Goal is zero suicides, says UND’s Thomasine Heitkamp, one of project leaders
UND and NORC at the University of Chicago, along with several government agencies and nonprofits, are partnering on a multi-year, multi-million dollar suicide prevention grant called North Dakota Healthcare, Opportunity, Prevention , and Education in Suicide prevention ( ND ESPOIRS).
ND HOPES will serve disproportionately impacted populations in western North Dakota, including rural residents, veterans, and LGBTQ+ youth.
This cooperative agreement has been granted by the United States Centers for Disease Control and Prevention and will provide UND with nearly $1 million per year for five years to implement several prevention and awareness programs in the 21-county catchment area.
“This grant will provide a lifeline to help western North Dakota reduce suicide rates, especially among these disproportionately affected populations,” said Ethan Dahl, UND Assistant Professor in Education, Health and Behavioral Studies and Principal Investigator of the grant.
Thomasine Heitkamp, a research developer in the Office of the Vice President of Research and Economic Development at UND, worked with Dahl and NORC at the University of Chicago on obtaining the grant for the ND HOPES project. Heitkamp used his longstanding relationships with health care providers and nonprofit groups across the state to gather partners for the grant. The ND HOPES Project requires a partnership with several state government agencies, health care providers, and state and local nonprofit groups.
“We can’t do this without collaborating with all the partners who are already doing good work in western North Dakota,” Heitkamp said.
State agencies involved in the grant partnership include the Department of Health, Department of Human Services-Behavioral Health Division, and Department of Veterans Affairs. Additionally, UND has partnered with the ND Governor’s Challenge to Prevent Suicide in Service Members, Veterans and their Families, and this funding will expand the capacity to contribute to this important effort.
Non-profit organizations include first link, which operates the 211 hotline and the 988 Suicide & Crisis lifeline, and source of strength, a wellness program developed in North Dakota and focused on suicide prevention in middle and high schools. More than a dozen state and non-profit 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: “It’s a great way for us to support our existing partners. They are already doing some of this work, but they are struggling to find the funding and support to complete it. This grant will piggyback on much of what they do and provide them with the tools and support they need to fill the gaps and continue 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 above the national average and continues to rise. In 2020, the suicide rate in North Dakota was 18.1 people per 100,000, compared to 13.5 people per 100,000 in the United States. In rural counties, the suicide rate is even higher.
Nearly half of the state’s population of about 780,000 live 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 region of the 21 border counties to be covered by the grant exceeds the rate for rural North Dakota residents in general, at 26.2 people per 100,000.
Rural population has less access to mental health care providers and state ranks 37e in the country in terms of supplier availability. In addition to lack of resources, the risk of suicide is exacerbated in rural areas due to social isolation and other factors, such as possession of firearms.
In addition to the rural population, North Dakota is home to 55,000 veterans and 20,000 people who identify as LGBTQ+. These groups have also been identified by the CDC and the ND HOPES team as being disproportionately affected by suicide.
“Under this grant, we will conduct routine and targeted surveillance to identify risk among specific populations and design tailored strategies to address the risk,” said Brett Harris, NORC project manager. “We will pay particular attention to rural communities, veterans and LGBTQ+ youth and communicate about our monitoring activities and strategies to all key stakeholders. We will also work to improve the state monitoring system so that the data is more accurate, timely and complete.
A Tiered Approach to Suicide Prevention
The ND HOPES program, based on routine and comprehensive surveillance, will be carried out in three levels. Community Level 1 will provide training on the warning signs of suicide and how to recognize those at risk of suicide. Training will be offered to select groups that regularly come into contact with the three underserved groups. Groups that will be offered the training include gunsmiths and range owners; organizations serving veterans; staff at youth work, a nonprofit group that helps runaway, trafficked, and troubled youth in North Dakota; and affiliates of Dakota OutRighta program that aims to increase connection, visibility and advocacy for people who identify as LGBTQ+.
In addition to training, ND Hopes will promote the safe storage of firearms in conjunction with the gun ownership community as part of Tier 1.
For Level 2, ND Hopes will strengthen access to and delivery of suicide care through the implementation of Zero Suicide. Zero Suicide is both an ambitious goal and a set of tools and strategies for effectively implementing suicide care in health care and behavioral health settings. It includes seven elements ranging from obtaining buy-in from leaders, training clinical staff, identifying and involving patients at risk of suicide, providing evidence-based treatment, coordinating care transitions and quality improvement.
Fidelity to the Zero Suicide model is associated with reductions in suicide across all health systems. UND is partnering with rural healthcare providers Sanford Health-Dickinson and Coal Country Community Health Center, which have offices in Beulah, Center, Hazen and Killdeer in western North Dakota, to implement Zero Suicide.
In addition to Zero Suicide, ND Hopes will also increase resources for crisis intervention under Tier 2. To do this, UND and NORC will partner with organizations that operate crisis chat and text lines such as 211, 988, Crisis Text Line, the Crisis Line for Veterans and The Trevor Project, an organization supporting people in the LGBTQ+ community that operates talk, text, and chat lines.
Under Tier 3, ND HOPES will address provider shortages through suicide education and care delivery at community clinics in Coal Country, federally licensed health centers, hospitals in critical access and inpatient psychiatric facilities in the program’s 21-county catchment area in western North Dakota. The program will offer evidence-based interventions including suicide risk assessment, safety planning intervention, dialectical behavior therapy (DBT), and aftercare.
ND HOPES will work with partners ND Cares, the ND Veterans Administration, Dakota OutRight and Community Uplift to provide tailored training and services to disproportionately affected populations.
John Mihelich, the UND’s acting vice president for research and economic development, said he’s delighted that the UND is participating in the ND HOPES project.
“My office is thrilled to be part of the UND effort to expand external funding to help address behavioral health needs in ND. I am thrilled to see this competitive award being focused on preventing suicide and that UND teachers provide support to rural communities in western ND.
Editor’s note: Help is always available. If you or someone you know is having suicidal thoughts or in crisis, free 24/7 help can be found by calling or texting 988 for Suicide and Crisis Lifeline or texting “HOME” at 741-741 for the Crisis Text Line. Veterans can choose to contact the Veterans Crisis Line, accessible by calling 988, then pressing 1. Members of the LGBTQ+ community can contact The Trevor Project, by calling 1-866-488-7386 or by sending an SMS. “START” at 678-678.
Here is a list of all ND HOPES Project partners, in addition to UND and NORC: North Dakota Department of Health; Department of Social Services – Behavioral Health Division; Department of Veterans Affairs; Sanford Health-Dickinson; Coal Country Community Health Center; West Vision; first link; North Dakota Chapter of the American Foundation for Suicide Prevention; Community Uprising, Dakota OutRight; National Shooting Sports Foundation; sources of strength; and Youthworks.