Advocacy and Policy Strategies for Suicide Prevention

Expand funding for culturally informed research into key topics for youth suicide prevention:

• Prevention
• Recognition of suicide risk
• Suicide prevention interventions
• After suicide/Postvention efforts (recommended response after a suicide occurs)
• Understanding and addressing stigma around suicide and mental health
• Responsible media and social media reporting on suicide
• Lethal means prevention and access restriction

Expand funding for research to better address suicide among Black youth, Indigenous youth, Latino youth, Asian-American youth, and other youth of color, with a focus on studies that aim to:

• Identify risk and protective factors
• Establish effective prevention/intervention strategies
• Understand cultural views of mental health and help-seeking
• Explore mental health utilization, engagement, and motivation for mental health treatment
• Develop research instruments that disaggregate data for different populations
• Adapt and validate existing screening tools for Black youth, Indigenous youth, and youth of color
• Build, adapt, and validate evidence-based care pathways and interventions that are developmentally, culturally, and linguistically appropriate
• Understand the impact of racism and historical and intergenerational trauma on suicide risk among Black youth, Indigenous youth, and youth of color
• Understand and address practical, systemic, and cultural barriers to mental health treatment

Expand funding for research to better address suicide among youth who identify as lesbian, gay, bisexual, transgender, queer, questioning, or two-spirit (LGBTQ2S+), with a focus on studies that aim to:

• Identify risk and protective factors
• Establish effective prevention/intervention strategies
• Adapt and validate existing screening tools for youth who identify as LGBTQ2S+
• Build, adapt, and validate evidence-based care pathways and interventions that are developmentally, culturally, and linguistically appropriate
• Understand the impact of discrimination on suicide risk among youth who identify as LGBTQ2S+
• Understand the impact that inclusive environments have on suicide risk among youth who identify as LGBTQ2S+
• Understand and address practical, systemic, and cultural barriers to mental health treatment

Expand funding for research to better address the intersection of identities that may be at increased risk of suicide, with a focus on studies that aim to:

• Identify risk and protecting factors
• Establish effective prevention/intervention strategies
• Adapt and validate existing tools/interventions for youth
• Understand the impact of discrimination on suicide risk

Expand funding for research to better address suicide risk in children under age 12, with a focus on studies that aim to:

• Identify risk and protective factors
• Establish effective prevention/intervention strategies
• Adapt and validate existing tools/interventions for younger children and their parents/caregivers

Expand funding for research to better address suicide risk in children and youth with special health care needs, with a focus on studies that aim to:

• Identify risk and protective factors
• Establish effective prevention/intervention strategies
• Understand how to implement developmentally appropriate screening protocols for youth with cognitive or language impairments

Expand funding for research that better addresses community needs, including:

• Community and youth engagement efforts that place the population-of-focus at the center of the research design
• Research-community partnerships
• Research in real-world settings, including effectiveness studies

Expand funding for research to understand the impact of policy changes on suicide rates

Require that research studies addressing youth suicide prevention include communities of color, LGBTQ2S+ populations, and other populations at highest risk in their sampling

Expedite public access to data on youth suicide prevalence at the local, national, and state levels:

• Increase quality of prevalence, including accuracy of cause of death, attempts and ideation

Promote diversity in suicide prevention research:

• Prioritize diversity in allocation of grant funding and in study section membership (race, gender/gender identity, sexual orientation, age)
• Encourage the continued investment and expansion of research programs that increase funding to suicide prevention researchers from underserved communities, including:
  • T32 programs
  • Minority Fellowship programs
  • Diversity supplements from NIH
  • National Institute of General Medical Sciences (NIGMS) Program
  • AFSP research grants
• Encourage researchers and funders to engage lower-resourced institutions that are more likely to support underserved communities
• Prioritize efforts to continually refresh the workforce pipeline to engage new researchers from communities that are underrepresented in medicine and science
  
  

Support provider payment for mental health and suicide prevention services, via development (if necessary), recognition and appropriate valuation of codes used to report necessary services:

• Behavioral and developmental screening and assessment
• Behavioral health counseling
• Telehealth for mental and behavioral health services
• Family therapy
• Care management services
• Preventive care
• Mental health care for conditions that don’t meet diagnostic criteria for specific mental health disorders
• Consultation services
• Services provided by nurses in clinics and schools
• Team-based approaches to screening and care management
• In-office follow-up services when mental health resources are unavailable

Incentivize screening and follow-up for mental and behavioral health needs at well-child visits

Incentivize financially sustainable collaborative care models for mental and behavioral health needs

Support the development of payment models that better account for patient needs across specialties and clinical disciplines

Encourage the development of payment models that support integrated, team-based care for children and families

Preserve and extend public and private insurance coverage for mental and behavioral health services for children:

• Enforce federal and state mental health parity laws
• Ensure providers who deliver services through telehealth receive equitable payment for their services
• Advocate for Medicaid and Children’s Health Insurance Program (CHIP) coverage of telehealth services across state-lines
• Incentivize mental and behavioral health care providers to join (and remain in) provider networks

Ensure payment to primary care providers for provision of appropriate mental and behavioral health care to children

Support billing for the services of community health workers that strengthen the chain of care

Increase funding and resources to ensure youth can access mental and behavioral health support in their communities, including:

• Substance use treatment programs
• Inpatient treatment facilities
• Outpatient treatment facilities
• Counseling services
• Evidence-based community-level programs
• School-based mental and behavioral health services
• Mental and behavioral health services on college campuses
• Pediatric Mental Health Care Access programs (also called Child Psychiatry Access Programs)

Increase funding and resource to promote innovative care strategies in areas with few mental and behavioral health providers:

• Telehealth services
• Teleconsultation models, including Pediatric Mental Health Care Access programs and mHealth innovations
• Crisis lines to support outpatient referral and follow-up
• Collaborative or Integrated Care Models
• Mental health task-shifting and task-sharing

Ensure that beyond the pandemic, telehealth for mental health and substance use treatment continues to be a part of the comprehensive set of care options available to children and families

Incentivize the integration of mental and behavioral health services into primary care:

• Increase training of primary care providers and mental and behavioral health professionals in prevention, early identification, and intervention
• Incentivize the integration of behavioral health workforce into primary care settings via collaborative or integrated care models
• Foster development of new sustainable models of co-location of mental health providers into primary care settings
• Incentivize the integration of mental health professionals into the pediatric medical home

Strengthen linkages between medical settings, social services, and other youth-serving systems to address intersecting needs of children and families:

• Schools
• Mental and behavioral health care
• Primary and subspecialty care
• Juvenile justice
• Child welfare

Promote training in suicide risk screening and support for all adults who work with children, including:

• Medical professionals
• Mental and behavioral health professionals
• Childcare workers
• Home visitors and early intervention providers
• Educators and school personnel
• College and university faculty and personnel
• First responders
• Child welfare workers
• Juvenile justice personnel
• Social workers
• Coaches
• Staff leading extracurricular activities

Promote mental, behavioral health, and suicide prevention competencies during training and in continuing educational requirements across disciplines:

• Pediatrics
• Family Medicine
• Primary Care
• Emergency Department
• Subspecialty Care
• Obstetrics/Gynecology
• Nursing

Promote equity, diversity, and inclusion in mental and behavioral health care:

• Promote policies, training, and hiring practices to establish culturally and linguistically competent clinics, clinicians, and care navigators
• Require anti-bias and cultural sensitivity education during training, continuing education, and Board Certification
  
  

Develop a nationwide strategy with public and private partners to expand the supply, diversity, and distribution of the mental and behavioral health workforce to address pediatric mental and behavioral health needs

Increase availability of providers in medically underserved areas and health professional shortage areas

Increase diversity of mental and behavioral health workforce:

• Support the development and funding of pipeline programs to increase diversity in the mental and behavioral health workforce
• Incentivize fellowship training and college programs to recruit diverse groups of students to pursue careers in mental and behavioral health
• Support the development and funding of programs that support and mentor diverse groups of people over the course of their education, training, and careers in mental and behavioral health

Support loan repayment assistance for child mental health professionals, pediatric subspecialists, psychiatrists, and other behavioral health clinicians, particularly those who practice in underserved areas

Identify new and expanded opportunities for accelerated behavioral health training programs for pediatric residents, pediatricians, and pediatric nurse practitioners (eg, Triple Board Program)

Increase provider knowledge and capacity in identifying and providing treatment for mental and behavioral health needs:

• Embed evidence-based approaches to suicide prevention and suicide loss support in training programs, continuing medical education, and Board Certification
• Integrate anti-bias education into training programs and continuing medical education
• Incentivize cultural and linguistic competency training for the mental and behavioral health and primary care workforce

Expand licensing requirements to include suicide prevention and mental health aptitudes for all healthcare providers

Expand workforce training programs:

• Examples include: HRSA Graduate Psychology Education Program, HRSA Behavioral Health Workforce Education and Training Program, Children’s Hospitals Graduate Medical Education Program, SAMHSA Minority Fellowship Program

Recognize peer supports and community health workers as integral behavioral health practitioners

Expand the mental health workforce by training non-mental health professionals in key community settings (eg, after-school programs, youth-serving community organizations) in evidence-based practices to identify mental health problems/suicide risk and interventions

Encourage training and policy efforts to support clinicians in screening for lethal means availability and providing lethal means safety counseling to youth and caregivers

Increase funding for research related to firearms and suicide prevention, including studies that aim to:

• Assess the efficacy of firearm policies in reducing suicide rates
• Assess the efficacy of physician educational efforts in changing attitudes and behaviors around firearms and suicide risk when paired with provision of safe firearm storage devices
• Determine how to best to bring promising practices to scale

Promote voluntary firearm removal initiatives (eg, temporary transfer exceptions, community storage options, and the creation of state voluntary do-not-sell lists)

Promote policies such as Extreme Risk Protection Orders (ERPO) or Red Flag Laws that allow family members and friends to petition a judge or law enforcement personnel to remove firearms from the environment of a person at risk of hurting themselves or others.

Promote policies to restrict access to medications, including National Prescription Drug Take Back Days and lock boxes

Increase funding and resources to promote education for parents/caregivers, youth, and the public about lethal means in the home, including:

• Safe storage of weapons
• Safe storage of medication
• Importance of limiting access to lethal means across the age spectrum (young children, school-age children, teens)
• Provision of safe firearm storage devices for families with firearms

Collaborate with leaders from the gun-owning community on firearm suicide prevention education

Educate clinicians, policymakers, public on the increasing rates of suicide among Black youth, Indigenous youth, other youth of color, and youth who identify as LGBTQ2S+

Educate clinicians, policymakers, the media, and the public about the importance of safe messaging when discussing suicide and disparities in suicide rates

Support policies to eliminate systemic racism and discrimination

Support appropriate medical care and school policies for youth who identify as LGBTQ2S+:

• Advocate for bans on conversion therapy
• Oppose proposals to limit access to or delay sexual, reproductive, and/or gender-affirming care
• Support gender-affirming care for youth who identify as transgender or gender-diverse
• Support participation in sports, physical education, and extracurricular activities by all youth, including allowing transgender youth to play on teams that align with their gender identity
• Support access to bathrooms, locker rooms, and other public accommodations in accordance with an individual’s identity.
• Support use of youth’s pronouns and names
• Advocate for no tolerance anti-bullying and harassment policies that include specific protections for youth who identify as LGBTQ2S+
• Ensure that personal identifiable and medical information related to gender identity, sexual orientation, and other sensitive issues are kept confidential

Promote enhanced suicide prevention and mental health resources for schools:

• Encourage implementation of evidence-informed suicide prevention and mental health programs and policies in schools and on college campuses
• Increase resources for mental health services and mental and behavioral health providers in schools
• Promote trauma-informed care principles in schools
• Establish national standards in social-emotional learning for Early Childhood through Grade 12
• Promote curricula that teach youth how to process and communicate emotion, recognize signs of deteriorating mental health or suicide risk, and reach out to a trusted adult for help
• Support schools in engaging families in social-emotional education
• Provide incentives to ensure school-based health providers are adequately trained to recognize the mental and behavioral health needs of children and offer culturally sensitive and responsive evidence-based services
• Support schools in building mental health 504 plans and Individualized Education Plans (IEP) with consideration for reducing suicide risk among this higher-risk population
• Normalize conversation about mental health in schools, and allow excused absences for mental and behavioral health concerns
• Promote healthy postvention efforts in the wake of a suicide at school

Promote mental health services and suicide screening for youth within the child welfare system:

• Ensure all children and youth have timely access to initial and comprehensive health assessments and all necessary services indicated during assessment
• Expand access to trauma-informed, evidence-based psychosocial interventions for children and youth in care provided in a community setting
• Promote thorough, coordinated communication between child welfare system, primary care providers, and schools related to a child’s suicide risk, attempts, or behaviors and appropriate follow-up care
• Promote policies to support youth involved with the child welfare system as they transition to adulthood and adult medical care

Promote suicide prevention services for children within the juvenile justice system, including:

• Initial mental health screenings for all youth confined for more than 1 week
• Efforts to ensure that confined youth receive at least the same level and standards of mental health and substance use care as non-confined youth accessing care in their communities
• Implementation of trauma-informed care principles in detention facilities
• Comprehensive suicide prevention programs that include ongoing suicide risk assessment within all juvenile justice facilities
• Confinement facilities should recognize and respond to the unique needs of justice-involved youth, youth who identify as LGBTQ2S+, and youth with chronic medical, mental health, and developmental needs.
• Promote continuation of Medicaid coverage for youth while in juvenile detention

Provide adequate funding and resources for programs aimed at developing, maintaining, or enhancing culturally and linguistically appropriate suicide prevention programs for children, adolescents, and families

Encourage funding and resources for evidence-based community/school programs intended to foster resilience and healthy mental and emotional development in youth and families

Increase funding for research to develop and scale up-stream interventions to promote healthy mental and emotional development in youth and families

Support policies and programs that address and mitigate the underlying factors that can contribute to suicide risk, including:

• Poverty
• Racism
• Discrimination
• Housing needs
• Gaps in insurance coverage
• Gaps in access to health care
• Stigma
• Violence
• Trauma

Encourage education and training to integrate strengths-based, trauma-informed care into clinical, community, and school settings

Support a national agenda to ensure families have access to high-quality childcare and educational environments from early childhood through adolescence

Increase funding and support for community programs that foster youth engagement, connection, and participation

Promote youth access to clean and safe outdoor recreation spaces

Increase funding to address suicide prevention for children and adolescents across the continuum of care, including:

• Pediatric training for crisis response
• Initiatives to relieve stress on emergency departments and inpatient units
• Mobile crisis intervention and follow-up services
• Intensive community-based services and supports, including case management
• Therapeutic foster care and other family-based settings that can prevent unnecessary congregate care

Increase funding and resources to support access to step-down programs (partial hospitalization, intensive outpatient programs) following crisis stabilization

Support policies intended to improve our national crisis response infrastructure:

• Support effective implementation of 9-8-8
• Crisis-training for first responders
• Trained crisis-response teams as an alternative to having law enforcement respond to mental health emergencies
• Behavioral health workforce development for professionals and paraprofessionals and staff training for crisis call centers

Support funding for the National Suicide Prevention Lifeline and its Centers

Support funding to enhance the promotion and accessibility of crisis response services