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National Strategy for Suicide Prevention [Internet]. Washington (DC): US Department of Health and Human Services; 2024.
Strategic Direction 1 focuses on community-based comprehensive suicide prevention activities that can help prevent the onset of suicide risk, sometimes called upstream, universal, or primary prevention. This strategy is focused on preventing suicide risk in the first place, identifying and supporting people at increased risk through treatment and crisis intervention, preventing reattempts, promoting long-term recovery, and supporting survivors of suicide loss.
Such activities can increase protective factors and decrease suicide risk factors that may lead to suicide thoughts, attempts, crisis situations, and deaths. Upstream prevention may have lasting positive outcomes across the life span (Hawkins, et al., 2016).
Community is a critical context for suicide prevention that encompasses the spaces where people live, work, learn, play, and/or worship. Community may be defined by geography, shared interests, or other characteristics such as race, ethnicity, disability, sexual orientation, gender identity, or military background. Community-based prevention is rooted in the cultural, social, and economic conditions and traditions of the populations being served. Every community can benefit from a coordinated, comprehensive suicide prevention approach that weaves together the many strands of prevention, intervention, and postvention.
A comprehensive approach begins with multi-sectoral partnerships. No one agency, organization, or sector can prevent suicide on its own (see Goal 1). All community-based organizations in public and private sector settings can take an active role in preventing suicide and creating communities where people can thrive. These include schools, places of employment, social service agencies, local businesses, legal systems, and other organizations and settings.
Shared strengths, capacities, expertise, and resources of a collective partnership can amplify the preventive impact beyond that of any one organization alone. Comprehensive suicide prevention requires a range of voices, identities, and perspectives informed by lived experience. This ensures that acceptable, accessible, and effective approaches to suicide prevention are chosen and implemented.
The comprehensive approach calls for communities to select, implement, and evaluate a range of strategies to address the many factors associated with suicide at the individual, relationship, community, and societal levels (see Goals 2, 3, 4, and 5). These decisions should be driven by data (see Strategic Direction 3). The most effective selections will complement existing suicide prevention programs such as the following strategies from the Centers for Diseases Control and Prevention’s (CDC) Suicide Prevention Resource for Action (CDC, 2022c):
All levels of government and tribal nations need strong suicide prevention infrastructure to carry out the comprehensive approach (see Goal 6). Integration of effective policies, programs, and practices; dissemination across community settings; and access to culturally relevant information and resources to get help, are essential (see Goal 7).
Federal investments in comprehensive suicide prevention approaches have grown since the 2012 National Strategy. In 2023, the Secretary of Defense outlined five lines of effort to reduce suicide risk among service members and their families (see Goal 2). In 2022, the Department of Veteran’s Affairs (VA) launched its Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program to support Veterans and their families through a range of community services and resources across the country. In 2020, CDC launched its flagship Comprehensive Suicide Prevention program providing funding to states and communities to implement and evaluate a data-driven comprehensive approach with a focus on populations disproportionately impacted by suicide. In 2019, the VA announced Suicide Prevention 2.0, a population-based public health program combining community-based prevention strategies and evidence-based clinical strategies.
In ongoing commitments, the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Garrett Lee Smith Youth Suicide Prevention Program (GLS) and the National Strategy for Suicide Prevention grant program for adults have provided millions of dollars to states, territories, and institutions of higher education to implement youth and adult suicide prevention efforts, respectively. These federal investments have supported the field in expanding its focus from suicide prevention efforts largely based on intervening after someone is already experiencing a suicide-related crisis to creating environments that reduce communities’ overall suicide risk. Evaluations of programs have shown the value of these efforts as evidenced by SAMHSA’s GLS grant program in which counties and communities implementing GLS-funded prevention strategies showed decreased suicide for youth (see Figure 5, Godoy Garraza et al., 2019). Other evaluations of GLS are currently underway.
Youth suicide mortality in counties implementing the Garrett Lee Smith Youth Suicide Prevention Program over time.
Suicide is a complex but preventable problem, often with many contributing causes. A combination of factors may increase suicide risk, such as job and financial problems, including housing and food insecurity; school problems; relationship problems, such as bullying, divorce, or breakups; adverse childhood experiences, such as physical abuse and neglect; chronic health conditions; mental illness; substance use; legal problems; easy access to lethal means among people at risk; historical trauma; and discrimination and racism, among others. Addressing these issues require a comprehensive approach to prevention that extends into communities. Not surprisingly, no single sector, agency, or organization can prevent suicide or carry out the comprehensive approach alone. Only by working together with diverse public and private sector partners and across community settings can we achieve measurable and sustained suicide prevention impacts at all levels.
Integrating and coordinating suicide prevention into and across community settings and sectors can help reach people who may be at risk, wherever they live, work, learn, play, and/or worship, for the greatest impact. It is important to involve a wide range of partners, including, but not limited to, the following:
Working together creates maximum impact. For example, the private sector may have flexibility in response to prevention opportunities as well as reach a variety of audiences with messaging, resources, and recommendations. Conversely, the public sector agencies may be able to influence long-term policy and decision-making for sustained impact. Working together creates a network of coordinated efforts that reflect the varied contexts in which community members interact and the underlying factors that contribute to suicide risk.
Successful partnerships maximize diverse experiences and expertise and foster creativity, new ideas, and perspectives. People engaged in such partnerships at the national, state, tribal, local, and territorial levels can create a shared agenda with a mutual vision for suicide prevention that is tied to goals, objectives, and actions with measurable outcomes, and where everyone has a defined role. For example, some people may have expertise in data collection and analysis, or program planning and evaluation, while others are expert communicators. Some bring a local perspective and have the pulse of the community, which can inform partners’ understanding of cultural beliefs and context key to effective prevention. Others bring their lived experience of recovery to inform improvements in systems and services. Ideally, coalitions can be formed to bring diverse partners together and provide its members with the training, funding, resources, and support necessary to carry out their respective roles. Likewise, organizational commitment through implementation of evidence-informed policies, programs, and practices for suicide prevention can ensure efforts are effective and sustainable across partners.
Below are the objectives for Goal 1 that will help advance the National Strategy to improve suicide outcomes in the country.
Suicide thoughts, attempts, and deaths can have lasting impacts on individuals, families, caregivers, relationships, and entire communities. Suicide risk may occur in response to mental disorders, relationship break-ups, adverse childhood experiences, stigma related to help-seeking, substance use, and lack of access to affordable care, among others. A comprehensive community-based approach can address these many risks and prevent the long-lasting effects of suicide. An upstream approach can foster well-being and promote safe, stable, nurturing relationships and environments while preventing suicide and related harms.
To learn more about the research and examples of effective policies, programs, and practices, see CDC’s Suicide Prevention Resource for Action.
Efforts to prevent someone from becoming suicidal are different from approaches taken once someone has thoughts about suicide or is in a crisis. Working upstream can prevent people from becoming suicidal in the first place and can have wide-ranging positive impacts across the life span. Effective upstream policies, programs, and practices as part of a comprehensive approach to prevention can address what are called social determinants of health. These determinants include social interactions such as social connectedness, economic stability, housing, education, and life skills. A range of social conditions can create disparities in social determinants of health. They include racism or discrimination; limited opportunities in support of positive health and well-being; and increased risk for suicide and related outcomes, such as drug overdose and adverse childhood experiences (Ayer et al., 2023; Education Development Center and National Association of County and City Health Officials, 2023; Hughes et al., 2017; Liu et al., 2023; Reider & Sims, 2016; SAMHSA, 2016).
The process for identifying the upstream efforts that best suit a specific community starts by understanding local conditions. Being aware of the latest trends and changes in suicide, suicide attempts, risk and protective factors, and identifying populations disproportionately impacted, will help focus prevention efforts. Assessing community strengths and gaps also informs effective suicide prevention. For example, states or local communities can assess:
To learn more about one state’s indicators and data sources used to measure progress across a range of risk and protective factors, visit the Colorado Shared Risk and Protective Factors Dashboard. The dashboard tracks indicators related to behavioral health, economic stability, connectedness, and positive social norms.
The following are examples of effective upstream strategies as part of a comprehensive suicide prevention approach from CDC’s Suicide Prevention Resource for Action:
For more information on these upstream strategies, see CDC’s Suicide Prevention Resource for Action.
Successful upstream comprehensive community-based suicide prevention involves assessing the following:
Prevention professionals and partners would use this information to advance comprehensive suicide prevention. This includes selection of effective upstream policies, programs, and practices related to economic stability, healthy connections, coping skills, substance use prevention, and providing access to downstream treatment and crisis intervention. A broad range of community partners in prevention efforts would be involved (see Goal 1). These partners might include key community agencies, such as K–12 schools, faith institutions, housing authorities, employment services agencies, and substance use treatment providers. These partners would be knowledgeable in suicide prevention best practices and would link their work with risk and protective factors to ongoing prevention efforts. Federal partners would support these community efforts in suicide prevention through technical assistance and by providing financial and public support for addressing risk and protective factors prevention.
Partnering with local food security, housing, and transportation organizations to address economic stability efforts in the community
Hosting and supporting several events for LGBTQI+ connection
Training over 2,500 community members per year in Question, Persuade, Refer (QPR), an evidence-based training program that teaches people about warning signs for suicide, how to respond, how to offer hope, and how to get help
Promoting the Colorado Gun Shop Project that focuses on lethal means safety
Hosting peer support groups that focus on priority populations, including teens, working-aged men, and Veterans
Promoting Zero Suicide (a framework for system-wide transformation of health care settings toward safer suicide care) learning collaboratives and Collaborative Assessment and Management of Suicidality (CAMS) trainings
Below are the objectives for Goal 2 that will help advance the National Strategy to improve suicide outcomes in the country.
In 2022, suicides by firearm comprised more than half (55%) of all suicide deaths in the United States (CDC, 2024a). Further, nearly 90% of people who use a firearm in a suicide attempt will die from their injury, making firearms the most lethal method of suicide (Conner et al., 2019). Other means of suicide used in 2022 included suffocation (25%), poisoning (12%), and other (8%) (e.g., cutting; CDC, 2024a). While attempted suicide is a leading risk factor for later death by suicide, most people who attempt suicide and survive never go on to die by suicide (Botswick et al., 2016; Carroll et al., 2014). Upstream prevention can prevent suicide risk in the first place. However, if someone is seriously considering suicide, an important community-based approach is to put time and distance between the person and the lethal means of carrying out an attempt.
International efforts have repeatedly shown that lethal means safety interventions are some of the most successful strategies in suicide prevention. Reduced access to lethal means among people at risk is associated with reductions in suicides (Bandara et al., 2022; Gunnell et al., 2007; Lee et al., 2021; Pirkis et al., 2015; Sarchiapone et al., 2011; Ueda et al., 2015). Suicide rates decline when access to a common and highly lethal means of suicide is reduced. In recent years, both CDC and NIH received funding to conduct research to prevent firearm-related injuries and deaths, including suicide. For more information on these prevention efforts, visit https://www.cdc.gov/violenceprevention/firearms/index.html and https://www.nimh.nih.gov/news/science-news/2020/nimh-awards-funding-for-research-on-preventing-firearm-injury-and-mortality.
Research indicates that among people who made serious suicide attempts, many thought about suicide for as little as 5 to 10 minutes before they acted (Simon et al., 2001; Deisenhammer et al., 2009). This suggests that suicide attempts can be impulsive, so safe and secure storage of lethal means can mean the difference between life and death among people at risk. Even if people have considered suicide in the past, the decision to act can take place in just minutes. Research suggests that when one means of suicide is unavailable or not accessible, people rarely substitute a different means of suicide (Hawton, 2007). In the case of firearms, if any other means are substituted, the likelihood of death from the alternative means will be reduced, since firearms are the most lethal method of suicide.
Effective and promising interventions related to reducing risk for firearm suicide include:
Other effective interventions for reducing access to other lethal means include: xs
It is important for all community efforts to be led and informed by community leaders and people with lived experience to reduce health disparities and to help protect against unintended trauma.
The above interventions help to create safer environments to support people who may be at risk of suicide. Another way to create protective environments is by reducing or preventing risk behaviors associated with suicide, such as drug and alcohol use, at the individual and community levels. Research indicates that during the 24-hour period preceding a suicide attempt, acute use of alcohol in a given hour is associated with increased intensity of suicidal ideation in the next hour (Bagge et al., 2014). Acute use of alcohol is also associated with a rapid transition from a desire to die to a suicide attempt (Bryan et al., 2016). Data show that alcohol intoxication is most commonly present in suicide by a firearm among young adult and middle-aged men (Conner et al., 2014). One recent study showed that all types of substance use disorders were significantly associated with suicide death (Lynch et al., 2020).
Interventions that address the relationship between alcohol and suicide include policies such as alcohol taxes, zoning, or restrictions on alcohol availability that serve to decrease alcohol use and alcohol use disorder (AUD; SAMHSA, 2022). Clinical policy interventions include targeting AUD and addressing the importance of AUD screening and suicide prevention efforts during treatment of AUD (Arakelian et al., 2023; Glasner, et al., 2023; SAMHSA, 2016). Assessing the motivation for drinking and the amount consumed prior to an attempt can be used to develop a personalized distress safety plan. This plan can address high-risk periods and warning signs and includes strategies for avoiding alcohol.
To learn more about the role lethal means play in suicide and guidance for reducing access during times of risk, read Lethal Means and Suicide Prevention: A Guide for Community and Industry Leaders.
Achieving Goal 3 would include engaging communities in the use of policies, programs, and practices that result in reducing access to lethal means among people at risk. This includes safe and secure storage of firearms, medications, and household products (e.g., poisons), especially among people at risk. Achieving Goal 3 would also include implementing workplace polices that support lethal means safety among occupational groups with increased rates of suicide and people who may have access to lethal means as part of their jobs. These would include law enforcement, military, veterinarians, and health care workers. It would also include institutional polices to keep people safe in health care and carceral settings such as prisons. Working with partners to limit access to lethal means in the physical environment and creating protective environments inclusive of substance use prevention also play important roles in a comprehensive approach to suicide prevention.
Train health and behavioral health providers and pharmacists in safe storage so they can then educate their patients
Provide Counseling on Access to Lethal Means (CALM) trainings to communities
Disseminate educational materials to law enforcement and first responders to promote help-seeking behavior, including education on safe and secure storage
Share educational materials and campaigns that educate partners and community members about existing state policies around safe and secure storage
Below are the objectives for Goal 3 that will help advance the National Strategy to improve suicide outcomes in the country.
The period following a suicide loss, attempt, or crisis is crucial to the health and well-being of individuals and the surviving friends, family members, caregivers, students, co-workers, neighbors, and others impacted by the event. Postvention after a suicide loss and support for people with suicide-centered lived experience provides people with the care and resources they need to prevent an increase in their suicide risk. Messaging that encourages help-seeking and hope can be helpful during this time. When additional suicide attempts or deaths occur close in time and/or geography, which is called a suspected suicide cluster, these events may need further systematic assessment to confirm the cluster, possible investigation to better understand the factors associated with the cluster, and implementation of a community response to prevent further events (Trinh et al., 2024; Ivey-Stephenson et al., 2024).
Postvention practices after a suicide death may include debriefing, counseling, and other outreach and support. Use of evidence-based or best practices for conveying information about a suicide loss should be shared safely along with culturally relevant supportive services and other resources.
Considerations following suicide attempts or deaths among those impacted may include:
People who are regularly exposed to suicide as part of their job have specific postvention needs that may differ from the general population. For example, some occupational groups are more likely to have many exposures to suicide over their career. Professionals who are repeatedly exposed to trauma can have a heightened risk for suicide and mental health challenges if needed supports are not available or accessible. First responders and other occupational groups with increased risk of suicide need suicide prevention and postvention programs and protocols.
Community members, employers, and school personnel; cultural, spiritual, and other leaders; and people with lived experience have a role to play in helping to inform, improve, expand, and carry out postvention and community response protocols and programs with the best available evidence. Support groups and other groups need evidence-based guidelines and protocols to carry out postvention and to support people with suicide-centered lived experience.
Individuals who have experienced suicide loss or the effects of their own or others’ suicide thoughts and attempts can offer unique insights into what others go through after such an event. Many types of support—peer/social, emotional, tangible, and informational—can be helpful to survivors. For example, many practical, logistical, and real-world concerns can be navigated with guidance from people with lived experience. These may include cleanup after formal investigation efforts and making funeral arrangements, among other activities. Resources related to mental health treatment; community prevention resources (e.g., self-care, services, prevention programs); and crisis intervention can also be provided to impacted friends, family, and other community members who may be struggling after a suicide or a suicide attempt.
How a community or organization responds after a suicide can impact, positively or negatively, the risk for future attempts and losses. In successfully achieving Goal 4, individuals, employees, students, families, and other groups will have evidence-based postvention and support options available and accessible. These can help reduce feelings of isolation and lessen the challenges people face after a suicide or suicide attempt. The ultimate result will be protection against future risk for suicide.
The Suicide Prevention Resource Center (SPRC) hosts several resources focused on postvention for a variety of settings, including schools, workplaces, and health care settings. See https://sprc.org/effective-prevention/a-comprehensive-approach-to-suicide-prevention/providefor-immediate-and-lonq-term-postvention/.
Creating the First to Respond, First to Ask for Help campaign
Investing in culturally competent evidence-based counseling and peer support services
Increasing worker compensation benefits for post-traumatic stress-induced mental health challenges
Below are the objectives for Goal 4 that will help advance the National Strategy to improve suicide outcomes in the country.
The community settings where people spend significant amounts of time are prime spots for prevention, and these settings may vary over the life span. For example, children, teens, and young adults spend significant time in schools, after-school programs, youth organizations, colleges, and workplaces. These are important locations for upstream prevention (see Goal 2). Families may spend time together at places of worship. They may also interact with the following:
Adults may also spend significant time at their workplaces; in formal or informal social organizations (e.g., sports activities, volunteer organizations); and in health settings. All people working in these settings have a role in preventing suicide among their clientele. Community settings can integrate effective suicide prevention policies, programs, and practices into their operations for worker safety and well-being. This combined effort provides critical support to people who may be at increased risk of suicide so that nobody falls through the cracks.
Workplaces can integrate pro-social norms and behaviors as part of their culture and values through comprehensive suicide prevention planning efforts. This could include effective policies, programs, and practices that prioritize employee well-being, help-seeking, and connectedness. Efforts could also include collecting worker satisfaction and well-being data for continuous quality improvement. Enacting such cultural shifts takes strong leadership support and buy-in at all levels. In addition to employers, employee groups can be important groups with which to partner. These groups include unions, trade organizations, and employee resource groups (Health Action Alliance, 2022; Leigh & Chakalov, 2021; Mind Share Partners, 2023; SkillSignal, 2023).
Implementation of effective policies, programs, and practices impacting employee health and well-being may include:
Workplaces can also offer supportive resources, such as:
These initiatives can improve worker mental health, connectedness, and well-being. They also positively impact measures of occupational effectiveness, such as improved job satisfaction, job security, workplace safety, and decreased absenteeism and presenteeism.
Civic organizations, places of worship and other community settings have a large role to play in suicide prevention. Many items mentioned above also pertain to other community settings. These entities can do the following:
In recent years, online gaming, chat groups, and other online settings and platforms have grown in use. They attract a range of people, some of whom may be at increased risk of suicide.
Using digital platforms allows access to a broad array of information and social circles. These settings can potentially increase depression, anxiety, and suicide risk, especially among youth, related to the following:
Further, according to the Surgeon General’s Advisory on Social Media and Youth Mental Health, adolescent girls and transgender youth are disproportionately impacted by online harassment and abuse which are associated with negative emotional effects (Office of the Surgeon General, 2023b). However, these platforms also present opportunities for support, access to helping resources, and connections that transcend geographic boundaries (e.g., among LGBTQI+ populations). Collaborating with digital and technology companies to create a safer more protective online environment for youth may help prevent suicide. Interventions include educating parents, caregivers, guardians, educators, and youth in digital literacy. This would include learning more about risks and harms present in some digital environments and ways to interact more safely in that space.
Achieving Goal 5 creates universal safety nets and extends support systems in communities where people live, work, learn, play, and worship. Whether at work, in the community, or online, people would interact with those who know how to identify individuals at risk and how to respond, have easy access to information and a range of helping resources, have opportunities for connectedness, and have the time and means for seeking out help and services. Over time, approaches to suicide prevention and improving mental health are finding their way into workplaces and popular media platforms and through a range of programs, campaigns, and other resources.
Routine suicide prevention training for all staff
Standardized intake screening and risk assessment
Safe physical environments
Emergency response protocols
Notification of suicidal behavior through the chain of command
Critical incident stress debriefing and death review
Quality improvement (Stijelja & Mishara, 2022)
Educate about the cost of poor mental health in the workforce
Develop best practices, resources, and interventions for health care workers
Develop partnerships
Invest in development of data, screenings, trainings, resources, and policies
Conduct a social marketing campaign to normalize the conversation around mental health (Cunningham et al., 2022)
To learn more on the campaign, visit https://blogs.cdc.gov/niosh-science-blog/2022/05/24/mental-health-initiative/.
Investing in research on social media and youth
Providing youth education on positive social media use
Monitoring social media to ensure it is safe
Placing safeguards within social media structures minimizing harmful information
Ensuring age-appropriate materials and functionality are tailored to youth (American Psychological Association, 2023).
Below are the objectives for Goal 5 that will help advance the National Strategy to improve suicide outcomes in the country.
Suicide prevention infrastructure at the state, tribal, local, and territorial levels is important to ensure availability of the capacity and resources needed to implement effective and sustained comprehensive suicide prevention in communities. However, suicide prevention infrastructure in most states is limited, making it difficult to impact suicide rates.
A state suicide prevention infrastructure is a state’s concrete, practical foundation or framework that supports suicide prevention-related systems, organizations, and efforts. It includes the fundamental parts, and the organization of those parts, that are necessary for planning, implementation, evaluation, and sustainability. To learn more, visit https://sprc.org/state-infrastructure/.
Adequate state infrastructure includes six key elements: Authorize, Lead, Partner, Examine, Build, and Guide, according to the Suicide Prevention Resource Center (SPRC). While state infrastructure can help improve suicide prevention, territories, local communities, and tribes may apply or adjust the same principles presented here to fit their specific context.
It is ideal to Authorize a lead agency or organization to coordinate suicide prevention activities across multiple agencies. The lead agency can do the following:
The agency can Lead by maintaining a dedicated full-time suicide prevention director or suicide prevention coordinator and core staff positions. This agency can provide training and technology to carry out all six functions and develop staff capacity to respond to information requests from officials, community members, and the media. Core staff may include data managers, epidemiologists, behavioral health specialists, data analysts, program managers, program planners, trainers, evaluators, and communication professionals.
Staff training and the development of knowledge and skills related to comprehensive suicide prevention are essential and may include the following:
The suicide prevention lead and/or core staff can bring their expertise to collaborative partnerships and strategic planning.
Components of the Partner function include the following:
The benefits of partnering include potential access to a range of resources (e.g., personnel, data, and funding); increased capacity to reach populations most impacted; reduced duplication of efforts; and knowledge sharing. Written agreements should be developed to formalize partnerships and detail commitment and responsibilities. (see Goal 1).
The comprehensive public health approach to suicide prevention relies on data. Rapidly evolving technology gives greater opportunities to work with traditional and novel data sources and employ data science techniques to better inform decision-making. It also provides opportunity to implement effective suicide prevention policies, programs, and practices. Infrastructure that supports the delivery and use of integrated, real-time public health data is essential to the Examine function. This may require significant modernization of existing technology, upskilling of the workforce to manage and use systems, data, and advanced analytic tools; and updating data processes, standards, and policies to enable high-quality, timely data to be accessed and shared appropriately. This includes better connecting public health and health care sectors. Investments to date in data modernization are laying the groundwork for the infrastructure needed. Sustainability will be needed to fulfill the Examine function.
Additional considerations for the Examine function relate to the design and use of data collection tools and data collected. Examples include the following:
Using data within a strong infrastructure supports a comprehensive approach to suicide prevention based on the best available evidence, across the life span. It should also be tailored for the context and populations disproportionately affected by suicides or suicide attempts. Elements of a comprehensive approach include upstream and downstream strategies and approaches found in the CDC Suicide Prevention Resource for Action and throughout this National Strategy.
Sustained funding and other resources to carry out and evaluate the comprehensive approach is essential. Diverse agencies, funding, resources, staff, and volunteers are needed who can bring together assets, expertise, experiences, and cultures to inform responsive prevention efforts. Ideally, any guiding suicide prevention plan will call for implementation of a comprehensive, life span approach to suicide prevention that reaches all facets of a state or community. Comprehensive plans will call for a variety of upstream and downstream prevention strategies with explicit roles for multiple partners. Implementation requires staff and resources dedicated to monitoring and evaluating prevention strategies over time.
Lead suicide prevention agencies are equipped to Guide and support suicide prevention efforts in the local community with adequate resources and other components of necessary infrastructure. Lead agencies can provide funding, consultation, and a range of training opportunities to local communities to engage in key tasks such as strategic suicide prevention planning and implementing evidence-informed and comprehensive approaches to suicide prevention.
Achieving Goal 6 involves national, state, tribal, local, and territorial investments in suicide prevention infrastructure. Suicide prevention infrastructure in states and communities strengthens the ability to implement comprehensive suicide prevention approaches. Adequate infrastructure includes all six essential elements—Authorize, Lead, Partner, Examine, Build, and Guide— in place with continual analysis into ongoing resource, funding, and support needs.
State suicide prevention professionals can build upon these six essential elements and ensure that they are prepared to provide ongoing updates and reports to state legislatures on the cost benefit of investments in the suicide prevention infrastructure.
Local-level suicide prevention professionals will be most effective when they are familiar with the elements of the suicide prevention infrastructure and ensure their local efforts contribute to state or territorial suicide prevention capacity. States and territories with strong infrastructures can develop a common vision for suicide prevention with their state and local partners, guided by a state suicide prevention plan informed by diverse community members.
Below are the objectives for Goal 6 that will help advance the National Strategy to improve suicide outcomes in the country.
How we talk and message about suicide and suicide prevention matters. The framing we use has the potential to open a door to dialogue, understanding, and support, or it may have unintended effects, such as increased perceived isolation, discrimination, and/or stigma. Evidence-based communication can increase awareness, provide information, shift attitudes and beliefs, and promote help-seeking behavior. Experts in communication science, social marketing, and media are key partners in this endeavor and can bring specialized skill sets to suicide prevention communication.
In a recent survey, 94% of respondents believed suicide can be prevented; three-quarters of those indicated an understanding that most people who die by suicide show some signs beforehand; and 96% reported they would take action to help prevent suicide if someone close to them was thinking about it (American Foundation for Suicide Prevention et al., 2022). Information needs to be accurate, understandable, practical, and action oriented because empowering communities with the knowledge about warning signs and what to do can be lifesaving.
Safe messaging guidelines seek to protect audiences from messages that inadvertently increase suicide risk. Certain types of public messaging about suicide or lived experiences of suicide thoughts and attempts can increase risk, even if they are shared in a well-meaning way.
Decades of research show unsafe messaging can contribute to real-world increases in suicide attempts and deaths—a phenomenon known as the Werther effect (Domaradzki, 2021; Etzersdorfer et al., 2004; Niederkrotenthaler et al., 2010; Niederkrotenthaler and Till, 2019).
Examples of unsafe messaging practices include:
On the other hand, safe messaging guidelines also provide evidence-informed recommendations for ensuring communication on suicide is not only safe but beneficial (known as the Papageno effect). Safe messaging includes the following:
Certain suicide prevention messaging practices have been shown to reduce individuals’ suicide risk. Research on the Papageno effect shows stories of individuals struggling with suicidal crisis and finding support to master the crisis directly influence listeners. For example, those with suicide thoughts show reduced levels of suicidality following exposure to these types of stories (Niederkrotenthaler, 2016; Till et al., 2018; Niederkrotenthaler & Till, 2020). Focusing on safe messaging avoids unintentional harm and promotes messages of hope and healing with real-world benefits.
Including individuals with suicide-centered lived experience adds valuable insights throughout the development and implementation of communication efforts. These individuals bring practical information about barriers to receiving care and support that can be incorporated into communication messages. Messages crafted and delivered by individuals with lived experience also convey authentic empathy. Perspectives grounded in experience help initiatives concentrate on the key elements that are likely to have the greatest impact on the local community.
Research found the use of social media can be associated with negative health outcomes, particularly for youth (e.g., Office of the Surgeon General, 2023b). However, social media also offers opportunities for beneficial communication about suicide prevention, as well as enhanced social support and connection. This is particularly true for LGBTQI+ youth, youth of color, rural youth, and other youth with historically marginalized identities (see Goal 5). Engaging young people directly represents a valuable opportunity for connection. Equipping young people with the knowledge and skills to make healthy digital choices enables a preventive effect across new technologies. Identifying youth with significant interest in prevention can provide early opportunities to develop future leaders, influencers, advocates, and champions. Digital and social media partners can also add value to communication efforts by delivering tailored messages from a broad matrix of potential stories and by monitoring and responding to harmful messages posted by users.
The actions of media, including news, entertainment, and social media, can have a range of effects—some positive and some negative. Media partners can be effective champions of suicide prevention by following guidelines for reporting on suicide, such as sharing stories of hope and recovery; providing local resources, including the 988 Suicide and Crisis Lifeline; and avoiding sensationalizing suicide thoughts, attempts, or deaths. Media organizations can provide information to their staff about current standards, guidelines, and ethics relevant to prevention efforts, and contribute their expertise in communications for suicide prevention campaigns. Behavioral health experts can also provide guidance about developing media material.
Communication about the 988 Suicide and Crisis Lifeline and other crisis support services will be most effective when they do the following:
Messages about 988 can be adapted by local communities to ensure lifesaving possibilities are presented within the context of realistic expectations as crisis response service delivery currently varies greatly across the country. Communication efforts need to embrace principles of cultural humility and avoid unintentional harm. Positive outcomes from crisis helplines showcase appropriate ways that encourage individuals to seek help.
Achieving Goal 7 needs to involve a variety of suicide prevention messengers including the following:
Each of these partners has a responsibility to understand best practices in safe suicide prevention messaging and to invest in trainings for professionals and volunteers about safe messaging. A shift in national, state, and local narratives from a focus on raising awareness of suicide to how to prevent suicide is imperative to reduce unsafe messaging practices and increase the promotion of stories that can positively impact the public.
Strong communication planning would be based on communication science best practices. This includes strategies such as audience research, message development and testing, and evaluation. Research into the impacts of social media on youth and young adult mental health must grow. The field needs better evidence on how to educate youth on safe social media practices, create spaces for diverse youth to develop healthy social connections, and put safeguards in place to minimize potential harms of social media use. All communication-based strategies should directly involve individuals with suicide-centered lived experience in their development, with the goal of providing safe and effective messaging focused on hope and healing.
Preventing suicide is actionable
Prevention works
Resilience and recovery are possible
Effective programs and services exist
Help is available
To learn more, visit the Framework for Successful Messaging website: https://suicidepreventionmessaging.org/.
Ongoing investments are essential in both communications and formative research to support the promotion of the 988 Suicide and Crisis Lifeline and other crisis or mental health resources using a shared messaging framework. To learn more about the project and to read the results, visit: https://suicidepreventionmessaging.org/988messaging/research.
Below are the objectives for Goal 7 that will help advance the National Strategy to improve suicide outcomes in the country.
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