Washington State recently announced an innovative approach to implement the 9-8-8 suicide prevention crisis hotline through the Native and Strong Crisis Lifeline.  The line is staffed by an all-Native team that receives specific training around language and cultural competence, in addition to the standard crisis counselor training.  Like the nationwide Veterans Crisis Line, which provides veterans and active service members with peer support, callers in Washington can access the Lifeline by dialing 9-8-8 and pressing 4 to connect with a counselor with an understanding of historical and intergenerational trauma and culturally rooted self-care and healing practices.

This new initiative comes at a critical time. In 2020, American Indian and Alaska Native individuals died by suicide at a rate 34% higher than the rest Washington residents. In 2019, suicide was the second leading cause of death for Native people aged 10-34. Suicide rates among Native communities have increased by nearly 20% from 2015, compared to a less than 1% increase in the overall U.S. population.

Native communities experience barriers to care such as inaccessible mental and behavioral health providers and programs, economic hardship, and, for many, a learned mistrust of state authorities and programs stemming from centuries of displacement, forced assimilation, racism, and systemic abuse. Washington’s Department of Health notes that while the Native and Strong Lifeline is “not meant to reconcile or undo the violence and traumas of the past, it does offer a new culture for healing that centers the lived experiences, traditions, and wisdom of Native people.”

There is a strong evidence base documenting the benefit of peer-to-peer services and centering lived experiences in healing and mental health care. A growing body of research continues to support peer support services and uplifting Native cultural practices as a best practice for crisis support. ChildTrends reports that there are six areas of Indigenous culture that directly correlate to protective and preventive outcomes: enculturation and Indigenous identity; traditional activities and games; relationships with the land; social connectedness among family, across generations, and with community; Indigenous languages; and spirituality and ceremonies. While Tribes are not homogenous, there are shared experiences – both positive and adverse – across Native communities. Staffing the Lifeline with an all-Native team provides a unique opportunity for callers to receive support tailored to their experiences, culture, and needs.

This initiative is supported by the Substance Abuse and Mental Health Administration. In addition to leveraging these federal funds, Washington is ensuring the long-term sustainability of 9-8-8 and the Native and Strong Crisis Lifeline by enacting an excise tax on every telephone line in the state.

Pathways to Resilience is a national initiative promoting trauma-responsive policies and programs. The goal of Pathways to Resilience is to support states in implementing actionable, evidence-based, and culturally responsive strategies like 9-8-8 and the Native Strong Crisis Lifeline. Pathways to Resilience commends Washington State for prioritizing the needs of Native and Indigenous communities and hopes to see other states follow suit.