STRATEGIES and
INTERVENTIONS to
REDUCE SUICIDE
PROCEEDINGS OF A WORKSHOP
Alexandra Andrada, Sharyl J. Nass, and Joe Alper, Rapporteurs
Forum on Mental Health and Substance Use Disorders
Board on Health Care Services
Board on Health Sciences Policy
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Purchase Order No. 75FCMC19P0036 with the Centers for Medicare & Medicaid Services and Contract No. HHSN263201800029I, Order No. HHSN26300025 with the National Institutes of Health and by the American College of Clinical Pharmacy, American Psychiatric Nurses Association, American Psychological Association, Association for Behavioral Health and Wellness, Council on Social Work Education, Janssen Research & Development, LLC, National Academy of Medicine, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, Office of the Assistant Secretary for Planning and Evaluation, Optum Behavioral Health, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-27773-0
International Standard Book Number-10: 0-309-27773-6
Digital Object Identifier: https://doi.org/10.17226/26471
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Strategies and interventions to reduce suicide: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26471.
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PLANNING COMMITTEE FOR A WORKSHOP ON STRATEGIES AND INTERVENTIONS TO REDUCE SUICIDE1
MARY ROARY (Co-Chair), Director, Office of Behavioral Health Equity, Office of the Intergovernmental and External Affairs, Substance Abuse and Mental Health Services Administration
MATTHEW TIERNEY (Co-Chair), President, American Psychiatric Nurses Association; Clinical Professor, University of California, San Francisco, School of Nursing; Clinical Director of Substance Use Treatment and Education, University of California, San Francisco, Office of Population Health
ERIN BAGALMAN, Director, Division of Behavioral Health Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
MICHAEL F. HOGAN, Principal, Hogan Health Solutions LLC
ANDREW MOON, Associate Director, Education and Training, Suicide Prevention Program, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs
JANE PEARSON, Special Advisor to the Director on Suicide Research, National Institute of Mental Health
Project Staff
ALEXANDRA ANDRADA, Director, Forum on Mental Health and Substance Use Disorders, and Program Officer
ADRIENNE FORMENTOS, Research Associate (from July 2021)
ANESIA WILKS, Senior Program Assistant
SHARYL NASS, Senior Director, Board on Health Care Services
ANDREW M. POPE, Senior Director, Board on Health Sciences Policy
Consultant
JOE ALPER, Consulting Writer
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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FORUM ON MENTAL HEALTH AND SUBSTANCE USE DISORDERS1
COLLEEN L. BARRY (Co-Chair), Johns Hopkins Bloomberg School of Public Health
HOWARD H. GOLDMAN (Co-Chair), University of Maryland School of Medicine
MARGARITA ALEGRÍA, Harvard Medical School
ERIN BAGALMAN, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
CARLOS BLANCO, National Institute on Drug Abuse, National Institutes of Health
DARLA SPENCE COFFEY, Council on Social Work Education
CHRIS M. CROWE, U.S. Department of Veterans Affairs
W. PERRY DICKINSON, University of Colorado
SYLVIA K. FISHER, Health Resources and Services Administration
RICHARD G. FRANK, Harvard Medical School
PAMELA GREENBERG, Association for Behavioral Health and Wellness
KRISTIN KROEGER, American Psychiatric Association
HUSSEINI K. MANJI, Janssen Research and Development, LLC
R. KATHRYN McHUGH, Harvard Medical School and Mclean Hospital
BEN MILLER, Well Being Trust
ANNIE PETERS, National Association of Addiction Treatment Providers
KATHY PHAM, American College of Clinical Pharmacy
JOE PYLE, Scattergood Foundation
DEIDRA ROACH, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health
MARY ROARY, Substance Abuse and Mental Health Services Administration
MARTIN ROSENZWEIG, Optum Behavioral Health
GLORINDA SEGAY, Indian Health Service
RUTH SHIM, University of California, Davis
MATTHEW TIERNEY, University of California, San Francisco, School of Nursing and Office of Population Health (representing the American Psychiatric Nurses Association)
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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Reviewers1
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HUGH TILSON, University of North Carolina. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
___________________
1 This text was changed after prepublication release.
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Acknowledgments
The National Academies of Sciences, Engineering, and Medicine’s Forum on Mental Health and Substance Use Disorders wishes to express its sincere gratitude to the planning committee co-chairs Mary Roary and Matt Tierney for their valuable contributions to the development and organization of this workshop. The forum wishes to thank all of the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the forum wants to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants.
Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to the forum’s work. The sponsors include the American College of Clinical Pharmacy, American Psychiatric Nurses Association, American Psychological Association, Association for Behavioral Health and Wellness, Council on Social Work Education, Janssen Research & Development, National Academy of Medicine, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, Office of the Assistant Secretary for Planning and Evaluation, Optum Behavioral Health, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter and Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust. We also thank staff member Ana Ferreras for reading and providing helpful comments on this manuscript.
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Contents
SUICIDE TRENDS IN U.S. SUBGROUPS
OPPORTUNITIES IN HEALTH CARE TO REDUCE SUICIDE RISK
EXPERIENCES IN IMPLEMENTING SUICIDE PREVENTION CARE IN FEDERAL HEALTH CARE SETTINGS
Assessment and Management of Those at Risk for Suicide
PROMOTING LETHAL MEANS SAFETY AMONG VETERANS: OPPORTUNITIES AND CHALLENGES
SUICIDE PREVENTION AND CARE PROGRAM
IMPROVING SUICIDE PREVENTION: ADDRESSING KNOWN BARRIERS TO HEALTH CARE ACCESS
RISK ID: THE VA SUICIDE RISK IDENTIFICATION STRATEGY
SUICIDE PREVENTION: BARRIERS TO CARE AMONG BLACK YOUTH AND FAMILIES
LEVELS OF PROGRESS TOWARD PREVENTION
BUILDING 9-8-8: AN OPPORTUNITY TO BUILD INCLUSIVE CARE STRUCTURES
IMPROVING CARE COORDINATION WITHIN CRISIS SERVICES
THE 9-8-8 LIFELINE: POTENTIAL AND IMPLICATIONS FOR CRISIS RESPONSE
The Community Mental Health Services Framework
Effectiveness of National Crisis Lines
Veterans Crisis Line 9-8-8 Expansion Initiative and Implications
9-8-8 ROLLOUT: PRIVACY, CONFIDENTIALITY, AND EQUITY CONSIDERATIONS
The 9-8-8 Workforce and Culturally and Linguistically Appropriate Services
PATIENT-CENTERED CARE CONSIDERATIONS IN CRISIS SERVICES FOR AMERICAN INDIAN/ALASKA NATIVE PEOPLE
BUILDING EQUITY INTO THE FRONT END OF 9-8-8
BUILDING CULTURAL COMPETENCE WITHIN CRISIS SERVICES
WORKING IN DIVERSE COMMUNITIES
LATINX YOUTH AND THE UNDOCUMENTED
BUILDING CULTURAL COMPETENCE WITHIN CRISIS SERVICES
9-8-8, HEALTH EQUITY, AND FAITH WITHIN THE BLACK COMMUNITY
A HISTORIC FIRST: SPECIALIZED SERVICES IN 9-8-8 FOR LGBTQIA+ YOUTH
INCLUDING SCHOOLS IN THE CRISIS RESPONSE SYSTEM
DISCUSSION: HEALTH EQUITY AND 9-8-8
REFLECTIONS: OPPORTUNITIES TO BUILD INCLUSIVE CARE STRUCTURES
Boxes, Figures, and Table
BOXES
1 Observations and Suggestions Made by Individual Workshop Participants
2 Research Opportunities Available at NIMH
3 Key Features of the Zero Suicide Initiative
FIGURES
1 Age-adjusted suicide mortality in the United States, 1999–2019
2 Suicide rates in U.S. youth ages 10 to 19 years old, 1999–2018
3 U.S. youth suicide rate by gender, 1999–2018
4 Age-adjusted suicide rates by race, 1999–2019
5 Suicide rates in U.S. youth ages 10 to 19 years old by ethnicity, 2010–2019
6 Age-adjusted suicide rates in the United States by state, per 100,000 individuals, 2019
7 Comparison of suicide incidence rates between Black and White youth from 2001 to 2015
8 Suicide rates by age and sex for U.S. children and adolescents, 2015–2019
Acronyms and Abbreviations
| ASL | American Sign Language |
| ASQ | Ask Suicide-Screening Questions |
| C-SSRS | Columbia-Suicide Severity Rating Scale |
| CDC | Centers for Disease Control and Prevention |
| CLAS | Culturally and Linguistically Appropriate Services |
| CPR | cardiopulmonary resuscitation |
| CSRE | VA Comprehensive Suicide Risk Evaluation |
| EHR | electronic health record |
| FCC | Federal Communications Commission |
| HHS | U.S. Department of Health and Human Services |
| IHS | Indian Health Service |
| IRR | incidence rate ratio |
| LGBTQIA+ | lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual and/or ally |
| LOG | natural logarithm |
| MIRECC | Mental Illness Research, Education, and Clinical Center |
| NIMH | National Institute of Mental Health |
| NOSI | Notice of Special Interest |
| PICOT | Population, Intervention, Comparison or Control, Outcome, and Time Period |
| QPR | question, persuade, and refer |
| Risk ID | VA Suicide Risk Identification Strategy |
| SA/SI | suicide attempt/suicide ideation |
| SAMHSA | Substance Abuse and Mental Health Services Administration |
| SWAT | Special Weapons and Tactics |
| TTY | teletypewriter |
| VA | U.S. Department of Veterans Affairs |
