Editor's note: If you or a loved one is in crisis, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 (1-800-273-TALK).

FARGO — North Dakota has seen the second highest rise in suicide rates since 2000 in the U.S., a recent report found.

Still, prevention experts are taking more action to get people the help they need, lessen the stigma and prompt more people to talk about the crisis than ever before.

The suicide rate climbed in North Dakota from 10.4 deaths per 100,000 people in 2000 to 19.4 in 2018, the latest numbers available from the Centers for Disease Control and Prevention. The 84% jump during that time puts North Dakota behind only New Hampshire’s 88%, according to a study from the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota.

Minnesota ranked 18th on the list of rate increases with 48%, going from 8.9 deaths per 100,000 people in 2000 to 13.1 in 2018, according to the center. South Dakota rose 52% for 15th place, from 12.7 to 19.3 for that time period.

Minnesota, North Dakota and South Dakota all saw a drop in rates from 2017 to 2018, the study said.

All rate increases were above the national average of 37%, SHADAC said. Rates accelerated across the U.S. from 2009 to 2018.

“One thing we do know is this is a pattern we also see with some other diseases that are commonly referred to as deaths of despair or diseases of despair,” SHADAC senior research fellow Colin Planalp said, noting drug overdoses and alcoholism.

Suicide rates also increased faster in rural areas than large metro areas, the study found.

Suicide is a complex issue, said Samantha Christopherson, Dakotas area director for the American Foundation for Suicide Prevention. There is not one single cause for it, and many factors that differ from person to person contribute to the tragedy, she said.

Rural areas tend to have fewer mental health resources, she said. Firearms, which are used in 50% of suicides, also are more accessible, she said.

“When we are talking about firearms, it’s a very quick happening, so it is less likely that someone can intervene to help,” she said.

Read "Breaking the silence," The Forum's series on suicide in North Dakota and Minnesota

Transformation in behavioral health

Behavioral health has undergone a large transformation in North Dakota, with the state dedicating more resources to suicide prevention so people have more access to the services they need, said Pamela Sagness, behavioral health division director at the state Department of Human Services.

“Certainly, we have a need to make some pretty significant transformations in our behavioral health system, which actually I’m happy to say the last couple of years we have made some pretty big changes that are underway,” she said.

North Dakota is in the middle of recognizing the problem and forming a plan, Sagness said. Some strategies expected to have large impacts are set to be implemented in the coming months, she said.

“For North Dakota, this is a priority, and we are absolutely invested in continuing to implement these strategies to reduce suicide in North Dakota,” she said.

AFSP has dedicated a lot of time and effort to try to reduce the stigma of suicide in rural areas like North Dakota and South Dakota, Christopherson said. That includes volunteers hosting programs about risk factors, warning signs and how to have a safe conversation on suicide.

“They’re changing the culture around mental health,” she said. “We want everyone to know it is smart to take care of your mental health.”

Minnesota also has implemented several changes in recent years, said Tanya Carter, supervisor of suicide prevention for the state Department of Health. It set up several programs to train different demographics, like the Zero Suicide Academy that provides intervention training to anyone who comes in contact with patients.

Both Minnesota and North Dakota have focused on working with youth, Carter and Sagness said. Middle-aged white men, including farmers, also have been a focal point of suicide prevention in both states, with education and training dedicated to that population.

Nationally, middle-aged white men have a higher rate of suicide than any other group, the AFPS said.

“We know that our farmers have been impacted in more than one way,” Carter said.

'Like any other health issue'

More people are talking about suicide prevention than ever before, Christopherson said.

People have become more comfortable talking about mental health, Carter said. That needs to continue in conjunction with implemented programs, training and strategies.

“Are we there 100% yet?” she said. “No, but I think we are definitely moving in that direction.”

Education and training are key to normalizing the idea that mental health is important, she said.

There needs to be more support for family, and resources need to be available so interventions can happen before a moment of crisis, Sagness said.

It’s unlikely rates will “spontaneously stop or reverse course in the near term,” the study said. The first step includes drawing attention to the fact that suicide is a growing problem around the U.S., Planalp said.

States should look at their own patterns since they vary so much. Suicide impacts different demographics more predominantly in different states. Even methods vary, he said.

Understanding the perspective of a person who is considering suicide has helped experts realize those feelings are temporary, even when they are strong, Christopherson said. Suicide is preventable, she added.

“We want to talk about suicide like any other health issue so we can save and help more people,” she said.