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Culture, Connection, and Conversation: Preventing Suicide Together

by Pamela End of Horn, DSW, LICSW, IHS National Suicide Prevention Consultant, Division of Behavioral Health

Suicide prevention begins with recognizing both the challenges people may face and the strengths that can help them navigate through hard times. For American Indian and Alaska Native people, practicing traditions, speaking Native languages, spending time with family and community, participating in ceremony, storytelling, and other cultural practices can foster a sense of identity, purpose, and belonging. These connections can be important protective factors, particularly during difficult times. 

A New Toolkit for Crisis Centers

An updated Toolkit for Crisis Centers Serving American Indians and Alaska Native Communities was developed with input from frontline specialists, Tribal liaisons, and community leaders to help build effective and sustainable programs. The toolkit includes three modules covering foundational knowledge, partnerships with Tribes, and culturally responsive approaches for crisis center counselors. The goal is to increase staff awareness of Tribal communities, cultural practices, traditions, and needs; increase usage of crisis services; and improve services for American Indian and Alaska Native help seekers by increasing cultural responsiveness in crisis centers.

The toolkit emphasizes working with Tribal communities — rather than utilizing a one-size-fits-all approach to crisis care. Explore it today to learn more and help prevent suicide.

Starting the Conversation

Challenges that people experience may increase their risk for suicide and can include relationship problems, the loss of a loved one, trauma, substance use, or other significant life stressors. Recognizing these risk factors, along with changes in someone’s behavior or circumstances, can help us know when it may be time to reach out and offer help.

Talking about suicide may feel uncomfortable, but a direct and compassionate conversation can help someone who is struggling to feel seen and supported.

If you are concerned about someone:

  • Share what you have noticed. Mention specific changes or warning signs that have caused you concern.
  • Ask directly and use clear language, such as “Are you thinking about suicide?” or “Are you thinking about killing yourself?”
  • Listen without judgment. Give the person space to talk and take what they tell you seriously.
  • Avoid leading questions. Asking, “You’re not thinking about killing yourself, are you?” can make it more difficult for someone to answer honestly.
  • Do not promise secrecy. If someone may be at risk, helping them connect with support is more important than keeping the conversation private.
  • Stay connected. If someone is in immediate danger, do not leave them alone. Help them connect with crisis support or emergency assistance.

These important conversations do not require having all the answers. Sometimes, the most critical thing we can do is listen, remind someone they matter, that they do not have to face difficult times alone, and help them take the next step toward finding support.

Our cultures, families, communities, and relationships can help create a strong foundation for prevention and protecting someone from harming themselves. By recognizing when someone may be struggling, reaching out with compassion, and being willing to talk openly about suicide, we can help our relatives find connection, support, and hope.

Additional Resources

If someone is in danger or has harmed themselves, call 911 for immediate assistance or go to the nearest emergency department.


Pamela End of Horn, DSW, LICSW, IHS National Suicide Prevention Consultant, Division of Behavioral Health
Pamela End of Horn, DSW, LICSW, is the national suicide prevention consultant at IHS headquarters in Rockville, Maryland. End of Horn is responsible for oversight of the Suicide Prevention and Care Program, and her work focuses on policy development, program implementation, and evaluation. She holds a Doctorate Degree in Social Work from the University of Pennsylvania, currently holds advanced practice licenses in North Dakota and Minnesota, and is pursuing a Master of Public Health from Johns Hopkins University in Baltimore, Maryland. End of Horn was born and raised in Pine Ridge, South Dakota, and is an enrolled member of the Oglala Lakota Sioux Tribe of the Pine Ridge Indian Reservation