SIOUX FALLS, S.D. (KELO) — “There’s a Lakota concept of being a good relative, that we’re supposed to walk in this world, regardless of if you’re related to someone or not — it’s being that good relative. How do you be a good person taking care of others — say you’re hosting somebody. How do you make sure they’re comfortable? How do you make sure their needs are taken care of? You’re showing support to somebody else, and you’re doing it in the best way possible. That’s what it means to be a good relative.”

These are the words of Tosa Two Heart. She is the Director of Community Behavioral Health at Great Plains Tribal Leaders Health Board (GPTLHB), an organization advocating for Native communities and working to improve the health and well-being of Native American peoples in the Great Plains region through tribal partnerships and public health practices.

In addressing the issue of elevated suicide rates in South Dakota’s Native American population, the idea of being a good relative falls within a holistic approach to health that Two Heart discussed in a June 1 interview with KELOLAND News.

For reference, according to 2021 provisional data from the South Dakota Dept. of Health, provided by South Dakota Suicide Prevention, 25% of South Dakota suicides were in the population defined as American Indian. This is despite the fact that, according to U.S. census estimates which indicate American Indians and Alaska Natives make up only 9% of the state’s population.

When it comes to the cause of this outsized suicide rate, there is no one simple reason. “I wish there was a way to simply explain the factors that go into increased suicide thoughts and attempts,” said Two Heart after a long sigh. “What it really comes down to though is how many protective factors one has in their life.”

Two Heart says these protective factors include such things as who they have around them for social support, what coping skills they possess, what type of trauma they have experienced and what resources are available to them.

Another distinct issue pointed out by Two Heart is the state of behavioral health resources in South Dakota.

“South Dakota is an area of behavioral shortage,” Two Heart explained. “There’s not enough behavioral health providers to meet the demand across the state.” On reservations, she says, such resources are at a minimum, in many cases due to funding.

The stigma around seeking help for mental and substance abuse disorders in South Dakota is also another factor. “There’s a lot of education that needs done around that,” Two Heart said.

Other factors in suicide ideation mentioned by Two Heart include education, self-esteem and issues of identity. “It’s a lot of different things,” she said, noting that suicide ideation and attempts are often symptoms of other underlying problems.

“When there is that historical trauma — and historical trauma does cause a lot of mental health issues because of that cultural loss — I know this is a touchy subject, but Native American People have suffered genocide, and a lot has been taken from them and continues to be taken,” said Two Heart. “That healing on a larger scale never happened, so you have families from different generations who are carrying that trauma.”

Two Heart notes that we’re only about two generations separate from the boarding school era, a time in which horrendous abuses were perpetrated on Native American children at an institutional level, and on an industrial scale, both in South Dakota as well as in other states and in Canada.

“We have grandparents who have survived that, who have had their language beaten out of them; have been abused in so many different ways in those schools — they were youth; they were young. When you come out of that and have that trauma and no way to deal with it, you raise the next generation on that trauma, and then so forth,” explained Two Heart.

South Dakota was in the top five states for the number of Indian boarding schools.

“You have youth who are trying to find their cultural identity, or figure out who they are and the beauty of who they are as a tribal person,” said Two Heart.

Contributing factors such as these historical traumas and identity issues are why Two Heart takes a holistic approach to suicide prevention and behavioral health.

This type of approach includes programs, such as the Connecting With Our Youth (CWOY) Support Navigator Program.

“Our support navigators teach a lot of coping skills using culture,” said Two Heart. She says that some of the youths have gone on to teach those skills to their families.

These navigators are not professionals, but rather everyday people, educated in trauma-informed care. This is where the concept of being a good relative shines.

Two Heart held up the Great Plains Connections Youth Navigator Program on the Crow Creek Reservation as an example. “We did research — we learned that there was a low high school matriculation rate, they were low on public health education on substance use and behavioral health,” she said. “We wanted to help the youth create life plans. If you’re not graduating and you don’t have a plan — how are you going to see the future.”

This program helps with compiling a life plan and provides direct assistance such as taking kids to visit college campuses. They also work to provide education and make sure that the youth’s behavioral health is taken care of, providing a non-judgmental and compassionate pillar of support; being a good relative.

But being a good relative does not only apply to those within Native American communities.

Due to many of the issues listed above, it can be easy for many to feel that the deck is stacked against them from the start.

“I grew up here in South Dakota,” said Two Heart, reflecting on this idea. “I grew up on the Pine Ridge Reservation, and I grew up with the idea that the world hated me, and that’s just the way it is. Because of the racism, I’ve seen throughout my life; because of the history — how could you feel like you have any place in the world when you feel hate towards you?”

Two Heart exemplified this exact struggle in her next statement.

“It’s sad because I thought that maybe things were going in a good direction in terms of like, valuing and protecting Native peoples,” Two Heart revealed. “But recent events show us that racism is still very much alive and real here in South Dakota.”

Two Heart expresses concern for the generation of Native youth growing up now in South Dakota. “How does that make them feel about themselves? Do they feel safe? Do they feel safe if they’re off the reservation — are they really safe? You can’t even address the deeper issues if you don’t feel safe.”

Addressing such a fundamental issue is out of the hands of a single individual like Two Heart. This is where you too can be a good relative.

“Show non-judgmental compassion to anyone and everyone,” says Two Heart, providing a framework for how those outside of Native communities can serve as an ally. “Hold your own family members and relatives accountable. I think that when a Native person is advocating for their voice and speaking their truth — a lot of times, non-Natives are more open to a non-Native explaining it. I really look to our allies to be able to help non-Natives understand where Native peoples are coming from and what they’ve experienced.”

Finding a solution to elevated rates of Native American suicide will not be a simple process. It is a complex problem, requiring a complex network of solutions and support to address. To do so, take a look around. How can you be a good neighbor today?

If you or someone you know is experiencing suicide ideation or crisis, call the suicide prevention helpline at 1-800-273-8255. You can find more info at