Montana State Department of Public Health and Human Services

Abstract: The Montana Department of Public Health and Human Services (DPHHS) is working with American Indian tribes and urban Indian health providers in our state to implement a Zero Suicide initiative targeted toward tribal and urban Indian communities for adults aged 25 and older. Montana has the highest suicide rate in the nation, and within our state, the American Indian suicide rate is greater than the general population. Our goal is to implement the Zero Suicide model using three tiers of implementation. Tier 1 will involve the implementation of Zero Suicide within two tribal communities wherein the tribe controls the majority of primary care and behavioral health resources. These tribes—the Confederated Salish and Kootenai Tribes, and the Blackfeet Nation—will govern the implementation of Zero Suicide within their delivery systems. Tier 2 will involve the implementation of the Zero Suicide model in communities where the tribes are significant ‘influencers’ of the primary care system, and provide critical behavioral health services and support. As ‘influencers’ these tribal partners will assert influence over the federal Indian Health Service provider systems serving their communities, and provide behavioral health treatment and support for those at risk for suicide. These tribes include Fort Belknap Tribes, Fort Peck Tribes, and the Northern Cheyenne Tribe. Tier 3 will involve the implementation of the Zero Suicide model in smaller urban Indian health organizations (UIHO) that provide limited primary care and critical behavioral health care. Coordination of care will be a major focus for the urban communities. The two urban Indian communities represented in Tier 3 are the Missoula Urban Indian Health Center in Missoula, MT, and the North American Indian Alliance in Butte, MT. Each tier accurately reflects the complexity of implementing a state-wide Zero Suicide model in Indian Country in Montana. Our State has worked with all tribes and urban Indian organizations to understand and implement Zero Suicide strategies—using evidence-based practices and best practices—to capture leadership buy-in, to train the workforce to be competent and confident in providing suicide care, to identify individuals receiving care that are at risk for suicide, to engage those individuals in safety planning or treatment, to transition individuals from treatment to home, and to improve suicide care within their systems as suicide care progresses. The Montana Legislature identified state resources to conduct statewide suicide prevention planning with tribes, and we will conduct a Zero Suicide Academy for 50 health and behavioral health care representatives from the 8 tribes and 5 urban Indian organizations across the state in October 2017. This grant will provide the needed support to fully implement the Zero Suicide model in each partner tribal and urban Indian community.