I attempted to take my life because of a breakup when I was 16. I woke up and I was fine, but I was really mad. I just didn’t want to live! I’d been trying to get a gun, and word got around. The school called my mom, and a social worker came to talk to me. But what really changed my mind was my dad. I could feel his love, and it felt like he would lay down his life for me. Thinking about that would snap me out of it—suicide would hurt my family more than I’m hurting now.

Annie Ost, Spokane
Source: WSDOH, 2016

Supportive third parties, good social support, and strong problem-solving skills can diminish the risk of suicide. A person’s support network provides strength in times of crisis and during recovery. Strong social ties can decrease stress and increase a person’s ability to cope with the stressful event or situation. A care network can offer general support, crisis support, and ongoing attentiveness to signs of a new crisis. Supports such as these are a key part of care for people at risk of suicide (WSDOH, 2016).

Peer support, community engagement and intervention programs, and tribal programs have had success in addressing and reducing the impact of suicide in our communities. Within these programs, as well as the larger medical community, continuity of care has proven to be a critical component of suicide prevention programs.

12.1 Peer Support Programs

To address steadily increasing suicide deaths, the U.S. national suicide prevention strategy  and other guidelines have included recommendations that peer support be integrated into the care of individuals at high risk for suicide. Mutual peer support groups have a long tradition of providing support to individuals in recovery from mental health crises, and historically, these groups grew out of a desire for alternatives to psychiatric hospitalization (Bowersox et al., 2021).

Within mutual peer support groups, receiving emotional support, sharing experiences, and building connections outside of meetings are key components of effective support. Peer support has been increasingly integrated into community mental health treatment services with the development and growth of the peer support specialist workforce. Peer specialists are individuals trained to utilize their lived experiences of mental health challenges and recovery to support others. Peer specialists report that their work often includes discussions of suicide, though there are not well-established professional standards among peer specialists for suicide prevention training (Bowersox et al., 2021).

Peer support has the potential to address suicide risk through multiple mechanisms. Peers providing emotional support and sharing their experience of recovery could increase perceived connectedness and reduce hopelessness among support recipients, two key factors for preventing suicidal ideation. Peer support may also reduce suicide risk by decreasing stigma, increasing orientation to personal growth and recovery, and encouraging active care engagement (Bowersox et al., 2021).

Despite guidelines recommending greater incorporation of peers into suicide prevention, the recent growth of peer services in community mental health care, and a theoretical rationale for peer support in suicide prevention, there has been little synthesis of the evidence on how peer support has been applied to suicide prevention (Bowersox et al., 2021).

Sources of Strength is an example of a peer support program for youth. The program seeks to normalize protective factors for suicide by encouraging help-seeking, talking to trusted adults, and promoting peer connectedness. These approaches typically target youth and are delivered in school settings but can also be implemented in community settings (CDC, 2022).

In a study of the Sources of Strength program conducted in 18 high schools, researchers found that the program improved adaptive norms regarding suicide, connectedness to adults, and school engagement. Peer leaders were more likely than controls to refer a suicidal friend to an adult. For students, the program resulted in increased perceptions of adult support for suicidal youths, particularly among those with a history of suicidal ideation, and the acceptability of help-seeking behaviors. Finally, trained peer leaders also reported a greater decrease in maladaptive coping attitudes compared with untrained leaders (CDC, 2022).

12.2 Community Engagement and Intervention Programs

Community engagement encourages involvement in a range of social activities. The goal is to improve physical health, reduce stress, and decrease depressive symptoms. Involving community members from the beginning and respecting them as experts on their own experience is critically important. Becoming familiar with the community’s history, risk and protective factors, cultural norms around language and communication, and beliefs about death are important for program organizers.

Community intervention programs aim to increase awareness of warning signs, increase knowledge of how to intervene, and improve attitudes towards suicide. Certain types of interventions have been shown to increase community engagement in suicide prevention. Besides educating the community about suicide warning signs and reducing stigma, community organizers and healthcare providers can work to:

• Increase knowledge of interventions (e.g., alerting emergency services)
• Increase the intention to intervene
• Increase confidence to intervene (Worsteling and Keating, 2022).

12.3 Successful Programs in Tribal Communities

Although Native Americans are at higher risk for suicide than the general population, suicide rates vary widely across tribal communities. Each Native community has different mental health challenges and ways of coping with them. Healthcare providers must understand these differences, as well as the specific cultural context of each tribal group, such as their views on illness and death. Involving Native people in prevention efforts can help ensure programs leverage local resources to meet the needs of the community (SAMSHA, 2019, November 15).

A successful community program designed by a community in Iqaluit, Nunavut (Arctic Canada) aimed at preventing suicide among Indigenous peoples can be applied to other community engagement efforts. The program considers differences in suicide rates across communities and recognizes the effects of rapid social and environmental changes that have taken place in the past two decades. Key themes include:

• Acknowledging the impact of colonization.
• Understanding that prevention strategies must be community-based and should integrate Indigenous ways of knowing.
• Involving youth in developing solutions, tightening their relation to the land, and creating strong linkages with Elders and culture.
• Moving from intention to action and from action to impact. (NIMH, 2017)

12.3.1 Healing of the Canoe

Another successful program based in Washington State is the Healing of the Canoe Project—a collaboration between the Suquamish Tribe, the Port Gamble S’Klallam Tribe, and the Alcohol and Drug Abuse Institute, University of Washington. It is a curriculum for Native youth focused on suicide and substance abuse prevention. The program uses the Canoe Journey as a metaphor—providing youth the skills needed to navigate their journey through life without being pulled off course by alcohol or drugs—with tribal culture, tradition, and values as compass to guide them and anchor to ground them (Healing of the Canoe, 2022).

12.3.2 Rising Sun

Rising Sun (Reducing the Incidence of Suicide in Indigenous Groups—Strengths United through Networks) is an initiative of the Arctic Council led by Canada and collaborating countries. Rising Sun is a toolkit of common outcomes that can be used to evaluate suicide prevention efforts across Arctic states. Common outcomes and their measures, developed through engagement with Indigenous peoples’ organizations, community leaders, and mental health experts, will encourage data sharing, assessments, and interventions across service systems in the Arctic region (MHIN, 2018).

The goal is to generate shared knowledge that will aid healthcare workers in better serving their communities, and help policy-makers measure progress, evaluate interventions, and identify regional and cultural challenges to implementation. Arriving at common outcomes is especially important in the Arctic, where the vast geography, high number of remote communities, and breadth of cultural diversity pose challenges for systematic approaches to suicide prevention (MHIN, 2018).

Did You Know. . .

American Indians and Alaska Natives are more likely than White Americans or Latinos to abstain from alcohol and drugs (SAMSHA TIP 61, 2018).