CDC was a leader in suicide prevention even before the establishment of suicide-specific appropriations at NCIPC. For example, CDC has provided data and expertise through its many data sources such as the National Vital Statistics System and the National Violent Death Reporting System; developed critical guidance for the field (e.g., on suicide clusters); developed surveillance definitions; conducted research on the best available evidence for suicide prevention; worked with federal, state, territorial, local, and tribal partners (e.g., investigations, communication activities, participation in the development of the 2001 and 2012 national strategies); and funded external groups to conduct critical research (e.g., to test suicide prevention interventions and to study factors associated with suicide).

NCIPC launched the Emergency Department Surveillance of Nonfatal Suicide-Related Outcomes (ED-SNSRO) program to enhance surveillance of nonfatal suicide outcomes. This pilot program helped states rapidly track and respond to changing patterns in suicidal behavior seen in emergency departments. Program successes garnered positive attention from Congress. Ultimately, Congress created a new appropriation line for NCIPC suicide prevention activities.

NCIPC received a new appropriation $10 million line for suicide prevention. With this funding, CDC funded nine recipients through the Comprehensive Suicide Prevention program to implement and evaluate a comprehensive public health approach to suicide prevention, with attention people who are at increased/higher risk of suicide.

The FY21 appropriation increased to $12 million, allowing NCIPC to expand the Comprehensive Suicide Prevention program to two additional states, bringing the total to 11 funded recipients. With the $8 million increase in FY22, NCIPC expanded the Comprehensive Suicide Prevention program by six additional recipients. Fourteen of the 17 recipients also use funds to support emergency department surveillance of nonfatal suicide-related outcomes.

The CSP program is funded through a cooperative agreement awarded to 17 recipients to implement and evaluate a comprehensive public health approach to suicide prevention, with attention to people who are at increased/higher risk of suicide. Each recipient uses data to identify populations with increased risk of suicide and assesses current programs addressing these populations in their jurisdictions to determine gaps in prevention. Some examples of these populations include youth, rural residents, Hispanic/Latino men, the LGBTQIA+ population, persons with disabilities, and veterans.

Based on this information and working with multi-sectoral partners, recipients select a combination of strategies and approaches with the best available evidence from CDC’s Suicide Prevention Resource for Action to implement and evaluate. These selections address the multiple contributors to suicide at the individual, relationship, community, and societal levels.

All 17 recipients have chosen to implement strategies and approaches to create protective environments (e.g., reducing access to lethal means among people at risk of suicide), identify and support people at risk, and promote connectedness. All recipients are implementing at least three strategies, with some recipients implementing up to seven.

14 CSP programs also use funds to support emergency department syndromic surveillance of nonfatal suicide-related outcomes (for example, suicide attempts and suicidal ideation). Collecting these near real-time data can help states rapidly track and respond to changing patterns in suicidal behavior. This surveillance work builds upon CDC’s previously funded Emergency Department Surveillance of Nonfatal Suicide-Related Outcomes program.

To learn more about each CSP recipient, open the state snapshot by clicking on the map or table above.

Comprehensive Suicide Prevention | Injury Center | CDC

CDC collaborates with the CDC Foundation to build the capacity of veteran serving organizations (VSOs) to evaluate their upstream suicide prevention activities. VSO recipients use CDC’s Evaluation Framework, resources, and technical assistance to develop and implement evaluation plans and build their capacity for ongoing program evaluation.

Most VSOs follow either a community integration model, linking veterans with community services to address issues like housing or transportation, or a connectedness model, which focuses on helping veterans engage with like-minded communities to avoid feelings of isolation. In both approaches, the goal is to address small, day-to-day issues before they become significant problems.

Organizations take a holistic approach to veteran suicide prevention, working with community organizations to address the challenges veterans face before they turn into deeper problems. Because circumstances surrounding veteran suicide are complex, this organization develops and maintains relationships with veterans to help them balance their lives collectively, from education and employment to housing and transportation, among others.

CDC Foundation understands that effective plans should include collaboration across sectors as part of an upstream public health approach to ending veteran suicide. For this purpose, a virtual meeting among VSOs, CDC, and CDC Foundation staff was held in June 2022 to increase understanding of the work and experiences of the VSO recipients and the integration of evaluation into suicide prevention efforts.

To learn more about each VSO recipient, open state snapshots by clicking on the map or table above.

Continuing the Work to Prevent Veteran Suicide | CDC Foundation

CDC Foundation Grants Help Combat Veteran Suicide | CDC Foundation

Virtual Meeting Brings Stakeholders Together to Provide Solutions to Combat Veteran Suicide | CDC Foundation

Project Helping to Reduce Veteran Suicide Provides Evaluation Findings

Through the Tribal Public Health Capacity Building and Quality Improvement cooperative agreement, CDC funds the Southern Plains Tribal Health Board and Wabanaki Health and Wellness tribal organizations to increase their capacity for comprehensive suicide prevention. In cooperation with partners and through a series of listening sessions, recipients use data to identify groups at increased risk of suicide in their communities. They assess gaps in prevention and choose at least one strategy/approach with the best available evidence from the CDC’s Suicide Prevention Resource for Action (or from another resource, such as the Substance Abuse and Mental Health Services Administration’s To Live To See The Great Day That Dawns [PDF – 184 pages]) to tailor based on the cultural context of their communities, for implementation and evaluation.

See below for some current examples of how these tribal organizations are working to prevent suicide.

• Southern Plains Tribal Health Board: With CDC funding, Southern Plains Tribal Health Board (SPTHB) supports suicide prevention among high school students from the United Keetoowah Band of Cherokee Indians in Oklahoma and Cherokee Nation. SPTHB developed partnerships with 16 external organizations and individuals. This includes a partnership with Northeastern State University’s Center for Tribal Studies program that assessed the needs of students and helped the university get approval for funding two additional mental health counselors, doubling their staff size to four counselors. SPTHB also implemented a culturally specific program called American Indian Life Skills training at two high schools. The program focused on helping students recognize risk factors for suicide, identify suicide prevention resources, improve problem-solving and coping skills, and seek help when needed.  Evaluation results indicated students’ knowledge of suicide prevention and protective factors increased 35% compared to baseline. In addition, SPTHB has trained over 1,000 individuals across 39 suicide prevention trainings, including Question, Persuade, and Refer, Talk Saves Lives, and Suicide Prevention for Youth, over the course of this cooperative agreement.
• Wabanaki Public Health and Wellness: Wabanaki Public Health and Wellness (WPHW) used CDC funding to develop a culture-based, holistic approach to wellness for the Wabanaki Tribes of Maine (Passamaquoddy, Penobscot, Maliseet, and Mi’kmaq Tribes). The Tribal Public Health Capacity Building and Quality Improvement cooperative agreement funded interventions designed to strengthen cultural identity and community connectedness, which can protect against poor mental health, suicidal thoughts and behavior, substance use, and injuries. Some of the cultural activities, including making traditional regalia and participating in drum making in a group setting, helped to foster connectedness among elders and veterans. Through the Color Paper Project, which provides food and other essentials to elders in Passamaquoddy territories, Sipayik and Indian Township, 243 homes received daily assistance from support staff during the COVID-19 pandemic. WPHW also implemented activities to educate community members and provide access to services, including through suicide prevention gatekeeper trainings, a Veterans Affairs claims clinic, and support groups.
• Tribal Suicide Prevention (cdc.gov)

CDC funding to United States territories supported their capacity building to prevent suicide. In 2018, as a part of the hurricane response, CDC awarded Puerto Rico and the US Virgin Islands $920,000 and $230,000, respectively, to aid in their suicide prevention efforts.

CDC funded Puerto Rico and the US Virgin Islands to support gatekeeper trainings designed to help participants learn the warning signs of suicide and how to appropriately respond. This work prioritized suicide prevention training in healthcare settings; educated gatekeepers about suicidal ideation and behavior; supported suicide surveillance and partnerships; created a network of front-line professionals to be activated during natural disasters; and built capacity of these professionals to identify, manage, and refer persons with suicidal ideation and/or behavior during natural disasters.