A key function of state suicide prevention programs is to oversee the implementation and evaluation of suicide prevention programming. To maximize resources available for program implementation, state-level efforts must include a combination of strategies that are supported by the best available evidence, are most appropriate for their context and populations, and are best able to reach groups at increased risk, such as American Indian/Alaska Native populations, service members and veterans, working-age men, and lesbian, gay, bisexual and/or transgender (LGBT) individuals.
Build a multifaceted, lifespan approach across the state, in concert with the state plan
This requires investment, engagement, and collaboration by multiple components of state government as well as the private sector. Suicide is a complex problem that needs a combination of approaches at various levels, including the following:
- Strategies to build positive social connections and life skills
- Identification of individuals at risk
- Support for help-seeking
- Effective care for suicide risk
- Crisis response
- Lethal means safety (including firearms)
- Post-suicide support (also called “postvention”)
While some of these strategies focus on individual behavior change, others may involve changes to policies, regulations, or voluntary practices of governments or other institutions.
Programming should address suicide prevention across the lifespan, and include strategies that build protective factors prior to crises occurring, as well as other types of approaches that have long-term impact. Conducting strong suicide prevention efforts in a small number of regions needs to be brought to scale throughout the state, particularly in all geographic areas with high suicide rates and/or numbers of deaths, in order to successfully lower suicide rates.
Understand, develop, and enforce expert-informed policies and regulations that support suicide prevention. Consider how legislation and policy could stabilize, sustain, and spur growth in parts of your suicide prevention strategy. Be sure to build in accountability and compliance measures; state leaders can use regulatory measures put in place by accrediting bodies, such as The Joint Commission and the Commission on Accreditation of Rehabilitation Facilities (CARF), as examples. Compliance can be monitored by the state quality assurance team, which can withhold funding from those who are not meeting standards.
Lawmakers should request input on draft bills from state suicide prevention leads and experts, suicide prevention advocates and nonprofits, those who have been personally touched by suicide, and communities or sectors that would be directly impacted by the legislation. Drafting or amending state agency regulations or internal policies (e.g., a law enforcement agency’s “general orders”) provides alternate mechanisms for improving suicide prevention infrastructure that may be easier to accomplish than legislative changes. National advocacy groups are helpful sources for tracking state suicide prevention legislation in other states and may have policy agendas, both of which can suggestion ideas for legislative and policy improvements.
Here are some examples of laws, policies, and enforcement in the area of school-related training:
- Law: Suicide Prevention Education Act – requires all educators to complete XX hours of suicide prevention every YY years.
- Regulation: Expert panel members define the suicide prevention courses that meet the requirement.
- Enforcement: School Districts keep records of teacher attendance. Compliance is monitored by school district accreditation review and by the professional teaching standards board (or similar institution) with sanctions defined and imposed by those institutions.
Strengthen the crisis system and policies, including mobile response and hotlines. Ensure that suicidal crises are included in crisis response policies at the state, county/community, and organizational levels, and that systems and sufficient resources are in place to support local response.This includes the National Suicide Prevention Lifeline’s local crisis centers and other suicide prevention and crisis hotlines, mobile outreach teams, crisis facility alternatives (like crisis stabilization programs), suicide prevention efforts in emergency rooms, and intensive follow-up support for people leaving acute mental health care. The key components that should be part of a state crisis system are listed in the National Action Alliance for Suicide Prevention’s Crisis Now report.
Establish policies and model practices in preparation for post-suicide response, including in the event of a suicide cluster. This area encompasses several activities, including guiding communities, schools, and organizations toward tools or models for developing protocols to follow in the immediate and near-term aftermath of a suicide (“postvention” protocols). In some states or counties, this may include teams of professionals, such as a Critical Incident Team, and/or peer specialists, such as a LOSS Team, focusing on support to families, friends, and loved ones in order to ease grief and prevent additional deaths. In others it may include local suicide prevention leaders.
It also includes maintaining a list of such resources, responding to questions from those groups, and helping to connect them with each other. Connections with school systems can help put in place youth-oriented postvention plans. States should also develop a plan for the rare event of multiple, potentially related suicides, including helping the community to make decisions about how to identify vulnerable individuals and disseminate information safely, and working proactively with the media on reporting practices that do not further inflame suicide contagion.
Promote “upstream” strategies that proactively prevent suicide risk and enhance protective factors. In addition to intervening with individuals who are thinking about suicide or are at an acute crisis point, building protective factors at various structural levels (e.g., adopting coping skills programming, encouraging supportive workplace policies and culture, passing legislation that strengthens economic stability, helping regions strengthen seniors’ feelings of connection to family and community), is crucial to preventing suicidal feelings before they begin, lessening the burden on and cost of crisis supports and treatment systems.
Preventing known risk factors for suicide, such as adverse childhood experiences and trauma, and access to lethal means of suicide, can also reduce risk for other negative outcomes, including violence and substance misuse. These “upstream” intersections can help to strengthen connections and collaborations with other state agencies, partners, and stakeholders, leveraging shared resources to achieve improvements across multiple health areas.
Designate sufficient funding for a multifaceted approach
Funding to support one or two strategies, or a few regions of the state is often not sufficient to make an impact. To ensure sustainable impact, funds must be provided beyond grants, as gains made by grant funding may be lost when the grants end. As described in Partner, partnerships can provide some resources, but state funds are essential to promote continuity, comprehensiveness, and sufficient reach.
Develop the ability to evaluate and share results
All programming, as well as the combined impact of state plan implementation, must be evaluated regularly to ensure that it is achieving intended measurable outcomes, and updated as appropriate to address limitations and new developments. Evaluations should not be limited to summarizing what activities have been done, but must also look at changes in risk and protective factors, as well as longer-term trends in state suicide deaths and attempts. The evaluation will be more accurate and useful if there is leadership by an evaluator in concert with the state suicide prevention lead. Findings must be used not only for program improvement but also to report outcomes to stakeholders and garner continued support.
To further strengthen your infrastructure
Embed expectations within relevant state-funded contracts
As contracts are renewed, states can provide guidance or require agencies within their authority (such as mental health, substance misuse, homelessness, and corrections services) to enact best practices for suicide prevention, such as continuous quality improvement measures, trauma-informed approaches, job skills, evidence-based screening, assessment, treatment, and follow-up best practices. Contracts can also require competency and training on these approaches for staff in relevant roles.