Revaluing Indigenous Models in Suicidology: A Brief Narrative Synthesis

Abstract

This review uses an anti-colonial approach to explore the characteristics of Indigenous interventions and best practice relating to suicidality. Well-established interventions led by Indigenous communities exist globally, yet their prevalence in academic discussions of suicide is comparatively limited. This represents a missed opportunity for the field of suicidology to learn from Indigenous community-driven models, which have the potential to be translated across contexts. The challenges of sharing best practice Indigenous interventions in academic literature can be situated within a pervasive colonial discourse, which categorises suicide as an ‘Indigenous problem’ and creates ill-fitted evaluation and intervention methodologies. Here, we provide a brief narrative synthesis of contemporary research on Indigenous suicide intervention models in Australia, Aotearoa New Zealand, the United States and Canada, focusing on key characteristics of interventions and a selection of Indigenous community-driven projects. These characteristics are: cultural and collective approaches as protective factors; recognising social determinants of health and the impact of colonisation; community control and governance; evaluation and available research; and relationships and connection. We discuss issues of sustainability, funding, decontextualised research, and publishing and put forward recommendations for future research. Rebalancing academic discussions to centre Indigenous leadership and culturally grounded research and practice is not without its challenges and complexity but can crucially enrich the field of suicidology.

1. Introduction: ‘Evidence’ and the Coloniality of Suicide Research

Indigenous approaches and interventions aiming to reduce suicide risks are diverse, drawing on local culture, knowledge, needs, and priorities (Sjoblom et al. 2022), with culture being “a cognitive map on how to be” (Masotti et al. 2023, p. 1). Indigenous communities around the world are leading such interventions in response to the disproportionately high suicide rates impacting Indigenous people. For example, in 2021, suicide accounted for 5.3 percent of deaths in Aboriginal and Torres Strait Islander communities compared to 1.8% for non-Indigenous Australians (Gayaa Dhuwi 2024). This review synthesises the literature on Indigenous intervention models that aim to decrease the incidence of suicide and address suicidality (i.e., thoughts about or preoccupations with thoughts of suicide) in several settler colonial nations (Australia, Aotearoa New Zealand, the United States (US) and Canada). Rather than prioritise an ‘evidence’ approach through conventional (i.e., positivist and externally defined) means, the purpose of this review is to provide an overview of the key characteristics, strengths, and best practices as reported in the literature on Indigenous suicide intervention and to identify key issues and recommendations for future research.

This review intentionally uses the term ‘Indigenous’ to refer to the First Peoples of all countries named. This is in line with current literature authored by Indigenous researchers and practitioners and reflects the preference of our research team, which includes two Indigenous authors. However, we acknowledge the colonial roots of the English language and its use in de-positioning and dispossessing the sovereignty of Indigenous peoples, including in framing the language used to describe their communities. We also acknowledge the diversity of preferences among Indigenous people in terms of what terminology should be used in each context. Where possible, culturally specific terms used to refer to First Peoples should align with the preferences of each individual or group.

Colonialism refers to ‘a political and economic relation in which the sovereignty of a nation or a people rests on the power of another nation, which makes such nation an empire’ (Maldonado-Torres 2007, p. 243), while coloniality refers to entrenched patterns of power based on colonialism, where notions of domination and inferiority are reproduced over time. Coloniality is ‘intertwined with whiteness’ (Dei and Lordan 2016); that is, it is perpetuated through the myth of white superiority and dominance. By “revaluing” Indigenous models in suicidology, we refer to western research processes and publications upholding the value of Indigenous research, knowledge, and practices (which are already of high value to Indigenous communities). This inevitably involves adopting an anti-colonial approach as western research needs to examine what knowledge and practices are associated with evidence-base and high quality, and which are assigned to peripheral or alternative approaches.

To frame this review, we first critique the standard approach to documenting ‘evidence’ from colonial standards and outsider perspectives that can harm Indigenous researchers and communities. Our rationale is to address the imbalance in knowledge relating to what models work, which is part of the legacy of epistemic injustice, whereby Indigenous knowledge and frameworks are considered inferior to western-based approaches. We do this by analysing key characteristics of Indigenous interventions in 12 recent publications. We then provide a selection of 11 project examples from the grey literature as a snapshot of Indigenous initiatives focussing on suicidality. This review contributes to discussions in critical suicide studies on why Indigenous research and practice should be more prominent in suicidology, and points to future research directions through five key recommendations.

As a group of Aboriginal (Wobcke and Wells) and non-Indigenous (Brooke and Lenette) researchers based in the settler colony of so-called Australia, we wanted to establish what models were prioritised in ‘mainstream’ suicide literature. We contend that there are rich learnings from Indigenous research and culturally grounded evidence that could inform the development of effective, community-led, and culturally safe models across contexts (i.e., not just for Indigenous communities). We acknowledge that Indigenous scholars already lead critical debates on what needs to change in research and practice, but these can be ignored in mainstream literature due to coloniality and epistemic injustice. This form of injustice “wrongs someone in their capacity as a subject of knowledge” (Fricker 2007, p. 5) through attempts to “disqualify a person from the status of knower” (Thomas 2018, p. 211). Coloniality frames western knowledges as superior to knowledge grounded in Indigenous expertise. As Ryder et al. (2020, p. 262) posit:

Colonisation, racism and whiteness have trained researchers to consider ‘Indigeneity’ as a risk factor, these ongoing processes (colonisation, racism and whiteness) have blinded researchers to the real truth. That truth being, that ‘colonisation’ is in actual fact the risk factor. In both questions, Indigenous Knowledges and voice are missing, clearly constructed from a colonial normative framework, underpinned by colonisation and further influenced by whiteness.

In the context of suicide research, cultural perspectives are often designated as a ‘special interest’ (e.g., as per the International Association for Suicide Prevention website) and has resulted in Indigenous people creating and organising their own, separate conferences (e.g., the Indigenous Suicide Prevention Forum in Australia, and the World Indigenous Suicide Prevention Conference). This is due to the general lack of attention to Indigeneity in mainstream discussions on suicide. Further, in our interrogations of the authorship in the articles synthesised for this paper, we found many instances where publications on Indigenous suicidality did not include any Indigenous authors (and therefore excluded them from our review) or had a white, western-based researcher as lead author—in which case it became difficult to ascertain whether the models and principles discussed in these articles reflected Indigenous knowledge.

Coloniality and epistemic injustice also mean that Indigenous research is generally characterised by a deficit lens whereby projects tend to decontextualise lived experiences and problematise communities. The discipline of suicidology is no exception. Suicide research continues to focus on individual interventions and frame suicide as an ‘Indigenous problem’, despite widespread acknowledgement of the link between structural violence in settler colonies and suicide in Indigenous communities (Ansloos 2018; Wexler et al. 2024). The recognition and sharing of best practices in Indigenous suicide research has been impacted by what Dudgeon et al. (2021, p. 32) call an “evidence-deficit narrative” and its associated “evidence ceiling”. Positivist evidence hierarchies such as randomised control trials to evaluate initiatives aiming to reduce suicide risks in Indigenous communities are ineffective to understand suicidality because they are rarely jointly negotiated with Indigenous organisations (Dudgeon et al. 2021; Groves et al. 2022). Similarly, frameworks such as the Canadian Hierarchy of Evidence for Promising Practices impose inappropriate measures that produce an evidence-deficit narrative on Indigenous suicide risks (Dudgeon et al. 2021). Positivist approaches risk reinforcing colonial notions of carrying out extractive research on rather than in collaboration with Indigenous communities as an ethical and culturally safe research principle. When careful negotiation based on reciprocity, humility and depth of relationships of trust guide inquiries (e.g., Ryder et al. 2020), the quality and effectiveness of the research improve.

The dominance of positivist evidence hierarchies has resulted in an imbalance in the body of knowledge on what practices and strategies work to reduce suicidality across contexts, especially when these are grounded in Indigenous knowledge, values, and wisdom. This is arguably another example of the perpetuation of coloniality in research and publication practices, whereby white, western-based models are considered the ‘standard’ while impactful Indigenous-led research and practices are relegated to the background and framed as non-existent, invisible, or discardable (Lenette 2025; Alonso Bejarano et al. 2019; polanco et al. 2020). Yet, initiatives built on meaningful community engagement and that incorporate Indigenous culture, knowledge, spirituality and decolonial methods have yielded substantial impact on suicide-related outcomes in the communities where they are used (Sjoblom et al. 2022; Masotti et al. 2023). Indigenous-led initiatives can contribute to the collection of data that might not be captured using other methodologies. For example, there is evidence that the Apache Surveillance System in the US can track trends and identify characteristics of suicide and suicide-related behaviour that clinical settings and coroner-level data cannot capture (Cwik et al. 2014—see Table 2, below), with significant implications for how suicidality is understood and addressed. As such, Indigenous principles and framings are crucial in defining and documenting what counts as evidence and what could be done differently to address suicidality.

To contribute to epistemic justice and address the harmful impacts of deficit-based and decontextualised suicide research, Dudgeon et al. (2021) suggest creating a community-validated Indigenous evidence hierarchy of what counts as culturally important evidence of best practice, using Indigenous knowledge systems, methodologies, and tools. This might include assessing improvements to the social and emotional wellbeing of community members, including through self-governance, cultural activity, physical health, employment, community safety and school attendance (Dudgeon et al. 2016). Groves et al. (2022) recommend using decentralised performance frameworks with indicators developed collaboratively with Indigenous organisations. Australia’s National Aboriginal and Torres Strait Islander Suicide Prevention Strategy 2025–2035 (NATSISPS) is a good example of a framework that positions Indigenous community leadership and governance as central to interventions, with five core principles for implementing the strategy effectively: Aboriginal and Torres Strait Islander-led; underpinned by culture; lived experience-informed; holistic and integrated systems and services; and place-based responses (Gayaa Dhuwi 2024).

To complement these recommendations, this brief review synthesises a selection of key sources of knowledge on Indigenous suicide interventions to identify gaps and suggest future research directions. Table 1, below, synthesises 12 academic reviews and discussions of Indigenous suicide interventions and their characteristics. Table 2 presents 11 examples of Indigenous-led projects from the grey literature that directly address suicide risks in communities. These examples are by no means exhaustive but merely establish what knowledge features prominently in the literature and are accessible through a broad search strategy such as ours. We then draw on this information to identify key gaps and suggest future research directions.

2. Materials and Methods

To develop our tables, we have used a narrative synthesis or realist review. Dudgeon et al. (2021) identify a narrative synthesis or realist review as the most appropriate way of evaluating Indigenous models to address suicide. A realist review is designed with complex and context-bound social interventions in mind, aiming to provide an explanatory analysis to discern what works, for whom, in what circumstances, in what respects, and how (Kantilal et al. 2020; Pawson et al. 2005). A key tenet is to identify the shared theory or strategy that drives successful interventions (Dudgeon et al. 2021). The traditional data source for realist reviews is secondary data from published documents (Kantilal et al. 2020). Our review seeks to demonstrate what information is available on Indigenous community-driven suicide interventions at a glance. Our search was conducted over a short time period (August–December 2024) and was therefore not systemic, but instead, used a subjective and iterative search to provide a snapshot of such interventions in CANZUS countries (Canada, Australia, Aotearoa New Zealand, United States). We focused our review on these four settler colonial nations as they are comparable through their historic, governance and practice contexts, to achieve a richer discussion within the timeframe of our research. The articles were chosen based on availability in English as a dominant language across these countries.

We developed a list of search terms based on the research question (‘What are the strengths and best practices of Indigenous intervention models to address suicidality?’). We used the following search terms in different combinations: suicide; prevent*; community-driven; communit*; evidence; intervention; Australia; Canada; US; North America; New Zealand; Aotearoa; Māori; Indigenous; Indig*; Aboriginal; Inuit; Native American. Search strings included variations of ‘suicide’, ‘Indigenous’, and ‘intervention’, alternating ‘Indigenous’ with more context specific terms (e.g., Inuit). Snowball searches then ensued by scanning the references of relevant articles for titles related to search terms. Large online databases were used (Google Scholar and the University of New South Wales Library), which is appropriate for a broad search, and we used the same process and keyword combinations. To manage the large volume of results returned in the databases, we conducted the search iteratively, screening papers by title and abstract. When the titles of new results consistently were no longer relevant to the research question, we stopped scanning. Through this process, we selected 35 articles based on relevance to the research question. These were then narrowed down to 12 based on the following selection criteria:

• Suicide was the central issue of the model or program discussed;
• Authorship included Indigenous scholars, sometimes as lead author;
• Models were discussed from a strengths rather than deficit perspective;
• Models were based in settler colonies of Australia, Aotearoa New Zealand, Canada, and US for comparison;
• Models were designed or led by Indigenous communities.

Rather than make assumptions about researchers’ backgrounds, we searched the articles for explicit mention of Indigeneity, followed by a scan of the researchers’ websites and affiliated projects. Our approach was not exhaustive and relied only on publicly available information. We did not directly approach researchers. Including this detail about researcher identity is important as it aligns with an anti-colonial research approach and informs readers about standpoints and positionalities.

Grey literature, including reports, websites, and strategic plans relating to Indigenous suicide research, were screened for relevance through titles and the objectives of models or programs reported on, using a similar search strategy as above. Initially, we used search term combinations of ‘suicide’, ‘project’, ‘communit*’ and alternating ‘Indigenous’ with more context specific terms (e.g., Māori). As the search progressed, and we learnt more about the topic through our simultaneous narrative review of the academic literature, we incorporated additional terms related to specific intervention models and strategies into the search (e.g., ‘culture-as-intervention’). We also used snowball searches to find any other relevant projects and related academic publications.

Wherever possible, we tried to establish whether the models discussed were community-driven and Indigenous-led, and whether publications included an evaluation of the model’s impact. To determine this, we established whether Indigenous communities were involved in either the governance, design, or implementation of the project. If we found one of these characteristics (as stated on the project’s website or cited in academic publications on the project), then we included it in our review. Some models were excluded due to their use of mainstream approaches applied to Indigenous communities without enough evidence of Indigenous involvement in governance, design, or implementation. Additionally, some models and programs were excluded from the review because they have not been thoroughly evaluated or did not provide enough information to determine if they met our review’s search criteria. Our search returned a dominance of articles and interventions from the US, followed by Canada and Australia, and limited results from Aotearoa New Zealand and Sweden (even though our initial focus did not include Sweden, we have included one article relating to this country based on our search results). This reflects a dominance of CANZUS and anglophone research in academic literature on suicide more broadly.

Table 1 provides an analytical summary of the articles selected for our review and indicates authorship, method, purpose and key findings. The last column provides information that directly addresses our topic and has been organised by intervention strategies, characteristics, theories or delivery method.

For Table 2, we provide examples of Indigenous interventions from grey literature. The models can broadly be categorised into school-based, place-based, gatekeeper training (i.e., community members trained to identify people experiencing suicidality and refer them to services), community education, surveillance systems (i.e., data collection and monitoring to improve quality and timeliness of available information about suicide), mobile crisis response teams, and capacity building interventions. We have sought to include at least one peer-reviewed academic citation that discusses the project named to support readers to find further information on these models. This is indicated as “citations” in the table. Direct program websites are also included for all projects.

3. Results

The following tables present key findings from our review. Table 1 presents models in order of strategies, characteristics, theories and delivery methods. Table 2 orders findings by country.

Table 1. Academic reviews of Indigenous suicide interventions.

Source No.	Review Type	Subject	Citation	Summary of Approach and Findings	Strategies, Characteristics, Theories and Delivery Methods
1.	Systemic review	The program rationales of interventions with American Indian and Alaska Native communities	(Pham et al. 2022) (includes Indigenous authors)	Provides an overview of the program theories for interventions aimed at reducing the risk of suicide in American Indian and Alaska Native communities. Synthesises 32 publications. Considerable overlap across literature in terms of strategies and interventions discussed. This review recommends multilevel approaches that incorporate individual-centred strategies that consider local contexts and social systems.	Strategies: Promote connectedness Create protective environments Identify and support people at risk Teach coping and problem-solving skills Strengthened access and delivery of suicide care Lessen harms and prevent future risk Strengthened economic support
2.	Scoping	Indigenous suicide prevention in Circumpolar region	(Redvers et al. 2015) (includes Indigenous authors)	Explores the extent to which interventions focused on Indigenous communities have been reported on from 2004 to 2014. Of 19 articles found to discuss suicide-related interventions, only 7 described evaluation or impact in detail. Most interventions were found in North American countries.	Strategies: Adapt to needs of community Integrating technologies Talking helps Screening Consider gender Partnerships with decision-makers Community researcher partners Community control Traditional and western knowledge
3.	Interpretive analysis	Mapping suicide prevention initiatives targeting Sami in Norway, Sweden and Finland	(Stoor et al. 2021) (Indigenous lead author)	Identified 17 initiatives that include prevention rationales focused on Sami self-determination, decolonisation, reducing exposure to violence or discrimination. Found initiatives varied in terms of being tailor-made for Sámi context, adapted or universal approaches and addressed suicide on all levels (individual, relational, community/cultural, societal and health systems levels). Gatekeeper and mental health literacy training programs were most common. Initiatives generally lacked thorough evaluation. Found majority of current initiatives do not address issues related to colonisation and systemic racism.	Strategies: Pay attention to issues of culture and context Anchor projects locally or be community-driven Address the following problems: (a) Lack of individual protective skills (b) Lack of peer support (c) Lack of occupational health and safety (d) Lack of awareness in general public (e) Lack of suicide prevention planning and perspectives (f) Lack of adapted, accessible clinical services
4.	Critical analysis	Tracking progress in public health suicide prevention in Indigenous communities in Canada	(Pollock et al. 2018) (no Indigenous authors; 1 global majority author)	Analysis of challenges related to suicide surveillance in Canada; assesses strengths and limitations of existing data infrastructure for monitoring outcomes in Indigenous communities towards improved public health system surveillance.	Strategies: Establish an independent community and scientific governing council Integrate Indigenous identifiers into population health datasets Increase geographic coverage Improve suicide data quality, comprehensiveness, and timeliness, Develop a platform for making suicide data accessible to all stakeholders.
5.	Narrative overview	Canadian Inuit community engagement in suicide prevention	(Kral et al. 2009) (includes Indigenous authors)	Review of Inuit meanings of suicide, using a strengths-based approach. Centres Aboriginal autonomy, control and community action. Puts forward a hope-driven narrative to discussions of Inuit suicide interventions and research, particularly pointing to the importance of the Inuit reclamation movement and collective agency.	Characteristics: Community ownership Partnerships between Inuit organisations and government bodies Documentation and evaluation of interventions
6.	Critical scoping review	Benefits of centring Indigenous knowledge and practices in suicide interventions in Australia, Canada, USA and NZ.	(Sjoblom et al. 2022) (includes Indigenous authors)	Reviewed 56 academic and 16 grey literature sources on Indigenous approaches to reducing the risk of suicide. Uses Metis knowledge to frame analysis. No suicide prevention initiatives from New Zealand were identified. Notable absence of inclusion of considerations for Indigenous sexual minorities and gender diverse persons in suicide prevention. Absence of articles concerning Indigenous approaches to tertiary suicide prevention (i.e., crisis response and postvention).	Characteristics: Engaging culture and strengthening connectedness Integrating Indigenous knowledge Indigenous self-determination Employing decolonial approaches
7.	Meta-synthesis of qualitative research	Suicide prevention amongst Indigenous communities in US	(Richardson and Waters 2023) (Indigenous lead author)	Uses Indigenous ways of knowing as a guiding framework to synthesise 15 qualitive articles on Indigenous suicide prevention. First meta-synthesis to assess suicide prevention interventions and programs amongst Indigenous communities, using an Indigenous Ways of Knowing theoretical framework.	Characteristics: Engagement and voices of Indigenous communities Reciprocal academic and healthcare system collaborations Sustainability strategies (financial and capacity) Cultural humility Communication Trust
8.	Case studies	Learning from American Indian and Alaska Native Communities	(Wexler et al. 2024) (includes Indigenous authors)	In-depth descriptions of three community-driven American Indian and Alaska Native models. All three programs feature an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. Asserts limitations of individual-focused approaches that ignore social determinants of health and impacts of structural racism. Suggests models in this case study have translational potential across cultures, communities, and contexts.	Characteristics: Strengths-based Identity development/cultural identity Connectedness, interpersonal and intergenerational protective factors Recognition of social determinants of health
9.	Discussion paper	Discussion of life promotion strategies in Canada, USA, NZ, Australia	(White and Mushquash 2016) (includes Indigenous author)	Thematic and theoretical discussion of suicide among Indigenous peoples within a broad sociopolitical and historical attention to highlight the legacy of colonisation. Summarises current knowledge base and highlights promising practices. Recommends 5 guiding principles for future interventions.	Characteristics: Indigenous ways of knowing Land language and stories Focus on strengths Decolonisation and community self-determination Collective responsibility and reconciliation
10.	Theoretical discussion	General, culturally based, and Indigenous theories on suicide	(O’Keefe et al. 2018) (Indigenous lead author and includes Indigenous authors)	Theoretical explanations of suicide from a psychological, sociological, cultural, and Indigenous perspective as applicable in American Indian/Alaska Native communities towards a future culturally grounded conceptualisation of American Indian/Alaska Native suicide.	Relevant theories: Sociological theory of suicide Escape model of suicide Psychache theory of suicide Interpersonal theory of suicide Cognitive model of suicide Racial-cultural framework American Indian Life Skills Intervention Historical Trauma Cultural Continuity Cuqyun model of Protective Factors Transactional-ecological approach to suicide
11.	Systemic review	Indigenous suicide prevention initiatives in Australia, USA and Canada	(Clifford et al. 2013) (2 global majority authors)	Found 9 evaluations of Indigenous suicide prevention initiatives. Of these, only 3 measured changes in rates of suicide or suicidal behaviour, all of which reported significant improvements. Finds there is a need to increase evaluations of interventions. Recommends combining and tailoring best evidence and culturally specific individual strategies for delivery to whole Indigenous communities/population groups.	Delivery methods: Community Prevention Gatekeeper Training Education
12.	Content analysis	Overview of suicide prevention projects targeting Aboriginal and Torres Strait Islander communities in Australia	(Ridani et al. 2014) (non-Indigenous authors)	Presents an inventory of suicide interventions in Australia, finding 67 interventions, categorised through delivery mode and target group. Key insights: majority of programs (57%) were run by Indigenous organisations or members of communities in partnership with external organizations such as universities or mental health services; majority of programs (63%) made no mention of program outcomes or only evaluated process or outputs; programs not owned or run by Indigenous corporations used workshops as their main delivery method.	Delivery methods: Training and educational workshops Creative means Pamphlets/resources Counselling Peer support/mentoring DVD Closure of alcohol outlet Restriction of alcohol strength for sale Restriction of access to means Radio broadcasts Interactive touch technology

Table 1. Academic reviews of Indigenous suicide interventions.

Source No.	Review Type	Subject	Citation	Summary of Approach and Findings	Strategies, Characteristics, Theories and Delivery Methods
1.	Systemic review	The program rationales of interventions with American Indian and Alaska Native communities	(Pham et al. 2022) (includes Indigenous authors)	Provides an overview of the program theories for interventions aimed at reducing the risk of suicide in American Indian and Alaska Native communities. Synthesises 32 publications. Considerable overlap across literature in terms of strategies and interventions discussed. This review recommends multilevel approaches that incorporate individual-centred strategies that consider local contexts and social systems.	Strategies: Promote connectedness Create protective environments Identify and support people at risk Teach coping and problem-solving skills Strengthened access and delivery of suicide care Lessen harms and prevent future risk Strengthened economic support
2.	Scoping	Indigenous suicide prevention in Circumpolar region	(Redvers et al. 2015) (includes Indigenous authors)	Explores the extent to which interventions focused on Indigenous communities have been reported on from 2004 to 2014. Of 19 articles found to discuss suicide-related interventions, only 7 described evaluation or impact in detail. Most interventions were found in North American countries.	Strategies: Adapt to needs of community Integrating technologies Talking helps Screening Consider gender Partnerships with decision-makers Community researcher partners Community control Traditional and western knowledge
3.	Interpretive analysis	Mapping suicide prevention initiatives targeting Sami in Norway, Sweden and Finland	(Stoor et al. 2021) (Indigenous lead author)	Identified 17 initiatives that include prevention rationales focused on Sami self-determination, decolonisation, reducing exposure to violence or discrimination. Found initiatives varied in terms of being tailor-made for Sámi context, adapted or universal approaches and addressed suicide on all levels (individual, relational, community/cultural, societal and health systems levels). Gatekeeper and mental health literacy training programs were most common. Initiatives generally lacked thorough evaluation. Found majority of current initiatives do not address issues related to colonisation and systemic racism.	Strategies: Pay attention to issues of culture and context Anchor projects locally or be community-driven Address the following problems: (a) Lack of individual protective skills (b) Lack of peer support (c) Lack of occupational health and safety (d) Lack of awareness in general public (e) Lack of suicide prevention planning and perspectives (f) Lack of adapted, accessible clinical services
4.	Critical analysis	Tracking progress in public health suicide prevention in Indigenous communities in Canada	(Pollock et al. 2018) (no Indigenous authors; 1 global majority author)	Analysis of challenges related to suicide surveillance in Canada; assesses strengths and limitations of existing data infrastructure for monitoring outcomes in Indigenous communities towards improved public health system surveillance.	Strategies: Establish an independent community and scientific governing council Integrate Indigenous identifiers into population health datasets Increase geographic coverage Improve suicide data quality, comprehensiveness, and timeliness, Develop a platform for making suicide data accessible to all stakeholders.
5.	Narrative overview	Canadian Inuit community engagement in suicide prevention	(Kral et al. 2009) (includes Indigenous authors)	Review of Inuit meanings of suicide, using a strengths-based approach. Centres Aboriginal autonomy, control and community action. Puts forward a hope-driven narrative to discussions of Inuit suicide interventions and research, particularly pointing to the importance of the Inuit reclamation movement and collective agency.	Characteristics: Community ownership Partnerships between Inuit organisations and government bodies Documentation and evaluation of interventions
6.	Critical scoping review	Benefits of centring Indigenous knowledge and practices in suicide interventions in Australia, Canada, USA and NZ.	(Sjoblom et al. 2022) (includes Indigenous authors)	Reviewed 56 academic and 16 grey literature sources on Indigenous approaches to reducing the risk of suicide. Uses Metis knowledge to frame analysis. No suicide prevention initiatives from New Zealand were identified. Notable absence of inclusion of considerations for Indigenous sexual minorities and gender diverse persons in suicide prevention. Absence of articles concerning Indigenous approaches to tertiary suicide prevention (i.e., crisis response and postvention).	Characteristics: Engaging culture and strengthening connectedness Integrating Indigenous knowledge Indigenous self-determination Employing decolonial approaches
7.	Meta-synthesis of qualitative research	Suicide prevention amongst Indigenous communities in US	(Richardson and Waters 2023) (Indigenous lead author)	Uses Indigenous ways of knowing as a guiding framework to synthesise 15 qualitive articles on Indigenous suicide prevention. First meta-synthesis to assess suicide prevention interventions and programs amongst Indigenous communities, using an Indigenous Ways of Knowing theoretical framework.	Characteristics: Engagement and voices of Indigenous communities Reciprocal academic and healthcare system collaborations Sustainability strategies (financial and capacity) Cultural humility Communication Trust
8.	Case studies	Learning from American Indian and Alaska Native Communities	(Wexler et al. 2024) (includes Indigenous authors)	In-depth descriptions of three community-driven American Indian and Alaska Native models. All three programs feature an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. Asserts limitations of individual-focused approaches that ignore social determinants of health and impacts of structural racism. Suggests models in this case study have translational potential across cultures, communities, and contexts.	Characteristics: Strengths-based Identity development/cultural identity Connectedness, interpersonal and intergenerational protective factors Recognition of social determinants of health
9.	Discussion paper	Discussion of life promotion strategies in Canada, USA, NZ, Australia	(White and Mushquash 2016) (includes Indigenous author)	Thematic and theoretical discussion of suicide among Indigenous peoples within a broad sociopolitical and historical attention to highlight the legacy of colonisation. Summarises current knowledge base and highlights promising practices. Recommends 5 guiding principles for future interventions.	Characteristics: Indigenous ways of knowing Land language and stories Focus on strengths Decolonisation and community self-determination Collective responsibility and reconciliation
10.	Theoretical discussion	General, culturally based, and Indigenous theories on suicide	(O’Keefe et al. 2018) (Indigenous lead author and includes Indigenous authors)	Theoretical explanations of suicide from a psychological, sociological, cultural, and Indigenous perspective as applicable in American Indian/Alaska Native communities towards a future culturally grounded conceptualisation of American Indian/Alaska Native suicide.	Relevant theories: Sociological theory of suicide Escape model of suicide Psychache theory of suicide Interpersonal theory of suicide Cognitive model of suicide Racial-cultural framework American Indian Life Skills Intervention Historical Trauma Cultural Continuity Cuqyun model of Protective Factors Transactional-ecological approach to suicide
11.	Systemic review	Indigenous suicide prevention initiatives in Australia, USA and Canada	(Clifford et al. 2013) (2 global majority authors)	Found 9 evaluations of Indigenous suicide prevention initiatives. Of these, only 3 measured changes in rates of suicide or suicidal behaviour, all of which reported significant improvements. Finds there is a need to increase evaluations of interventions. Recommends combining and tailoring best evidence and culturally specific individual strategies for delivery to whole Indigenous communities/population groups.	Delivery methods: Community Prevention Gatekeeper Training Education
12.	Content analysis	Overview of suicide prevention projects targeting Aboriginal and Torres Strait Islander communities in Australia	(Ridani et al. 2014) (non-Indigenous authors)	Presents an inventory of suicide interventions in Australia, finding 67 interventions, categorised through delivery mode and target group. Key insights: majority of programs (57%) were run by Indigenous organisations or members of communities in partnership with external organizations such as universities or mental health services; majority of programs (63%) made no mention of program outcomes or only evaluated process or outputs; programs not owned or run by Indigenous corporations used workshops as their main delivery method.	Delivery methods: Training and educational workshops Creative means Pamphlets/resources Counselling Peer support/mentoring DVD Closure of alcohol outlet Restriction of alcohol strength for sale Restriction of access to means Radio broadcasts Interactive touch technology

Table 2. Project examples of Indigenous suicide interventions by country name (ascending).

Project No.	Project Name	Type of Approach	Characteristics of Best Practice	Significance to Research Context
1.	Tiaki Whānau—Tiaki Ora (Aotearoa New Zealand) Website: https://centreofmaorisuicideprevention.com/wananga/tiaki-whanau-tiaki-ora/ (accessed on 17 March 2025) Citation: (Sewell et al. 2021)	Family (Whānau) champions model	Whanaungatanga (relationship, kinship, family connection) Māori models of wellbeing Reciprocal learning and support Capacity building	This program seeks to contribute to the evidence base for what works for Māori and Pacific communities and build national leadership and vision to address suicide among Māori and Pacific communities. A key assumption of the program is the belief in the inherent strengths and assets of whānau and Māori communities to facilitate and maintain their own wellbeing, prevent suicide, and provide their own support to each other, that is effective and safe.
2.	Family Wellbeing Program at Yarrabah (Australia) Website: https://family-wellbeing.squarespace.com/ (accessed on 17 March 2025) Citations: (Tsey et al. 2019) (Prince et al. 2018)	Family Wellbeing Program Australia	Reconnection and transmission of cultural processes and traditions Community empowerment Local responses	This model has been replicated in over 55 Aboriginal and Torres Strait Islander communities across Australia, as well as being used internationally in Timor Leste, Papua New Guinea and China.
3.	Yiriman Project (Australia) Website: https://kalacc.org/projects/yiriman-project/ (accessed on 17 March 2025) Citations: (Palmer 2013) (Dudgeon et al. 2016) (Grey literature)	Intergenerational ‘on Country’ cultural program	Connecting to Country and culture Elders leading program Cultural awareness Leadership skills Life skills Land management Self-identity Relationship-building Restricted alcohol Place-based activities	Longstanding project designed and led by Elders in the Kimberley region of Western Australia. Evaluated and cited in several reviews of Indigenous suicide interventions with intergenerational model put forward as a delivery method replicable across contexts.
4.	Manitoba Keewatinowi Okimakanak Mobile Response Team (Canada) Website: https://mkonation.com/health/mobile-crisis-response-team/ (accessed on 17 March 2025) Citation: (Sjoblom et al. 2022)	Mobile crisis response team model	First Nations delivery team Culturally safe Trauma-informed	This program presents an approach that uses a mainstream model (mobile crisis response) tailored, delivered by First Nations community leaders, and governed by First Nations communities.
5.	Promoting Community Conversations to End Suicide (PC Cares) (US) Website: https://www.pc-cares.org/ (accessed on 17 March 2025) Citations: (Wexler et al. 2024) (Trout et al. 2018)	Community health education model using learning circles designed and led by the remote communities of northwestern Alaska	Centring local contexts Culture-centric narratives Generation of collective knowledge Coordinated and self-determined action Capacity building Community healing.	This model translates Alaska Native perspectives on health and wellness into a viable funding and implementation strategy for western health research, then returns this research to local communities to inform practice.
6.	American Indian Life Skills Curriculum (US) Website: https://cncfr.jbsinternational.com/node/577 (accessed on 17 March 2025) Citations: (LaFromboise and Lewis 2008) (LaFromboise and Fatemi 2011)	School-based life skills approach developed for replication across communities from Zuni Life Skills program	Connecting with cultural resources Cultural identity Cultural pride/self-esteem Family commitment, safe and healthy relationships Historical trauma resilience Increasing coping skills Personal capacities	This model was first developed with the Zuni Pueblo in New Mexico and has been expanded into a broader curriculum to be used by a diversity of American Indian and Alaska Native populations with culturally and contextually grounded modifications.
7.	Elders Resilience Curriculum (US) Website: https://cih.jhu.edu/programs/the-elders-resilience-curriculum/ (accessed on 17 March 2025) Citation: (Cwik et al. 2019)	Intergenerational education model facilitated by Elders in schools	Strengths-based (individual, cultural, community strengths) Upstream prevention Locally identified, ground-up solutions	Upstream prevention and locally identified, ground-up solutions are underrepresented in suicide research, this curriculum could bring an innovative model to diverse contexts.
8.	Celebrating Life (US) Website: https://cih.jhu.edu/programs/celebrating-life/ (accessed on 17 March 2025) Citations: (Cwik et al. 2014) (Brockie et al. 2023)	Community-based surveillance and case management follow-up program to collect local data, inform strategies, and enhance continuity of care led by White Mountain Apache Tribe	Facilitate connections to care Increase community awareness Inform targeted prevention and treatment interventions	This surveillance system has been adopted by the San Carlos Apache Tribe, the Hualapai Tribe, Cherokee Nation, areas of Navajo Nation, and Colville Confederated Tribes in Washington State. Plans to package model for widespread implementation in other tribal communities. Its strengths for replication have been evaluated as: Able to gather accurate, real-time data to track trends and capture characteristics of suicidal behaviour beyond clinical settings and coroner-level data to advance prevention strategies. Allows for examination of the relationships among behaviours along the continuum of self-injury, providing a deeper understanding of patterns of suicide behaviour across time, including potential contagion effects, in a population-based sample. Demonstrate how community mental health workers can play a key role in continuity of care for suicidal individuals, which is particularly important in rural and under-resourced communities with low access to mental healthcare. Provides an innovative model of collective consent to identify and assist persons engaging in suicidal and self-injurious behaviours
9.	Qungasvik (Tools for Life) (US) Website: https://canhr.uaf.edu/research/past-canhr-projects/qungasvik-toolbox-indigenous-intervention-science-model-alaska-native-communities/ (accessed on 17 March 2025) Citations: (Allen et al. 2022) (Wexler et al. 2024)	Culture-as-intervention multilevel approach in rural Alaska Native communities	Indigenous local control Indigenous theory of change model Contextual and community-driven implementation Indigenous approach to knowledge development	Strength of this model is its recognition of structural racism, social determinants of health and use of a strengths-based approach; making it potentially translatable across cultural, community and practice contexts.
10.	Culture forward (US) Website: https://cih.jhu.edu/programs/cultureforward/ (accessed on 17 March 2025) Citation: (O’Keefe et al. 2022)	National resource guide titled for tribal leaders and stakeholders to support youth suicide prevention through cultural strengths	Networks harness belonging Connection to land and Elders Traditional knowledge as key to health and healing Reclaiming autonomy and wellbeing Self-determination	This model is potentially translatable to other research and practice contexts due to its central community-engaged strategy. This takes into consideration context-specific factors; community needs and how to disseminate of programs with communities in accessible and engaging ways.
11.	Hawai‘i’s Caring Communities Initiative (HCCI) for Youth Suicide Prevention (US) Citations: (Antonio et al. 2020) (Chung-Do et al. 2014)	Youth leadership model	Prioritising relationships Community awareness Capacity building Youth empowerment	This program has been evaluated (Antonio et al. 2020) and showcases the use of a youth leadership model and strengths-based approach.

Table 2. Project examples of Indigenous suicide interventions by country name (ascending).

Project No.	Project Name	Type of Approach	Characteristics of Best Practice	Significance to Research Context
1.	Tiaki Whānau—Tiaki Ora (Aotearoa New Zealand) Website: https://centreofmaorisuicideprevention.com/wananga/tiaki-whanau-tiaki-ora/ (accessed on 17 March 2025) Citation: (Sewell et al. 2021)	Family (Whānau) champions model	Whanaungatanga (relationship, kinship, family connection) Māori models of wellbeing Reciprocal learning and support Capacity building	This program seeks to contribute to the evidence base for what works for Māori and Pacific communities and build national leadership and vision to address suicide among Māori and Pacific communities. A key assumption of the program is the belief in the inherent strengths and assets of whānau and Māori communities to facilitate and maintain their own wellbeing, prevent suicide, and provide their own support to each other, that is effective and safe.
2.	Family Wellbeing Program at Yarrabah (Australia) Website: https://family-wellbeing.squarespace.com/ (accessed on 17 March 2025) Citations: (Tsey et al. 2019) (Prince et al. 2018)	Family Wellbeing Program Australia	Reconnection and transmission of cultural processes and traditions Community empowerment Local responses	This model has been replicated in over 55 Aboriginal and Torres Strait Islander communities across Australia, as well as being used internationally in Timor Leste, Papua New Guinea and China.
3.	Yiriman Project (Australia) Website: https://kalacc.org/projects/yiriman-project/ (accessed on 17 March 2025) Citations: (Palmer 2013) (Dudgeon et al. 2016) (Grey literature)	Intergenerational ‘on Country’ cultural program	Connecting to Country and culture Elders leading program Cultural awareness Leadership skills Life skills Land management Self-identity Relationship-building Restricted alcohol Place-based activities	Longstanding project designed and led by Elders in the Kimberley region of Western Australia. Evaluated and cited in several reviews of Indigenous suicide interventions with intergenerational model put forward as a delivery method replicable across contexts.
4.	Manitoba Keewatinowi Okimakanak Mobile Response Team (Canada) Website: https://mkonation.com/health/mobile-crisis-response-team/ (accessed on 17 March 2025) Citation: (Sjoblom et al. 2022)	Mobile crisis response team model	First Nations delivery team Culturally safe Trauma-informed	This program presents an approach that uses a mainstream model (mobile crisis response) tailored, delivered by First Nations community leaders, and governed by First Nations communities.
5.	Promoting Community Conversations to End Suicide (PC Cares) (US) Website: https://www.pc-cares.org/ (accessed on 17 March 2025) Citations: (Wexler et al. 2024) (Trout et al. 2018)	Community health education model using learning circles designed and led by the remote communities of northwestern Alaska	Centring local contexts Culture-centric narratives Generation of collective knowledge Coordinated and self-determined action Capacity building Community healing.	This model translates Alaska Native perspectives on health and wellness into a viable funding and implementation strategy for western health research, then returns this research to local communities to inform practice.
6.	American Indian Life Skills Curriculum (US) Website: https://cncfr.jbsinternational.com/node/577 (accessed on 17 March 2025) Citations: (LaFromboise and Lewis 2008) (LaFromboise and Fatemi 2011)	School-based life skills approach developed for replication across communities from Zuni Life Skills program	Connecting with cultural resources Cultural identity Cultural pride/self-esteem Family commitment, safe and healthy relationships Historical trauma resilience Increasing coping skills Personal capacities	This model was first developed with the Zuni Pueblo in New Mexico and has been expanded into a broader curriculum to be used by a diversity of American Indian and Alaska Native populations with culturally and contextually grounded modifications.
7.	Elders Resilience Curriculum (US) Website: https://cih.jhu.edu/programs/the-elders-resilience-curriculum/ (accessed on 17 March 2025) Citation: (Cwik et al. 2019)	Intergenerational education model facilitated by Elders in schools	Strengths-based (individual, cultural, community strengths) Upstream prevention Locally identified, ground-up solutions	Upstream prevention and locally identified, ground-up solutions are underrepresented in suicide research, this curriculum could bring an innovative model to diverse contexts.
8.	Celebrating Life (US) Website: https://cih.jhu.edu/programs/celebrating-life/ (accessed on 17 March 2025) Citations: (Cwik et al. 2014) (Brockie et al. 2023)	Community-based surveillance and case management follow-up program to collect local data, inform strategies, and enhance continuity of care led by White Mountain Apache Tribe	Facilitate connections to care Increase community awareness Inform targeted prevention and treatment interventions	This surveillance system has been adopted by the San Carlos Apache Tribe, the Hualapai Tribe, Cherokee Nation, areas of Navajo Nation, and Colville Confederated Tribes in Washington State. Plans to package model for widespread implementation in other tribal communities. Its strengths for replication have been evaluated as: Able to gather accurate, real-time data to track trends and capture characteristics of suicidal behaviour beyond clinical settings and coroner-level data to advance prevention strategies. Allows for examination of the relationships among behaviours along the continuum of self-injury, providing a deeper understanding of patterns of suicide behaviour across time, including potential contagion effects, in a population-based sample. Demonstrate how community mental health workers can play a key role in continuity of care for suicidal individuals, which is particularly important in rural and under-resourced communities with low access to mental healthcare. Provides an innovative model of collective consent to identify and assist persons engaging in suicidal and self-injurious behaviours
9.	Qungasvik (Tools for Life) (US) Website: https://canhr.uaf.edu/research/past-canhr-projects/qungasvik-toolbox-indigenous-intervention-science-model-alaska-native-communities/ (accessed on 17 March 2025) Citations: (Allen et al. 2022) (Wexler et al. 2024)	Culture-as-intervention multilevel approach in rural Alaska Native communities	Indigenous local control Indigenous theory of change model Contextual and community-driven implementation Indigenous approach to knowledge development	Strength of this model is its recognition of structural racism, social determinants of health and use of a strengths-based approach; making it potentially translatable across cultural, community and practice contexts.
10.	Culture forward (US) Website: https://cih.jhu.edu/programs/cultureforward/ (accessed on 17 March 2025) Citation: (O’Keefe et al. 2022)	National resource guide titled for tribal leaders and stakeholders to support youth suicide prevention through cultural strengths	Networks harness belonging Connection to land and Elders Traditional knowledge as key to health and healing Reclaiming autonomy and wellbeing Self-determination	This model is potentially translatable to other research and practice contexts due to its central community-engaged strategy. This takes into consideration context-specific factors; community needs and how to disseminate of programs with communities in accessible and engaging ways.
11.	Hawai‘i’s Caring Communities Initiative (HCCI) for Youth Suicide Prevention (US) Citations: (Antonio et al. 2020) (Chung-Do et al. 2014)	Youth leadership model	Prioritising relationships Community awareness Capacity building Youth empowerment	This program has been evaluated (Antonio et al. 2020) and showcases the use of a youth leadership model and strengths-based approach.

Key Themes Presented in Table 1 and Table 2

We identified four themes in our narrative review on the characteristics of Indigenous models of suicide prevention as found across selected academic and grey literature.

• Cultural and collective approaches as protective factors;
• Recognising social determinants of health and the impact of colonisation;
• Community control and governance;
• Evaluation and available research.

Based on Table 2 we also found one additional theme: Relationships and connection.

• Cultural and collective approaches as protective factors

Table 1: The strongest theme was that connection to culture is a protective factor in community-driven Indigenous suicide prevention. Cultural continuity, that is, the connection to and transmission of cultural processes, traditions, cultural resources and cultural identity, is a prominent characteristic of Indigenous models (O’Keefe et al. 2018; Sjoblom et al. 2022; Wexler et al. 2024). This includes integrating Indigenous knowledge, decolonial approaches, and a culturally grounded concept of suicide (Sjoblom et al. 2022; O’Keefe et al. 2018). Interventions grounded in Indigenous knowledge are characterised by collective responsibility and multilevel approaches over individualised strategies (White and Mushquash 2016; Wexler et al. 2024; Pham et al. 2022; Kral et al. 2009).

Table 2: Cultural continuity is a prominent characteristic in four of the Indigenous community-driven models (American Indian Life Skills Curriculum; Yiriman; Culture Forward; Family Wellbeing Program at Yarrabah). Indigenous knowledge and theories of change are translated into interventions (Tiaki Whānau—Tiaki Ora; PC Cares; Quangasvik Tools for Life; Culture Forward). Two models are characterised by a belief in the inherent strengths and assets of Indigenous communities to lead their own wellbeing, care and community healing (Tiaki Whānau—Tiaki Ora; PC Cares).

2.

Recognising social determinants of health and the impact of colonisation

Table 1: A key characteristic in Indigenous suicide-related interventions is the importance of recognising social determinants of health. Interventions that are individual-focused risk ignoring these determinants and the impacts of structural racism (Wexler et al. 2024). O’Keefe et al. (2018) emphasise the importance of understanding trauma from colonisation and applying a racial-cultural framework in suicide prevention initiatives with Indigenous communities. In the Canadian context, Kral et al. (2009) note that Inuit-driven community action for suicide prevention is directly linked to a broader Inuit reclamation movement, putting forward the idea that Indigenous community-driven suicide prevention interventions are expressions of reclamation and collective agency.

Table 2: Addressing social determinants of health is also a strong theme across models, which directly focus on the impact of colonisation, historical trauma and structural racism on health and wellbeing (PC Cares; Tools for Life; Elders Resilience Curriculum; American Indian Life Skills Curriculum).

3.

Community control and governance

Table 1: Another characteristic of Indigenous suicide interventions is the crucial importance of community control (Redvers et al. 2015; Kral et al. 2009). For instance, White and Mushquash (2016, p. 9) suggest that community self-determination in suicide prevention strategies is directly underscored by decolonisation. Community control or ownership is often practiced through partnerships between Indigenous organisations or communities and decision-makers and research institutions (Redvers et al. 2015; Kral et al. 2009). Pollock et al. (2018) recommend interventions establish an independent community and scientific governing council. Ridani et al.’s (2014) content analysis of suicide prevention projects targeting Aboriginal and Torres Strait Islander communities in Australia found the majority of interventions were run by Indigenous organisations or members of communities in partnership with external organisations.

For interventions to be responsive to community contexts, this involves anchoring projects locally, adapting to the needs of community and community driving the intervention (Stoor et al. 2021; Redvers et al. 2015). Key linked recommendations include multilevel approaches that consider local contexts and social systems and tailoring best evidence and culturally specific individual strategies for delivery to whole Indigenous communities (Clifford et al. 2013; Pham et al. 2022; Stoor et al. 2021).

Table 2: A key characteristic was Indigenous local control with either governance or implementation led by community (Quangasvik Tools for Life; Yarrabah; PC Cares; Elders Resilience Curriculum; Manitoba Keewatinowi Okimakanak Mobile Response Team). While most models were designed and led by community (Family Wellbeing Program at Yarrabah; Elders Resilience Curriculum), we included one outlier example—Manitoba Keewatinowi Okimakanak Mobile Response Team—because even though it uses a mainstream model, the intervention is adapted, delivered and governed by Indigenous community leaders.

4.

Evaluation and available research

Table 1: Our analysis found a limitation in terms of evaluations. Redvers et al. (2015) reviewed interventions focused on Indigenous communities across a decade and out of 19 articles, only 7 described evaluation or impact in detail. Ridani et al. (2014) similarly found most Indigenous suicide prevention interventions in Australia made no mention of program outcomes or only evaluated process or outputs. Clifford et al. (2013) have emphasised the need to increase evaluations of interventions.

Table 2: Building an evidence base for the effectiveness and replicability of Indigenous community-driven models is a key theme across projects. Indigenous community-led models seek to build a new evidence base for what works in Indigenous suicide prevention by gathering data, evaluating programs, and translating Indigenous knowledge into a funding and implementation strategy for western research and providing a deeper understanding of patterns of behaviours (Tiaki Whānau—Tiaki Ora; PC Cares; Celebrating Life; Hawai‘i’s Caring Communities Initiative). Three of the models in our analysis have been successfully adopted in other communities and contexts (Celebrating life, American Indian life Skills Curriculum; Family Wellbeing Program at Yarrabah).

5.

Relationships and connection

Table 2: Prioritising and building relationships are central to some models (Family Wellbeing Program at Yarrabah; Culture Forward). Connection to family and connection across generations came across strongly (American Indian Life Skills Curriculum; Elders Resilience Curriculum; Yiriman; Tiaki Whānau—Tiaki Ora), while leadership by Elders is a focus of three models and noted as a strength (Yiriman; Elders Resilience Program; Culture Forward).

4. Discussion

To achieve a significant and sustained reduction in suicide rates in Indigenous communities, it is crucial to revalue models and practices grounded in Indigenous knowledge and wisdom—this could have a significant impact that extends across contexts (see Masotti et al. 2023). The key themes from publications and resources summarised in Table 1 and Table 2 show that the body of knowledge on Indigenous suicide research approaches and practices is diverse and dynamic. The knowledge shared often involved Indigenous authors or perspectives, but not always. While data on best practices and strategies abound, evaluations about their impact are not always prioritised, suggesting that evaluation is a challenging aspect of suicide research and practice. Here, we discuss issues of sustainability of interventions, funding, decontextualised research, and publishing as central problems to revaluing Indigenous suicide intervention models.

Sustainability: Much of the literature discussed the issue of sustainability in interventions due to a lack of evaluation or documented evidence of efficacy or outcomes (Antonio et al. 2020; Cwik et al. 2014; Clifford et al. 2013). A persistent and prevalent problem across community-driven interventions concerns the lack of sustainability in grant funding, causing many projects to discontinue despite producing promising outcomes (Brockie et al. 2023). Further, funding agencies may not be willing to provide the substantial budgets necessary for evaluations of suicide prevention interventions in Indigenous communities (Clifford et al. 2013). Our brief review shows that the extent to which the strengths and value of Indigenous intervention models are recognised is determined by how their impact is evaluated. Sharing evidence on Indigenous initiatives requires appropriate and culturally safe methodologies to evaluate impacts and outcomes (Gillespie et al. 2020). These methodologies must centre self-determination so that outcomes reflect Indigenous worldviews, ways of knowing, and priorities, and are evaluated meaningfully from the perspectives of Indigenous communities.

For example, Australia’s NATSISPS 2025–2035 identified three enabling factors that can facilitate the effective, meaningful, and sustainable implementation of this national strategy: (1) sustained and targeted funding; (2) rigorous implementation; and (3) governance, monitoring, and evaluation (Gayaa Dhuwi 2024). In relation to the third factor, it is essential that Aboriginal and Torres Strait Islander peoples’ perspectives are prioritised in any governance, monitoring, and evaluation processes. There are overlaps between this national plan’s strategies and the problems we highlight below, suggesting that common objectives cut across research, policy and practice. An ongoing issue is that evaluation methodologies in suicide research and practice are fundamentally grounded in western-based and colonial knowledge systems, even though evaluation outcomes play a crucial role in supporting ongoing resourcing of initiatives (Sjoblom et al. 2022).

Funding: There are substantial barriers to implementing Indigenous community-driven initiatives that directly target suicidality because existing funding and health service provision systems operate from a western, biomedical lens and may be reticent to resource Indigenous approaches appropriately (Sjoblom et al. 2022). In the US, for example, there is a systemic underfunding of the health infrastructures that support community-driven suicide interventions (e.g., Indian Health Service) (Brockie et al. 2023). We acknowledge that this issue is relevant to other minority communities and is linked to broader contextual funding issues. While this is more of a policy and practice-related problem, it nevertheless has a bearing on the kind of research that can be undertaken. Consequently, mainstream suicide interventions do not typically draw on Indigenous knowledge, principles, and models, because these are relatively limited in the form of published articles or reports. For instance, a recent review of national suicide prevention strategies globally makes no mention of Indigenous or Indigenous communities (Sinyor et al. 2024). In the case of Australia’s NATSISPS 2025–2035, Gayaa Dhuwi (2024, p. 14) names “sustained and targeted funding” as one of three enabling factors, especially for effective community-driven suicide interventions that will support “flexible, improved, increased and, where appropriate, joint jurisdictional funding for existing and emerging suicide and self-harm prevention responses and (…) ongoing Aboriginal and Torres Strait Islander leadership, governance, workforce development, research, and evaluation of suicide and self-harm prevention activities”.

Decontextualised research: While we suggest that Indigenous suicide intervention models and principles can be applied in other contexts, there is wide cautioning about the use of ‘pan-Indigenous’ approaches, that is, applying Indigenous-driven suicide interventions in contexts they were not designed for (Sjoblom et al. 2022; Goebert et al. 2018). A pan-Indigenous approach negates the diverse cultural practices, values, sociohistorical contexts, and geographic conditions of each Indigenous community and decontextualises models, which risks diluting the impact of such interventions.

Publishing: It is crucial for academic publishing outlets such as peer-reviewed journals to prioritise articles that report on the impact of suicide interventions and models grounded in Indigenous knowledge; are authored by Indigenous authors; and include the work of early career scholars, to cede space for revaluing Indigenous knowledge. This could complement journal Special Issues on Indigenous suicide research; editorial board positions specifically for Indigenous scholars; waiving article processing charges for Indigenous authors; and ensuring Indigenous academics and practitioners are invited to review Indigenous scholarship for a culturally safe process. These initiatives can contribute to redressing epistemic injustice in the body of knowledge on suicide. Two recent examples are The Lancet Regional Health (Western Pacific)’s special collection on Aboriginal cultural health (issue 52, 2024) and Social Sciences’ Special Issue on ‘Critical Suicide Studies: Decolonial and Participatory Creative Approaches’ (Lenette is guest editor) in 2024–2025.

4.1. Recommendations for Future Research

4.1.1. Comprehensive Model

A comprehensive model to better understand Indigenous-defined evidence bases for addressing suicidality, culturally appropriate evidence of healing, and how to evaluate social and emotional wellbeing has yet to be fully developed and integrated into suicide research (Dudgeon et al. 2021). This needs urgent attention so that the suicidology literature can be expanded with more critical perspectives and new understandings of what impact means from Indigenous perspectives. The discipline of suicidology can thus rely less heavily on western-based, outsider-defined frameworks of evaluation.

4.1.2. Focus on Colonial Trauma

Research should more explicitly acknowledge and address the impacts of colonial trauma on suicidality (Richardson and Waters 2023). The crucial nature of cultural safety in research, policy and practice cannot be overstated (see Gayaa Dhuwi 2024). Despite a growing and excellent body of work on the complex impact of colonial violence on suicidality (Ansloos 2018; Wexler et al. 2024), it is concerning to note the lack of acknowledgement of coloniality as a key determinant of suicidality in many recent sources including national plans. We point to the important work of We Al-li in leading a Culturally Informed, Trauma Integrated Healing Approach (We Al-li 2025) to address the traumatic impacts of multiple intergenerational experiences of colonisation in Australia (Atkinson 2002).

4.1.3. Mixed-Methods Research

To generate a more robust evidence base, mixed-methods research can be useful to identify how suicide intervention strategies or their specific components reduce suicide rates in a context of complex sociocultural and political changes (Lewitzka et al. 2019). We are not advocating here for establishing simplistic or positivist causal relationships, and such mixed-methods research should still be lived-experience-led and culturally safe. This approach can shed light on ethical evaluation models that align with Indigenous knowledge and wisdom. A useful existing resource, the Indigenous Evaluation Toolkit, supports researchers and organisations to Indigenise and decolonise their evaluation models (Gaffney et al. 2024). This toolkit is particularly useful in recognising how some types of Indigenous knowledge do not yield measurement in standard quantitative or qualitative methods and provides strategies to account for this.

4.1.4. Research on Postvention Programs

The lack of research on postvention programs (i.e., interventions following a suicide to support those affected by it) and their impacts should also be addressed. Sjoblom et al.’s (2022) review of interventions across CANZUS countries (see Table 1) found no examples of Indigenous approaches to postvention, despite the additional trauma, grief and loss and possibilities of suicide clusters that might affect Indigenous communities (we note here the excellent work of Thirrili, an Indigenous suicide postvention service in Australia: see thirrili.com.au).

4.1.5. Research on Model Limitations

More research should elucidate why Indigenous suicide interventions do not work (Dudgeon et al. 2021). The persistent rises in suicide rates among Indigenous communities each year—among some of the highest in the world—suggest there are problems with current models but limited understanding of these limitations and how to address them. Achieving this research objective requires honest and reflexive evaluations of current models, where recognition of strengths and impact does not overshadow the need to address the constraints and limitations of current models and programs.

5. Conclusions

This review provides a snapshot of Indigenous interventions and best practices relating to suicidality. We suggest that the field of suicidology decentres a pervasive colonial discourse and learns from Indigenous community-driven models. Our brief narrative synthesis of contemporary research on Indigenous suicide intervention models in Australia, Aotearoa New Zealand, the US and Canada found the following themes: cultural and collective approaches as protective factors; recognising social determinants of health and the impact of colonisation; community control and governance; evaluation and available research; and relationships and connection. Sustainability of interventions, funding, decontextualised research, and publishing are key issues to revaluing Indigenous suicide intervention models. To balance this, we recommend the development of a comprehensive model to better understand Indigenous-defined evidence bases for addressing suicidality, increased focus on colonial trauma, mixed-methods research, research on postvention programs and research on model limitations. Rebalancing academic discussions to centralise Indigenous culturally grounded research is not without its challenges but has the potential to significantly enhance the field of suicidology.