About the Recommendations

Working Definition

A state’s concrete, practical foundation or framework that supports suicide prevention-related systems, organizations, and efforts, including the fundamental parts and organization of parts that are necessary for planning, implementation, evaluation, and sustainability.

Since its inception in 2002, SPRC has worked with state suicide prevention leaders to help them build a strong prevention infrastructure at the state level (see sidebar for definition). Such an infrastructure is essential for advancing suicide prevention efforts. Indeed, the Substance Abuse and Mental Health Services Administration notes that “the absence of [a strong state] infrastructure almost certainly compromises suicide reduction efforts to a significant degree.”1

In 2018, SPRC began a project to articulate the critical infrastructure elements all states need to have in place for effective and sustained suicide prevention efforts. After conducting an environmental scan, SPRC formed an advisory panel composed of experts from the public and private sectors to share their experience in this area.

Working in small groups, the panel developed a set of recommendations for states that reflect current research and practice on the development of a state-level infrastructure for suicide prevention and related areas, including public health and mental health. These recommendations are organized into six areas that represent the essential elements of a state infrastructure for suicide prevention.

For more information on the challenge of suicide, learn about the scope of the problem.

Why Were the Recommendations Developed?

Although state health departments and offices of suicide prevention must be able to fulfill a number of functions, the current infrastructure in many states has significant limitations. Suicide prevention, mental health, and substance misuse prevention often receive less attention and funding than other public health problems.2 Unlike mental health and substance misuse prevention, there is not even a designated federal funding stream for suicide prevention in all states (i.e., no suicide prevention block grant). Resources are diverse and often change. As a result, the suicide prevention infrastructure in most states is often limited and underfunded, making it difficult to impact suicide rates and to achieve sustainability.

The recommendations were developed to help state leaders establish a solid foundation for suicide prevention and guide policymaking, funding, and administrative decisions, with a view toward improving sustained suicide prevention efforts across the country. They provide a backbone for supporting the principles and activities laid out in the National Action Alliance’s (Action Alliance’s) Transforming Communities report, and the Center for Disease Control and Prevention’s (CDC’s) Suicide Prevention Resource for Action. The information may also be useful to all others who support suicide prevention efforts at the federal, state and local levels, including funders, suicide prevention coordinators, community organizations, advocates, and researchers.

How Were the Recommendations Developed?

The recommendations were developed based on a review of the research literature and input from national experts and stakeholders, including consultation with state suicide prevention leaders.

The development process included the following:

  • A literature review and an environmental scan of how other health fields have identified and/or recommended key infrastructure components at the state level.
  • A key informant interview with a representative from the Safe States Alliance, which has developed similar guidance for state injury prevention programs.
  • Consultation with state suicide prevention coordinators across the country via focus groups to identify key components of state suicide prevention infrastructure, common elements across states, and feedback on initial recommendations.
  • Guidance from an advisory group of national experts from diverse public and private organizations who brought experience in infrastructure development, suicide prevention, and state policy and administration. The lives of many advisory group members had been personally impacted by suicide.

How Can the Recommendations Be Used?

The recommendations can help state leaders assess the status of their current suicide prevention infrastructure to identify gaps and needed resources to improve the foundation for suicide prevention in their state. They can also be used to identify and engage important partners, support the development of action plans, and build a strong infrastructure to support and sustain suicide prevention efforts. Lastly, they provide a framework for a public health approach to suicide prevention, encouraging states to regularly examine the current extent of suicidal behavior, evidence-based prevention efforts, funding, and personnel in order to identify and address needs.

Are These Recommendations Appropriate for Tribal Nations?

Although the recommendations were primarily developed with states in mind, many may be relevant to infrastructure in tribal nations. These recommendations would need to be tailored by individual tribal nations to fit their community, context, culture, and governmental structure.


Special thanks to: Elisabeth Frankini, (formerly) Intern, Tufts School of Public Health, who conducted our environmental scan and literature review and Rich Lindsey, Consultant, Council of State Governments of the U.S. West, who championed the recommendations.

Advisory Panel and Work Group Members

Kirk Bol, Manager, Vital Statistics Program, Colorado Department of Public Health and Environment

Cicely Burrows-McElwain, Military and Veteran Affairs Liaison, National Policy Liaison Branch, Substance Abuse and Mental Health Services Administration

Akeiisa Coleman, (formerly) Senior Policy Analyst, National Governor’s Association

Amanda Deutsch, Director, Public and Behavioral Health Integration, Association of State and Territorial Health Officials

Mighty Fine, Director, Center for Public Health Practice and Professional Development, American Public Health Association

Keita Franklin, (formerly) Senior Executive Director, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs

Kristi Fredritz, Implementation Lead – Suicide Prevention, Office of Mental Health and Suicide Prevention, Veterans Health Administration

Barb Gay, (formerly) Executive Director, Area Substance Abuse Council; Suicide Attempt Survivor

Nicole Gibson, Senior Director, State Policy & Grassroots Advocacy, American Foundation for Suicide Prevention

Sharon Gilmartin, Deputy Director, Safe States Alliance

Randall Head, Senator (R-18), Indiana State Senate

Jenna Heise, Texas State Suicide Prevention Coordinator, Office of Mental Health Coordination, Texas Health and Human Services Commission

Brian Hepburn, Executive Director, National Association of State Mental Health Program Directors

Jarrod Hindman, (formerly) Violence and Suicide Prevention Section Manager, Violence and Injury Prevention-Mental Health Promotion Branch, Colorado Department of Public Health and Environment

Brandon Johnson, Public Health Advisor, Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration

Laura Leone, Integrated Health Consultant, National Council for Behavioral Health

Jody Levison‑Johnson, (formerly) Assistant Vice President, Practice Improvement, National Council for Behavioral Health

Tim Marshall, Director of Community Mental Health, Connecticut Department of Children and Families

Richard McKeon, Branch Chief, Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration

Linda Newell, (retired) Senator, Colorado State Senate

Scott Ridgway, Executive Director, Tennessee Suicide Prevention Network

Chris Salyers, Education and Services Director, National Organization of State Offices of Rural Health

Janet Schnell, past Chair, Loss Survivor Division, American Association of Suicidology

Deb Stone, Behavioral Scientist, Suicide, Youth Violence, and Elder Maltreatment Team, Research & Evaluation Branch, Division of Violence Prevention, Centers for Disease Control and Prevention

Sandra Wilkniss, Program Director, National Governors Association

James Wright, (formerly) Public Health Advisor, Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration


Richard Barrett, (formerly) Special Counsel to Wyoming Governor Matt Mead

Hilary Brazzell, Policy Chief, Children, Families and Seniors Subcommittee, Health and Human Services Committee Florida House of Representatives

Stephanie Craig Rushing, Director, Project Red Talon, Northwest Portland Area Indian Health Board

Kelley Cunningham, Massachusetts Department of Public Health

Lindsey Tucker, Associate Commissioner, Massachusetts Department of Public Health

SPRC Staff

Avery Belyeu, (formerly) National Partnerships Associate

Julie Ebin, Manager, Special Initiatives

Shawna Hite-Jones, Senior Prevention Specialist

Terresa Humphries-Wadsworth, Associate Project Director

Amy Loudermilk, Manager of Grantee and State Initiatives

Kristen Quinlan, Lead Epidemiologist

Kerri Smith Nickerson, Director of Grantee and State Initiatives

Elly Stout, Director


  1. Substance Abuse and Mental Health Services Administration: National Strategy for Suicide Prevention Implementation Assessment Report. HHS Publication No. SMA17–5051. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2017.
  2. Centers for Disease Control and Prevention: State of the States of Suicide Prevention. In press. Atlanta, GA: Centers for Disease Control and Prevention.