Building a Suicide Prevention Infrastructure

Recent data from the Centers for Disease Control and Prevention (CDC) show the national suicide rate decreased 2.1% between 2018 and 2019.

The CDC Morbidity and Mortality Weekly Report (MMWR) analysis, Changes in Suicide Rates—United States, 2018-2019, shows specific declines in the rates of suicide in females and males and in certain age groups, states, counties, and mechanism of suicide. Another report by CDC, The State of State, Territorial, and Tribal Suicide Prevention: Findings from a Web-Based Survey, highlights the important work being done across the U.S. to strengthen suicide prevention infrastructure. For example, 90% of states, 75% of territories, and 33% of surveyed tribes reported having a suicide prevention plan in place.

While such findings are promising, the analyses nonetheless point us to the existing gaps in suicide prevention infrastructure that jeopardize our ability to meet the national goal of reducing suicide 20% by 2025. For example, the MMWR analysis indicates persistent disparities in historically marginalized and underserved populations. American Indian and Alaska Native populations have not seen the same decreases in their suicide rates as other communities, such as non-Hispanic White populations, in which rates decreased between 2018 and 2019. The analysis also suggests rates of suicide increased as counties became more rural.

The State of State, Territorial, and Tribal Suicide Prevention report also shows an overwhelming majority (88.2%) of participating states, territories, and tribes reported financial barriers as their largest obstacle to meeting national goals in suicide prevention. Nearly 80% reported lack of staffing as a significant barrier, and over a third of states (37%) reported a state budget less than or equal to $100,000. A fifth of states (22%) had no state appropriations for suicide prevention. These weaknesses in suicide prevention, particularly inadequate staffing levels, limit the ability to put what works into practice. They also make it difficult to accurately plan, implement, and evaluate prevention activities for the places and populations that need them the most.

Fortunately, we have at our fingertips effective suicide prevention tools: SPRC’s Recommendations for State Suicide Prevention Infrastructure (Infrastructure Recommendations) and CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices. Both of these resources provide states, territories, and tribes with the guidance to build effective, comprehensive, and sustainable suicide prevention efforts that address the range of factors influencing suicide risk.

SPRC’s Infrastructure Recommendations—in particular, the Authorize and Build essential elements—call for carrying out a multifaceted approach to suicide prevention, through adequate staffing of state-designated prevention organizations or entities. CDC is funding the new Comprehensive Suicide Prevention Program in eight states and one university. The awardees are focused on implementing prevention strategies in disproportionately affected populations. The comprehensive approach includes working with multi-sectoral partners to use data to define the problem and understand factors associated with suicide. Awardees will apply the best available evidence from CDC’s technical package to reduce suicide and suicide attempts by 10% over five years in their chosen populations.

The Examine element of SPRC’s Infrastructure Recommendations identifies high-quality, timely surveillance data as a need. These data would help identify which specific suicide prevention strategies to put in place, and with whom. However, nearly 73% of survey respondents said that lack of surveillance resources was a common barrier to suicide prevention.

The CDC report identifies individuals with lived experience and survivors of suicide loss as some of the most influential champions in prevention. SPRC recently launched a Lived Experience Advisory Committee with culturally and geographically diverse representatives to help promote these individuals as opinion leaders in all areas of program development, dissemination, evaluation.

In March, SPRC also began a series of listening sessions with tribal representatives to strengthen relationships with those communities, better share their resources, and meet their needs. We hope this ongoing relationship building will help enhance suicide prevention efforts.

Sufficient funding, staffing, and timely suicide data along with strategic partnerships are key opportunities for strengthening the foundation of our overall suicide prevention infrastructure. Fully implementing SPRC’s Infrastructure Recommendations and CDC’s technical package best practices can serve as a roadmap to its construction.

As the nation continues to deal with the impacts of the COVID pandemic, it is more important now than ever before to empower states, territories, and tribes to use the available research-based resources so that they can successfully reduce suicide deaths, as well as attempts and thoughts.

We urge our partners across the country to continue using SPRC’s Infrastructure Recommendations and CDC’s Preventing Suicide technical package to build on the recent reduction in suicide rates. It will take all of us to meet our 2025 goal.

Deborah Stone, ScD, MSW, MPH

Lead Behavioral Scientist

Suicide Prevention Team

Centers for Disease Control and Prevention

Beverly Funderburk, PhD

Professor of Research

SPRC Co-Director

Center on Child Abuse and Neglect

University of Oklahoma Health Sciences Center

Julie Ebin, EdM

Manager, Special Initiatives

Suicide Prevention Resource Center Project

Education Development Center