SUICIDE PREVENTION STRATEGIES
Effective suicide prevention is a comprehensive undertaking requiring the combined efforts of every healthcare provider and addressing different aspects of the problem. A model of this comprehensive approach includes:
- Identifying and assisting persons at risk. This may include suicide screening, teaching the warning signs of suicide, and providing gatekeeper training (see below).
- Ensuring access to effective mental health and suicide care and treatment in a timely manner and coordinating systems of care by reducing financial, cultural, and logistical barriers to care.
- Supporting safe transitions of care by formal referral protocols, interagency agreements, cross-training, follow-up contacts, rapid referrals, and patient and family education.
- Responding effectively to persons in crisis by ensuring crisis services are available that provide evaluation, stabilization, and referrals to ongoing care.
- Providing for immediate and long-term postvention to help respond effectively and compassionately to a suicide death, including intermediate and long-term supports for people bereaved by suicide (see “Postvention for Suicide Survivors” below).
- Reducing access to lethal means by educating families of those in crisis about safe storage of medications and firearms, distributing gun safety locks, changing medication packaging, and installing barriers on bridges.
- Enhancing life skills and resilience to prepare people to safely deal with challenges such as economic stress, divorce, physical illness, and aging. Skill training, mobile apps, and self-help materials can be considered.
- Promoting social connectedness and support to help protect people from suicide despite their risk factors. This can be accomplished through social programs and other activities that reduce isolation, promote a sense of belonging, and foster emotionally supportive relationships.
(SPRC, 2020a)
Public Health Suicide Prevention Strategies
The Centers for Disease Control and Prevention “Suicide Prevention Resource for Action” details the strategies based on the best available evidence to help states and communities prevent suicide.
- Strengthen economic supports
- Create protective environments
- Improve access and delivery of suicide care
- Promote healthy connections
- Teach coping and problem-solving skills
- Identify and support people at risk
- Lessen harms and prevent future risk
(CDC, 2022d)
GATEKEEPER TRAINING PROGRAMS
Gatekeeper training (GKT) is one of the most widely used suicide prevention strategies. It involves training people who are not necessarily clinicians to be able to identify individuals experiencing suicidality and refer them to appropriate services. GTK improves people’s knowledge, skills, and confidence in helping those who experience suicidal ideation and enhances positive beliefs about the efficacy of suicide prevention (Hawgood et al., 2023).
One example of gatekeeper training, QPR, involves three steps—Questions, Persuade, and Refer—that can be learned in as little as two hours (Purdue University, 2022).
VETERANS HEALTH ADMINISTRATION PREVENTION FRAMEWORK
Within the Department of Veterans Affairs (VA), the Veterans Health Administration’s approach to suicide prevention is based on a public health framework that focuses on intervention within populations rather than a clinical approach that intervenes with individuals.
This public health perspective considers questions such as:
- Where does the problem begin?
- How can we prevent it from occurring in the first place?
The VA follows this systematic approach:
- Define the problem by collecting data to determine the who, what, where, when, and how of suicide deaths.
- Identify and explore risk and protective factors using scientific research methods. Develop and test prevention strategies.
- Assure widespread adoption of strategies shown to be successful.
(VA, 2018)
Under the Veterans Comprehensive Prevention, Access to Care, and Treatment (COMPACT) Act of 2020, veterans in suicidal crisis can receive free emergency healthcare at any VA or non-VA healthcare facility (VA, 2023).
Resources available for veterans and their families include:
- Suicide Prevention Coordinator, available at each VA medical center, who provides veterans with counseling and other services; as appropriate, callers to the Veterans Crisis Line are referred to their local coordinator
- Coaching Into Care, a national telephone service to educate, support, and empower family members and friends seeking care or services for a veteran (call 888-823-7458)
- Veterans Crisis Line (call 988 or text 838255)
- Suicide Safety Plan template
- inTransition, a free, confidential program offering coaching and specialized assistance over the phone for active-duty service members, Guard and Reserve members, and veterans who need access to mental health care
- Make the Connection, an online resource that connects veterans, family members, friends, and other supports with information and solutions to issues affecting their lives
- Vet Centers’ readjustment counseling services
(VA, 2018)
Washington State Suicide Prevention Initiatives
In March 2014, Washington law required the Department of Health to create a statewide suicide prevention plan for people of all ages, and in 2016, the plan was released. The Washington State Suicide Prevention Plan is based on core principles identified by the State Suicide Prevention Plan Steering Committee as key values and attitudes. These principles state that:
- Suicide is preventable.
- Everyone has a role in suicide prevention.
- Silence and stigma are harmful.
- Known factors contributing to suicide must be changed.
- Prevention should be based on best available research and best practices.
- Persons deserve dignity, respect, and the right to make their own decisions.
(SPRC, 2020b)
Washington State’s Bree Collaborative recommends integration of specified implementable standards into clinical pathways for the following focus areas:
- Identification of suicide risk through universal screening of all patients over age 13
- Assessment of suicide risk following identification
- Suicide risk management, including clinical pathways for timely and adequate care
- Suicide risk treatment using available evidence
- Follow-up and support after a suicide attempt
- Follow-up and support after a suicide death
(Foundation for Health Care Quality, 2023)
Forefront Suicide Prevention focuses on reducing suicide by empowering individuals and communities to take sustainable action, championing systemic change, and restoring hope. It offers the following:
- LEARN Suicide Prevention, a training in suicide awareness, intervention, and response skills
- Safer Homes, Suicide Aware campaign, focusing on safe storage of medications and firearms
- Education and intervention programs in schools, colleges, and universities, and consulting services for healthcare organizations
- Volunteer program for people who have attempted suicide and those who have lost a loved one to suicide to help build resilience and restore hope through support networks
Project AWARE (Advancing Wellness and Resilience in Education), through the Office of Superintendent of Public Instruction, equips adults to detect and respond to youth mental health issues (OSPI, 2020).
Reducing Access to Lethal Means
When a person is at risk for suicide, actions are required to removal lethal means. There are many actions that can be taken by families, organizations, healthcare providers, and policymakers to reduce access to lethal means of self-harm. Examples include:
- Responsible firearm storage involves keeping them locked and preferably unloaded, and separating firearms and ammunition when not in use.
- Reducing means of suffocation includes taking measures to reduce suicide by hanging in controlled environments including hospitals, prisons, and police custody.
- Safe storage and disposal of prescription and nonprescription drugs includes drug lockboxes, drug buyback programs, and confidential drug return programs.
(NAASP, 2020)
Postvention for Suicide Survivors
All settings should incorporate postvention as a component of a comprehensive approach to suicide prevention. Postvention is a term often used in the suicide prevention field. It is an organized response in the aftermath of a suicide to accomplish any one or more of the following:
- To facilitate the healing of individuals from grief and stress of suicide loss
- To alleviate negative effects of exposure to suicide
- To prevent suicide among people who are at high risk after exposure to another’s suicide
Postvention ensures that individuals and families who have experienced a suicide and/or suicide attempt are offered support. Postvention activities are intended to normalize anger, minimize self-blame, help survivors find meaning in the victim’s life, and be sensitive to cultural differences regarding suicide.
Key principles for creating a comprehensive postvention effort include:
- Planning ahead to address individual and community needs
- Providing immediate and long-term support
- Tailoring responses and services to the unique needs of suicide-loss survivors
- Involving survivors of suicide loss in planning and implementing postvention efforts
All suicide prevention efforts should include a comprehensive postvention component that reduces risk and promotes healing for the immediate family and reaches out into the community to support the broader group of loss survivors, including friends, coworkers, first responders, treatment providers, and others exposed to the death (SPRC, 2020c).
INSURANCE COVERAGE FOLLOWING SUICIDE OR ATTEMPTED SUICIDE
There are federal protections to ensure that most health insurance plans will pay for medical care resulting from a suicide attempt. There are, however, many forms of health insurance, and some plans may expose people to substantial uncovered costs after an attempted suicide (NAMI, 2021).
Many people have life insurance policies. However, a suicide clause is a standard clause in life insurance policies that limits payments made to survivors of a policyholder who dies by suicide within a certain period after purchasing the policy. Insurance companies typically do not pay a death benefit if the covered person dies by suicide within the first two years of coverage, commonly known as the exclusion period.
When the exclusion period ends, the policy’s beneficiaries can receive a death benefit if the covered person dies by suicide (Cornell Law School, 2021).
POSTVENTION SERVICES AVAILABLE IN WASHINGTON STATE
Washington State offers many support groups for people who have lost a loved one to suicide, such as Crisis Connections (CC) Cares, a program for those newly bereaved by suicide provided by those who have experienced it themselves. CC Cares was originally a program started and nurtured by Forefront Suicide Prevention: A Center of Excellence at the University of Washington.
Other services offered include:
- Bridges: A Center for Grieving Children
- After a Suicide: A Toolkit for Schools
- Guide for Response to Suicide on College Campuses
- Suicide Survivors Support group
- S.O.S.L. (Survivors of Suicide Loss) support group
- Uniting for Suicide Postvention
- A Manager’s Guide to Suicide Postvention in the Workplace
- The Faith Hope Life campaign
(Mary Bridge Children’s, 2023; WSDOH, n.d.)
POSTVENTION SUPPORT TO MILITARY FAMILIES
Military-sponsored programs for families and next of kin have been established to assist military dependents. Most commonly, a casualty assistance office works with them. Mental health and counseling services are available to all dependents, as are religious, financial, and legal services. A military family life consultant is available to work with the families.
- Casualty Assistance Program provides support for understanding all benefits and other forms of assistance.
- Veterans Affairs Bereavement Counseling offers bereavement support to parents, spouses, and children of active-duty and Guard or Reserve members who died while on military duty.
- Tragedy Assistant Program for Survivors (TAPS) is a national nonprofit veterans service organization that provides services to help stabilize family members in the immediate aftermath of a suicide.
- TRICARE provides mental health care services during bereavement; outpatient psychotherapy is covered for up to two sessions per week in a combination of individual, family, group, or collateral sessions.
- Bereavement camps and other groups for children include:
- Comfort Zone Camp
- The Dougy Center
- Eluna
- Good Grief Camps
- SnowballExpress