By Franz Strasser and Sharon Carpenter BBC World News America, Fort Yates, North Dakota

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Jon Eagle Jr explains how teaching disconnected teenagers in his reservation about horses gives them 'courage'

Suicide rates among Native American teenagers continue to be higher than the national average and experts see cultural differences and a lack of awareness as the main problems.

Christian Phelps lives on the Pine Ridge Indian Reservation in South Dakota.

"I used to live in Kentucky. I had two friends who killed themselves. My dad died in Iraq. I came up here, two more friends I just made killed themselves," he says.

INDIAN RESERVATIONS 32% of people on reservations live below the federal poverty line Teenage suicide three times the national average Alcoholism rate more than 600 times the national average

He is 15-years-old and says he doesn't want to sound too negative - but he also wants people to stop trying to "sugar-coat the problem".

In 2007, suicide was the 11th leading cause of death among all ages and demographics in the United States.

Among Native Americans and Alaska Natives between the ages of 15 and 34, suicide was the second leading cause of death.

"In many of our tribal communities, suicide is not just an individual clinical condition, but also a community condition," said then Surgeon General Richard Carmona in front of the Indian Affairs Committee in the US Senate in 2005.

Among Native American males, aged between 15 and 19, the numbers are even more grim. In a span of five years, 202 young men took their own lives, a rate of 34.6 per 100,000.

In comparison, the rate for males in the same age group was 13.7 for whites, 9.7 for Hispanics and 7.2 for African-Americans.

Lack of prospects

Young adults perform a play about suicide in front of peers and educators

"I know a lot of people around Pine Ridge that are suicidal," says 14-year-old Bryan. "It's probably just stress and no one is there for them to help them through school and other things."

Isolation is combined with a high use of alcohol and drugs, and a high incidence of crime leads to many fathers going to jail, says Yevonne Decory, who was born in Pine Ridge.

She left the community to get her college degree in Oklahoma and later came back to work as a teacher and youth development specialist.

She says that the communities do not have the economic prospects to give teenagers enough hope.

The long-term legacy of separation, ridicule, grief, all emotional issues that occur in a training, is significantly different than... with non-Natives Sue Eastgard Youth Suicide Prevention Program

"They ask - what am I going to come home to? Unless they're going to the military. 'I'm gonna graduate high school and then what? I'm stuck here.'"

Ms Decory leads the BEAR programme, which initially started as a literacy outreach programme but has evolved into a group of teenagers performing plays dealing with suicide in front of their peers and other educators.

Last year marked the highest rate of suicides on the Pine Ridge Reservation in recent history, says Richard Iron Cloud, director of the Sweetgrass Project, a suicide prevention programme funded by the Substance Abuse and Mental Health Services.

"We need to train community members and family members on how to stay with our relatives," says Mr Iron Cloud, who admits the issue of suicide was never discussed openly in his culture before.

Attitudes and beliefs

It is a challenge for non-Native Americans to develop programs for a population that is in some cases so different from the mainstream culture.

Sue Eastgard, of the Youth Suicide Prevention Program in Seattle, says you cannot begin a discussion about suicide without paying some attention to the attitudes and beliefs of the community.

"When we do training with Native Americans, the long-term legacy of separation, ridicule, grief, all emotional issues that occur in a training, is significantly different than in the same conversation with non-Natives. That makes it much harder."

Recent years have seen an increase in effort and the attention paid to the issue of teen suicide, government officials say.

"The issue has always been a priority," says Dr Rose Weahkee, director for the Indian Health Service Division of Behavioral Health, a US government agency. "Now we are seeing additional resources."

Dr Weahkee points to the Methamphetamine and Suicide Prevention Initiative, a new program that is completely community driven and currently supports 129 prevention and intervention pilot programs nationwide.

Federal funding for the project has risen to $16.4m (£10.2m) in 2010, an 18% increase since 2008.

On Pine Ridge, the teenagers from the BEAR initiative established their own personal programs to make a difference.

Erin, 16, says joining BEAR and helping out is her therapy to get over her friend's suicide, which she had a hard time dealing with.

The program, she says, helped her to approach friends who feel left out.

"I usually invite them over to my house, we'll hang out and I have the entire weekend to make them feel better. They say 'oh look she's there for me, I have a reason to still live.'"

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