This webpage, focused on suicide and suicide prevention, is geared toward health, behavioral health, and integrated care leadership, providers, and patients/consumers. The information and resources listed here can be easily adapted to other groups and settings. Suicide, Intimate Partner Violence (IPV), and Trauma are often interrelated. Trauma is highly prevalent and a major risk factor for suicide and IPV. It is, therefore, vital for all staff employed by health, behavioral health, and integrated care organizations to understand the nature and impact of trauma and how to use principles and practices that can promote recovery and healing: Trauma-Informed Approaches. In addition to information and resources on Suicide Prevention, at the CIHS website you will find links to Trauma and Trauma-Informed Approaches webpages, as well as IPV webpages, which we encourage you to explore.
Every 12 minutes, someone in the U.S. takes his or her own life. And for every one suicide, there are 25 attempts. Suicide is the 10th leading cause of death in the U.S., and the number and rate of suicides are rising. Each year, more than 900,000 emergency department (ED) visits are made by people thinking of suicide.
Suicide as a public health issue affects everyone: families, health care providers, school personnel, faith communities, friends, and government. The good news is that suicide is often preventable. Research findings by the Henry Ford Health System clearly make the case that health care providers can play a critically important role in preventing suicides by identifying those at risk and responding appropriately. They found that the mental health conditions of most people who die by suicide remain undiagnosed, even though most visit a primary care provider, ED, or medical specialist within the year before they die. The risk of suicide attempts and death is highest within the first 30 days after a person is discharged from an ED or inpatient psychiatric unit, yet as many as 70 percent of patients of all ages who attempt suicide never attend their first outpatient appointment. Therefore, access to clinical interventions and continuity of care after discharge is critical for preventing suicide.
Integrated behavioral health, primary care, and EDs provide ideal settings for diagnosing and treating mental health and substance use disorders and for preventing suicide. Screening for suicidal thoughts and harmful behaviors, including IPV, is critical to good care. According to the American Psychological Association (APA), cases of murder-suicide are most likely to occur when abuse is present. For these reasons, it is important to consider IPV in relationship to trauma and suicide risk. Knowing suicide’s warning signs and how to help a person contemplating suicide can save lives.
Warning signs of immediate risk:
• Talking about wanting to die or to kill oneself
• Looking for a way to kill oneself, such as searching online or obtaining a gun
• Talking about feeling hopeless or having no reason to live
Some groups of people are at higher risk for suicidal behavior than the general population:
• People who have attempted suicide
• Lesbian, Gay, Bisexual, and Transgender (LGBT) people
• American Indians and Alaska Natives
• Individuals who have lost someone to suicide, especially a family member or close friend
• Individuals in the justice or child welfare systems
• Individuals who engage in non-suicidal self-injury
• People with chronic or painful medical conditions
• People with mental disorders, especially mood disorders (major depression, bipolar disorder), but also schizophrenia, borderline personality disorder, and anxiety disorders (post-traumatic stress disorder [PTSD], generalized anxiety disorder, obsessive-compulsive disorder [OCD], etc.)
• People with substance use disorders
• Members of the Armed Forces and veterans
• Men in midlife
• Older men
As mentioned above, trauma is one of many risk factors associated with suicide and one that does not get enough attention. Using a trauma-informed approach to care can create a safe, accepting and respectful space. This type of safety is needed to reveal thoughts or behaviors associated with suicide and can promote healing and recovery from the trauma that may underlie them. It is not always necessary for a person to disclose past painful experiences. Through education about the impact of adverse childhood experiences along with teaching healthy coping skills, within a trauma-informed culture, providers can promote positive health and behavioral health outcomes. It is important to note that exploring traumatic experiences requires sensitivity, skills and training.
The following resources will help you improve suicide screening and provide brief interventions and needed follow-up. You will also find resources on related topics such as trauma, Trauma-Informed Care (TIC) and Intimate Partner Violence (IPV) on other CIHS webpages. These resources are arranged by audience.
- Resources for Clinicians/Staff
- Resources for Organizations
- Resources for Patients/Consumers and Families
- Resources for Policymakers and Leadership
Assessing and Addressing Risk
Zero Suicide is an aspirational initiative committed to achieving zero suicide in health and behavioral healthcare. The foundational belief of Zero Suicide is that suicide deaths are preventable. The initiative also offers functional tools to aid in the implementation of Zero Suicide.
Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments is designed to assist ED professionals with decisions about the care and discharge of patients with suicide risk. Its main goal is to improve patient outcomes after discharge. The Consensus Guide includes a secondary screening tool known as the Decision Support Tool to help inform providers of next steps and whether patients who have suicidal ideation or suspected suicide risk need further assessment before determining level of care. The guide also includes brief suicide prevention interventions and a discharge planning checklist which could be helpful for non-ED providers as well.
A Guide for Medical Providers in the Emergency Department Taking Care of Suicide Attempt Survivors provides tips for emergency department providers in assessing and treating survivors of suicide attempts. It also includes resources on confidentiality and communicating with families and other providers.
The SAFE-T Card guides mental health clinicians through five steps that address the patient’s level of suicide risk and suggest appropriate interventions. It provides an accessible and portable resource to the professional whose clinical practice includes suicide assessment.
Suicide Safe is a suicide prevention, mobile-learning tool to help providers integrate suicide prevention strategies into their practice and reduce suicide risk among their patients. SAMHSA'S free app is available for Android and iOS operating systems.
Sentinel Event Alert 56: Detecting and Treating Suicide Ideation in all Settings is an alert in which The Joint Commission aims to assist all health care organizations providing both inpatient and outpatient care to better identify and treat individuals with suicide ideation.
TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment offers guidelines for helping suicidal adults living with substance use disorders. Included are risk factors and warning signs for suicide, as well as information on core competencies and sample vignettes for clinical care.
Assessment and Management of Patients at Risk for Suicide outlines the VA/DoD clinical practice guidelines for patients at risk for suicide. These gold-standard instructions include helpful algorithms, safety planning worksheets, and even a pocket guide.
Screening and Assessment Tools
The Columbia-Suicide Severity Rating Scale (C-SSRS) is a questionnaire used for suicide assessment. It is available in 114 country-specific languages. Mental health training is not required to administer the C-SSRS. Various professionals can administer this scale, including physicians, nurses, psychologists, social workers, peer counselors, coordinators, research assistants, high school students, teachers and clergy. Learn more about the C-SSRS and how it can be used.
The MacArthur Depression Toolkit helps primary care clinicians recognize and manage depression. This toolkit includes user-friendly instruments to assist with recognizing, diagnosing, treating, and monitoring depression.
Preventing Suicide among Men in the Middle Years: This publication helps state and community suicide prevention programs design and implement projects to prevent suicide among men in the middle years (ages 35–64). It includes a review of the research, recommendations that provide guidance for state and community suicide prevention programs on addressing suicide in this population, and an annotated list of programs and resources.
The Safety Plan Treatment Manual to Reduce Suicide Risk: Veterans Version is a manual describing brief clinical intervention and safety planning, that can serve as a valuable adjunct to risk assessment and may be used with veterans who have made a suicide attempt, have suicide ideation, have psychiatric disorders that increase suicide risk, or who are otherwise determined to be at high risk for suicide (cf. Stanley & Brown, 2008).
Racial and Ethnic Minority Populations
The Suicide Prevention Resource Center’s American Indian/ Alaska Natives website helps individuals who work with Native populations to support suicide prevention and mental health promotion.
The Rural Health Information Hub (Formerly the Rural Assistance Center) provides tools and resources to address suicide in rural and frontier areas of the U.S., where suicide is the second leading cause of death.
Suicide Prevention Toolkit for Rural Primary Care, developed by Western Interstate Commission for Higher Education (WICHE) Mental Health Program, in collaboration with the Suicide Prevention Resource Center, assists rural primary care providers in effectively identifying and intervening with individuals who are suicidal. (New edition coming soon.)
Children and Youth
Youth.gov hosts information on suicide prevention in youth populations, as well as resources on responding in the aftermath of a youth suicide or attempt. Education on early warning signs, latest research findings, and links to related videos, guides and community-focused tools are also provided.
The Society for the Prevention of Teen Suicide offers specific talking points for discussing suicide with teenagers and young adults. Information for parents on warning signs and navigating medications and treatments is available.
StopBullying.gov is a government resource managed by the Department of Health and Human Services (HHS) in partnership with the Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Administration (SAMHSA), and others dedicated to prevention, identification, and response to bullying. The website includes resources on talking to children about bullying, cyber bullying, and specific tools for schools, families, and communities.
Education and Training
Preventing Suicide in Emergency Department Patients: This free, online course is based on the ED Consensus Guide and teaches professionals who work in emergency departments how to conduct screening, assessment, and brief interventions with patients at risk of suicide. It also addresses patient-centered care for patients with suicide risk, patient safety during the ED visit, and incorporating suicide prevention into discharge planning. This course was created in partnership with the Massachusetts Department of Public Health Bureau of Healthcare Quality and Suicide Prevention Resource Center (SPRC).
The Suicide Prevention Resource Center (SPRC), funded by SAMHSA, provides technical assistance, training, and materials to increase the knowledge of professionals serving people at risk for suicide.
The SPRC Training Institute has a variety of available trainings from research to practice webinars to free online trainings to workshops that focus on suicide prevention among specific populations, including for LGBT youth and youth in juvenile justice facilities. The institute also offers a one-day curriculum for mental health professionals on assessing and managing suicide risk. SPRC also offers a database of local community and state-based prevention resources
Counseling on Access to Lethal Means (CALM): Access to lethal means can determine whether a person who is suicidal lives or dies. This free, online course helps providers develop effective safety plans for people at risk of suicide. This course was produced through a collaboration between the Harvard Injury Control Research Center; SPRC; the Dartmouth Injury Prevention Center; and the developers of the original CALM workshop, Elaine Frank and Mark Ciocca.
The American Association of Suicidology offers trainings on recognizing and responding to suicide risk and recognizing the warning signs, including Recognizing and Responding to Suicide Risk: Essential Skills in Primary Care (RRSR-PC), a one-hour training program that provides physicians, nurses/nurse practitioners, and physicians assistants with the knowledge they need in order to integrate suicide risk assessments into routine office visits, to formulate relative risk calculations, and to work collaboratively with patients to create treatment plans.
Mental Health First Aid is an eight-hour course that teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives the course participant the skills needed to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.
National Resource Center on Domestic Violence (RCDV) is supported by HHS, with supplemental funds from the CDC and others to provide technical assistance, resources, and an online learning center to educate on domestic violence interventions and prevention efforts.
The importance of understanding and addressing burnout, vicarious trauma, and compassion fatigue among behavioral health providers is essential to providing effective care for persons served in behavioral health and integrated care settings. The American Institute of Stress lists a myriad of symptoms of compassion fatigue, which it defines as, "The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events." The frequent listening to and/or direct observation of the suffering of others may elicit strong emotional, psychological and physical reactions that leads to emotional exhaustion, a cynical attitude towards one’s work, and a loss of empathic connections to others.
The ProQOL is the most commonly used tool to measure staff burnout as it relates to the effects of helping others who experience suffering and trauma. The ProQOL has sub-scales for compassion satisfaction, burnout, and compassion fatigue.
National Suicide Prevention Lifeline’s “With Help Comes Hope” website has information for survivors, friends and families, and clinicians. It has survivor stories, self-care tips, “7 things attempt survivors wish their friends and families knew,” a therapist and support group finder, videos, and more.
Family & Youth Services Bureau's Family Violence Prevention Services Program exists to ensure that all victims of domestic violence have access to the services and supports that they need to live a life free of abuse.
A Guide for Taking Care of Yourself after Your Treatment in the Emergency Department is a brief brochure designed to support people in recovery from a suicide attempt. This resource guides individuals moving forward following emergency department treatment and coping with thoughts of suicide. A Spanish version is also available.
A Guide for Taking Care of Your Family Member after Treatment in the Emergency Department is an accompaniment to the patient guide designed for families coping with a relative’s suicide attempt. It reviews treatment processes and typical follow-up arrangements. A Spanish version is also available.
A Journey Toward Health and Hope: Your Handbook for Recovery After a Suicide Attempt guides individuals through the first steps toward recovery after a suicide attempt. Includes personal stories from survivors who share their experiences as well as strategies, such as re-establishing connections and finding a counselor to work with.
Stories of Hope and Recovery is a video guide for suicide attempt survivors and features inspiring stories from three people who survived an attempted suicide. Told through their voices and those of their families, the stories recount their journeys from the suicide attempt to a life of hope and recovery. Includes a video guide.
Zero Suicide is an aspirational initiative that is committed to achieving zero suicide in health and behavioral healthcare. The foundational belief of Zero Suicide is that suicide deaths are preventable. The initiative offers functional tools to aid in the implementation of Zero Suicide.
The 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action is a joint effort by the U.S. Surgeon General and the National Action Alliance for Suicide Prevention. The strategy provides clear directions with specific goals and objectives to guide suicide prevention actions in the U.S. over the next 10 years. Check out the National Strategy for Suicide Prevention overview.
The Promoting Individual, Family, and Community Connectedness to Prevent Suicidal Behavior describes a five-year vision for the CDC's work to prevent fatal and nonfatal suicidal behavior. The proposed strategic direction is to prevent suicidal behavior by building and strengthening connectedness or social bonds within and among persons, families, and communities.
Trauma and Trauma-Informed Approaches
Understanding trauma, all types, its impact and prevalence is critical to working with individuals exposed to or perpetrating IPV. For more information and resources on these and other areas of trauma, including Post-Traumatic Disorder (PTSD) as well as Trauma-Informed Approaches, please visit the CIHS Trauma webpage.
Intimate Partner Violence
IPV is highly prevalent and preventable, therefore It is important that providers screen for and address issues of IPV. For information and resources on IPV, please visit the CIHS Intimate Partner Violence webpage.