When the Commission first met in 2014, one clear theme emerged: successful suicide prevention in Colorado will only be achieved with comprehensive and sustained efforts across community groups and agencies; no one group or single intervention is sufficient. This priority has structured how the Office of Suicide Prevention approaches suicide prevention. Suicide can be prevented upstream, by creating the community conditions that encourage everyone to feel that their life has meaning. Suicide can be prevented during a crisis by creating mental-health services that are accessible and relevant to people across Colorado and by putting safety measures into place that make it less likely for a suicide attempt to be fatal. Lastly, suicide can be prevented by making sure that we meaningfully support individuals after a suicide attempt and after a suicide loss. Although this may sound counter-intuitive, providing caring and supportive services and resources for people mourning a loss to suicide as well as people who have survived a suicide attempt is, itself, upstream suicide prevention by making sure that people after a crisis can still feel that their lives have meaning.
Since 2014, the Commission has created recommendations that strengthen and flesh out this comprehensive approach, with strategies to prevent suicide upstream, as an intervention to a suicidal crisis, and after a suicide loss or attempt (also called postvention). These recommendations, in turn, have changed the programs and operations of the Office of Suicide Prevention, and the way that suicide prevention is carried out statewide. Please check out the Office of Suicide Prevention’s latest Annual Report for even more information on what we’ve accomplished!
Commission results:
| Recommendation | What’s been done |
|---|---|
| Develop and implement comprehensive suicide prevention strategies for priority industries. |
Colorado data show that some industries experience a higher rate of suicide, including construction, emergency responders, oil and gas, OSP is a founding partner of Mantherapy.org, a campaign to support working-age men, and has expanded outreach to the above priority industries. OSP has also provided funding to OperationVeteranStrong.com, a resource for Colorado veterans and their families. |
| Support schools and other youth-serving organizations in implementing comprehensive protocols and evidence-based programming focused on enhancing protective factors. |
Schools and youth-serving organizations are crucial partners in preventing youth suicide; though they are not solely responsible for youth suicide prevention efforts. K-12 school settings, as well as institutions of higher education need comprehensive, proactive suicide prevention policies and procedures. OSP provides funding for training, policy development and implementation, and school climate efforts and technical assistance; and facilitates community connection to suicide prevention initiatives. The Commission recommends that every middle and high school have an evidence-based prevention program and its complements, such as gatekeeper trainings for all staff and established referral protocols with resources like the Second Wind Fund and statewide crisis services system. The Commission recommends Colorado expand implementation and evaluation of school-based suicide prevention programs, like Sources of Strength™, which promote resilience and positive youth development as protective factors from suicide and other forms of violence. |
| Increase the prevalence of community-level programs supporting connectedness and positive social norms. | Connectedness is a pillar of the Colorado-National Collaborative (CNC) project, which supports county-level work to promote people’s sense of belonging within their communities. Connection can reduce suicide risk factors that can lead to isolation, loneliness, suicide attempts and deaths. |
| Support youth populations experiencing suicide-related disparities. |
The Youth-Specific Initiatives Workgroup has made recommendations to support Coloradans ages 0-24 who experience greater disparities related to suicide, which the workgroup identifies through the Healthy Kids Colorado Survey and the Suicide Fatality Data Dashboard and broad partnerships. The Commission’s recommendations to create supportive, inclusive, and safe communities, especially for Black, Indigenous, and Youth of Color and especially for LGBTQIA2S+ youth and young adults and to support comprehensive suicide prevention strategies that specifically address the unique needs and experiences of young adults ages 19-24 are infused in OSP grant narratives for federal funding and are included in opportunities for Colorado partners to receive OSP funds. OSP grants and programs contain equity-specific deliverables. The Commission encourages communities to address their unique needs based on data, lived experience, and community leadership. |
| Strengthen equitable economic stability and supports, including food security, affordable housing, livable wage and other family-friendly workplace policies, as well as access to representative care and Broadband Internet. | Economic stability is a pillar of the Colorado-National Collaborative (CNC), which supports county-level work to increase housing stability and food security, and to promote working conditions that enable everyone to thrive. OSP partners with non-traditional suicide prevention partners (i.e., food banks, housing stability organizations, and homelessness prevention organizations) on this work. Read the final workgroup recommendations and corresponding justifications. |
| Support spiritual communities in implementing comprehensive strategies and evidence-based or evidence-informed programming that are relevant for their communities in preventing suicide. |
The Spiritual Communities Workgroup’s recommendation to support spiritual communities in implementing suicide prevention strategies and programming that are relevant for their communities involves support for identifying and referring individuals in suicidal crises to appropriate supports; and providing appropriate postvention resources, supports, and messaging following a suicidal crisis, suicide attempt, and death by suicide. Creation of the Spiritual Communities Suicide Prevention Resource List and webpage, a living community-made compilation of general, religious, and faith-specific suicide prevention programs and resources at the upstream prevention, intervention, and postvention stages of comprehensive suicide prevention. |
| Support the legal community with gatekeeper training to identify those at risk for suicide and link them to care. | The legal system represents another opportunity outside of the health care system to reach individuals at risk for suicide. OSP created and distributed the Suicide Prevention Benchcard, a resource for judges and other partners in the legal community (e.g., attorneys, and probation departments) that facilitates connections with evidence-based suicide prevention tips and resources. |
| The Older Adults Work Group of the Suicide Prevention Commission recommends that older adult-specific gatekeeper trainings be available, accessible, and inclusive for peers, community members, and workplaces that support and serve older adults. | The Office of Suicide Prevention is working with partners to identify opportunities to identify and expand older adult-specific trainings. Currently, the Office of Suicide Prevention has created a suicide gatekeeper training comparison table, to share more about additional recognized gatekeeper trainings. More information on state trainings can be found on the Colorado Office of Suicide Prevention Training webpage. |
| Recommendation | What’s been done |
|---|---|
| Adopt the Zero Suicide (ZS) model within healthcare systems | In 2015, the Commission first identified Zero Suicide as a priority. OSP began supporting the implementation of the Zero Suicide Model in 2017. In 2019, OSP hired a full-time staff member to coordinate this initiative. The Coordinator offers monthly learning collaboratives for healthcare administrators and providers. The collaboratives support agencies implementing Zero Suicide by bringing in speakers, creating space for peer-based discussions, and addressing challenges. OSP also supports elements of the Zero Suicide Framework in faith communities, shelters, the justice system, education settings, and local coalitions. |
| Promote screening to identify suicide risk within health care settings | During its first year, the Commission recommended screening for depression and suicide risk in the emergency department. This has since expanded to all health care settings. The Zero Suicide initiative asks health systems to screen every new client or patient for suicidal thoughts and behaviors. OSP encourages universal screening among its ZS grantees and other health system partners, as screening is the first step in formulating a plan for safer suicide care. |
| Support primary care practices in adopting suicide prevention protocols. | Primary care is often the first line of contact for individuals who are hesitant or resistant to seeking out traditional mental health services directly. Created by the Office of Suicide Prevention and its partners, the Suicide Prevention Toolkit for Colorado Primary Care Practices is a comprehensive resource that guides primary care practices through planning and implementing key components of safer suicide care. The toolkit focuses on identification, risk assessment, safety planning, lethal means counseling, and follow-up care. OSP offers free or reduced cost evidence-based training protocols on suicide prevention to healthcare providers. |
| Prioritize, promote, and expand community-based alternatives to involuntary treatment for support, respite, and recovery prior, during, and after periods of crisis that preserve dignity and are responsive to identity, culture, and personal autonomy. |
The Commission adopted four recommendations from the Investigating the Use of Forced Treatment on People Experiencing Suicidal Thoughts Workgroup. The workgroup found there is limited evidence that hospitalization (voluntary and involuntary) is more effective at decreasing the likelihood of a suicide attempt or death than outpatient treatment. The rate of people dying by suicide following hospitalization (voluntary and involuntary) is high, particularly during the first week. The rate decreases after the first 2–3 months, but remains many times higher than for non-hospitalized patients for years. OSP piloted brief Cognitive Behavioral Therapy and Crisis Response Planning workshops with behavioral health providers in 2022. The training gave providers tools and alternative interventions to reduce resorting to involuntary treatment. Preliminary feedback suggests these workshops are helpful in providing alternatives to forced treatment. The Office of Suicide Prevention has also provided education to primary care providers about Colorado’s involuntary treatment laws, and emphasizes to all partners that involuntary treatment should be a last resort. |
| Recommendation | What’s been done |
|---|---|
| Identify gaps in postvention services and needs (recommendation in progress) |
“Postvention” includes resources and services provided to suicide attempt survivors, suicide loss survivors, individuals supporting a person who is suicidal, and communities impacted by a suicide loss.
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| Fill data gaps and enhance data collection tools and sources in Colorado, and enhance information-sharing between organizations. | OSP collaborated with CDPHE’s Office of Vital Statistics and Office of Public Health Practice, Planning and Local Partnerships to transition data from the Colorado Violent Death Reporting System to an interactive data dashboard. This dashboard provides a usable interface to inform prevention efforts at the local and state levels. |
| Encourage and incentivize coroners, medical examiners, and law enforcement to adopt a standardized suicide investigation form | The Office of Suicide Prevention partnered with the Child Fatality Prevention System State Review Team’s Data Workgroup to develop a Suicide Death Investigation Form to streamline the data collection and submission process for death investigators and facilite the collection of data that may be useful in preventing future suicides. For example, the form hasfields to report on decedents’ gender identity and sexual orientation, and includes language to educate around what these terms mean. OSP offers annual mini-grant opportunities to incentivize offices across the state to adopt this system as well as help coroners and medical examiners to understand how to use the form. |
| AAll schools in Colorado implement a full spectrum suicide prevention programming starting with comprehensive protocols to address prevention, intervention, and postvention. |
Colorado law allows teachers and other designated staff to take suicide prevention training to fulfill continuing education requirements. Schools can leverage this requirement. The Commission recommends additional funding for schools to ensure that every school district has access to behavioral health staff who are fully trained in suicide assessment and prevention, or who are available in communities where staff serve multiple schools or districts. |
| Adopt the Colorado Follow-Up Project as standard protocol for following up with suicidal patients after discharge from emergency departments and inpatient settings. |
The Commission recommended the adoption of standardized protocols for following up with suicidal patients after discharge from emergency departments. OSP piloted the Follow-Up Project in which patients receive follow-up services post-discharge through the Colorado Crisis & Support Hotline. Following the success of the pilot program, the Commission recommended that all emergency departments, inpatient settings, and psychiatric facilities have a standardized protocol for follow-up care and adopt telephonic caring follow-up as a standard of care. OSP received SAMHSA funding in 2020 to fund a full-time coordinator for this initiative. As of January 2022, the Follow-Up Project more than doubled the number of sites enrolled in the past calendar year. |
Commission materials
List of commission members, agendas for upcoming meetings, meeting minutes, and more.
Questions? Comments?
Please contact Alise Nichols, Suicide Prevention Commission Coordinator, at alise.nichols@state.co.us.