Introduction

Suicide is a critical public health problem in the United States. Despite a national strategy for suicide prevention and multiple federal, national, and state/local initiatives, as well as a large community of suicide prevention champions, suicide rates continue to climb. In 2018, suicide took more than 48,000 lives and was the 10th leading cause of death in the United States. A CDC Vital Signs report found that, between 1999 and 2016, rates of suicide increased by more than 30% in half of states (Stone et al., 2018). Further, suicide deaths represent just the tip of the iceberg with respect to individual, family, and community impacts. In 2018, 10.7 million adults reported having serious thoughts of suicide in the past year, 3.3 million made a suicide plan, and 1.4 million attempted suicide (SAMHSA, 2019). A forward-looking effort built upon new evidence and past accomplishments is needed to reduce suicide, suicide attempts, and related health and social impacts.

Mental health conditions are often seen as the cause of suicide, but suicide is rarely caused by any single factor. Suicide risk goes beyond a focus on mental health concerns alone. Factors increasing and decreasing suicide risk occur at the individual, relationship, community, and societal levels. Risk factors include adverse childhood experiences (ACEs [e.g., exposure to violence]); relationship, school/job/financial, criminal/legal, and health problems; loss of a friend or loved one to suicide; prior suicide attempts; easy access to lethal means among people at risk; substance use; and mental health concerns, among others. Given the multiple factors associated with suicide, multiple opportunities for prevention and intervention exist.

To prevent suicide and to address the broad range of risk and protective factors (e.g., social connectedness, effective clinical care, problem-solving skills), a comprehensive and coordinated approach is needed. Such an approach involves data driven decision-making, relies on the best available evidence, and requires strong leadership and collaboration of multi-sectoral partners. Public health departments are poised to take the lead on advancing a comprehensive approach to suicide prevention due to their focus on social determinants of health (e.g., safe housing, job opportunities, social support, access to health care services, education), and shared risk and protective factors (Wilkins, et. al., 2014); their long-standing role as community conveners to address complex health challenges; and the essential services they provide to their communities (e.g., monitoring health, mobilizing community partnerships, and evaluating effectiveness of interventions) (CDC, 2018).

In 2017, the National Action Alliance for Suicide Prevention (Action Alliance), the public-private partnership working to advance the National Strategy for Suicide Prevention, and the American Foundation for Suicide Prevention (AFSP) put forth a national goal to reduce suicide rates by 20% by 2025 (Action Alliance, 2017). To facilitate achievement of this goal, CDC developed its comprehensive public health approach to suicide prevention that relies on data, science, and action, grounded in a strong foundation of collaboration for maximum impact.

• Data are used to track trends and understand the nature of the problem, who is impacted, and what factors contribute to or reduce suicide.
• Science affords us the opportunity to rigorously test and evaluate what works to prevent suicide and to guide the implementation of evidence-based approaches.
• Together, data and science contribute to public health action, the results of which feed back into the system for continuous program improvement.
• These efforts are best achieved through collaboration and engagement with federal, national, and state/local partners, such as the Action Alliance, Federal Working Group on Suicide Prevention (e.g., SAMHSA, NIMH, VA, IHS), Safe States Alliance, suicide prevention champions, including survivors of suicide loss and the lived experience communities, and national organizations such as AFSP, Suicide Awareness Voices of Education (SAVE), American Association of Suicidology, and the Suicide Prevention Resource Center (SPRC), among others.

Together, the effective utilization of data, science, action, and collaboration will help save lives.

The following three-year strategic plan leverages CDC’s strengths and collaborations and focuses resources on the areas where greatest impact on suicide prevention can be achieved. This plan includes four priorities:

• DATA: Use new and existing data to better understand, monitor, and prevent suicide and suicidal behavior
• SCIENCE: Identify risk and protective factors and effective policies, programs, and practices for suicide prevention in vulnerable populations
• ACTION: Build the foundation for CDC’s National Suicide Prevention Program
• COLLABORATION: Develop and implement wide-reaching partnership and communication strategies to raise awareness of suicide prevention activities