Suicide is a public health issue that requires work at the individual, system and community levels. Prevention strategies include gatekeeper training, suicide screening and teaching warning signs.
Helping people at risk develop a safety plan that includes coping strategies, sources of support and safe people to call in a crisis. Reducing access to lethal means can also reduce the risk of tragedy, such as storing medications in secure locations and keeping firearms locked up.
Screening and Risk Detection
Suicide is a preventable public health issue. Universal screening of patients in hospitals and other settings is feasible and improves identification, increases equity in identification across racial groups, and reduces suicide risk. Health care settings, including primary care, are the setting for most suicides, as are hospitalizations, so the opportunity for identification and intervention is vast.
Research is ongoing on new, more effective screening tools and strategies for risk assessment. Ideally, biomarkers and improved measures of risk will eventually replace existing screeners. The use of a validated tool and careful clinical judgment is important. It is also important to include a thorough safety planning process in response to positive screening results. Most people who die by suicide exhibit warning signs, such as searching for ways to kill themselves, displaying impulsivity or aggression, sleeping less and acting anxiously, or being isolated from friends and family. These are often the only clues loved ones have that their loved one is in danger.
Prevention Strategies
Increasing life skills, decreasing suicidal ideation, and lowering the barriers to help-seeking can reduce suicide. Education about risk factors, warning signs and suicide-related stigma through media campaigns, training for health and social service professionals and community outreach can all lower barriers to help-seeking.
Reducing access to lethal means of self-harm can also reduce suicide rates. Examples of this include teaching people about gun safety locks, changing the packaging of medications and providing psychiatric services to reduce medication side effects. Physical protection systems can also be built on bridges and other dangerous points where suicide attempts often occur to prevent deaths.
Protective factors can also reduce suicide rates, including strong personal relationships, spiritual or religious beliefs and positive coping and wellbeing practices. These programs can be offered through schools, workplaces and communities. Programs that support individuals through crisis, such as hotlines and walk-in clinics, hospital based psychiatric emergency services and peer-support programs can be critical to helping a person through distress.
Identifying People at Risk
Suicide prevention strategies include reducing access to lethal means, keeping people who are at risk connected with ongoing support networks (like friends, family, spiritual advisors and mental health professionals) and training others in the community to recognize warning signs. These community-wide efforts may also involve teaching coping and problem-solving skills, encouraging mental health treatment and providing safe housing or access to emergency financial assistance.
The Columbia Protocol is an evidence-based screening tool designed to identify people at risk for suicide. It was the first scale to ask about not only current feelings of hopelessness and worthlessness, but also a person’s history of trying to kill themselves or their preparations for attempting suicide (for example, buying a gun or collecting pills). It is simple enough that it can be used by non-professionals, such as family members, school staff, police officers, emergency room personnel and primary care physicians.
If someone displays any of the warning signs of a suicide attempt, they should be encouraged to seek immediate professional help and have their access to lethal means restricted until they can receive treatment. This might be as simple as providing a lock for their guns or removing them from the home.
Suicide Prevention in Public Places
Suicides in public places can be devastating to a community, especially those who know and care for the deceased. These people may include family members, friends, neighbors, co-workers, on site employees, frontline workers and other community members. These people need to be supported.
Prevention initiatives that aim to create protective environments by limiting access to lethal means in public places and connecting people with services are important. Interventions that teach coping skills and promote safer and more responsible substance use are also critical.
Many national organizations offer training, funding opportunities and resources for schools to implement comprehensive suicide prevention models. Examples of such prevention programming include classroom curriculum and peer-based prevention programs. The Jed Foundation provides support for colleges and universities to create policies that protect emotional health and prevent suicide among students. The Trevor Project offers crisis support and advocacy for LGBTQ young people who are at risk of suicide.