New National Strategy for Suicide Prevention Reflects Today’s Challenges

National Action Alliance for Suicide Prevention

In April, the U.S. Department of Health and Human Services released its 2024 National Strategy for Suicide Prevention. The comprehensive plan comes as suicide deaths among Americans have reached a record high.

Colleen Carr directs the National Action Alliance for Suicide Prevention (Action Alliance), a public-private partnership housed at the Education Development Center that works with more than 250 organizations to advance the National Strategy and coordinate a national suicide prevention response plan and its implementation. Carr has more than 20 years of experience working in public health, with the last 15 years focused on suicide prevention.

This interview with her has been edited for length and clarity.

Q: The last National Strategy for Suicide Prevention came out 12 years ago. What’s new since then?

A: In the last 12 years we’ve learned a lot about suicide prevention. There have been advances in research, significant advances in suicide care and crisis care, an emerging evidence-base around the impact of social determinants of health and suicide, and a greater societal understanding that suicide is a preventable public health problem. These changes presented an opportunity to update the National Strategy and develop a new 10-year vision.

Q: How are those developments reflected in the new National Strategy?

A: Today’s strategy includes more content around youth and social media—which was barely mentioned in 2012 but is a much greater part of our culture today. There are also new recommendations based on research around risk and protective factors, and increased attention to the intersection of suicide and substance use. And there’s an entirely new strategic direction added on health equity, recognizing the avoidable disparities that exist around suicide between different socioeconomic and demographic groups, and specific approaches to address them. The new National Strategy also emphasizes the importance of engaging individuals with suicide-centered lived experience—including suicide attempt survivors, those who have experienced a suicidal crisis, and people who have lost a loved one to suicide—throughout the development and implementation of all prevention efforts.

Lastly, while crisis services were included in the 2012 strategy, the 988 Suicide and Crisis Lifeline hadn’t been launched yet. So this year’s strategy was really expanded around 988.

Q: The new strategy highlights the role of health care systems in suicide prevention. Can you talk about that?

A: Most people who die by suicide have touched a health care system in the weeks or months leading up to their death. The new strategy calls for developing and implementing standard protocols to identify, engage, and treat people with risk; improving follow-up care for these individuals; and ensuring they have the support they need to stay engaged in care. It’s important to focus on systems and organizations providing support and care, instead of placing that responsibility on the individual-level patient or provider. Up to now, these best practices have been the exception, not the standard.

Q: How can that model be flipped so that these practices in fact become the standard?

A: By improving how people are screened, supported, and receive follow-up treatment from an emergency department. For example, if a health system finds someone is at risk for suicide, providers should consistently be asking this person and their families about access to lethal means—and offering the person supports to reduce that access during the period of risk. There also needs to be an integration of substance use and suicide care, recognizing the close connection between the two. And finally, the full continuum of crisis care needs to be built out over the next 10 years; that means 988 call centers, mobile response, crisis stabilization, and community alternatives to 911 emergency response.

The bottom line is it shouldn’t matter which health care system’s door you walk into or what your ZIP code is. You should receive access to standard care just as you would expect if you had a heart attack or another physical health issue.

Q: Universal screening of all patients for suicide risk, regardless of why they’re seeking care, is one best practice that health systems can adopt to improve suicide prevention. Why is that important?

A: More than 80% of people who die by suicide interact with health care services in the year before their death, often for nonpsychiatric reasons, and only half who die by suicide have a diagnosed mental health condition at the time of their death. So screening only those with known behavioral health disorders will miss many, if not most, adults and children at risk.

Q: So what can be done to encourage all health systems and providers to adopt universal screening?

A: First, it’s critical to understand what’s currently preventing this best practice from being adopted at scale. In some cases, there may not be adequate staff to support a full suicide prevention assessment for those who screen positive for risk. However, in many cases, there’s support for doing the best practice, but there isn’t the infrastructure or policies in place to make universal screening a viable option.

Q: The new strategy also has a section devoted to data collection. Why is that important?

A: As a nation, and globally, we learned during the COVID-19 pandemic that good public health data is critical for making timely and informed policy decisions. In suicide prevention, that timely data—which compiles coroner, medical examiner, and toxicology reports—helps the field understand who’s dying from suicide and who’s struggling with thoughts of suicide. That data, in turn, helps direct long-term outcomes and tracks indicators of progress around the system. Without measuring progress, informed decisions cannot be made, nor will there be an understanding of the existing gaps in data.

Q: How will the plan help address these data gaps?

A: Improving suicide data requires investment not just at the national level, but in states and communities to support a healthy, local, cross-cutting, and modernized public health data infrastructure.

The new strategy also calls for exploring other types of data to inform efforts and track progress. How, for example, do 911 and 988 work together? How do people receive a mental health-focused response rather than a public safety response to a mental health crisis?

There are also still gaps in data systems that affect our understanding of suicide risk factors for different populations. To improve our understanding of these disparities, and the response to them—including effective programs and targeted interventions for different populations—investments in research are crucial.

Q: How does health equity, or a lack of it, contribute to suicide risk?

A: The new strategy highlights the importance of social determinants of health—which are the conditions in which people live, learn, work, and worship, and haven’t been considered traditional factors in suicide prevention. But they should be. For example, American Indian and Alaska Native populations in the U.S. have consistently had a much higher suicide rate than other populations. The data also tells us that suicide is increasing among Black people ages 10 to 44, and Hispanics ages 25 to 44. In each case, why? What’s causing the persistent disparity?

Q: What would you suggest?

A: One way to address these disparities is to build an equitable and diverse mental health workforce. Our health system needs to increase the number of suicide prevention professionals that come from historically marginalized communities or have lived experience with suicide. Following the release of the National Strategy, the Action Alliance published “Sustaining the Crisis Workforce: A National Roadmap” with a focus on strategies to recruit, retain, and support these vital workers.

Q: For the first time, the National Strategy was accompanied by a Federal Action Plan. Why is that important?

A: The Federal Action Plan formalizes U.S. agency commitments to the National Strategy from a broad swath of the federal government—from agriculture to transportation to labor to education to justice to defense. That underscores the recognition of the roles all these sectors play in suicide prevention—and also that truly preventing suicide will take more than health system improvements. For example, suicide rates are high in rural settings, so having commitments from federal agencies such as the U.S. Department of Agriculture—and the Health Resources Services Administration, which supports rural health care—is important.

The federal plan provides specific timelines for these agencies to act over the next three years, after which it will be updated again. This creates accountability for reaching concrete milestones toward meaningfully reducing suicides and addressing this complex, wide-ranging public health issue.