Taking Action for Suicide Prevention

Introduction

In recent years, following the crisis of the COVID-19 pandemic, U.S. rates of suicide—a self-inflicted injury with the intent of death—increased significantly; the number of suicides in 2023 surpassed 50,000. The number of suicides in the U.S. in 2022 increased nearly 3% from the previous year, following a 5% increase in 2021. Although most demographics saw a rise in suicide rates, suicides among youth ages 10 to 24 dropped 8.4% in 2022 and a 6.1% drop among American Indian/Alaska Native people.

Suicide continues to be a leading cause of death, with nearly 132 suicide deaths a day. Suicide has a significant ripple effect, impacting the mental and emotional health of families, friends, coworkers, and communities. Those who lose someone to suicide experience grief, anger, guilt, anxiety, depression, and sometimes suicidal thoughts. There is no one cause of suicide; however, there are many risk factors, including a history of depression and other mental illnesses, access to lethal means, trauma, substance use, loss of a relationship, social isolation, and stigma.

In recent years, prominent organizations such as the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the American Public Health Association, and the National Institute for Mental Health have described suicide as a serious public health issue that impacts individuals, families, and communities. This collection focuses on taking action for suicide prevention and offers context for addressing suicide as a systemic public health crisis.

Addressing the Root Causes of Suicide

Suicide is rarely caused by a single circumstance or event; a range of factors can increase risk at the individual, relationship, community, and societal level. Risk factors include life experiences or challenges that increase the possibility that a person will attempt suicide. While anyone can experience suicide risk, some population groups experience more negative social conditions, resulting in higher rates of suicide or suicide attempts than the general U.S. population:

Adults aged 35-64 years account for nearly half of suicides in the U.S.
Men aged 75 and older have the highest rate compared to other age groups
Suicide is the second leading cause of death for youth and young adults ages 10-24
LGBTQ+ people experience a rate of suicide four times that of their non-LGBTQ+ counterparts
Veterans experience a rate of suicide 57% higher than that of non-veterans in the United States
Suicide is the 9th leading cause of death among non-Hispanic American Indian and Alaska Native (AI/AN) people
Between 2014 and 2019, suicide rates among Black and Asian or Pacific Islander people increased by 30%

Historically, efforts to address suicide focused on providing mental health support to individuals already grappling with suicidal ideation or behavior. While interventions like therapy and hospitalization are vital for those in crisis, they primarily react to, rather than prevent, suicidal tendencies. Furthermore, the risk factors for suicide extend beyond mental health issues alone. Addressing the risk factors at the community and societal level can aid in preventing suicide upstream.

Access to healthcare services is associated with a decrease in suicide rates
Adverse childhood experiences, such as child abuse and neglect, increase the likelihood of suicidal behaviors in adulthood
Encounters with violence are associated with a 1.7 times higher risk for suicidal ideation among adolescents with depression
Racism and childhood trauma can increase the risk of suicidal ideation and suicide deaths
Firearms account for over half of suicide deaths and are the most fatal method of suicide, with 85-90% of suicide attempts with a firearm being fatal

Addressing Suicide as a Public Health Issue

Interventions to prevent suicide in the U.S. have been fragmented, primarily focusing on clinical responses for individuals in immediate crisis. To effectively reduce suicide rates in the United States, a comprehensive public health approach needs to be adopted. As a Nation, we need to adopt an approach that acknowledges and tackles the multitude of factors at play when it comes to suicide risk. In turn, we can align efforts and adopt a national strategy akin to the holistic preventive measures employed for conditions like heart disease or diabetes. Addressing upstream contributing factors while enhancing protective measures is likely to decrease suicide.

Changemakers and public health professionals should advocate for a multifaceted suicide prevention approach, which includes bolstering national, state, and local infrastructure to support prevention efforts, improving access to timely and accurate suicide-related data, enhancing research and evaluation efforts to grasp contextual risk factors, and promote community resilience, particularly among marginalized populations. Efforts should include addressing lethal means safety including limiting access to medications, firearms and sharp instruments, policy-making and advocacy, and evidence-based strategies for acute crisis intervention.

Actions to Get Started

Access to Lethal Means

Create and distribute educational materials regarding lethal means and suicide prevention, including safe storage of firearms, medications, and sharp objects.
Educate healthcare professionals about the importance of lethal means counseling in the treatment of individuals experiencing a suicidal crisis.
Implement voluntary removal initiatives, such as temporary transfer exceptions, community storage options, and Voluntary Do-Not-Sell Lists.
Consider using Extreme Risk Protection Orders (ERPOs) as a tool to help prevent suicide when voluntary efforts to separate an at-risk individual from a firearm are unsuccessful or impossible and suicide risk is imminent.

Behavioral Health and Crisis Response

Improve the function and accessibility of crisis services and bridge the gap between 988 and post-crisis supports, including crisis stabilization, outpatient care, and follow-up services.
Promote safety planning, lethal means counseling, caring contacts, and other best-practice short-term interventions for patients at risk for suicide.
Train ED personnel regarding best practices in suicide prevention for individuals at risk for suicide and promote culturally competent training requirements for healthcare providers regarding best practices in suicide prevention, assessment, treatment, and management.
Expand the behavioral health workforce by promoting access to peer support specialists and adequately trained and supervised para-professionals who can provide support for suicide-focused care.
Expand primary care and behavioral health integration through the Collaborative Care Model, minimize barriers to accessing best-practice behavioral tele-healthcare, and ensure coverage for those services at parity, particularly within rural and other underserved communities.

Public Policy and Funding

Maintain and expand funding and grant programs for implementing comprehensive K-12 school mental health and suicide prevention initiatives and policies, including requirements for personnel training, student education, caregiver education, and regular student, parent, and staff notification of resource availability.
Increase funding for and assist in the implementation and evaluation of state suicide prevention initiatives.
Advocate for legislation and increased research funds for the National Institute of Mental Health (NIMH) and the promotion of suicide prevention research within key institutes and centers.
Integrate LGBTQ populations into existing data collection tools on suicide mortality and risk behavior and advocate for bans on conversion therapy/sexual orientation change efforts.
Support policies that improve behavioral health services and crisis response services for Service Members, Veterans, and their families.

Public Messaging

Do not refer to a suicide attempt as “successful,” “unsuccessful” or as a “failed attempt,” and do not use the word “committed.” Instead, use “attempted suicide,” “made an attempt,” “died by suicide” or “took his/her life.”
Inform people as needed without sensationalizing the suicide. This means excluding images or graphic depictions of a suicide death, such as details, notes, and location of death, and not mentioning the method used. Instead focus on the lives lived, any mental health or general struggles they had been public about, as well as positive aspects of the individual.
Avoid reporting that a suicide death was caused by a single event, such as a job loss or divorce, since research shows no one takes their life for a single reason, but rather a combination of factors.
Do not refer to suicide as an “epidemic,” or “skyrocketing” as this has shown to cause contagion. When referencing suicide as a “leading cause of death,” include the most recent rates to ground people in facts.
Show that help is available and recovery is possible. Include hopeful messages for the public that support and treatment – including therapy and medications – are available for mental health conditions. Always provide helpline information – “If you are in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.”