“Can I get a paper towel?” someone asked of Cheryl Goodman. That request, which seems quite basic, meant the world to Goodman.
“I was like, ‘Great. Oh my god, he asked me for help,’” she thought to herself.
In her semester interning as a therapist at the Mino Oski Ain Dah Yung Center (ADYC), a permanent supportive housing program for people ages 18 to 24, she has seen what breaking down the shame barrier can do for someone’s health.
Goodman, who is getting her master’s in marriage and family therapy from St. Mary’s University, says the culture of openness and acceptance at the center is how it makes an impact. Just a couple of months ago, Goodman saw it in action. When one of the building’s residents had a mental health crisis — and one of his peers saw him doing something dangerous, they alerted the staff.
“I have been able to see it happen in real-time and not have to wait for years on end to run into a client or figure out what happened to them later on down the line,” Goodman said.
The center, based in St. Paul, also has programs, from street outreach and case management for unhoused people and an emergency shelter, to supportive housing programs for other ages and prevention programs, which aim to address the underlying risk factors for suicide.
The deep disparity
Across the U.S., American Indian and Alaska Native (AI/AN) people die by suicide at disproportionate rates. The suicide rate among Native Americans in the nation is close to three times that of whites, who have the second-highest rate among ethnic groups.
The rate has also been increasing. From 2018-2021, AI/AN people also experienced the highest percentage increase of suicides — a 26% increase.
The same is true in Minnesota.
In 2021 and 2022, suicides in Minnesota increased across all groups. But that increase was more dramatic among Native American and Hispanic/Latino populations. In 2021, AI/AN people in the state had their highest rate of suicides since at least 2000, according to the Minnesota Department of Health (MDH).
Deaths of despair
There’s some research explaining how deaths caused by alcohol, drug use and suicide, referred to as “deaths of despair” affect Native Americans differently than white communities. The research, published in the Opportunity & Inclusive Growth Institute of the Federal Reserve Bank of Minneapolis, wanted to focus on how economic activity and deaths of despair interact with each other in Indigenous communities. The relationship between deaths of despair and economic conditions for Native Americans has gone largely unexamined, despite the fact that deaths of despair are two to four times more prevalent among Native Americans than the white population, the researchers said.
“There’s been so much emphasis on these deaths among white Americans and not very much has been said about deaths of despair among Indigenous communities,” said Marina Mileo Gorzig, one of the authors of the paper.
They found that in counties with more economic activity, the proportion of deaths attributed to suicide among Native Americans is lower, but the proportion of deaths attributed to drug use go up in almost equal measure. They also found that deaths of despair among Native Americans occur much earlier in life than for non-Hispanic white Americans.
Its findings contrast with research from 2020, which found that a dip in economic status and long-term outlook tracked with increases in deaths of middle-age white men attributed to drug use, alcohol and suicide. For Native Americans, economic activity in an area did not necessarily mean that portions of death attributed to drug use and alcohol go down.
The authors think that understanding how those patterns differ from other populations can help identify more effective intervention and prevention strategies.
Prevention and practices
Not everyone who experiences a “death of despair” will follow the same pattern, however. That’s extremely important to remember when helping people, said Sharla Burth, the clinical health and wellness director at the ADYC.
The former suicide prevention coordinator, Alex McDougall, was accredited to provide three different trainings. One of them focused on the best ways to intervene with someone who has expressed thoughts of suicide. The other one, known as Safe Talk, focused on best practices for having an open dialogue in conversations about suicide, she said.
McDougall estimated that about 70% of the center’s staff is trained in QPR (question, persuade and refer), and about 67% are trained in Safe Talk.
“A front desk staff would typically not be trained in therapeutic interventions,” Burth said. “Going through the Assist and Safe Talk program, he (front desk staff) was trained. He knew what to do. He actually was initially the one who dealt with it and then triaged and like several different programs and people had to get involved to like fully encompass this individual.”
Goodman feels that the culture of openness and nonjudgment makes it so people in hard situations become comfortable seeking help.
“If it wasn’t for his (a resident in crisis) connection with one staff, that would not happen,” Goodman said.
“I’ve seen this work in real life. I’ve seen it save a life,” Goodman said.
Goodman and Burth provide solution-focused therapy and trauma-informed therapy. Their goal is just to get talking with residents.
“The residents are still in survival mode for sometimes years here. It is also that they are 18- to 24-year-olds, so they are all over the map. We don’t know if one thing is going to work this day, it might not work the next day,” Burth said.
ADYC is one of many Indigenous-led organizations across the state dedicated to reducing deaths facing their communities. Those organizations attempt to soften the impact of historical traumas, and their resulting implications, like loss of Indigenous knowledge and identity, or economic hardships — which they say contribute to the high suicide rates in the community.
There are also prevention and support services in rural areas, with tribal nations, like Mille Lacs Band of Ojibwe and White Earth offering mental health services.
What’s missing?
There needs to be more emphasis on protective factors that capitalize on community strengths, said Jim Allen, a retired professor at the University of Minnesota Duluth, who has helped create multiple frameworks centered on protective factors for suicide prevention in different communities.
One paper he worked on highlighted using community strengths to be a prevention method — dealing with problems before they emerge.
“This approach is about building strengths on a community or population level. And by building those strengths, it lessens the likelihood of a young person becoming suicidal,” Allen said.
Another paper examined the effectiveness of the community strengths as a response to the alcohol problems facing Alaska Native communities.
“We were focused on those protective outcomes; outcomes that our research had associated with either buffering suicide risks or promoting wellbeing in ways where suicide risk doesn’t emerge in the first place. We showed across several communities that the intervention produced growth in protective factors over the two-year period … and that this growth in protective factors displayed a dose relationship. That meant the more activities in the ‘Tools for Life’ (the Qungasvik intervention) young people participated in, the more their protection grew.”
Centering culture as a prevention measure
Goodman’s capstone paper to graduate from her program is about ADYC’s successes in using culture as a prevention method. It also brings urban Indigenous communities into this field of research.
“I hope that somebody somewhere picks it up and reads it and takes it for what it’s worth and sees that, what I’m saying is true,” Goodman said.
Not only that — but the profession doesn’t generally consider culture as a prevention method. For example, the center commonly takes people to ceremonies or a sweat lodge as a form of providing mental health therapy, but insurance companies don’t consider that “billable.” Goodman even had to challenge her school’s rules around “clinical hours,” since therapy at the center looks different than how it is done in other practices.
Goodman herself had an urban Indigenous upbringing. She is Ojibwe, Menominee and Potawatomi, and grew up in south Minneapolis in a large family. Being the ninth child in a family of 10, her parents signed her up for various programs that embedded her in culture.
“I have been able to work around a lot of the barriers that a lot of the residents here have,” she said. “I give credit to my parents for allowing me to do that and trusting programs to help raise me … If there wasn’t anything going on in Minneapolis, my mother came here to St. Paul and was like, ‘What’s there for her to do here?’ To keep me off the streets, to keep me from getting pregnant, all of those things.”
She sees how those programs, and being immersed in traditional and tribal ways, allowed her to get to where she is now — compared with her older siblings who didn’t have those same connections.
“I’m the first one to graduate high school, graduate college. I’m the first one to get a graduate degree. I’m the first homeowner. I’m the first one to own a car. There’s a lot of firsts for me,” she said. “When I talk to the residents, I can say, ‘From personal experience, I know this works if you give it a try. I also know this doesn’t work when you give it a try,’ and they’re so receptive to that and it’s all because of the shared culture.”
And while the staff at the center don’t know the entirety of how the residents got to where they are today, they see the progress day by day.
“We see it working real-time right now because of their changed behavior,” Goodman said. “We get to see them in that survival mode too but we also get to shift it a little in a healthier way. I had that conversation with one of the residents recently, ‘You have survived to this point for a reason and I’m proud of you. You’re here. Today you woke up. You’re sober. You can breathe. You can see. Amazing.’”
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