North Dakota is launching a new rural healthcare suicide prevention initiative aimed at strengthening follow-up care and closing critical gaps after suicide risk is identified. The effort follows recommendations from the North Dakota Suicide Fatality Review Commission and supports the Zero Suicide framework across rural and tribal healthcare systems.
The initiative will support rural and tribal healthcare providers in implementing standardized suicide risk screening, follow-up care after suicide attempts and improved referral pathways into mental health and behavioral healthcare services.
“This effort is about turning what we already know into consistent action inside the health system,” said North Dakota Health and Human Services (HHS) Commissioner Patrick Traynor. "In rural North Dakota, health care is often the only touchpoint. We have to make sure those moments are not missed opportunities.”
The announcement comes during Mental Health Awareness Month and amid continued concern about the growing number of North Dakotans, including students, parents, farmers, veterans and healthcare workers experiencing mental health challenges and suicide risk.
Funding Opportunity Details
The competitive funding opportunity provides approximately $400,000 in year one federal funding, with one award expected. It is part of North Dakota’s Rural Health Transformation Program, a five-year federal initiative to strengthen rural health systems and improve outcomes.
Eligible applicants include 501(c)(3) nonprofit organizations, private sector agencies, educational institutions, hospitals and clinics and other healthcare providers.
The selected awardee will serve as a statewide implementation support partner, working directly with rural and tribal healthcare facilities across North Dakota to help operationalize suicide prevention strategies in clinical settings. This includes coordinating training, providing technical assistance, supporting implementation of standardized screening and follow-up protocols and strengthening referral pathways into behavioral healthcare.
The program will support:
- Routine suicide risk screening in clinical settings
- Standardized follow-up protocols after suicide attempts
- Strengthened behavioral health referral pathways
- Integration of North Dakota Suicide Fatality Review Commission recommendations into clinical practice
Why This Matters Now
This initiative focuses on moving evidence-based suicide prevention practices into consistent use across rural and tribal healthcare settings by supporting implementation at the system level, where many providers face workforce and resource constraints.
National research shows nearly half of people who die by suicide had contact with a healthcare provider in the month before their death. In many rural North Dakota communities, a primary care clinic or local emergency room may be the first, and sometimes only, place someone experiencing a mental health crisis seeks help. State leaders say strengthening suicide prevention practices within healthcare settings can help ensure people are identified and connected to support earlier.
Preliminary state data shows 164 North Dakotans died by suicide in 2025, an average of more than three lives lost each week.
According to the National Survey on Drug Use and Health, an estimated 5.4% of North Dakota adults age 18 and older (approximately 31,000 adults, or 1 in 20 statewide) reported serious thoughts of suicide during 2023-24, similar to the national average of 5.5% of U.S. adults.
Data from the 2023 Youth Risk Behavior Survey (YRBS) further details the impact on the state’s student population:
- 17.5% of North Dakota high school students reported seriously considering suicide in the previous year (approximately 5,500 students, or 1 in 6 students).
- 7.4% of North Dakota high school students reported attempting suicide in the previous year (approximately 2,300 students, or 1 in 13 students).
- The national average for high school suicide attempts stands at 9.5%.
While North Dakota’s reported suicide attempt rate among high school students is lower than the national average, the data represents thousands of students across the state struggling with suicidal thoughts and behaviors.
“We know that youth who have a trusted adult in their lives are less likely to ideate or attempt suicide,” Traynor said. “We need all North Dakotans to heed the call to be a trusted adult for our youth.”
“This initiative focuses on learning from real-life cases to strengthen our systems, ensuring that the same vulnerabilities are not repeated,” said HHS Suicide Prevention Administrator Melissa Markegard. “Through widespread implementation of these strategies, we can identify those in need of support earlier and prevent future tragedies.”
The effort also aligns with the national Zero Suicide framework, which emphasizes system-wide responsibility for identifying and responding to suicide risk in health care settings.
Apply here: Rural Health Transformation Funding Opportunities | Health and Human Services North Dakota
If You or Someone You Know Needs Help
Research consistently shows that strong, supportive relationships are among one of the most important protective factors for youth and adults. It is especially important to feel connected to family, friends and caring adults in their communities who listen, show up and offer support. North Dakotans can play an important role by checking in with both the young people and adults in their lives, listening without judgment and helping connect them to support when needed
If you or someone you know is struggling with mental health or suicidal thoughts, help is available. Call or text 988 or chat at 988lifeline.org to connect with the Suicide & Crisis Lifeline, available 24/7. Support is free and confidential.
The Rural Health Transformation Program is supported by Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (US HHS) as part of a financial assistance award totaling $198,936,969.55 with 100% funded by CMS/US HHS. The contents are those of North Dakota Department of Health and Human Services and do not necessarily represent the official views of, nor an endorsement, by CMS/US HHS, or the U.S. Government.