Champions, Catalyzers, and Cultivators

By Doryn Chervin, DrPH, Executive Secretary of the National Action Alliance for Suicide Prevention and Vice President and Senior Scientist at Education Development Center, Inc.

The National Action Alliance for Suicide Prevention (Action Alliance) continues to work toward fulfilling a vision of a nation free from the tragedy of suicide. As executive secretary of the Action Alliance, I am incredibly grateful to the members of this public-private partnership for their ongoing dedication and efforts to champion, catalyze, and cultivate suicide prevention as a national priority.

The last 18 months have been exceptionally noteworthy. The vision, perseverance, and accomplishments of our Executive Committee, Task Forces, and Tiger Teams have resulted in steady progress in advancing the objectives of the 2012 National Strategy for Suicide Prevention. I would like to acknowledge some of the many Action Alliance members whose contributions have made a significant and lasting impact in the field of suicide prevention.

In March 2015, under the leadership of Research Prioritization Task Force co-leads Thomas Insel (National Institute of Mental Health [NIMH]) and Phillip Satow (Jed Foundation), the Action Alliance released U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses. This report showed that investments in suicide research are severely lagging relative to research on other leading causes of death. The Portfolio Analyses calls for a large-scale research investment focused on a comprehensive prevention strategy and timely and effective evidence-based interventions. This report was made possible only through the herculean efforts of Jane Pearson from NIMH. She deserves all of our gratitude for her tireless work on this important initiative.

Also deserving of our thanks is each and every person who contributed his or her time and expertise to the development of two important sets of guidelines released by the Action Alliance. Special thanks go to the co-leads of our Clinical Workforce Task Force, Brian Boon (CARF International) and Alexander Ross (Health Resources and Services Administration). In November 2014, this task force released Suicide Prevention and the Clinical Workforce: Guidelines for Training. This resource will help assure that the nation’s clinical workforce is prepared to treat persons at risk for suicide. Under the leadership of Drs. Boon and Ross, the task force spent more than three years creating guidelines which can serve as the foundation for creating suicide prevention training programs in health and human services professions. Gratitude is also due to Lori Rogers (CARF) for her time and contributions to this important work.

I also would like to acknowledge Franklin Cook (Unified Community Solutions), Karen Moyer (Moyer Foundation), and John Jordan (Family Loss Project), the co-leads of the Action Alliance’s Survivors of Suicide Loss Task Force. Their hard work and dedication brought forth the landmark report Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines. This publication, released in April 2015, is a set of comprehensive and strategic guidelines detailing how communities can effectively respond to the devastating impact of suicide loss. These guidelines pave the way for decisive advances in postvention. Responding to Grief also puts forth a call to strengthen and expand care to meet the needs of the bereaved and others who suffer from the effects of suicide loss.

A very special thanks is due the Action Alliance’s Faith Communities Task Force which, in September 2014, launched the Your Life Matters! campaign. Your Life Matters! is an opportunity for any faith community to focus one Sabbath each year on the core characteristics common to most faiths that help prevent suicides.The task force co-leads, Talitha Arnold (Unified Church of Santa Fe), Anne Matthews-Younes (Substance Abuse and Mental Health Services Administration), and David Litts (formerly with SPRC) worked diligently on the campaign’s successful launch and are true stewards, serving those in suicidal despair through their work with faith leaders and faith communities.

Several members of the Action Alliance’s Public Awareness and Education Task Force have contributed significantly to suicide prevention educational programs and resources. Jack Benson (Reingold, Inc.) and Dan Reidenberg (Suicide Awareness Voices of Education), along with partners from the Department of Veterans Affairs, the American Foundation for Suicide Prevention, and SPRC were instrumental in establishing the Poynter/Action Alliance Covering Suicide and Mental Health Reporting Institutes. In one year these educational sessions equipped 90 journalists from 30 states with the tools to produce balanced and safe suicide prevention coverage.

Finally, I wish to recognize and celebrate the accomplishments of Public Awareness and Education Task Force co-lead Brian Dyak (Entertainment Industries Council, Inc.) for the Council’s ongoing development of educational resources: Social Media Guidelines for Mental Health Promotion and Suicide Prevention and Entertainment and Media Depiction Suggestions for Portraying Behavioral Health Conditions: Mental Illness and Substance Abuse Disorders.

Again, to all our hard-working and committed volunteers, thank you!


This post has been cross-posted on the Suicide Prevention Resource Center website.

Treating and Preventing Suicidal Behavior

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Brian Ahmedani, Henry Ford Health System; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

There is no one-size-fits-all approach to treating and preventing suicidal behavior. That is why it’s important to understand a variety of research-based strategies that can help you most effectively serve your patients’ unique needs.

1) Train Providers
Research shows that clinicians are likely to come in contact with individuals at risk for suicide over the course of their training and careers, but too few clinicians (even those trained in behavioral health) are adequately prepared to work with individuals at risk for suicide.

It is critical to assess the training needs of clinicians in your organization. For example, a staged training approach might be best-suited to your organization’s needs where all staff has basic knowledge and skills to identify individuals at risk for suicide, and clinicians most likely to see high-risk patients receive advanced training in suicide assessment and treatment. Research can inform the most effective models for sustaining clinician knowledge include ongoing training sessions like annual training or regular online training.

The National Action Alliance for Suicide Prevention recently released Suicide Prevention and the Clinical Workforce: Guidelines for Training. This tool can help you develop suicide training guidelines specific to the needs of your organization’s clinical staff to improve the delivery of suicide care.

2) Increase access to affordable care
Suicide rates are higher where there is less access to trauma centers and where there are high rates of uninsured individuals. There are a number of ways to improve access to affordable care. Mental health parity benefits legislation is one way to encourage utilization of mental health services for people who need them. Implementation of comprehensive parity legislation has proven to increase access to care, increase diagnosis of mental health conditions and reduce the prevalence of poor mental health and suicide rates. Specifically, strong state mental health parity laws have been associated with decreases in suicide rates in the year after the law is enacted.

3) Improve Continuity of care
A 2010 research review on continuity of care concluded that the lack of continuity of care within and across systems increases suicide risk. Repeated follow-up contacts after hospitalization or emergency care have been found to reduce suicidal behavior.

Consider how your organization can establish systems, policies and practices that improve the likelihood of continuity of care for your patients at risk for suicide as part of your standard care, and how you can track these improvements.

One promising example is from Henry Ford Health System’s Perfect Depression Care initiative. In 2001, Henry Ford implemented follow-up appointments based on risk level, established access to a 24-hour crisis line, offered online and drop-in appointments provided email contact and tracked patient follow-up in an electronic medical record system. The results were impressive with suicide mortality rates dropping from over 100 per 100,000 to less than 20 per 100,000 after full implementation.

4) Increase help-seeking and referrals for at-risk individuals
Reluctance to seek help is often multi-faceted. Embarrassment or shame, the belief that treatment is not needed, treatment would not be effective, treatment is inconvenient and/or difficult to obtain, treatment will be unpleasant, or treatment would be detrimental to a specific career path are all factors that can discourage people in need from pursuing care.

To improve help-seeking, it is important for clinicians and organizations to address this reluctance, whether it is related to self-stigma or other beliefs that get in the way. It is not enough to talk broadly about improving awareness by “reducing stigma.” In fact, experts suggest avoiding the term “stigma” in public messaging as it can reinforce negative attitudes and be counter-productive. Instead, it may be more useful to provide stories of successful treatment—by expert providers, peer support specialists and/or family members—where describing a range of effective treatment options and outcomes could improve the community’s knowledge about behavioral health services.

This post has been cross-posted on the National Council for Behavioral Health site.

What Is in Your Treatment Toolbox? Clinical Interventions to Prevent Suicidal Behavior

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Joel Sherrill, National Institute of Mental Health; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

Community behavioral health providers are expected to know how to treat suicidal patients. As so often is the case, though, the practice demands are ahead of the research. New studies are testing the best ways to treat and prevent suicidal behavior, but how do you treat these behaviors without a full toolbox?

Medication Interventions

Many individuals with suicidal ideation will receive medications to address symptoms and “underlying” psychiatric conditions. However, most medication takes weeks to provide relief from psychiatric symptoms.

Currently, the only medication with a specific FDA indication relevant to suicide is clozapine. Clozapine is indicated for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder. However, agranulocytosis, a rare side effect of clozapine, results in the need for frequent monitoring of white blood cells, which limits its use in practice.

Although not FDA-indicated, lithium medication has been associated with lowering suicide risk in individuals with bipolar disorder. Research has found that individuals who remained adherent to lithium treatment were at lower risk for suicide, but placebo-controlled studies of lithium are still needed to isolate the medication versus compliance benefits in reducing suicide risk.

Ketamine, originally used as an anesthetic, is a repurposed medication that is showing promise as a fast-acting treatment for severe depression and suicidal ideation. Additional research is needed to determine the safety, feasibility, dose and duration for the use of Ketamine, but it does open up the potential for future fast-acting medication treatments for suicidal ideation that could be used in acute care settings.

In addition to tracking possible untoward side effects, there is also a need to test suicidal events as outcomes in medication research studies focused on treating mental disorders. In the past, many industry-sponsored trials excluded suicidal individuals from efficacy trials.

Psychotherapy Interventions

Several research reviews have found that outpatient psychotherapies (e.g., cognitive behavior therapy; dialectical behavior therapy; problem solving therapy) reduce suicidal thinking and re-attempts among high-risk adult patients. One review notes that psychotherapy recipients had, on average, a 32 percent reduction in the likelihood of a suicide attempt compared with usual care within a year.

Another study from the Danish health care registry followed recipients of psychotherapy and those not receiving psychotherapy for up to 20 years. Those who received psychotherapy were 16 percent less likely to attempt suicide and 25 percent less likely to die by suicide.

Modeling the future

In 2014, the Action Alliance’s Research Prioritization Task Force modeled optimal implementation of evidence-based psychotherapy delivered to the U.S. population of adults seen in emergency care for suicide attempts. The model estimated that more than 109,000 suicide attempts and more than 13,000 suicide deaths could be averted over 5 years by delivering effective psychotherapy to adults seen in emergency care settings for self-harm. This demonstrates enormous potential for successful intervention. In the meantime, we must continue to invest in suicide research.

Unanswered Questions

Research challenges include the need to better understand developmental and contextual factors:

• Youth, adult, older adult;
• Transitional, work and health contexts such as discharge from military and COPD onset;
• Co-occurring psychopathology (e.g., substance use);
• Social context (LGTBQ; domestic violence; recent loss);
• Prior suicidal behavior;
• Treatment history and
• Current setting–including immediate (referred from inpatient or emergency care)–in intervention research.

We need to know how to better match potential interventions to the patient’s needs. New treatment targets (e.g., isolation; anhedonia; insomnia; agitation; psychosis) might also be more efficiently addressed.

While suicide research around effective interventions is rapidly increasing, there remain many questions left to answer. For lives to be saved, effective research must be translated into practice.

As community behavioral health providers on the front line, you are the lifeline for patients at risk for suicide and those recovering from an attempt.

(See Section IX in the Research Agenda for citations for all research mentioned above. )

This post has been cross-posted on the National Council for Behavioral Health site.

What We Know (and What We Don’t) About Predicting Suicide Risk

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Lisa Colpe, National Institute of Mental Health; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

Screening for suicide risk is common to most suicide prevention efforts and clinical practices that aim to identify at-risk individuals. To reduce suicide’s burden, there are a number of research-supported screening and risk detection tools to employ, but there is no doubt that further research is necessary to better understand the various factors that put people at risk of suicide.

The Continuum of Suicide Risk
Ideas about screening reflect our assumptions about a continuum of suicide risk—it is assumed there is a progression of suicide ideation, plans and eventual behavior (i.e., suicide attempts, suicide death). For example, multinational surveys have found that about a third of individuals who think about suicide make a plan and about a third go on to attempt suicide. Meanwhile, another subgroup reports having made an attempt with little or no ideation or planning.

Active versus Passive Ideation
Current approaches to assessing risk are heavily weighted toward identifying active ideation with a plan versus passive ideation (e.g., desire for death). However, some studies have found that passive ideation is just as strongly associated with morbidity as active ideation.

Screening Approaches
Many stakeholders consider screening for suicide risk an essential step in reducing suicides—and there are many opportunities to screen. Holding an annual depression screening day in the workplace or a school screening event following a suicide are two community examples. Screenings can be standalone, web-based for use in public settings or clinical tools (e.g., PHQ-9) integrated into primary care or other intake procedures to detect and monitor depression with suicide ideation. In fact, research looking at a large set of electronic health record data found a six-fold increased risk for suicide attempt (includes 709 attempts and 46 deaths) if someone responded ‘every day’ to the question, “Over the past two weeks, how often have you been bothered by thoughts that you would be better off dead, or hurting yourself in some way?” on PHQ-9.

Screening within Health Systems
Screening practices are ahead of research. The Joint Commission recommends screening in all medical care settings to prevent suicide attempts and deaths. However, health care settings vary with regard to the proportion of patients at risk and the steps necessary to get identified patients to adequate care. In any setting, risk detection alone will not reduce suicide. Assessment, adequate intervention and ongoing monitoring must support screening and detection efforts to have the desired impact of reduced suicidal behavior.

Promising Research
Research links neurocognitive science with risk detection and screening. For example, the Suicide Implicit Association Task (IAT) has shown to improve prediction of who will attempt suicide in the future. It examines reaction times to ‘life’ and ‘death’ words and can be administered on the computer in 5-10 minutes. It is currently being studied in emergency department environments with both youth and adults.

Recent research has also identified specific genetic markers for suicidal behavior, but the studies require replication before having a role in clinical practice.

How Can Risk Detection Contribute to Achieving a 20% Reduction in Suicide?
There are a number of ways to model how our nation could achieve a 20% reduction in suicides. One strategy is to stratify risk and identify those in the high-risk group due to risk factors and those in the low-risk group due to risk and protective factors. If we can identify those in the high-risk group and intervene so we move more individuals into the lower part of the triangle (see graphic), we can begin to reduce suicide’s burden on our nation.

On January 29, the National Council launched a six-part webinar series highlighting the National Action Alliance for Suicide Prevention’s Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. This series is a collaborative effort between the National Council for Behavioral Health,National Action Alliance for Suicide Prevention and the National Institute of Mental Health. Subsequent webinars will describe how this current understanding influences detecting those at risk, clinical care and services, as well as highlighting a number of the pressing research needs to reduce the burden of suicide. For more information about this webinar series, see Linda Rosenberg’s recent blog post announcing this collaboration.

This post has been cross-posted on the National Council for Behavioral Health site.

The Four Factors that Lead to (and Protect Against) Suicide

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Elizabeth Ballard, National Institute of Mental Health; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

The ultimate answer to “Why do people become suicidal?” is complex, and as depicted in the figure below, research has focused on several long- and short-term risk factors that interact to place an individual at increased suicide risk.

1. Social Determinants

Healthy connectedness with family members, neighborhoods, cultural groups and society can serve as a protective factor against suicide. Conversely, social isolation is associated with increased risk. Social networks can be leveraged to promote protective influences across all ages. Young people’s attachment to their family and schools can serve as a protective factor with “school-connected” teens exhibiting a decreased risk for suicidal behavior over time. Interventions that increase healthy connections have been related to reduced suicide risk in older Japanese adults.

At the same time, certain types of social networks can relate to increased suicide risk, both in person and via media influences. Social networks can contribute to a “contagion” of suicidal behavior, potentially through imitation, idealizing and/or by ‘normalizing’ suicidal behavior. Media reporting of high-profile suicides also carries a concern for increased suicidal behavior.

2. Clinical Factors

Research has identified a host of clinical suicide risk factors. Psychiatric risk factors for suicide include depression, anxiety, post-traumatic stress and addiction; physical symptoms include pain and insomnia. Suicide has been associated with specific cognitive symptoms such as suicidal thoughts, making a plan, hopelessness, feeling like a burden and impulsiveness. However, it is important to note that the vast majority of people with behavioral health and physical illness diagnoses do not kill themselves.

3. Neurocognitive Factors

There is a connection between suicide attempts and deficits in basic cognitive functions (e.g., attention, memory), executive performance (e.g., conceptual processes, reversal learning), impulse control, decision-making and implicit thought processes (e.g., implicit associations, like preference and self-esteem). The neurocognitive findings associated with suicide risk include motor impulsivity, decision-making, response inhibition, flexibility of response generation, self-monitoring/error-processing, sensitivity to others’ anger, impaired response to positive emotional stimuli, harm avoidance and an inability to delay rewards. Recent research demonstrates that teens who attempt suicide may have impaired decision making on tasks such as the Iowa Gambling Test.

None of these factors has been determined to be entirely specific to suicide—whether or not these factors can be used reliably as clinical predictors remains to be seen.

4. Biomarkers that Reflect Biological Processes

Early research provided some evidence that suicidal behavior is heritable. Twin studies report 36-43 percent heritability; non-fatal suicide attempts have heritability estimates of 17-45 percent, even after controlling for any psychiatric disorders. In addition, children are five times more likely to attempt suicide if a parent has a history of suicide attempts, and it may relate to impulsive aggression. Another example of tragic and toxic parent-child outcomes, between 10-40 percent of individuals who experience suicidal thoughts and behavior have a child abuse history.

Immune factors, patterns of brain activity observed with imaging and genetic variants, have all been studied to identify biomarkers that can help predict risk or resilience. Current research trends include serotonergic functioning, glutamatergic functioning and responsiveness to stress in the HPA (hypothalamic–pituitary–adrenal) axis, which may be linked to childhood traumatic experiences.

At this point in time, there is no biomarker with diagnostic clinical utility.

There is a great deal to be hopeful about with regard to improving our understanding of why people consider and try to kill themselves. For more information and detailed citations on the information presented above, see the full Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives.

On January 29, the National Council launched a six-part webinar series highlighting the National Action Alliance for Suicide Prevention’s Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. This series is a collaborative effort between the National Council for Behavioral Health, National Action Alliance for Suicide Prevention and the National Institute of Mental Health. Subsequent webinars will describe how this current understanding influences detecting those at risk, clinical care and services, as well as highlighting a number of the pressing research needs to reduce the burden of suicide. For more information about this webinar series, see Linda Rosenberg’s recent blog post announcing this collaboration.

This post has been cross-posted on the National Council for Behavioral Health site.

Breaking the Silence – Learning from the experience of Suicide Attempt Survivors

By Doryn Chervin, Action Alliance Executive Secretary

We live during a time, for better or worse, in which suicide is prominently covered in the media. Whether the story is a high-profile suicide, the ongoing fight to prevent military and veteran suicide, or other tragic stories of grief and loss, there is one voice that has been missing – the voice of the suicide attempt survivor. There is a movement underway to change this.  Suicide attempt survivors are emerging with a collective voice and a plan for re-shaping the delivery of suicide care in health care, strengthening community services, and improving suicide prevention efforts.

This Suicide Prevention Week, September 8 – 14, we embrace and support the suicide attempt survivor movement. For far too long, the perspectives of those with lived experience of suicide have not been integrated into treatment services and suicide prevention efforts. Whether this was due to fear, stigma, shame, or other reasons – the important fact is that this is changing.

For the many thousands of Americans who are now living as attempt survivors, their experience of resiliency and lived experience is an untapped resource that could potentially advance suicide prevention and save the lives of others in suicidal despair.  They understand better than providers or researchers how to find meaning in the midst of great darkness.

The National Action Alliance for Suicide Prevention (Action Alliance) is the nation’s public-private partnership advancing the National Strategy for Suicide Prevention and championing suicide prevention as a national priority. The Action Alliance’s Suicide Attempt Survivors Task Force, recently released a groundbreaking report, The Way Forward, which makes recommendations to improve our nation’s health systems, emergency services, and suicide prevention efforts based on the experience of attempt survivors. This report, which incorporates the lived experience of recovery and resilience, provides the missing bridge between suicide attempt survivors and treatment services, suicide prevention leaders, and policy makers.

The Way Forward marks the beginning of a new era, in which families, communities, clinicians, and health systems do not fear persons with a known history of suicidal thoughts and behaviors. Similar fears and concerns were once directed at persons with histories of mental illness, and alcohol or drug abuse; yet we have increasingly benefited and learned from the inclusion of persons with these lived experiences.

Let’s mark this week, 2014 Suicide Prevention Week, as the moment when families, communities, and organizations commit to fully supporting suicide attempt survivors in their recovery and in our efforts.

As the Executive Secretary of the Action Alliance, I welcome this movement. I welcome the stories of survival, hope, and recovery that suicide attempt survivors contribute to the cause of suicide prevention. The era of silence is over. Just as people once whispered about cancer, we will one day look back in wonder that we ever whispered about this.

If you, or someone you know is in crisis (no matter how small or big), help is available. By calling the 24/7 National Lifeline, 1-800-273-TALK (8255), you’ll be connected to a skilled, trained counselor who will help you find a reason to keep living.

Doryn Chervin, Dr.P.H., M.Ed.

Executive Secretary, National Action Alliance for Suicide Prevention
Vice President and Senior Scientist, Health and Human Development Division, Education Development Center, Inc.

The Framework for Successful Messaging

By Dr. Jerry Reed, member of our National Strategy for Suicide Prevention Revision/Update Task Force and Director of the Suicide Prevention Resource Center

Each September, World Suicide Prevention Day and National Suicide Prevention Week provide special opportunities to bring our message of prevention to millions of people around the world. This year, we have an exciting new resource to help us engage the public in suicide prevention and enlist them in supporting the cause that means so much to so many of us. The new resource is the National Action Alliance for Suicide Prevention’s Framework for Successful Messaging.

The Framework is a web-based resource developed to support the Action Alliance’s priority to “change the national narratives around suicide and suicide prevention to ones that promote hope, connectedness, social support, treatment, and recovery.” It will help everyone who communicates with the public about suicide – educators, researchers, policy makers, practitioners, and advocates – to create messages based on the best available evidence about safe, effective, and helpful communications. The Framework should be used when developing any message for the public, including educational materials, newsletters, event publicity, and fund-raising appeals.

The Framework outlines four critical issues to consider when messaging to the public about suicide. These issues are:

Strategy. Successful messages are focused and intentional. Understanding the audience and tailoring messages to their context is key to successful messaging. It is important to ask ourselves questions such as:
Why we are messaging?
How does the message fit into our overall mission and connect to other suicide prevention efforts?
Who is the audience for this message?
What channels will best reach this audience?
What do we want the audience to do in response to the message?
How can we frame the message to achieve this result?

Safety. Safety focuses on avoiding potentially harmful message content. We have made great strides in ensuring that we do not unintentionally raise the risk of suicide by, for example, discussing the data on suicide risk in ways that normalize suicide or imply that there is nothing that can be done to prevent suicidal behavior. We have worked hard to spread this message to our colleagues in mental health services and journalism, and must continue to consciously ensure that our own messaging is both safe and helpful.

Positive Narrative. We need to ensure that our messages “accentuate the positive” about suicide prevention and offer solutions rather than focus on the problem of suicide. There are many ways to promote a positive narrative; the best approach will be guided by your strategy. Our messages can help the public envision prevention by including concrete actions that the audience can take to help prevent suicide; sharing stories of coping, resilience, and recovery; describing the successes of prevention programs; helping people access valuable resources; and sharing what we know about effective prevention.

Guidelines. It is important to consult recommendations and best practices that apply to your particular messages. The Guidelines section of the Framework website links to a variety of resources, for example, guidelines for telling personal stories, discussing LGBT suicide, reaching young people, and creating culturally specific messages. Additional guidelines will be added over time.

As we prepare for World Suicide Prevention Day on September 10 and National Suicide Prevention Week September 8-14, let us be intentional about our messaging. By considering Strategy, Safety, Positive Narrative, and Guidelines as we craft our important messages, we can engage the public to take action and join us in our quest to prevent suicide and save lives. I urge everyone who creates suicide prevention messages to visit the Action Alliance Framework for Successful Messaging and take advantage of this unique resource.

This post was cross-posted on the Suicide Prevention Resource Center's Director's Corner.