Stronger Together: Six Strategies to Enhance Your State’s Suicide Prevention Infrastructure

May 06, 2021 | Julie Ebin, Julia Wunder

Woman-resting-chin-in-her-hands_profile-view_1200x740.jpgThis May, we recognize Mental Health Awareness Month and the importance of continued mental health promotion and suicide prevention efforts during the COVID-19 pandemic. As we address the physical effects of COVID-19 through social distancing, mask wearing, and vaccination, we still need to prioritize mental health and well-being during and after the pandemic. A recent Morbidity and Mortality Weekly Report found increases in adults reporting symptoms of anxiety or depression (36.4% to 41.5%) and unmet mental health care need (9.2% to 11.7%) between August 2020 to February 2021.

In September 2020, ASTHO underscored the potential collateral damage of COVID-19 with respect to suicide and provided examples of how to address elevated rates of stress, depression, and anxiety. To streamline, coordinate, and enhance the success of suicide prevention efforts, state health departments can invest in building their suicide prevention infrastructure.

In 2019, the Suicide Prevention Resource Center (SPRC) at Education Development Center launched the first State Suicide Prevention Infrastructure Recommendations. SPRC defines state suicide prevention infrastructure as “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.” SPRC highlights the importance of dedicated funding, traditional and new partnerships, multi-faceted efforts across the lifespan, and engagement with populations disproportionately impacted by suicide. The recommendations identify six areas in which state leaders can fortify their suicide prevention foundation. Read more about them below.

Officially authorize and resource a lead organization for state suicide prevention.

Designating a lead organization can help align priorities and coordinate efforts across different state-level departments, and between public and private sector partners. Once selected, the lead organization should guide the maintenance of a comprehensive state suicide prevention plan. State health departments can provide access to suicide-related data to help guide the plan. The plan should be developed in collaboration with key stakeholders to coordinate efforts and ensure engagement with priority populations across the lifespan. Providing regular progress reports to the legislature or governor helps foster transparency and accountability, maintain momentum, and aid in planning and evaluation of state plan efforts.

Passed in 2017, Indiana’s House Enrolled Act No. 1430 mandated the creation a state suicide prevention program in the Division of Mental Health and Addiction and the development of a state suicide prevention plan.

Lead by staffing state efforts adequately.

A strong suicide prevention team is essential for the success of suicide prevention efforts. In addition to a designated leader, suicide prevention teams should include epidemiologists, data managers, administrative support, evaluators, and, depending on the size of the state, regional coordinators. Staff should have regular access to opportunities for developing suicide prevention, program management, and other necessary skills. Furthermore, the state suicide prevention program should invest in building the capacity of the suicide prevention team to share the narrative of suicide prevention safely and effectively with elected officials, the media, community members, and new partners. Funding for these positions and resources can be secured by building line items into the state budget and authorizing the lead suicide prevention organization to seek funding from private sector grants.

Passed in 2013, Utah’s House Bill 154 created and provided funding for full-time suicide prevention coordinators in the Division of Substance Abuse and Mental Health and at the State Board of Education.

Partner across public and private sectors.

Engaging with public and private sector stakeholders through a statewide coalition can help maximize the effectiveness and reach of suicide prevention efforts. Public and private partnerships can increase access to resources, improve engagement with priority populations, reduce duplicity of efforts, and introduce opportunities for innovation. Common partners include state mental health and substance misuse agencies, state tribal liaisons, people with personal experience of suicide, and researchers and academic institutions. Focusing on the shared risk and protective factors between suicide and other health issues can help identify new partnerships and opportunities to incorporate suicide prevention into existing efforts. Partners should develop a shared vision and language of suicide prevention in the state and clearly delineate each partner’s role in achieving the vision.

Established in 1999, the Massachusetts Coalition for Suicide Prevention leads the coordination and evaluation of suicide prevention efforts across the Department of Public Health, legislature, community-based agencies, people with personal experience of suicide, and other partners in the state.

Examine and improve data to inform and evaluate prevention efforts.

Data analysis helps illustrate the state’s suicide landscape, identify populations at disproportionate risk, select appropriate interventions, monitor impact, and disseminate information to further advance efforts. The state suicide prevention program should develop a plan for compiling and analyzing suicide deaths, attempts, and ideation and the related risk and protective factors using data from local, state, and federal sources. When not readily available, the program should intentionally seek out data on historically underserved populations by engaging with stakeholders around alternative data sources or the creation of new ones.

Minnesota developed a Suicide-Related Data Plan in 2016 to guide improvements in data collection, analysis, dissemination, and use as related to their 2015-2020 State Suicide Prevention Plan.

Build a multifaceted suicide prevention program across all ages and areas of the state.

The state suicide prevention program should adopt a comprehensive suicide prevention approach by coordinating programs and services across the lifespan. Key efforts across the prevention spectrum include:

  • Addressing risk and protective factors before suicidal ideation begins.
  • Ensuring successful interventions for people experiencing suicidal ideation, including crisis call lines, crisis response teams, and evidence-based treatments.
  • Providing postvention services after a suicide death occurs.

State health departments should also engage with populations disproportionately impacted by suicide, such as American Indian/Alaska Native populations; service members and veterans; working-age men; and the LGBTQ+ community. The program should practice continuous evaluation of results to monitor effectiveness and identify opportunities for continuous process and quality improvement.

In 2021, Nebraska’s Divisions of Behavioral Health and Public Health began developing an implementation plan for their statewide crisis call line, using funding from the National Suicide Prevention Lifeline’s 988 State Planning Grant through Vibrant Emotional Health.

Support and guide county and local efforts.

The state health department can support the success of suicide prevention efforts by working with the designated lead organization to provide consultation and training to local health departments and other state and local partners. State health departments can help develop essential skills by identifying and providing trainings on data collection and surveillance, evidence-based interventions, postvention, lethal means safety, strategic planning, evaluation, and messaging. They can also connect groups across the state through opportunities for continued learning, such as webinars, email listservs, conferences, and specialized meetings.

In collaboration with Case Western Reserve University, Ohio Suicide Prevention Foundation (OSPF) provides learning and networking opportunities through webinars, an online collection of suicide prevention resources and materials, and email updates to partners across the state.

To learn more about strengthening your state’s suicide prevention infrastructure, view the summary recommendations checklist and more state infrastructure success stories at SPRC’s website. Together, we can help build a stronger foundation for lasting state and local efforts to reduce suicide and improve quality of life across the country.