December 2016

Wellness Efforts in Indian Country

Resilience, empowerment, and hope help 

AI/AN communities overcome experiences of cultural 

suppression and trauma. Tribal communities face 

challenges and risks that are rooted in poverty, chronic 

trauma, and a lack of resources. Yet AI/AN communities 

have the knowledge and strength to address suicide 

when their cultural practices and spiritual beliefs act 

as foundations for taking action, solving problems, and 

promoting lasting wellness.

The National Strategy for Suicide 

Prevention: What Works in Indian 

Country

The 1999 Surgeon General’s Call to Action to Prevent 

Suicide introduced a blueprint for suicide prevention 

and guided the development of the 2012 National 

Strategy for Suicide Prevention. The Strategy is 

organized into four interconnected, strategic elements. 

Examples of what works in Indian Country are provided 

for each element of the Strategy.

Suicide Prevention in Indian Country

Suicide prevention is a health issue that must 

be addressed at many levels by different 

groups working together in a coordinated 

and synergistic way. Federal, state, 

tribal, and local governments; health care 

systems, insurers, and clinicians; businesses; 

educational institutions; community-based 

organizations; and family members, friends, 

and others all have a role to play in suicide 

prevention. 

– National Strategy for Suicide Prevention

Suicide rates for American Indians and Alaska Natives (AI/ANs) are four times higher than the national average. Suicide 

is the second leading cause of death for AI/AN youth between the ages of 15 to 24.1

This fact sheet, developed for tribal audiences and the agencies that work with them, reviews suicide prevention in 

Indian Country and how the 2012 National Strategy for Suicide Prevention can apply to tribal communities. 

1

 United States. Department of Health and Human Services, Indian 

Health Service. (n.d.). Trends in Indian health, 2002-2003. Rockville, 

MD: Indian Health Service.

1. Supportive environments for healthy and 

empowered individuals, families, and 

communities

• Implement ongoing and collaborative efforts

• Focus on the community’s level of awareness of 

the issue and readiness for change

• Support the local vision and solutions that come 

from the community 

• Strengthen cultural beliefs and practices

• Promote a sense of belonging and increase 

protective factors, including strengthening cultural 

identities, the sense of family and community 

connectedness, and communication skills 

• Build supportive school environments to further 

increase protective factors by:

• implementing a life skills curriculum that 

includes problem-solving and positive thinking

• instituting strong anti-bullying policies and 

practices

• implementing dating violence prevention 

programs

2. Enhanced clinical and community preventive 

services

• Implement a trauma-informed care approach 

to understand and acknowledge the impact and 

effects of historical trauma and poverty

• Identify and draw upon protective and cultural 

resilience factors to help restore resilience

• Routinely train substance and clinical service 

providers in suicide prevention 

• Train community prevention and clinical staff in 

evidence-based interventions 

• Assure continuity of care during high-risk transition 

times
About the Tribal TTA Center

The Tribal Training and Technical Assistance Center (Tribal 

TTA Center) is funded by the Substance Abuse and Mental 

Health Services Administration (SAMHSA). The Tribal 

TTA Center uses a culturally relevant, holistic approach 

to deliver TTA on mental and substance use disorders, 

suicide prevention, and mental health promotion. TTA 

is offered to a broad audience of all tribal communities, 

a focused audience of SAMHSA tribal grantees, and an 

intensive audience of selected AI/AN tribes per year.

For More Information 

To request more information about the Tribal TTA Center 

or to submit a technical assistance request, call (301) 

257-2967 or visit http://www.samhsa.gov/tribal-ttac.

Other Helpful Resources

Please review the following resources to help in your 

suicide prevention efforts. 

• SAMHSA’s webpage: http://www.samhsa.gov

• Suicide Prevention Resource Center (SPRC) webpage:

http://www.sprc.org

• 2012 National Strategy for Suicide Prevention: Goals

and Objectives for Action:

http://www.surgeongeneral.gov/library/reports/

national-strategy-suicide-prevention/full-report.pdf

One way to address and prevent suicide 

is to plan and host a Gathering of Native 

Americans/Gathering of Alaska Natives (GONA/

GOAN) event. The GONA/GOAN facilitates 

the community’s planning process. Examples 

of cultural activities identified through this 

process include drumming, dancing, and 

sweat lodges, all of which build supportive 

environments and provide opportunities for 

skill transfer from AI/AN elders to AI/AN youth.

3. Available, timely treatment and support

services

• Address shame, negative attitudes, taboo, and

silence about mental and substance use disorders

and suicide to allow and encourage culturally

appropriate conversations

• Enhance the community’s capacity through

collaboration efforts and grant writing or

administration training

• Provide culturally informed approaches in

appropriate cultural settings

• Focus services on groups at increased risk of

suicide, including AI/AN youth, suicide survivors,

individuals who have attempted suicide, Twospirited populations, members of the armed

forces, and veterans

• Address multi-jurisdictional issues through

collaboration and long-range planning

• Provide and monitor post-intervention and

aftercare

4. Improved suicide prevention data collection,

research, and evaluation

• Build local evaluation capacity and develop

infrastructures to gather effective data, as needed

• Consider Indigenous practices for improving

knowledge, storytelling, and other indigenous ways

of knowing

• Address data collection, research, and evaluation

on a tribal level to best navigate issues of

sovereignty, confidentiality, and culturally

appropriate evaluation methods

This fact sheet was prepared for the Substance Abuse and Mental Health Services 

Administration (SAMHSA) under contract number HHSS280201300001C with 

SAMHSA, U.S. Department of Health and Human Services (HHS). The views, 

opinions, and content of this publication are those of the author and do not 

necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

HHS Publication No. SMA-16-4995