State of State, Territorial, and Tribal Suicide Prevention

Suicide has no single cause. Reducing suicide requires a comprehensive approach that starts with data to understand the extent of the problem, who is impacted, and what increases or decreases risk. Additionally, this comprehensive approach includes implementing and evaluating multiple prevention strategies with the best available evidence.

Suicide rates increased 33% from 1999 to 2019. CDC conducted an environmental scan to better understand the current infrastructure and suicide prevention landscape among states, territories, and tribes/tribal organizations (STT), to identify resource levels, and to inform comprehensive suicide prevention in the future. The scan’s objectives and methods are outlined in The State of State, Territorial, and Tribal Suicide Preventionpdf icon report. Results can inform suicide prevention infrastructure and prevention activities necessary to reduce the rates of suicide across the United States.

Part One
Background

This report highlights key findings from a web-based survey. The web-based survey covered 10 domains considered critical to a public health approach to suicide prevention, including:

  1. Awareness of recent suicide trends
  2. Data sources
  3. Infrastructure
  4. Prevention planning
  5. Collaboration
  6. Legislation/policy
  7. Prevention readiness/capacity
  8. Populations addressed
  9. Risk and protective factors addressed
  10. Barriers and facilitators

Key Findings

The suicide prevention landscape across states, territories, and a selection of tribes and tribal organizations depicts a diverse array of existing suicide prevention infrastructure, capacity, partnerships, prevention activities, and overall progress towards a national goalexternal icon to reduce suicide rates 20% by 2025. Key findings include:

  • 90% of states, 75% of territories, and 33% of tribes had a suicide prevention plan.
  • States rated nonprofit organizations and survivors of suicide loss as the most active and influential champions, or supporters, of suicide prevention.
  • Six states (12%) said it was “somewhat likely” and none said it was “very likely” that they could reach the national goal to reduce suicide 20% by 2025.
  • 37% of states reported state funding of ≤$100,000, including 11 states (22%) that reported no state funding.
  • 81% of states and 50% of territories reported increased awareness of suicide prevention as a public health issue as a key facilitator to suicide prevention. The facilitator reported most frequently by tribes was federal funding dedicated to suicide prevention (42%).
  • 73% of states and 33% of tribes identified a lack of surveillance resources as a barrier.
  • 88% of states and 50% of territories reported insufficient funding as a barrier.

Conclusion

Results of this survey highlight state, territorial, and tribal feedback on their need for resources and capacity to carry out a comprehensive public health approach to suicide prevention inclusive of strong infrastructure, multisectoral partnerships, use of data for decision-making, and implementation and evaluation of prevention strategies with the best available evidence.

Part Two
Background

This report reveals key findings from two reviews of suicide prevention plans:

  • The first review highlights characteristics and activities described in state and territorial suicide prevention plans and alignment of those activities with CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practicespdf icon.
  • The second review examines whether state suicide prevention plans included a focus on groups with increased risk of suicide and the extent to which the plans included specific activities to reduce the identified disparities.

Key Findings

First Review:

  • 68% of states and territories had suicide prevention plans dated within the five years preceding the scan.
  • All states and territories included veterans/active-duty military, faith-based organizations, and other community-based organizations in plan development.
  • Most states and territories included tribal organizations, private sector, government, media, healthcare, and schools in plan development.
  • Less than half of states and territories appeared to include crisis services, first responders, and individual community members and families in the development of plans.
  • 62% of states and territories used the 2012 National Strategy for Suicide Preventionpdf iconexternal icon as a guiding framework.
  • Suicide prevention strategies found in plans aligned with the seven strategies outlined in CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practicespdf icon.
    • A high percentage of states and territories included strategies to strengthen access and delivery of suicide care (100%), promote connectedness (100%), identify and support people at risk (100%), lessen harms and prevent future risk (98%), and create protective environments (96%).
    • Only 8% of states and territories included strategies to strengthen economic supports.
  • Eighteen (40%) states and territories described an evaluation plan.

Second Review:

  • 98% of state suicide prevention plans mentioned population groups with increased risk of suicide, or disproportionately affected populations.
  • On average, state plans named six disproportionately affected populations, with specific strategies included for four of those population groups on average.
  • The most commonly named disproportionately affected populations were youth (89%) and veterans/active-duty military (70%).
  • State plans most often included specific strategies for youth (94%) and veterans/active-duty military (78%), when named as groups with increased risk of suicide.

Conclusion

The following factors support a comprehensive approach to suicide prevention that can have the greatest impact:

  • working with a range of multi-sector partners,
  • using data to drive decision-making,
  • keeping plans updated with activities with the best available evidence that address the multiple factors associated with suicide risk, and
  • evaluating plans and activities.
Additional Resources
suicide technical package cover

States and communities can use resources such as CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices pdf icon[PDF – 6.1 MB] to better understand suicide, prioritize evidence-based comprehensive suicide prevention, and save lives.

SPRC infrastructure recommendations

Suicide prevention is more than crisis services and treatment. A strong state infrastructure serves as a solid foundation for effective, comprehensive, and sustained suicide prevention. It includes six essential elements: Authorize, Lead, Partner, Examine, Build, and Guide. States can use the State Suicide Prevention Infrastructure Recommendations pdf icon[PDF – 838 KB]external icon as a solid foundation for effective, comprehensive, and sustained suicide prevention.

SPRC call to action

The Office of the Surgeon General, in collaboration with the National Action Alliance for Suicide Prevention (Action Alliance), released The Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention. pdf icon[PDF – 707 KB]external icon This report outlines the actions that communities and individuals can take to reduce the rates of suicide and help improve resilience.