Results indicated that young American Indians primarily avoided seeking help while suicidal because of internal factors, including lack of perceived need for help, embarrassment, feelings of hopelessness, fear, and an attitude of self-reliance. Only two of the reasons reported by participants were structural barriers--lack of transportation and cost--and these were cited only rarely. It is possible, however, that the participants never sufficiently entertained the idea of seeking help to consider the details of how to get there and pay for it. Participants did make use of informal supports, however, seeking out the support of family and friends. The findings suggest the need to focus on cultural and internal factors when designing outreach programs for youths at risk of suicide. Data were drawn from a larger, longitudinal study funded by the National Institute on Drug Abuse, which focused on substance abuse, mental illness, trauma, violence, neighborhood and personal strengths, and help seeking among a stratified random sample of 401 American Indian adolescents. Data were collected via personal interviews annually for 4 consecutive years from 2001 through 2006. The current study analyzed data from a subsample of 101 participants who reported that they had thought about or attempted suicide at some point in their lives. In addition to using univariate counts to establish the frequency of each response, bivariate comparisons were used to analyze whether the frequency of specific responses differed by age, gender, location, and suicide attempt history. Future research should investigate how barriers to care may vary within American Indian communities and among different cultures and ethnicities. Tables, references