FARGO — Law enforcement officers, paramedics and social services providers in the Fargo-Moorhead area are regularly asking people they encounter in a mental health crisis some questions to assess their suicide risk.

Last year, professionals asked those questions of more than 1,200 people in the midst of a mental health crisis using a suicide risk assessment tool that professionals credit with helping to identify those at serious risk of harming themselves and to get them needed help.

The initiative, launched in 2017 by an area group called ReThink Mental Health, is now well established and in widespread use — but also requires proper training to use.

Karen Nitzkorski, who directs the suicide screening initiative for ReThink Mental Health, is worried that the need for widespread assessment will only grow because of the stresses and social isolation caused by the coronavirus pandemic.

During the pandemic, 41% of adults reported adverse mental health conditions, with depression and anxiety up three-fold, she said. Reports of loneliness increased 20% to 30%, she said.

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“With mental health needs on the rise, so is the need for appropriate screening skills,” Nitzkorski said.

The concerns are especially acute in North Dakota, which saw the nation’s highest increase in suicide rates, 58%, from 1999 to 2016, according to federal figures. Minnesota experienced an increase of 41% during the period. Both states were well above the national average increase, 25%.

Fargo police are perhaps the most frequent users of the screening tool. Officers used the six-question, evidence-based assessment tool at least 1,017 times in 2020 — or almost three times daily, dispatch records show. All area law enforcement agencies used the tool a total of 1,318 times.

Since the program launched in 2017, 1,234 area professionals have received training in the screening tool and are using it, Nitzkorski said.

They ask, for example, “Over the past month, have you wished you were dead or wished you could go to sleep and not wake up?”

If the answer is yes, they ask, “Have you actually had any thoughts of killing yourself?”

Based on the person’s answers, the tool also assesses whether the person is at low, moderate or high risk of suicide, and recommends appropriate steps to take.

Before the screening tool was adopted locally, law enforcement agencies, social services and health providers were using different methods of assessment, leading to a scattershot approach, said Dr. Jon Ulven, a clinical psychologist at Sanford Health in Moorhead who instigated the screening initiative.

The need for an effective screening and assessment tool was widely recognized by professionals, who were encountering more and more people at risk of suicide, he said.

Using a universal screening and assessment tool offers at least two big advantages, Ulven said.

Now, everyone is using a common language and strategy for assessing suicide risk. Also, the initiative has involved widespread training and discussion among professionals in many fields.

“We’re better connected and more aware of suicide risk and strategies for suicide prevention,” Ulven said.

As a result, Ulven and Nitzkorski said, lives are being saved. A survey by North Dakota State University of professionals who use the screening tool found that 74% reported it was successful in getting people the help they needed.

They cited as examples cases in which suicide screening provided opportunities for parental involvement and encouraged those experiencing a mental health crisis to be more forthcoming about their mental health.

“Without any evidence-based tool, they would need to rely on their gut or instinct,” said Cory Beil, director of health promotions for Clay County Public Health and director of ReThink Mental Health. “If you don’t ask people about suicide, you can’t help them.”

Training equips professionals to ask the right questions in a way that is helpful, he said. Done poorly, interventions sometimes can elevate risk. “We know that it’s helping people get through situations,” Beil said.

The initiative is funded by the United Way of Cass-Clay.

More info

For more information, contact Karen Nitzkorski at ReThink Mental Health, knitzkorski@gmail.com, or call 701-371-9644.