
“My office is excited to be part of the UND effort to expand external funding to assist in addressing behavioral health needs in North Dakota. I am pleased to see the focus of this competitive award on suicide prevention and for faculty at UND to provide support to rural communities in western North Dakota.”
Editor’s note: Help is always available. If you or someone you know is experiencing suicidal thoughts or is in crisis, free, 24/7 help can be found by calling or texting 988 for the Suicide and Crisis Lifeline or by texting “HOME” to 741-741 for the Crisis Text Line. Veterans may choose to reach out to the Veteran’s Crisis Line, which can be accessed by calling 988 and then pressing 1. People in the LGBTQ+ community may reach out to The Trevor Project, by calling 1-866-488-7386, or by texting “START” to 678-678.
The following is a list of all partners in the ND HOPES project, in addition to UND and NORC: North Dakota Department of Health; Department of Human Services- Behavioral Health Division; Department of Veteran’s Affairs; Sanford Health- Dickinson; Coal Country Community Health Center; Vision West; First Link; North Dakota chapter of the American Foundation for Suicide Prevention; Community Uplift, Dakota OutRight; National Shooting Sports Foundation; Sources of Strength; and Youthworks.