New Hampshire’s State Plan Implementation Approach

New Hampshire’s implementation of its state suicide prevention plan provides a powerful example of coordinated work resulting in tangible improvements to the state’s prevention infrastructure. Through New Hampshire’s Suicide Prevention Council (SPC) subcommittee structure, SPC members remained focused on ensuring the plan’s implementation in the midst of competing demands. Finally, the SPC maintained trust by publicly reporting on the state of suicide and prevention in New Hampshire, including the progress of the plan’s implementation.

Although the SPC is legislatively mandated, it acts as an independent body. In consultation with state partners, the SPC updates the New Hampshire state plan every three years. Each of the SPC’s seven subcommittees focuses on one or more key areas in the state plan:

  • Communications and public education
  • Data collection and analysis
  • Law enforcement (includes all first responders)
  • Military and veterans
  • Public policy
  • Suicide fatality review
  • Survivors of suicide loss

The strong leadership and active participation the subcommittees provide was particularly important before the recent addition of the state suicide prevention coordinator role. The subcommittees still play a critical role in planning and implementing statewide efforts in concert with the state coordinator. Accomplishing everything that needs to be done requires many people’s input, expertise, energy, and efforts.

Because each SPC subcommittee focuses on a specific area of the state plan, they have a greater chance of actually implementing changes outlined in the plan as well as improving infrastructure. For example, the Public Policy Subcommittee’s work led to the passage of RSA 193-J, which requires schools to develop suicide prevention policies and training. The subcommittee developed the first draft of the bill, helped solidify bipartisan sponsorship, and advocated at the local and state levels for its passage.

To document the state’s progress on suicide prevention, each year the SPC publishes an annual report that includes accomplishments and suicide-related data. In 2020, the subcommittees and SPC members additionally evaluated how well they did in implementing the state plan goals, as well as the subcommittee structure itself. The results will be shared broadly, including with the governor and legislature, and incorporated into the new state suicide prevention plan.

A key initial finding of the evaluation is that the state plan’s goals need to be more specific and measurable so the subcommittees and the public can see progress—or lack thereof—more easily. The evaluation also highlights a need to improve coordination among the subcommittees and the SPC. To address these challenges, the SPC is using tools developed by the Suicide Prevention Resource Center (SPRC) to clearly identify measurable goals for each subcommittee that align directly with the state plan goals. Using the Recommendations for State Suicide Prevention Infrastructure: Essential Elements Assessment Tool will also allow the SPC to build consensus on how they will prioritize their goals.

The new prevention plan will be closely tied to the New Hampshire Department of Health and Human Service’s (DHHS) 10-year Mental Health Plan so that suicide prevention remains at the forefront of the state government’s behavioral health efforts. Several SPC members served on the plan development team, further demonstrating the council’s influence and leadership while building state prevention infrastructure.

Additional Resource

Learn how your state can develop similar infrastructure and read additional examples by visiting the Authorize and Partner essential elements of SPRC’s state Infrastructure Recommendations.

Suicides Decrease as Utah’s Prevention Infrastructure Grows

In this short video, Utah Division of Substance Abuse and Mental Health Director Doug Thomas discusses the importance of putting suicide prevention leadership in place and how it was done in Utah. The state led an effort to build partnerships among different types of organizations and is using SPRC’s recommendations to enhance Utah’s capacity and resources. Since that effort began, Utah’s suicide rate has decreased, and the state has a suicide prevention infrastructure that can remain in place even when staff and leadership change.

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Colorado Legislator Acts with Bold Humility to Prevent Suicide

In this short video, former state Senator and suicide loss survivor Linda Newell shares lessons from her involvement in building Colorado’s suicide prevention capacity. With input from the state’s coalition of experts and people with personal or family experience with suicidality, legislators expanded support for foundational aspects of suicide prevention. The state has been able to address suicide by analyzing infrastructure gaps and embedding public health approaches into all levels of support.

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Building State and Local Funding in Colorado

In this five-minute story, Sarah Brummett of Colorado’s Department of Public Health & Environment describes how Colorado leveraged existing infrastructure and champions to fund state and community efforts. Through support from advocates and the legislature, as well as building on an interactive data map and prevention partnerships, Colorado has drawn down substantial funds to support suicide prevention at the state and local levels.

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Tennessee’s Statewide Suicide Prevention Network

The Tennessee Suicide Prevention Network (TSPN) is an independent nonprofit organization that is housed within Mental Health America of the MidSouth and has regional staff across the state. TSPN provides leadership for suicide prevention in Tennessee and administrative backing for a statewide coalition called the Advisory Council, which is responsible for oversight of the Tennessee Strategy for Suicide Prevention.

The Advisory Council follows bylaws that ensure its membership includes loss and attempt survivors, health care workers, K-12 professionals, justice system professionals, and people from other fields. The Advisory Council bylaws serve as a key document to which members commit in order to ensure effective participation and division of activities across the state.

The bylaws also require that the Advisory Council includes three representatives from each of nine different regions in the state. These members of the Advisory Council are appointed by the Office of the Governor and serve for two-year appointments. Tennessee also ensures public representation on the Advisory Council through ex officio membership from state departments. The Advisory Council’s structure allows for input from a broad range of Tennessee’s leaders as well as different populations and regions in the state.

The Advisory Council also helps integrate suicide prevention strategies across organizations at the local level. Each of Tennessee’s nine regions has its own local council led by the three-person team that serves on the statewide Advisory Council. These three-person teams hold their own local council meetings with community members who are appointed to serve on the local councils by their county commissioners. The three-person teams then report back to the statewide Advisory Council on the needs, resources, and trends identified through their local council’s work.

The statewide Advisory Council evaluates and reports on suicide prevention activities annually to the Tennessee governor. The Advisory Council’s role in evaluation and reporting enables it to provide guidance on suicide prevention and garner infrastructure support for local efforts.

The Advisory Council believes it is important for all members to come together with a purpose and role to play. Those who serve on Tennessee’s local and state councils often feel they are supporting their own healing and recovery while contributing to a larger cause.

Learn how your state can develop similar infrastructure and read additional examples by visiting the Partner essential element of SPRC’s State Infrastructure Recommendations.

Utah’s Multifaceted Suicide Prevention Program

The Utah Department of Health and Human Services’ Division of Substance Abuse and Mental Health oversees the implementation of the state’s multifaceted suicide prevention plan in collaboration with the Utah Suicide Prevention Coalition. Utah has provided consistent state funding for implementation of prevention efforts since 2013, when HB 364 mandated the creation of a Utah suicide prevention program and suicide prevention coordinator. Also since 2013, a combination of federal and state funding has supported a variety of suicide prevention strategies. There is also an annual line item for suicide prevention in the state budget.

Utah has developed a comprehensive state suicide prevention plan that addresses suicide through all levels of the social-ecological model. Utah’s suicide prevention program identifies key groups at increased risk of suicide and their associated risk and protective factors, and then chooses strategies to effectively reach these groups. Through this process, the state ensures a lifespan focused, statewide approach to suicide prevention in which funds are used to support evidence-based strategies and programs, including primary prevention, crisis response, and postvention activities.

To enhance its ability to reach high-risk groups across the lifespan and the state, the Utah Suicide Prevention Coalition maintains work groups focused on special populations and evidence-based strategies. The statewide coalition provides technical assistance to community coalitions that guide the development of local infrastructure to prevent suicide.

Utah ensures continued funding for the approach described above through evaluation and reports to the legislature and the Governor’s Mental Health Advisory Committee. But the Utah suicide prevention program does not just use its data for reporting. It also examines data for new risk and protective factors and gaps that need to be addressed through prevention programming. Utah’s suicide prevention and crisis services administrator shared that in order to have a sustainable and effective suicide prevention program, prevention leadership must have a solid sense of what needs to be done, how they will use funding, and how that funding will help address the problem.

Learn how your state can develop similar infrastructure and read additional examples by visiting the Build essential element of SPRC’s State Infrastructure Recommendations.

New York’s Suicide Prevention Academy

In 2014, the New York Office of Mental Health created the New York Suicide Prevention Office (SPO) to coordinate its suicide prevention activities. The SPO receives an allocation in the state’s annual budget. In turn, the SPO uses a portion of its budget to fund the Suicide Prevention Center of New York (SPC-NY) and to help support the Columbia University Medical Center’s Suicide Prevention – Training, Implementation, and Evaluation (SP-TIE) program and the Mental Health Association of New York State (MHANYS).

These three organizations support New York state’s suicide prevention initiatives, including comprehensive suicide prevention training and education. MHANYS provides administrative support for the state’s gatekeeper training initiative in schools and communities, logistical support for New York’s annual state suicide prevention conference, and support for other prevention tasks as needed. SP-TIE has developed online learning modules for health care clinicians on safety planning, risk assessment, and more. SPC-NY houses a resource library and list of available trainings in New York focused on communities, schools, and health care.

New York also has county-level suicide prevention coalitions. Providing support to these coalitions is a focus of New York State’s suicide prevention plan, since the coalitions help implement suicide prevention strategies.

In 2016, the SPO developed a suicide prevention coalition academy through which coalitions were invited to participate in two-hour, in-person trainings followed by a series of online modules focused on strategic planning. Participant coalitions were given $3,000 to help them develop and launch their strategic plan. Additionally, six counties that did not have coalitions were given full-day trainings on coalition development. All of these efforts to support coalitions help them develop a shared language and strategic planning focus.

The SPO has continued to develop and offer new online modules and webinars on a variety of prevention topics from mission statements to data analysis to postvention. The SPO also continues to provide targeted infrastructure funding opportunities to help coalitions implement projects in alignment with the state plan. With the combination of New York’s state funding, inter-agency collaboration, and support of local coalitions, key players receive the education and support they need to develop and implement effective suicide prevention efforts across communities.

Learn how your state can develop similar infrastructure and read additional examples by visiting the Guide essential element of SPRC’s State Infrastructure Recommendations.

New Hampshire’s Thriving Suicide Prevention Council

In 2006, representatives from public and private agencies, citizens, and state legislators in New Hampshire came together to form a suicide prevention council. Members of this new group, who were committed to suicide prevention across the lifespan, signed a memorandum of understanding to confirm their dedication to the council.

Two years later, building on the council’s work to create a sustainable and unified suicide prevention effort, the state legislature formally established the New Hampshire Suicide Prevention Council (SPC). The SPC continues to serve as the lead for suicide prevention in the state and includes several subcommittees focusing on different areas of suicide prevention. Its main goal is to connect private and public partners in a unified prevention effort. To accomplish this, the SPC oversees development and implementation of the state’s suicide prevention plan. The SPC also creates formal reports that are made available to the public and submitted to the governor annually, ensuring accountability.

The SPC’s ability to bring public and private partners together has promoted community ownership of suicide prevention planning and implementation. This council helps unite grassroots efforts with state leaders for effective, locally driven suicide prevention. Trust between partners has developed through the SPC and has furthered the state’s ability to address many prevention issues related to suicide. Finally, the SPC has minimized duplication of efforts and increased coordination among mental health services and a variety of prevention agencies, including those focused on suicide, substance abuse, and violence prevention.

Additional Resource

Learn how your state can develop similar infrastructure and read additional examples by visiting the Partner and Authorize essential element of SPRC’s state Infrastructure Recommendations.

Massachusetts Authorization for Suicide Prevention Funding

The Massachusetts Coalition for Suicide Prevention (MCSP) was established in 1999 as a public/private partnership between government agencies such as the Massachusetts Department of Public Health (MDPH), community-based agencies, and individuals. The MDPH provides administrative support to the MCSP and also houses the Massachusetts Suicide Prevention Program, through which it provides leadership for suicide prevention in Massachusetts.

Members of the MCSP pay tiered dues that generate revenue to help fund a paid staff person who advocates to the legislature for suicide prevention. The coalition also provides an annual strategic evaluation of the suicide prevention efforts carried out by the MDPH and its statewide partners.

The MDPH has a full-time managing director of suicide prevention and provides funds to 10 regional suicide prevention coalitions. The MDPH develops an annual report on suicides, as well as an annual data bulletin on regional suicide prevention efforts. These reports and bulletins are informed by the evaluation efforts of the MCSP and are shared regularly with the state’s legislature, demonstrating the impact of funding for suicide prevention in Massachusetts.

Through these collective efforts, Massachusetts has created a self-sustaining prevention effort in which leaders, advocates, and the legislature share a common understanding of and dedication to suicide prevention. This self-sustaining effort did not appear overnight. Massachusetts state funding for prevention began in the early 2000s when the legislature approved a line item for suicide prevention in its annual budget. In 2006, a champion within the state legislature and his wife shared their personal testimonies of suicide loss. Once they did, other legislators with similar experiences came forward. This led to growth in state support for suicide prevention and a budget increase to $2.5 million dollars, which has grown to $4.49 million over the years.

When asked how other states could garner support for an annual state budget line item in suicide prevention, the director of the Massachusetts Suicide Prevention Program shared the following:

“You must involve individuals with lived experience in advocacy to and with the legislature. Survivors’ stories enable government to see the value and need for suicide prevention in the state. In addition, you cannot forget the importance of finding a champion within the state legislature or a prominent figure who can present his or her own or constituents’ experiences connected to suicide prevention.”

Learn how your state can develop similar infrastructure and read additional examples by visiting the Authorize essential element of SPRC’s State Infrastructure Recommendations.

Suicide Prevention Leadership in Texas

Texas houses suicide prevention in the Health and Human Services Commission’s Office of Mental Health Coordination. In 2003, Texas Health and Safety Code 533.040(c) created a school suicide prevention liaison. A bill was passed in 2015 to increase the visibility and focus of the liaison, and the position became the state’s suicide prevention coordinator. This position now serves as the suicide prevention team lead.

The Texas suicide prevention team has grown over time and now includes the following:

  • a Zero Suicide Safer Care coordinator who works with 39 community mental health centers and the state hospital system
  • a suicide prevention specialist who focuses on K-12 behavioral health coordination and suicide prevention
  • an epidemiologist/suicide prevention policy, programs and outcomes specialist who focuses on upstream prevention and analysis of program data
  • a youth suicide prevention specialist who serves as the project director for a suicide prevention and early intervention federal grant
  • a veteran‘s mental health and suicide prevention coordinator who writes and maintains the Texas veteran suicide prevention action plan that was mandated through Texas Senate Bill 578

Suicide prevention in Texas is also guided by state-level groups that bring public agencies and private partners together to support suicide prevention. The Texas Suicide Prevention Council provides guidance on the state’s suicide prevention plan. The Texas Behavioral Health Advisory Committee and the Statewide Behavioral Health Coordinating Council ensure that the Statewide Behavioral Health Strategic Plan, which includes content on suicide prevention and early intervention, is implemented and monitored.

To connect state-level oversight to local efforts, the Health and Human Services Commission directs Local Mental Health Authorities (LMHAs), which cover 254 counties. To ensure that enough local staff time, skills, and resources are dedicated to suicide prevention, each LMHA is required to have a suicide prevention coordinator who leads suicide care best practices and participates in a local suicide prevention coalition. These LMHAs and coalitions are encouraged to collaborate with drug and alcohol councils and substance abuse prevention coalitions to address shared risk factors whenever grant funds or trainings are provided by the Texas Health and Human Services Commission.

The strong presence of both state and local staff dedicated to suicide prevention, as well as emphasis on collaboration at the state and local levels, have enabled Texas to understand, respond to, and address suicide prevention and related needs throughout this large and diverse state. The connections made through the councils, committees, and LMHAs ensure that all Texas communities have clear leadership and direction in suicide prevention. 

Learn how your state can develop similar infrastructure and read additional examples by visiting the Lead essential element of SPRC’s State Infrastructure Recommendations.